1. Physical Activity Policy Interventions: The Big Opportunities In Our Cities Enrique Jacoby PAHO/WHO

2. LEADING RISK FACTORS FOR GLOBAL MORTALITY High blood pressure13% Tobacco use 9% High blood glucose 6% Physical inactivity 6% Overweight & obesity 5%

3. LEADING RISK FACTORS FOR GLOBAL MORTALITY High blood pressure13% Tobacco use 9% High blood glucose 6% Physical inactivity 6% Overweight & obesity 5%

4. RECREATION WORK DOMESTIC TRANSPORT

5. RECREATION WORK DOMESTIC TRANSPORT

6. Adults 18-64 should do at least 150’ of moderate- intensity aerobic p.a. throughout the week OR at least 75’ of vigorous-intensity a.p.a. throughout the week WHO, Global Recommendations on Physical Activity for Health, 2010

9. 1999

10. Exercise is good for your health

11. Physically Active Adults Overweight Exercise is good for your health

12. Participation Adherence

13. Education and Communication approaches School and Workplace interventions/policies WHO, Interventions on diet and physical activity: What Works, 2009 Urban policies: Transport & Land Use and Recreation

14. Health 1 LAND USE POLICIES: PROXIMITY & CONNECTIVITY TRANSPORT OPTIONS 2

15. Enrique Jacoby, OPS Walk / Bike to work 3-7 Km per day (3-5 d/wk) Improve CR fitness (Hendriksen, 2000; P. Oja, Vuori I, et.al. 1998) Weight Control (Vuori I, 94; Boyd, 98; Bell et.al, 02; Wen&Rissel, 08) ↓ CVD risk (SR: Cavill&Davis, 2007; Meta-A N=18: Hamer & Chida, 2008) Health Impact

16. In 8-year: + 2.1 Kg

17. Enrique Jacoby, OPS 40% reduction in mortality (Anderson et. al., 2000) 40% reduction in mortality DBT and CV (Matthews, 2007) All-cause mortality (n=18): (Meta-A N=18 Hamer and Chida, 2008) Mortality Walk / bike to work 7-10 Km per day

19. Health LAND USE POLICIES: PROXIMITY & CONNECTIVITY TRANSPORT OPTIONS 2

20. Where do you live?

23. Enrique Jacoby, OPS Active Transportation and Obesity Rates (Basset y col, 2008)

24. Transportation options and urban development: Cuasi-exp Portland, Oregon Ohland 2006

25. FACTOREFFECTSTUDIES Density and Diversity + Walking, Biking - Polution + Quality of Life 95/3 Street Connectivity + Walking, Biking 29/1 Active Transportation + Walking, Biking - Polution 58/4 Hosking J et.al WHO Report, unpublished

26. 55% of Bogotanos are physically active LF Gomez y col., 2004

27. 37% 55% of Bogotanos are physically active LF Gomez y col., 2004

28. 37% 3% 15% 55% of Bogotanos are physically active LF Gomez y col., 2004

29. Enrique Jacoby, OPS +200 km of bikepaths 2.5 to 4.12 m 2 Green Areas m2 100 km de Ciclovia +120 km TransMilenio

30. 3 Bogota A TransMilenio user, compared to a non user, is 70% more likely to be “physically active”

31. Health 2 LAND USE POLICIES: PROXIMITY & CONNECTIVITY TRANSPORT OPTIONS: MOBILITY

32. Health 2 COMPACT DEVELOPMENT MASS PUBLIC TRANSPORTATION

33. Spillover benefits

34. Spill over

36. Enrique Jacoby, OPS IV Congreso de Transporte Sustentable Ciudad de Mexico, 27-29 octubre 2008 50 3000 900 Liters of gas per person / year

37. Annual miles in mass transportation Road deaths and mass public transport use Deaths /100,000

38. Physical activity and health Pollution reduction Road safety Mental health Affordability Mobility

39. Annual miles per capita Mileage Change SuburbanGood Transit TOD Automobile base-case-2480-3501 Transit travel base-case447687 Walking base-case119274 Cycling base-case2139 T Litman, Evaluating public transportation health benefits, June 2010

40. Annual health benefits when 1-m residents move TOD BENEFITSFrom 10% to 20%From 10% to 40% ROAD SAFETY55 m151 m ↓ EMISSIONS3.3 m9 m WALKING11.5 m52.6 m CYCLING0.8 m2.9 m TOTAL BENEFITS 71 m216 m T Litman, Evaluating public transportation health benefits, June 2010

41. Ciclovias

42. Enrique Jacoby, OPS Bogota

43. Guadalajara

44. Mexico City

45. 41% of Ciclovia’s participants in Bogota participate 3 hours: Cycling (49%), running or walking (36%) and roller-skeating (38%) If Ciclovia were not in operation 60% would pursue sedentary activities

46. Average cost per user per year (USD) of different physical activity programs Montes F et.al. Cost-benefit of Ciclovias, unpublished

47. Cost-Benefit ratio of Bogotá’s Ciclovía for every Dollar invested: 5-year simulation using different values for the Direct Health Benefit Montes F et.al. Cost-benefit of Ciclovias, unpublished