Stephen Rees's blog

Dr. James Sallis Professor of Psychology, San Diego State University; Director, Active Living Research

The automobile may be close to our heart, but unfortunately that heart has become a lot less healthy as a result. Dr. James Sallis does “Active Living Research,” making the connection between how we move and our physical health. Dr. Sallis shows how a balanced transportation and transit system is critical for our quality of life.

The Path from Health to Transport

Dr Sallis is a Health Psychologist whose current filed is research into active living – the science of how built environment determines health.

Streaming video

He said he was impressed with Vancouver as a walkable city (though it was clear he was only familiar with downtown). It is only in recent years that the health care field has become interested in transportation, so his research is a new field. Formerly health interest in transport was concentrated on air quality but it now extends to the built environment.

The greatest health problems we now face are tobacco use, poor diet and lack of physical activity. “These three risk factors contribute to four major chronic diseases – heart disease, type 2 diabetes, lung disease and many types of cancers – which are responsible for more than 50% of the deaths in the world.”

Two million deaths a year worldwide (200,000 of them in the US) can be attributed to inactivity. This compares to 435,000 attributable to tobacco use. Not so long ago we used to get everywhere by walking. Our work practices have also changed – we now move information electronically rather than move or transform matter. Walking and working served us well for millennia: because we were physically active, obesity was quite rare. Now it is common. Promoting exercise has not worked: he presented the graph below which shows that the amount of reported activity has hardly changed

(Dr Sallis has copies of his presentations on his web page, and I will not copy all of his slides here). The number of minutes of physical activity per day across the age range falls off with age, and only children seem to manage the required minimum of 30 minutes per day. Studies which record the actual amounts of physical activity show not the 25% who self report: we see only 5 to 10% of people getting enough exercise

Twenty years ago in the US10% of all trips were by walking: in the intervening period we have managed to cut that in half. While we have invested huge sums in motorised transportation and have a big health issue, there has only been a minor investment in programs. These have concentrated on psychological and social influences, education and so on. While these programs can be effective they have a limited reach: it is hard to get people in, and the effects are modest and short term. Researchers have tended to blame the people, but the programs were not designed to change the root causes.

Why has physical activity declined? He asked the audience had people changed in recent years or was it the environment? There was a strong consensus that it is the environment but the current programs deal only with psychological and sociological motivations not the built environment in which people find themselves.

He presented an ecological model of health behaviour, which sets the individual into a physical environment and a policy context. It was essential, he said, to change all of the factors: for example in low income neighbourhoods, sources of healthy foods are not available – so while a program tried to give residents the skills to be smart shoppers their environment prevented them from putting thier knowledge into action. Similarly while there are issues of parks and sidewalks, just changing the environment in and of itself is not enough. To achieve transformative change all of the influences must change

The Promise of Built Environment

The root cause of inactivity is that people do not incorporate physical exertion into their daily routines. While behavioural studies are useful, changes to the built environment are permanent, and gone on having an influence for many years. A favourable environment should reinforce changes in personal choices. An activity friendly environment builds upon the SLOTH model (Sleep, Leisure, Occupation, Transport, Home) Each of these domains of activity have their own ecological model.

A summary of the literature shows that adults respond to walkability in their neighbourhoods. The installation of sidewalks means people will walk for recreation and leisure. Walkability has been related to obesity in 11 studies of adults. It is the biggest health challnge in the world. In only 2-3 studies of youth no association could be established.

In the Neighbourhood Quality of Life Study they examined walkability against income in several neighbourhoods. The recorded the activity of 2,000 adults and found that walkability has definite effect and it is permanent and there is a good correlation to both obesity and overweight (JAPA Apl 2006 L Frank et al – Walkability) They also found a 6.5% decrease in VMT therefore walkable neighbourhoods produce less pollution. And this is not just a US phenomenon: there are studies now of 11 countries including Canada. If there are the right conditions people will meet the minimum physical activity guidelines – proximity to shops, a transit stop, sidewalks, bike facilities and access to low cost recreation are all necessary but interestingly fear of crime is not a significant deterrent. One factor alone is not enough but 4 to 6 of these factors will influence activity.

The more VMT the more risk of obesity: this is not just due to inactivity – people tend to eat when they are driving – and often it is junk food since it ios so readily available to drivers. The daily steps of those who commute by train are very good, but are much lower by car. While the presence of sidewalks may look small but it is significant as it accumulates over time. There is a need to quantify the monetary benefits of good walkability: Wang studied four trails in Nebraska and found that while the cost of building and maintaining the trails was $98 per year, per person who used the trails, inactive people have health costs of between $300 to $400 pp pa. Children who live in mixed use area are more likely to be physically active, not just walking to school. It also works for older women, but there is need for walk destinations – shops and other services.

Active Living Research has all of its material available on line including conference papers and a journal.

Bogota has a culture of active learning with car free weekends and where the parks have hourly dance/exercise classes on Sundays

Panel

Nick Losito of Vancouver Coastal Health Authority and Dr Don Hunter of the Coalition for Active Living both provided a short summary of what we are doing here.

Dr Hunter said that there are significant differences in the Canadian data. Physical activity has gone up since 1981 –when the federal government started “Participaction” but recently “the feds have vanished”. Obesity is tow thirds of the US but still “far above everybody else”. Women more active in Canada. Act Now BC is the first major physical activity program which is now in 158 BC communities. The BCHLA, UBCM, and the Parks and Recreation Association are now at the same table and approved in 2006 $25m for strategies to tackle tobacco use, healthy eating and physical activity. Walking is the entry point to physical activity for the 35% of people who are totally sedentary in BC.

The alliance is looking at the economics of physical activity including accessibility in low income areas and active transportation. This includes the target officials in government and municipalities and also includes major greenway developments.

Nick Losito started by speaking of his own “health protection bias”. He though that the 2010 Olympic challenge from the Premier that we should be the healthiest host city and also implementing “Clouds of Change” fit well with the greenhouse gas reduction strategy, which will apply equally to HAs, for example as employers. He said that an expected rewrite of Public Health Act will move health authorities more into promotion and prevention activities.

There are inhibitors. The growth of health budget threatens to take over the whole of the available funds in future, and the need to address chronic diseases means that recent gains against tobacco use will be offset by obesity and inactivity. Public health officials will need to “look not just at water and waste” adopt a broader perspective.

The success of the fight against tobacco showed that there are four key success factors –

1. public support
2. political champions
3. partnerships
4. science

“The guys with white hats are winning”

Larry Frank opened the discussion by pointing out that current and expected investments in transportation are a concern. “We are losing ground South of the Fraser. There is a roaring silence about Gateway, which is so massively wrong. [applause] How can we get the alliance and consortia to engage in the debate?”

Nick Losito said that while they do have a mandate for health advocacy it is awkward for provincial agency to speak against government policy.

Don Hunter noted that there was some mention of with cycling in recent provincial announcements with a figure of $50m mentioned but “there are no firm plans”. Greenways have to start with a comprehensive plan. What was demonstrated in Saanich with the galloping Goose Train was that it needed an overall plan, but it could then be built “in bits – and stick to the plan”.

Larry Frank responded that there was an obvious disconnect between transportation and health. We could do nothing on Active Transportation and just stop the freeway and have the same impact.

Questions and comments from the audience

• Have you looked at the work by [Mayer] Hillman in UK where fear of the car actually reduced walk and bike to school. He went on to point to the dualling the Sea to Sky for the Olympics but the parallel railway is unused. “The roads have the money and the health and climate change have only words”

• Mark Allison asked about knowledge transfer. It seems to be a small component but we are not getting to the decision makers. One municipality (not named) has a ratio of expenditure of 1,000 to 1 : roads to sidewalks
  James Salis responded that it is very critical. There is no infrastructure for knwledge transfer and all are disconnected. The advocates don’t talk to each other and we don’t get in the faces of councillors. We need studies on how to promote advocacy
• At this point I spoke about how we do not have a health system but a sickness system. I may have been less than clear, but I wanted to point out that prevention is much more economically effective than treatment, but diagnosis and treatment is where all the resources are currently going. As a planner at Translink I found I could not even get a meeting with planners at the Health Authorities
  Dr Sallis replied that in Australia all of government had got involved in the issue with cabinet level committees representing all the agencies
• In Latin America everywhere has plazas and street activity: there are artists and musicians evertywhere who are essential or healthy and happy cities. In contrast we insist on licenses and regulations and move on buskes and pavement artists. He went on that he felt ecodensity would be less safe and that it would tend to encourage people to drive more.
  Larry Frank pointed out that it required a lot more than just density – “its about choice – and density is not an easy sell”
• An advocate for bike co-ops pointed to the free bike program in Paris which had “changed the whole physiology of the city. North American cities are not as well built.” But when there is no need to haul a bike with you, there is a greater probability that you can use a bike for part of your trip. He said that he felt safer in Paris as there were fewer SUVs there.”Do we need to look at banning Hummers?”
  Larry Frank said that J C Decaux are hoping roll something out in “urban Vancouver”. A proposal from City Cycling Task Force had suggested that vehicle registration costs should increase with ghg emissions
• Someone said that simply eating less and building less would solve out long term problems
• An activist from Delta spoke about a new Greenway from Hwy #91 to Centennial Beach and then potentially onto Blaine, WA. This could mean the relocation of the BNSF tracks but that in itself was worthwhile as it would increase capacity for both freight and passenger trains. “There are things happening in community – its individuals not government.” But he also noted that ActNow BC does have cabinet position.
• A planning student asked how do we get healthy food into low income neighborhoods?
  BHLA (?)– includes healthy foods –
  Nick Losito said that the Health Authority is concerned with communiy food security and the future of urban agriculture
  James Sallis said that Los Angeles city council has looked at a moratorium on fast food places as well as incentives to draw grocrey stores into low income areas. New York City funds fruit and vegtable carts. If we follow smart growth guidelines we will “not suck up all the farmland”.
• Someone commented that contrary to the presentation there was data on the walk to school of our grandparents’ generation. It was either six miles through three feet of snow or three miles through six feet of snow – and uphill both ways. A study of a “happiness index” in St John NB found that stability in neighbourhoods, the strong connection to the people you see every day was most important and he wondered about the compatibility with current goals of a walkable distance to work, given the number of times people had to change jobs
  James Sallis agreed that we understand the value of stability, but the disconnect is not in smart growth but the lack of commitment to long term employment in companies
  Larry Frank spoke about social capital (and its obverse “bowling alone”) He pointed to the significance of tenure in residence: “walkability does not do much for social capital” but in California your property taxes don’t go up until you move, which encourages social stability.
• A teacher said that she had experienced a battle to explain urban design to a PE teacher
  James Sallis said that people with a commitment to physical activity need to learn about the policy areas that affect the area
  Don Hunter agreed: “Unless you get out of your gym, you will not change behaviour patterns.”
• Another teacher trying to get more teachers cycling to school to set a good example asked: “Who is responsible?”He had found that the responsibility currently is simply shuttled between school districts and municipalities.

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Reaction

It has often been said that social science simply records things which we already know. The studies simply reinforce what those of us in planing and transportation have known for a long time.

But there is a complete disconnect in our system of government between engineers and planners on the one hand and health professionals on the other. Only a few people like Fred Bass actually cross over that line. The urban professionals have been convinced for years that what they are doing is “good for us”. After all suburban sprawl was actually planned. There are still professionals in both fields who think that widening a freeway is a Good Idea.

Mayer Hillman was a figure to be reckoned with when I was a planning student. I do not think there is any doubt that he is right, but that does not mean he has ever had the attention of policy makers. And I think when the Transport Minister and the Health Minister in the UK or BC look at each other across the table, they do not realise that they are in the same business. I am sure they regard their colleague as simply a competitor for limited capital spending funds. And “winning” means just having more and bigger projects for your department.

When Richmond Hospital goes out for a fund raiser it is to buy an MRI – not fund healthy community initiatives. The City of Richmond simply refuses to listen to suggestions that the Garden City Lands could be a significant gain in community food security as well as an important opportunity as community gardens for apartment dwellers to work their own plots. You try and find somewhere affordable to live in Richmond where you can grow more than two flower pots of herbs! And in the East End of London, where I come from existing community garden were rudely shoved out of place when the 2012 summer Olympics came along. It was completely unnecessary of course. But not seen as “appropriate”.

Our priorities are all wrong. If only from the standpoint of economics, ensuring that people are happy and healthy must be cheaper than failing to cope with various overwhelming health care crises like adult onset diabetes – and our system doies love to put the blame on individuals. As though how we live and work was within our control and that stress was simply something we create for ourselves.

Despite the evidence of the failure of the free market model to the south of us, that is still the paradigm that out political leaders have in mind. As long as GDP and Olympics are our goals, we will continue to flounder and fail.