September--October 2016

The active living research field has been working for over 15 years to create evidence about the role of built and social environments in shaping physical activity patterns. The growth in quantity and quality of this scientific evidence has been substantial and appears to be contributing to healthy movements, such as complete streets policies, the Urban Land Institute's Building Healthy Places Initiative, the National Association of City Transportation Officials developing standards for pedestrian- and bicycle-oriented streets, and the American Institute of Architects’ Design and Health Initiative. But the impacts of city planning and transportation policies and practices on health have been studied for much longer. The health consequences of automobile-associated road crashes and injuries are well-documented and routinely considered in transportation decision-making.

Lancet Series on Urban Design, Transport, and Health

As the multiple health impacts of practices in the city planning, urban design, and transportation fields are more fully documented, the evidence is drawing increased interest from the public health and medical fields. A major inflection point in this evolution is likely to be the September 2016 publication of the Lancet Series on Urban Design, Transport, and Health. The Series, led by Mark Stevenson of the University of Melbourne Australia, consists of three papers and three commentaries. The Series website provides open access to all the papers and commentaries.

Billie Giles-Corti, also of the University of Melbourne, led the first paper that summarized evidence about the relation of urban design and transport practices to multiple health outcomes plus health inequities and environmental sustainability. Eight intervention strategies related to regional planning and local urban design were identified that could improve the health of people living in cities.

Mark Stevenson's paper two in the series modeled the effects of improving land use and transport policies and practices in six diverse cities, including Boston, London, and Delhi. Impacts on four health outcomes were modeled: cardiovascular diseases, type 2 diabetes, respiratory diseases, and road trauma. Policies that led to large shifts from vehicular trips to active transport were found to be the key to improving health.

I led the third paper on research translation that considered whether and how city leaders use evidence in urban design and transport decisions. Several case studies demonstrated that cities such as Atlanta, Stockholm, and Bogota had used research in the process of increasing active transport. We made recommendations about how to enhance routine use of health-related evidence by city leaders. I want to express my thanks to the co-authors of the paper I led. They provided excellent material, and it was a pleasure to work with them.

New York City

I was fortunate to be able to attend two launch events for the Series. The first one was held in New York City on September 23, 2016. The venue was the Japan Society, which is across the street from the United Nations, which was in session that week. Speakers included Lancet Editor-in-Chief Richard Horton, a leader of the UN Sustainable Development initiative from Barbados, and Jeffrey Sachs, director of the Sustainable Development Solutions Network, which was one of the primary sponsors of the event. Dr. Sachs spoke powerfully about how the urban design and transport interventions featured in the Series were essential to meeting global goals for Sustainable Development. Videos of the NYC launch event are posted.

       At the Lancet Series launch event at the Japan Society, near the United Nations. Sabine Kleinert (Series editor), Jim Sallis (UCSD), Mark Stevenson (Series lead, University of Melbourne), Richard Horton (Lancet Editor-in-Chief), Billie Giles-Corti (University of Melbourne).

After the launch, Billie, co-author Rodrigo Reis, Lou Saliba (Rodrigo's wife), and I decided to rent Citi Bikes, test the bicycle infrastructure in Manhattan, and find the mural that was used on the cover of the Lancet Series. It was easy to rent the bikes, but even with the major improvements in bike facilities, it was still a sometimes-scary adventure to ride around. Nevertheless, we found the mural, which depicts the vitality and edginess of New York City, in the person of "Joey Ramone". The mural is across the street from the famous punk club "CBGBs", now closed.

Billie Giles-Corti, Rodrigo Reis, and I biked to the mural that was used on the cover of the Lancet series. We wanted to add some activity to the scene.

   Billie Giles-Corti, Lou Saliba, and Rodrigo Reis on our bicycle tour of Manhattan. Notice the semi-protective bike path.

The next day I took another bike ride, focusing more on the protected bike paths along the Hudson River, where you can ride peacefully for miles, which I did. In Battery Park I came across a series of artistic globes with various ecological themes. Here are a couple of shots of the globe that connected children's outdoor play with environmental sustainability. The title of this one is "Unplugged Fun." What a great theme.

     This art encourages children to go outside and play! It was one of several globes on display in Battery Park, at the Southern tip of Manhattan.

      Another view of the Unplugged Fun globe.

     Information on the globe, and giving credit to the artist.

Bogota, Colombia

The second event I attended to launch the Series was much different. Mark Stevenson arranged for us to present the Lancet Series on the first day of the World Summit of Local and Regional Leaders in Bogota, Colombia. This is a very international event that is held only every three years. Most of the attendees are mayors and other government officials. The scope of the event is shown in one of the posters on bus shelters around the city.

Attendees at the World Summit of Local and Regional Leaders came from 100 countries.

Thus, the audience was ideal for the Lancet Series since they had the power to implement the recommendations made in the Series. Our presentation put into action the Research Translation theme of the paper I led for the Series. The context of the conference was strongly in tune with message of the Series. The chair of the conference was the Mayor of Bogota, Enrique Penalosa. He was also mayor about 15 years ago when he gained fame for his leadership in promoting active transport and compact, mixed use development. He is widely credited with investing heavily in bus rapid transit (TransMilenio) and protected cycle paths (CicloRuta) and vastly expanding the weekly open streets (Ciclovia) connecting parks with hourly group exercise sessions (Recreovia). His talk at the opening session stressed the role of bicycling, walking, and public transport to create healthy, sustainable, equitable, and economically successful cities. Another highlight of the opening session was the talk by Juan Manuel Santos, the President of Colombia who had just been awarded the Nobel Peace Prize for his work to end the 50-year guerrilla conflict. I saw another impressive session with Mayor Penalosa who presented a healthy/sustainable vision for redeveloping the river area, creating four new sub-cities to accommodate growth in Bogota, and vastly expanding public transport. That session included Peter Calthorpe who presented an ongoing process to change development and transport practices in California to meet environmental goals, Philipp Rode who is Executive Director of the London School of Economics Cities Program, and Joan Clos who is Executive Director of the UN Habitat Program and former Mayor of Barcelona, Spain. All of their recommendations for compact cities and a new urban mobility (i.e., less reliance on cars) were completely consistent with our recommendations in the Lancet Series.

       Bogota Mayor Enrique Penalosa, Colombian President Juan Manual Santos, Joan Clos from UN Habitat, the announcer, and the conductor of the orchestra at the Opening Ceremonies of the World Summit of Local and Regional Leaders.

    The conference logo.

   Active transport, particularly bicycling was prominently featured as part of the modern vision for sustainable cities.

However, the connection between city planning and health was rarely mentioned, so our session at the end of the first day filled this major gap. The setting for our session was not ideal, because it was an open area where many people were lounging in comfortable chairs and many other people were passing through. Nevertheless, we captured the interest of some people who became engaged in the session and stayed for a lively discussion afterward. Mark Stevenson began with an orientation to the session and the Lancet Series. Then I led a brief activity break to draw their attention to the stage and inform them of the dangers of sitting too long. Thiago de Sa, from University of Sao Paulo, presented the first paper that described the model of how urban planning and transport are related to multiple health outcomes. He presented in Spanish to appeal to a wider audience. Mark Stevenson presented the paper on models that demonstrated more compact, mixed use planning with promotion of active transport would create substantial health benefits for six diverse cities. Finally I described how city leaders could benefit from using more evidence in their decision making processes, but this will require changes in usual practices from both city leaders and researchers. We had a good discussion at the end of the session, and I estimate we distributed 50-75 copies of the hardcopy Lancet Series.

    Thiago de Sa, Mark Stevenson, and Jim Sallis presented the Lancet Series on Urban Design, Transport, and Health.

While I was in Bogota, Olga Lucia Sarmiento arranged a meeting with the Epidemiology Group she leads at the Universidade de Los Andes. We had a very interactive afternoon as her team presented some of their current projects. The projects included a collaboration with the Bogota parks department to use a decision analysis tool to guide investments in new recreovia programs in existing parks, deeper evaluations of the ciclovia, and economic analyses of physical activity initiatives. The creativity of the projects was in part due to the diversity of disciplines represented by the team. In my experience this is a uniquely diverse team, with backgrounds in engineering, economics, and law, in addition to public health and medicine. Here is a photo of the team, with the mountains in the background.

    The Epidemiology Group at Universidade de Los Andes, in Bogota, Colombia.