How can the urban environment impact people’s level of physical activity?
We are very concerned that people are just not getting enough exercise, and when you look at why this is happening, it all comes back to the environment people are living in and the lifestyle people are choosing. By this I mean the lack of active transport, the reliance on cars and a whole load of effects and causes.
The urban environment is often not supportive of physical activity, people simply don’t find it conducive to go out for a walk, the park’s too far away, the shops are too far away, the schools are too far away and people are just using their cars.
We have evidence that shows physical inactivity is certainly a big risk factor for heart disease and other chronic diseases, and the only way to do something about it is to start looking at our environments and our lifestyle. Where we live, where we work, how we move around, and supporting people to understand that.
Now we need to work out how we’re going to make that happen, through advocacy, the media and trying to get the message to people, such as developers, who can actually make a difference.
It’s really about getting that level of connectivity, when people leave their home they can actually walk somewhere or cycle, and they can actually get to where they need to go safely. Safety is a big issue for most people.
We must convince people that public transport is important, not just to move people around but for active living as well. We need to get kids more active through bicycle paths, walking paths, parks and gardens. There’s not much point in having a park if everybody must drive there.
As an authority and research body on community health issues what is the Heart Foundations primary aim.
The heart foundation is a health charity and our primary goal is to improve the heart health of Australia’s population. We deliver a number of programs and initiatives aimed at translating evidence into policy and practice. We do this through:
What are the main community health issues you believe occur as a result of poorly planned urban environments?
The heart foundation is primarily interested in how poorly planned urban environments contribute to the development of heart disease. In this context, the risk factors of most concern to the heart foundation are inadequate physical activity and sedentary behaviour. We know that the urban form can significantly influence the amount of physical activity undertaken by a community on a day-to-day, week-to-week basis.
More than a third (36%) of Australians aged 15 and over do very little or no exercise at all, and the trend since 2001 indicates that the proportion and number of Australians doing very little or no exercise has continued to increase, up by 14% in 2011/12. (ABS, Australian Health Survey 2011/2012). Almost a quarter of Australia’s burden of cardiovascular disease is attributable to inadequate physical activity.
Elements of the built form do have a significant effect on people’s physical and social experiences. The heart foundation wants to see our urban and land-use planning better supporting the development (and retrofitting) of communities that entice people to participate in physical activity.
Environments in which people study, work, live and recreate can be designed in a manner to support opportunities for social interaction. This is important because the amount of social interaction we experience can affect our mental health; social isolation can lead to depression which in turn is a risk factor in the development of heart disease.
People have a limited ‘time budget’ and often physical activity gets pushed aside for other demands such as long-work hours, time with family and the chores of daily living, therefore we are supportive of active forms of travel such as walking or cycling to school, the shops or work. In most cases the incidental exercise that public transport commuters achieve on a daily basis is an improvement when compared to travelling by car and then sitting behind a desk for the better part of the day.
Often when we use public transport our trip requires us to walk between stops or stations. A recent study of incidental physical activity in Melbourne has found that people who commute by public transport achieve on average 35 minutes of physical activity per day, while cyclists and walkers averaged 38 minutes. These results suggest that the average active travel time was enough to meet Australia’s National Physical Activity Guidelines for adults. (It is recommended that adults achieve 150 to 300 minutes of physical activity per week or 75 to 150 minutes of vigorous-intensity physical activity).
Please identify the top 5 things that have the greatest impact on community health?
We know that there are particular elements of the built environment that either support or deter people from participating in physical activity, particularly walking. Many of the design elements that are conducive to physical activity are similar to the elements we see promoted in best practice place making. The following is adapted from the Blueprint for an active Australia (2nd edition).
What international examples demonstrate best practice built environment initiatives?
It’s difficult to highlight any one international development over another; however towns like Portland, Oregon have really embraced active travel, as has New York, London and many European cities. A number of the adaptations led by Janet Sadik-Kahn in New York are great examples of tactical urbanism, such as converting Times Square into a place for people rather than cars. So too is the Chelsea High-Line project which re-purposed a disused rail line into a stunning elevated park; this was a community led initiative, and is now one of New York’s favourite tourist destinations.
The Designed to move – Active cities report showcase a number of cities around the world who have embraced design for physical activity. Adelaide, Australia is one of the featured cities with its Urban Design Framework applauded for its focus on accessibility and emphasis on walking and cycling.
I think these examples highlight that existing urban spaces can be reshaped in a way that makes them attractive places to visit and to move around, rather than drive through. The design of these spaces forces people to leave the car behind and experience the world while interacting with others.
Is there a relationship between active urban environments and economic prosperity?
A discussion paper commissioned by the South Australian heart foundation and written by Dr Rodney Tolley, the Director of Walk 21 highlights the impact that active urban environments have on economic development opportunities. There is growing consumer demand for more walkable neighbourhoods, this provides an economic driver to the planning principles we are hoping to promulgate.
Canada – In Vancouver the introduction of segregated cycling facilities was initially resisted by traders but they have gradually accepted that they have been of benefit
United Kingdom – In the United Kingdom, pedestrian and cycling friendly designs have been shown to substantially increase business for local traders. You can read more here:
Paved with gold, researched by Colin Buchanan, is the latest project in a long-term CABE research programme to investigate the value of design. Well-designed buildings, spaces and places contribute to a wide diversity of values and benefits. These range from direct, tangible, financial benefits to indirect, intangible, long-term values such as improved public health or reduced levels of crime.
How can the planning and design of urban environments overcome cultural/behavioural lifestyles that aren’t naturally active or outdoors?
If you consider our lifestyles, much of our recreational and work time is spent sitting. We have an abundance of labour saving devices which remove the need to exert physical energy doing chores at home, most workplaces are now highly mechanised and there is an overwhelming availability of unhealthy food temptations. This lifestyle is coupled with a lot of time spent sitting in cars due to the nature of our transport system.
The combination of these factors creates obesogenic environments, and these environments normalise unhealthy lifestyles. This is one of the reasons the heart foundation places so much emphasis on active travel for personal transport, it replaces time spent sitting with a physical activity. The heart foundation have found, through our own research that more than 70% of people would support increase government investment in cycling walking and public transport. 
The design principles which the heart foundation supports are also those which promote social inclusion and from a built environment perspective this includes promoting social interaction through public squares, parks and appropriately designed recreational spaces.
Perceptions of safety are very important. As stated in the Blueprint, emerging evidence suggests that fear of crime can restrict adults’ walking and their children’s independent mobility. We want all people to feel part of the community, and safe enough to participate in walking and other outdoor activities.
Children are more likely to be physical active in more walkable neighbourhoods which access to recreation facilities. In adolescents, physical activity is associated with higher land use mix and residential density. Having access to a range of local recreational destinations also appears to limit sedentary behavior in young people.”
Is there one State in Australia which is deliver better quality and healthier urban outcomes?
We really need to consider progress in light of legacy issues including the way a city has developed in response to its geography and the dominant land-use approaches of previous generations of planners and decision makers.
There has been impressive progress in many of the states and territory. Measuring progress really depends on the foundations on which you inherit. Some cities, like Canberra and Melbourne have a geography which makes them more attractive to cyclists and some cities have more developed public transport systems.
What strategic directions has the Heart Foundation set at local, state and federal levels over the next five years?
Each heart foundation division is responsible for its own planning, advocacy and policy development; however we also work collectively through a federated plan which informs priority issues such as active living, health equity, improved heart care and research. We do have a strong research and guideline development ethic but we are also committed to evidence translation and to applying this to transforming our built environments toward healthier spaces for people.
When it comes to the built environment we seek to influence all levels of government to invest in environments that support physical activity and healthy eating. We recognise that while it is important to encourage individuals to adopt healthy eating and exercise habits, we are also aware that there are many physical and social barriers to overcome.
Who does the Heart Foundation typically look to form partnerships with?
The Heart Foundation has forged partnerships with many peak and professional bodies from outside of the health sector. This work demands we apply a multi-disciplinary approach. We work closely with peak and professional bodies representing disciplines such as urban and transport planning, sustainable building design, landscape architecture, place-making and cycling groups.
How might we improve the design industries awareness of the Heart Foundation?
The heart foundation’s primary goal is translating evidence which is generated by researchers, to make it more accessible to people whose roles directly influence the built environment.
The heart foundation is an industry partner to the Centre for Research Excellence in Healthy Liveable communities. The CRE is a National Health and Medical Research Council (NHMRC) funded initiative being delivered across five universities; University of Melbourne, Queensland University of Technology, University of Queensland, The University of Western Australia and the University of South Australia. There is strong evidence linking built environment design with CVD health outcomes. This evidence base is being strengthened by the CRE and the heart foundation will focus on contributing to the dissemination of the research findings.
At a practical level, we will work to embed health considerations in planning codes and guidelines. To achieve this we will work closely with peak and professional bodies representing disciplines such as urban and transport planning, sustainable building design, landscape architecture, place-making and cycling groups.
How can your research actually start to change outcomes on ground?
Where possible designers should consider how the built form will entice or deter people from moving and taking part in physical activity. The heart foundation has provided a number of guides which recommend planning principles and features which enhance liveability and physical activity.
From a land-use and place making perspective: There are common design principles which are shared among great places and healthy liveable environments; examples include attractive places to meet and recreate, compact mixed use neighbourhoods (including commercial, retail, community facilities and residential), spaces that put the emphasis on people rather than cars (including pedestrian friendly paths and safe cycle routes to school, work or local services), safe places to rest such as shaded seating, and accessible public transport which links to walking and cycling paths.
From an architectural perspective: There are design elements which will promote people to move more within and around a building; these are now being incorporated into a number of well-designed buildings. These features include prominent and attractive stair cases, signage to encourage people to take the stairs and attractive communal meeting places which encourage standing rather than sitting. These are particularly important in the workplace and school environments that have predominantly designed around sitting.
What barriers have prevented the Heart Foundation’s research, policies or collaboration other stakeholders?
The Heart Foundation has found a lot of decision makers and developers are interested in the link between health and the built environment. The real challenge is changing traditional approaches to land-use planning and place-making and this takes time and persistence.
Low-density developments on the outskirts of cities have often been our response to housing pressures, but these developments are much more expensive to service in the long term, particularly for big ticket items such as public transport. Essentially they might seem inexpensive options, particularly for householders, but they inadvertently impact on the public pursue through negative health impacts.
To change these approaches requires cooperation across many sectors, departments and professions. A multi-disciplinary approach to development is needed which is driven by a commitment to human health above all types of expediency, including monetary and political. The built form, whether a building, a road, a public park or an entire neighbourhood, usually prevails for many human generations, therefore we should choose very wisely, for its impact on health will also prevail.
If you could change one thing about the way we currently create communities what would it be?
The heart foundation is primarily interested in how poorly planned urban environments contribute to the development of heart disease. In this context, the risk factors of most concern to the heart foundation are inadequate physical activity and sedentary behaviour.
So when it comes to the built environment and creating healthy communities we seek to influence all levels of government to invest in environments that support physical activity and healthy eating. We recognise, however that there are many physical, economic and social barriers to overcome.
In terms of one thing we could change, I believe that we need to retrofit, design and develop communities in a more integrated and consultative way that will increase both the liveability and walkability of communities. This would automatically encourage people to be more physically active and less sedentary and support them to meet their physical activity requirements of 30 minutes of physical activity a day.
 Begg SJ, Vos T, Barker B, et al. Burden of disease and injury in Australia in the new millennium: measuring health loss from diseases, injuries and risk factors. Med J Aust 2008; 188:36-40. Cited in Blueprint for an Active Australia (ed 2).
 Incidental physical activity in Melbourne, Australia: health and economic impacts of mode of transport and suburban location. Health Promotion Journal of Australia, 2014, 25. 174-181
 Investment in Active Transport Survey, the National Heart Foundation of Australia and the Cycling Promotion Fund 2015
 Giles-Corti B, Badland H, Hooper P, et al. Action area 1: built environments, In: Blueprint for an active Australia. 2nd edn. Melbourne; National Heart Foundation of Australia, 2014.
 See footnote 1