Presentation at the 2014 Active Living Research Annual Conference.
Background and Purpose
In the U.S., diseases related to obesity and physical inactivity are among the leading causes of death, and as a result, built environments are being modified to promote daily activity during work, travel, and play. Efforts to promote environments that facilitate opportunities for physical activity should consider the fact that injuries are the leading cause of death for Americans ages 1 to 44, with transportation-related injuries the most common cause. Urban design strategies for safe neighborhoods, streets, and outdoor spaces can be implemented to reduce injuries while simultaneously encouraging walking and bicycling and increasing access to public transit. Building design strategies that affect where individuals live and work can also be implemented to promote both an active lifestyle and safety (e.g., safe design of stairs). Drawing on the latest academic research and best practices in the field of injury prevention, the purpose of this project is to provide those working to promote physical activity with evidenced-based recommendations on how to build in safety while designing active environments.
In 2010, twelve New York City (NYC) government agencies collaborated to create the Active Design Guidelines (ADG) (www.nyc.gov/adg), which provided evidence-based and best practice urban and building design strategies for creating environments that promote daily physical activity. With support from the CDC, partners from the Johns Hopkins Center for Injury Research and Policy, NYC’s Health Department and Department of Transportation, and the Society for Public Health Education developed a supplement to the ADG, Promoting Safety, which provides information that links safe design and active design strategies. A systematic review of the existing literature was conducted to identify injury prevention strategies applicable to the ADG objectives. Injury prevention strategies were rated as strong, emerging, or best practice, according to the strength of the supporting research evidence. We identified 18 urban design strategies and 9 building design strategies that promote safety and physical activity. Evidence was strong or emerging for 14/18 urban design strategies and 7/9 building design strategies. The product that resulted included a summary of the strategy, evidence, rating, visuals, and a matrix to illustrate how active design objectives relate to safety promoting strategies. The product was designed for print and online dissemination, and was peer-reviewed by injury prevention professionals, design and transportation experts, and key stakeholders.
Since this work was interdisciplinary and transdisciplinary, we learned the importance of framing and language to meet the needs of a variety of audiences including health, safety, architecture, planning and transportation. In addition, because of the array of stakeholders who could potentially be affected by this work, we had to include additional time to ensure that we had reviews and buy-in from the different relevant groups. Finally, designs for safety and active living are often complementary and synergistic, which increases the likelihood that these strategies will be implemented.
Conclusions and Implications
Several key findings emerged from the evidence reviewed. First, active design strategies are often wholly compatible with well-accepted injury prevention principles. One example is where properly built bike lanes offer good street connectivity and are supported with appropriate, well-displayed signage and traffic controls. Second, the safety of multiple active design strategies can often be enhanced simultaneously by a single injury prevention strategy. For example, improved timing of traffic signals benefits pedestrians, bicyclists, and transit users. It is also important to note that motor vehicle drivers and passengers will also be better protected when active design strategies that reduce crash risk, such as traffic calming, are implemented. Third, for several of the active design objectives reviewed, there is not yet evidence on the ways in which injury outcomes are involved, and further research is needed.
This project makes significant contributions to the field. By partnering with architects, planners and other transportation professionals, injury prevention and public health professionals can contribute to ensuring that new and renovated spaces maximize both active living and safety. The Active Design Supplement, Promoting Safety, is the first resource of its kind to meet that goal. This project is significant for the field because it highlights the importance of interdisciplinary collaborations to foster the creation of safe environments. It also emphasizes the critical role that injury prevention professionals have in ensuring safety is incorporated when interventions to promote activity are being developed in the future. Finally, this work highlights one approach to making these interdisciplinary partnerships between public health, architects, planners and other transportation professionals, more common and eventually the norm.
Widespread dissemination is planned with targeted outreach to the active living community, planners, architects, and transportation professionals. We are also writing a peer review manuscript documenting this work.
Johns Hopkins Center for Injury Research and Policy, NYC Health Department, and Society for Public Health Education. Active Design Supplement: Promoting Safety. 2012. Available at: http://centerforactivedesign.org/promotingsafety.
Support / Funding Source
This document was supported by a cooperative agreement to the Society for Public Health Education from the U.S. Centers for Disease Control and Prevention (CDC) 1U58DP0001335.