Parks & Recreation

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Parks and recreation facilities provide opportunities for physical activity and can help people of all ages lead a more active lifestyle. People who live near parks are more likely to be active. However, some lower-income communities and communities of color tend to have less access to quality parks and recreation facilities. Our research documents the most effective ways to improve the design, quality and availability of parks and recreation resources. Making recreational facilities accessible in all communities is a critical strategy for increasing physical activity and preventing obesity.

Download our Parks and Recreation-related Resources Sheet for the best evidence available about a variety of park- and trail-based strategies for promoting physical activity.

View The Role of Parks and Recreation in Promoting Physical Activity infographic.

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Strategies, Techniques and Best Practices for Building a Multinational Collaboration to Promote Physical Activity

Description: 

Workshop at the 2015 Active Living Research Annual Conference.

Date: 
02/22/2015
Abstract: 

Initiating and developing multi-national collaborations is a task- and socially-oriented, dynamic process that results in shared goals and products. The initiation of the collaboration can occur from any side, but the development process—the adoption of a shared identity with the collaboration, the transcultural learning and sharing, the tolerance of differences and the recognized benefits outweighing the limitations—must be endorsed by all sides to achieve desired outcomes. This workshop discussed strategies and techniques drawing on community based participatory research methodology, Cialdini’s Principles of Persuasion, reflective listening and cultural anthropology to identify culturally relevant practices and described lessons learned during the implementation of the CAMBIO Project – Canada and Mexico Battling Childhood Obesity and the development of the Multinational Collaboration to Increase Physical Activity in Hispanics. Participants in this workshop received classroom style training and interactive demonstrations along with small group work to master skills focused on identifying collaboration strengths and weaknesses along with areas of opportunity and threats to productivity. Specific examples came from innovations in reverse innovation, relevant technology and cultural trends.

Authors: 
Rebecca E. Lee, PhD, Arizona State University, Juan Lopez y Taylor, MD, University of Guadalajara, Lucie Lévesque, PhD, Queen’s University
Location by State: 

Systematic Observation of Physical Activity and Its Contexts - 2015

Description: 

Workshop at the 2015 Active Living Research Annual Conference.

Date: 
02/22/2015
Abstract: 

Park, recreation, and school settings are viable locations for physical activity accrual, but investigations of physical activity and associated variables in these “open” environments have been challenging because the number and type of users and their activity levels are highly variable and the setting characteristics change often. We have designed, tested, and validated several systematic observation tools (e.g., SOFIT, SOPLAY, SOPARC, SOPARNA) that permit the assessment of physical activity in various locations while simultaneously providing contextually-rich data on the environment. These tools have the advantages of flexibility, high internal validity, low inference, and low subject burden. Nonetheless, they have disadvantages including personnel costs, need for observer training and recalibration, inaccessibility to certain environments, and potential subject reactivity. The workshop uses PowerPoint presentations and video examples to reach the objectives. Discussion includes an overview of recent innovations (e.g., free RAND website for data entry and analysis; apps for IPADS), definitions of behavioral categories, protocols for use (e.g., pacing of observations), coding conventions (i.e., interpretations of common scenarios), observation techniques (e.g., duration, frequency, interval, and time-sampling recording), observer training and recalibration, inter-observer reliability, subject reactivity, activity level validation, and practical issues.

Authors: 
Thomas McKenzie, PhD, San Diego State University; Monica Lounsbery, PhD, University of Nevada, Las Vegas
Location by State: 

'The Park a Tree Built': Evaluating How a Park Development Project Impacted Where People Play

Date: 
03/01/2015
Description: 

King, D. K., Litt, J., Hale, J., Burniece, K. M., & Ross, C. (2015). 'The Park a Tree Built': Evaluating How a Park Development Project Impacted Where People Play. Urban Forestry & Urban Greening, 14(2), 293-299.

Abstract: 

Community parks have achieved recognition as a public health intervention to promote physical activity. This study evaluated changes in population-level physical activity when an undeveloped green space adjacent to transitional housing for refugees was transformed into a recreational park. A prospective, nonrandomized study design used the System of Observing Play and Recreation in Communities (SOPARC) to document the number and activity levels of park users over time, and to compare trends pre- and post-construction. T-tests or tests of medians (when appropriate) were used to compare pre- and post-construction changes in use of non-park and park zones for physical activity and changes in park use by age and gender. Pre- and post-comparisons of people observed using non-park zones (i.e., adjacent streets, alleys and parking lots) and park zones indicated a 38% decrease in energy expended in non-park zones and a 3-fold increase in energy expended within the park (P = 0.002). The majority of park users pre- and post-construction were children, however the proportion of adolescent males observed in vigorous activity increased from 11% to 38% (P = 0.007). Adolescent females and elderly continued to be under-represented in the park. Our findings support an association between creation of accessible outdoor spaces for recreation and improvements in physical activity. Community involvement in park design assured that features included in the park space matched the needs and desires of the communities served. Some demographic groups were still under-represented within the park, suggesting a need to develop targeted outreach strategies and programming.

Location by State: 

Making the Case for Active Cities: The Co-Benefits of Designing for Active Living

Date: 
03/15/2015
Abstract: 

Creating "activity-friendly environments" is recommended to promote physical activity, but potential co-benefits of such environments have not been well described. An extensive but non-systematic review of scientific and "gray" literature was conducted to explore a wide range of literature to understand the co-benefits of activity-friendly environments on physical health, mental health, social benefits, safety/injury prevention, environmental sustainability, and economics. Five physical activity settings were defined: parks/trails, urban design, transportation, schools, and workplaces/buildings.

A peer-reviewed paper based on this report is available online through open access here.

Authors: 
James F. Sallis, PhD & Chad Spoon, MRP, Active Living Research
Location by State: 

The Active By Community Design Project: Partnerships, People and Parks

Date: 
02/25/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
Population-based approaches are an important response to addressing low levels of physical activity (PA) with strong evidence for environmental-based interventions. Ecological-based models acknowledge and recognise the influence of factors outside the individual when attempting to change PA behaviours and generally exert that interventions are most effective when they change the person, the social environment, built environment and policies. Parks in this context represent an important location in communities for PA, with domains including access, aesthetics and certain characteristics as, facilities, programs and perceptions of safety associated with increased park visits and PA. The ABCD project examined the translation of this evidence to create supportive environments for PA, focusing on the re-design of parks in a community of low socio-economic status in regional Queensland, Australia.  The purpose of the project was to engage local residents, living in close proximity to two parks, in the re-design and use of the spaces for increasing no-cost opportunities for physical activity. Baseline data collection, existing evidence and community and stakeholder input shaped the re-design of the two parks for increasing PA. A range of traditional and non-traditional health partners were gathered to oversee project design, implementation and evaluation, including primary health care, local government, university, police, a non-government organisation and the sports sector.

Description
Drawing on Bedimo-Rung, Mowen & Cohen’s (2005) conceptual model and the more recent evidence synthesis published by Active Living Research (2010) the ABCD project developed a community based participatory action research evaluation approach. It was anticipated by adding local preferences for PA to the consideration of park re-designs along with data and evidence, the project would achieve increased levels of community engagement and subsequent increases in park visits and PA. Using a pre-post evaluation design a series of baseline measures were completed (i.e., park audits, park observations, household survey and community engagement) using a series of validated tools (e.g., EAPRS, CPAT and SOPARC). All baseline data, evidence and community and stakeholder input was presented through a ‘design sub-committee’, comprising a Landscape Architect, Parks and Open Space Operational Manager and the ABCD Project Manager, to translate into ‘real-world’ open space designs. Conceptual landscape drawings for the two re-designed parks were approved by the project steering group and construction commenced and concluded during the summer of 2013/14.

Lessons Learned
Two case studies will be presented outlining the process and outcomes of the project. Park 1 baseline audit indicated the space was accessible, had limited facilities for PA, with overall aesthetics rated as fair with safety concerns highlighted regarding surveillance. Park 2 baseline audit indicated the open space was accessible, had very good surveillance and no facilities or infrastructure for PA. Park 1 baseline observations (n=170) indicated users were mostly adults (51%) and children (35%) with equal gender distribution (females 51%). The main activity was walking (21%), with the majority observed as moderately active (51%) or sedentary (31%). Park 2, baseline observations recorded only two total park visitations. A household survey and open days identified the parks were not designed for the activities residents wanted and there was a lack of information on PA opportunities within the parks. Park re-designs focused on maximising access, infrastructure to support PA, programs and enhancements to improve aesthetics and perceptions of safety. In Park 1 total park visitations increased from 170 at baseline to 562 at follow-up. Paired t-tests revealed that in park 1 (n=168) the average number of people per observation significantly increased.

Conclusions
The ABCD project successfully demonstrated a process of translating evidence for increasing PA, combined with community and stakeholder engagement to achieve the creation of more supportive environments for PA in the park setting in an Australian context. Local stakeholder and resident input into the re-design process assisted in translating and implementing best practice evidence in ways that increased acceptance and subsequent park visits and levels of PA. The involvement of a range of traditional and non-traditional health partners in the project was also critical to the overall success of the project and the project adds further evidence to the generalizability of the evidence for increasing PA in a park setting.

Next Steps
The partnership model the ABCD Project will allow other local government and health authorities to implement a practice-based evidence approach to future park developments.

References

  1. Bedimo-Rung, A.L., Mowen, A.J., Cohen, D.A., 2005. The significance of parks to physical activity and public health: a conceptual model. American Journal of Preventive Medicine. 28, 159-168.
  2. Active Living Research, 2010. Parks, playgrounds and active living: research synthesis. http://activelivingresearch.org/files/Synthesis_Mowen_Feb2010_0.pdf, accessed (7th August, 2014).

 

Support / Funding Source
Former Australian National Preventive Health Agency (Department of Health).

Authors: 
Glenn Austin, MHSc, Wide Bay Medicare Local
Location by State: 

The Paradox of Parks in Low-Income Areas: Park Use and Incivilities

Date: 
02/25/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
In prior research, individual perceptions of safety influence self-reported park use, such that people who consider a park unsafe are less likely to use it.  Nevertheless, in multiple studies we have conducted, neither park users’ nor nearby residents’ perceptions of safety were correlated with observed park use. We did, however find that parks in low-income areas are used less than those in high income areas, even after adjusting for differences in size, local population size, staffing, and programming.  In 2013-2014 we collected baseline data in 48 parks in low-income areas in Los Angeles as part of an RCT. We analyzed the data about park conditions, particularly incivilities (e.g., observed presence of homeless persons, gang members, people under the influence of alcohol and drugs) relative to observed park use in an effort to better understand if these incivilities are associated with park use.  Further, we explored whether there is a relationship between collective efficacy, mental health, and park use.

Objectives
1) To describe the relationship between incivilities and use of low-income area neighborhood parks 2) To describe the relationship between collective efficacy, a measure of community members’ willingness to help and trust each other, and park use and perceptions of park safety and incivilities in low-income neighborhoods. 3) To describe the relationship between self-reported mental health among park users and residents and perceptions of park safety and incivilities in low income neighborhoods.

Methods
The 48 neighborhood parks and recreation centers studied were in low income neighborhoods (poverty> 19% of households) within the City of Los Angeles and collectively served a population of about 2 million people (primarily Latino and African American) who lived within a 1-mile radius of the parks.  Trained observers used SOPARC (System for Observing Play and Active Recreation in Communities) and conducted environmental audits while visiting each park on 6 days, 3 times per day on randomly selected days and times over a 6 month period spanning 2 consecutive seasons (e.g., spring to summer, fall to winter).  Observers counted park users by age group and physical activity level and documented contextual factors, including the presence of apparently homeless individuals, gangs, drinking, smoking, (smoking is banned in City of LA public parks) and stray dogs.  In addition the observers surveyed over 2,800 park users and residents living within a 1-mile radius of the park.  They asked respondents about their park use and health as well as a measure of collective efficacy and mental health.

Results
Observers made 864 visits to the parks and counted over 65,000 park users. There were more people seen in parks that had more supervised and organized activities.  Observers noted multiple incivilities—of the 48 parks 7 had dogs without leashes, 25 had people smoking, 26 had people drinking alcohol and appeared to be intoxicated, 44 had individuals who appeared to be homeless, 9 had over 7 homeless persons observed at least once, 7 had groups of males considered intimidating or gang members.   Nonetheless, there appeared to be no negative correlation of any of these incivilities and number of park users.  In fact, the correlations were positive:  the more people in a park, the more likely we were to observe intimidating groups, homeless people, intoxicated people, and loose dogs. Measures of collective efficacy and social cohesion also were not associated with observed park use. However, where collective efficacy and social cohesion was higher among park users and residents, there were less likely to be individuals in the parks who were either smoking or appeared to be intoxicated. Higher levels of collective efficacy were associated with higher levels of park safety perceptions among park users and residents.  However perceptions of park safety were again not associated with observed park use. Perceived lack of park safety was associated with lower mental health.

Conclusions
In these urban neighborhood parks, incivilities did not appear to be related to park use; the availability of supervised and organized activities still appear to be the main drivers of neighborhood park use.  In low-income neighborhoods, incivilities may be a consequence of high park use rather than causing low use. Collective efficacy may be a mechanism that provides some social control to reduce anti-social behavior, or it could be a consequence of how parks and used and how people behave in them.

Implications
Because this is a cross-sectional analysis, it is not possible to know the direction of how parks influence or are influenced by collective efficacy.  Longitudinal studies may help clarify the relationship. “Incivilities” in low-income parks should not necessarily be the direct target of interventions, if the ultimate goal is to increase park use.  Focusing on programming might be more fruitful.

Support / Funding Source
NHLBI  #R01HL114283

Authors: 
Deborah Cohen, MD, MPH, RAND
Location by State: 
Study Type: 

The Chicago Plays! Initiative: Evaluation of a Natural Experiment to Increase Park Use

Date: 
02/25/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
A needs assessment of all Chicago parks, conducted in 2009 through 2011, identified 300 playgrounds in need of repair. Using Chicago Park District (CPD) earmarked capital improvement funds, the Chicago Plays! Initiative was created to renovate these 300 playgrounds over the next five years and enhance safety and accessibility for all Chicago residents. The CPD and Friends of the Parks (FOTP), a local nonprofit organization, developed a competitive application process where community groups (e.g., park advisory councils, block and church groups): 1) nominated playgrounds to be renovated in Year 1 of the program and 2) proposed plans for ongoing playground maintenance. The process was meant to empower residents living in intervention areas (i.e., those receiving first stage renovated playgrounds) to improve their neighborhoods and health by increasing park utilization and PA for children and their families. Just over 100 of 300 possible applications were received, and 50 of those parks were selected for first stage (Year 1) renovation. This new initiative, using community engagement to enhance playground renovations, provides a rare opportunity to evaluate a timely natural experiment.

Objectives
In a sample of racially, ethnically, and socioeconomically diverse neighborhoods, and using a quasi-experimental prospective longitudinal study design, we examined whether involvement of community groups influences park-based utilization and physical activity (PA) post-playground renovations (N=74 matched parks, 37 intervention and 37 control). We hypothesize that compared to playground renovation alone, sites with playground renovation plus community engagement will have increased park-based utilization and PA through positive effects on park programming, ongoing maintenance, and safety.

Methods
In summer/fall 2013 and 2014 baseline and 12 month follow up data were collected on park-based utilization and PA, presence and condition of existing playground equipment, presence of physical disorder, park programming, and park and neighborhood-based crime data. Field staff collected baseline park-based utilization and PA data (one weekday and one Saturday with 4 scans per day)  in 37 intervention and 37 matched control parks; 12-month follow up data collection includes 3 days of observation (2 weekdays and one Saturday with 4 scans per day).  Field staff also conducted playground environmental observations pre- and post-playground renovation, and took photographs of the equipment for future reference. Observation instruments were used to audit the presence and condition of the playground and all other park features and amenities.   Analyses of both the number of people in parks and the number of people in parks engaged in PA as determined by direct observations will be conducted using a mixed-effects linear regression model.

Results
Preliminary results of baseline data showed Of the 74 parks in the sample, nearly all parks (n=68) had posted signage regarding park rules and hours of operations, but only half (n=34) of the playgrounds observed had lighting present. Across the 74 parks, field staff observed a total of 5,592 visitors across the two days of observations. The majority of visitors (59%) were sedentary, with 23 and 18 percent observed engaging in moderate and vigorous activities respectively. Both control and intervention sites are subject to the same historical trends, thus we will be able to detect changes due to playground renovations prospectively even without having additional historical baseline measurements. Citywide crime data for the 12 months leading up to and including our park observation dates have been collected. During the 12-month period, a total of 304,276 reported crimes occurred in Chicago. Preliminary analyses show, over the past 12 months, 15 percent of all park-based crimes occurred in our sample of parks, which represent 13 percent of all CPD parks. The most commonly reported park-based crimes were drug, assault, battery, and theft-related crimes. Preliminary analyses also show approximately 40,000, or 13 percent of reported crimes occurred in the ¼ mile park buffers over the past 12 months. The most commonly reported street crimes were theft, vandalism, assault, battery, disorderly conduct, and prostitution-related crimes. Park program data for the past year is currently being compiled for analysis, but since January 2013 there were a total of 2,586 programs (e.g., team-based sports) or events (e.g., movie night) offered across the 74 parks with approximately 45,000 community participants across all ages (children, adolescents, adults and seniors). Programs and events are a mix of sedentary (e.g., sewing, arts and crafts) and active (e.g., basketball, gymnastics, swimming) activities. Following baseline data collection schedules, field staff is currently collecting 12-month follow up data this summer and fall.

Conclusions
Results of changes in park utilization, park-based PA, programming, maintenance and safety between baseline and 12-month follow up will be presented.

Implications
With recent evidence showing physical inactivity, and not diet, as the primary driver in obesity prevalence communities need rigorous scientific evidence to inform future policy decisions on how to increase park utilization in diverse neighborhoods.

Support / Funding Source
UIC Institute for Public and Civic Engagement

Authors: 
Sandy Slater, PhD, University of Illinois at Chicago
Location by State: 

Atlanta Streets Alive: A Movement Building a Culture of Health in an Urban Environment

Date: 
02/24/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
Ciclovias are multisectoral community-based programs that promote the use of public space for physical activity, recreation and socialization by closing streets temporarily to motorized vehicles, allowing access to pedestrians. The Ciclovias movement has grown exponentially worldwide, and in the US, where more than 70 events (called “Open Streets”) have been documented in different cities. The city of Atlanta hosted its first Ciclovia event,   Atlanta Streets Alive (ASA), in May 2010. For this initial event, the city closed 1.5 miles of streets in Downtown Atlanta and opened them for people to become physically active and enjoy a portion of the city safely and in the absence cars.  Since the initial launch of ASA, 8 additional events have been held in different parts of the city. Preliminary evidence has shown a positive association between Ciclovia programs and public health outcomes including  increased physical activity, improved social environments and air quality, enhanced perception of safety, and increased equity in access to recreational activities among low-income populations. In an effort to strengthen the evidence on the public health impact of “Open Streets” programs in the U.S, an evaluation sub-committee was established as part of the larger ASA steering committee. The sub-committee designed and implemented the evaluation of the first 5 ASA events from May 2010 to May 2012.  The purpose of the evaluation was to learn about the characteristics of ASA participants, the influence of the event on their physical activity, as well as their perceptions of safety and neighborhood social capital during the event.

Description
ASA’s evaluation had two components: participant counts and observation and a participant survey. Participant counts and observations included estimating the number of participants, their demographic characteristic, and type of physical activity they performed during the events. Participant surveys included 22 questions that assessed 5 components: (1) physical activity, (2) transportation mode to the event (3) social capital and safety perceptions, (4) characteristics of participation and perceptions about the event, and (5) demographics.

Lessons Learned
Participant counts The estimated participation at the 5 ASA events was 28,143 participants. The majority of participants were adults in each ASA event. Youth accounted for between 9 and 15% of participants.  The activity most commonly observed was walking across all five events. Survey A final sample of 589 surveys was included in the analysis. Overall, 19.4 percent of participants met the weekly PA recommendation of 150 minutes of PA during one ASA event. The estimated average number of minutes of PA for participants at the 3 events was 99 minutes. Walking and cycling were the most frequently primary activities reported at ASA (73.7% and 37.7%, respectively). Ninety-seven percent (97%) of participants reported feeling safe or very safe at ASA. Similarly most respondents agreed that ASA was an event that welcomed everyone (99.7%), and that people at “ASA” generally get along with each other (93.9%). Thirty eight percent (38%) of respondents indicated they would be at home indoors, watching TV, or on the computer if they were not participating at the event.

Conclusions
Attendance at ASA has increased significantly from approximately 5,000 in 2010 to more than 60,000 participants in 2013.  The route has expanded reaching some of the main streets in the city and increasing the number of miles of streets closings, ranging from 3 miles to 5 miles in 2013. Such growth suggests that ASA has been a widely received program, one that is beginning to achieve sustainability through partnerships and sponsorships. The preliminary findings of this study support previous research that have identified Ciclovias as promising interventions to increase PA levels while providing opportunities for recreation and health promoting social environments. The goals of increasing PA and decreasing sedentary time are important for population health in Atlanta given the strong evidence that shows that physical inactivity increases the risk of adverse health conditions including non-communicable diseases.5,6 Data from 2012 showed that 53.8% of the adult population in Metro Atlanta were not physically active at least moderately,7  60.9% were overweight or obese,8 and 8.7% had diabetes.7

Next Steps
This study provides important preliminary information to understand the potential impact that ASA can have in the local areas where it is implemented. However, future evaluations should increase efforts to move beyond cross-sectional evaluation to pre and post assessments in communities where ASA will be implemented for the first time. There is much to be learned from Open Streets events across the nation and internationally. More research is needed to build the evidence base for such programs.

References

  1. Sarmiento O, Torres A, Jacoby E, Pratt M, Schmid TL, Stierling G. The Ciclovía-Recreativa: A mass-recreational program with public health potential. J Phys Act Health. 2010 Jul;7 Suppl 2:S163–180.
  2. Meisel JD, Sarmiento OL, Montes F, Martinez EO, Lemoine PD, Valdivia JA, et al. Network analysis of Bogotá’s Ciclovía Recreativa, a self-organized multisectorial community program to promote physical activity in a middle-income country. Am J Health Promot AJHP. 2014 Jun;28(5):e127–136.
  3. Zieff SG, Hipp JA, Eyler AA, Kim M-S. Ciclovía initiatives: engaging communities, partners, and policy makers along the route to success. J Public Health Manag Pract JPHMP. 2013 Jun;19(3 Suppl 1):S74–82.
  4. Torres A, Sarmiento OL, Stauber C, Zarama R. The Ciclovia and Cicloruta programs: promising interventions to promote physical activity and social capital in Bogotá, Colombia. Am J Public Health. 2013 Feb;103(2):e23–30.
  5. Kohl HW, Craig CL, Lambert EV, Inoue S, Alkandari JR, Leetongin G, et al. The pandemic of physical inactivity: global action for public health. Lancet. 2012 Jul 21;380(9838):294–305.
  6. Lee I-M, Bauman AE, Blair SN, Heath GW, Kohl HW, Pratt M, et al. Annual deaths attributable to physical inactivity: whither the missing 2 million? Lancet. 2013 Mar 23;381(9871):992–3.
  7. American College of Sports Medicine. American Fitness Index. Full report 2012 [Internet]. [cited 2014 Aug 7]. Available from: http://americanfitnessindex.org/report/.
  8. CDC. Behavioral Risk Factor Surveillance System-BRFSS City and County Data [Internet]. [cited 2014 Aug 7]. Available from: http://apps.nccd.cdc.gov/brfss-smart/MMSARiskChart.asp?yr=2012&MMSA=5&cat=EX&qkey=8041&grp=0.
Authors: 
Andrea Torres, MPH, PhD candidate, Georgia State University
Location by State: 

Investing in Health: An Analysis of Economic Development Initiatives that Promote Physical Activity and Healthy Lifestyles

Date: 
02/23/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
The health of New York’s economy, communities, and residents is inextricably linked. People living in low-income and distressed neighborhoods often experience poor health outcomes, and poor health and illness create an economic burden that affects individuals, companies, regions, and, ultimately, the entire state. New York ranks second highest in the United States for medical expenditures attributable to obesity, spending $11.1 billion (in 2009 dollars)[i] each year. Being physically active and eating healthy foods are two key variables that contribute to preventing obesity and other related chronic illnesses. Therefore, community and economic development that supports increased access to physical activity and healthy foods within all our communities is vital to addressing both the economic and physical health of New York State.   In 2011, New York State Governor Andrew M. Cuomo and Lieutenant Governor Robert Duffy created 10 Regional Economic Development Councils (REDCs) to develop long-term plans for economic growth across the state. The REDC plans have largely focused on job creation. An analysis was done by The New York Academy of Medicine (NYAM) as part of its Designing a Strong and Healthy New York (DASH-NY) Obesity Prevention Policy Center to show that economic development initiatives are also opportunities to simultaneously enhance public health. Staff reviewed the 725 projects funded through the REDC process in 2012 and 824 projects in 2013 and compared them against evidence-based and recommended interventions for increasing access to healthy foods and physical activity in communities. The analysis found close to two hundred projects that simultaneously meet health and economic development goals. This approach can be utilized by other states and communities to align economic development initiatives with community health improvement efforts.

Description
Research demonstrates that the way communities are designed can make it easier for people to live healthier lives.[ii]  For instance, physical activity has been shown to prolong life, and there are ways to design communities to make daily activities like walking, biking and shopping easier and safer.  Making physical activity an easier choice can reduce risks associated with leading chronic diseases, such as stroke, cardiovascular disease, and some types of cancer.[iii].  The methodology developed for this analysis can help others interested in building multi-sector partnerships develop and implement projects that promote health in a way that will have synergy with economic development goals.  This presentation will use NYAM's analysis of the New York State REDC funding process to show how specific evidence-based interventions that promote health can be incorporated into economic development initiatives.

Lessons Learned
1.  There are specific strategies to help shape communities’ physical and social environments in ways that promote healthy behaviors, prevent illness and premature death, and promote community and economic development. These strategies include promoting active design, encouraging transit oriented development, and making healthy and local foods available through investment in grocery stores, farmers markets, and improved regional agricultural infrastructure  2. Funding for projects that promote health in the REDC process is increasing, which shows there are great examples for how economic development and health can be mutually supportive. *Out of the 725 projects awarded in 2012, there were 45 potentially health promoting projects, with 21 projects supporting healthy eating and 24 projects supporting physical activity. The 45 projects represent 2.2% of total funding ($16 million of the total $738 million). *Out of the 824 projects that were awarded in 2013, there were 22 projects that support healthy eating and 109 that support physical activity. The 131 projects cover 7.4% of total funding ($53 million of the total $716 million).   3. The distribution of projects with potential to promote healthy eating and physical activity varies greatly. Opportunities exist through the REDC process to promote greater health equity across demographic and county lines.

Conclusions
Statewide economic development initiatives represent an exciting opportunity for strategic planning and alignment of multiple resources toward improving health. The 2012 and 2013 awards in New York State demonstrated increased opportunities for health promotion through the REDC process, the core goal of which may be economic development. As NYS refines its economic development initiatives, and other states consider similar initiatives, there will be additional opportunities to consider health as a core objective in economic development activities.  For example, the creation of metrics by which economic development projects can account for health in plans and setting targets for dollars invested in projects that have a positive impact on health.

Next Steps
NYAM plans to work with partners across the REDCs in NYS to inform its members about how health and economic development are mutually supportive and to identify future opportunities for synergistic projects.  NYAM also plans to repeat its analysis of the NYS REDCs with an expanded set of metrics for the next round of awards to see how funding for projects that support healthy behaviors are maybe changing over time.

References

  1. “Focus Area 1: Reduce Obesity in Children and Adults,” New York State Department of Health, accessed August 26, 2013, http://www.health.ny.gov/prevention/ prevention_agenda/2013-2017/plan/chronic_diseases/focus_area_1.htm.
  2. “Healthy Community Design,” Centers for Disease Control and Prevention, accessed August 14, 2014, http://www.cdc.gov/healthyplaces/factsheets/healthy_community_design_factsheet_final.pdf.
  3. McCann BA, Ewing R. Measuring the effects of sprawl: A national analysis of physical activity, obesity and chronic disease. Smart Growth America Surface Transportation Policy Project: September 2003, accessed August 14, 2014, http://www.smartgrowthamerica.org/documents/HealthSprawl8.03-1.pdf and Centers for Disease Control and Prevention. Physical activity for everyone [online], accessed August 14, 2014, www.cdc.gov/physicalactivity/everyone/guidelines/.

 

Support / Funding Source
The New York Academy of Medicine’s work on funding from the New York State Department of Health, DASH-NY serves as New York State’s Obesity Prevention Coalition and Policy Center.

Authors: 
Monica Chierici, MPA, The New York Academy of Medicine
Location by State: 
Study Type: 

The Role of Health-Related Community Investing as an Active Living Research Implementation Strategy

Date: 
02/23/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
The National Prevention Strategy [1] recognizes active living as a priority area for reducing the burden of chronic disease, and emphasizes safe and healthy community environments as a key strategic direction to guide actions that will demonstrably improve health. New financial incentives created by the Affordable Care Act to facilitate population health, complemented by recent private sector interest in health-related community investing [2-4] provide an unprecedented opportunity to implement active living policies and create healthy community environments, particularly for populations who need them most. For example, population subgroups that are at increased risk of obesity and related chronic diseases include lower socioeconomic (SES) persons [5], racial/ethnic minorities [6, 7], those living in rural areas of the U.S. [8], and persons with disabilities such as mobility limitations [9] [10, 11]. The purpose of this paper is to explore a key aspect of policy implementation pertaining to Active Living Research: Innovative financing mechanisms to support safe places for physical activity, such as high quality parks, trails, community recreation areas, access to healthy foods, and multi-modal transportation systems.   We will explore health-related community investing and new mechanisms created under the Affordable Care Act (ACA) that can be leveraged to support activity-friendly community environments.

Description
We will share lessons learned from the Financial Innovations Roundtable (FIR), which has created cross-sector partnerships among conventional and non-traditional lenders, community development organizations, and other types of financial institutions over the past 14 years to provide low-income communities with increased access to capital and financial services. Recently, the FIR entered into a partnership with the Federal Reserve Board of Governors in Washington, D.C., and selected health-related community investing as its focus for 2014. Although health is a new explicit focus for the FIR, many successful ideas developed at the FIR have been implemented, resulting in transformative investments in affordable housing, small and minority businesses, community facilities, and other community development efforts, in addition to new tools, policies and practices. Over the past year, the FIR engaged financial institutions, funders, and health partners to holistically examine the social determinants of health - including pertinent ALR domains such as community recreational environments and transportation systems.  Through document review, analysis of transcripts from the FIR’s 2014 dialogue, and interviews with FIR members, and case examples, we explore potential partnerships, synergies, and focus areas relevant to ALR goals.

Lessons Learned
We will have a complete summary of lessons learned as FIR continues its dialogues focused on healthy communities through 2014-15. Preliminary lessons learned include:  1)  FIR stakeholders established a matrix to delineate how various community stakeholders can define community, list accountability mechanisms, and identify opportunities for alignment; 2)   FIR stakeholders are deeply committed to addressing the social determinants of health and improving places where we live, learn, work, and play; 3)   FIR stakeholders expressed interest in learning more about shared metrics that allow us to measure positive change in communities. This is an important point of intersection with RWJF/ALR, as many existing metrics developed by RWJF/ALR may be useful to the FIR; 4)   Innovative examples from diverse communities were shared, such as Boston Community Capital’s focus on “transformation zones,” (which support grocery stores, health clinics, housing areas, commercial space, and housing).   Similarly, the Federal Reserve Bank of Boston’s Working Cities Challenge is helping to improve the health of low-income people while advancing collaborative leadership in Massachusetts’ smaller cities. As an awardee, the City of Fitchburg, MA works through its broad health promotion partnership, Fun ‘n FITchburg, to develop shared metrics for neighborhood health and well-being with the goal of making its North of Main neighborhood a place where residents choose to live, work, and invest. In Omaha, NE, traditional providers and funders of clinical care now invest in infrastructure projects to create better access to active transportation in the public space. The city’s new B-cycle membership bike rental system and rental stations have been supported by funders such as Blue Cross Blue Shield of Nebraska, Alegent Creighton Health, the Peter Kiewit Foundation and the Sherwood Foundation.  5)   FIR stakeholders identified Treasurers of hospitals as frequently overlooked partners,as they can facilitate collaborations between hospitals, Community Development Finance Institutions, and banks.

Conclusions
Raising awareness about innovative health-related community investing strategies and exploring ways to partner with community development and other types of financial institutions are key aspects of ALR policy implementation. By addressing these areas, the National Prevention Strategy’s key strategic directions pertaining to active living - safe and healthy community environments, empowered people, and elimination of health disparities - are more likely to be achieved.

Next Steps
The FIR stakeholders are currently exploring new opportunities for alignment, and discussing ways to diversify investment strategies to improve health outcomes. An important opportunity exists to explore synergies with ALR, particularly with respect to harnessing innovative financing mechanisms to  implement active living policies.

References

  1. National Prevention Council. National Prevention Strategy. 2011  [cited 2014 July 27]; Available from: http://www.surgeongeneral.gov/initiatives/prevention/strategy/index.html#The%20Strategic%20Directions.
  2. Mair, J., Milligan,K.,, Q&A Roundtable on Impact Investing. Stanford Social Innovation Review, 2012.
  3. Fleming, D., Achieving Individual Health through Community Investment: A Perspective from King County, Washington, R.C.t.B.a.H. America, Editor. 2013.
  4. Swack, M. Financial Innovations Roundtable. 2014  [cited 2014 August 14]; Available from: https://carsey.unh.edu/csif/financial-innovations-roundtable#.
  5. Go, A.S., et al., Heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation, 2014. 129(3): p. e28-e292.
  6. Kurian, A.K. and K.M. Cardarelli, Racial and ethnic differences in cardiovascular disease risk factors: a systematic review. Ethn Dis, 2007. 17(1): p. 143-52.
  7. Mensah, G.A., et al., State of disparities in cardiovascular health in the United States. Circulation, 2005. 111(10): p. 1233-41.
  8. Cooper, R., et al., Trends and disparities in coronary heart disease, stroke, and other cardiovascular diseases in the United States findings of the national    conference on cardiovascular disease prevention. Circulation, 2000. 102(25): p. 3137-3147.
  9. Kirchner, C.E., E.G. Gerber, and B.C. Smith, Designed to deter. Community barriers to physical activity for people with visual or motor impairments. Am J Prev Med, 2008. 34(4): p. 349-52.
  10. US Census Bureau, American Community Survey and Peurto Rico Community Survey 2012 Subject Definitions. 2012.
  11. US Census Bureau, American FactFinder. Disability Characteristics 2010-2012 American Community Survey 3-Year Estimates. 2010.
Authors: 
Semra Aytur, PhD, MPH, University of New Hampshire
Location by State: 
Study Type: 

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