Healthy living

By Kim Powell

Seven million Australians are overweight, and two million of us are obese. Our well-rounded figures indicate that two in three Australian males aged over the age of 25 are now overweight, and physical activity is the second biggest risk factor for disease in this country, second only to tobacco smoking.

The financial cost alone is estimated to be over $1.2 billion each year.

Being overweight or obese increases your risk of cardiovascular disease, type 2 diabetes, osteoporosis, colon cancer, breast cancer, prostate cancer, gallbladder disease, chronic musculoskeletal problems, high blood pressure, sleep apnoea, skin problems, osteoarthritis and reproductive problems. Along with helping to prevent these diseases, physical activity has been shown to alleviate depression and anxiety, and increase social interaction. Therefore, providing environments that encourage people to be out and about will contribute to a healthier, happier society.

Faced with such a weighty problem, the experts agree on one thing: walking should be encouraged to improve public health. This simple activity is promoted as it is low cost, does not require any special skills and is something people can do even if they have been inactive for a long time. It is also something families can do together.

The problem is many suburbs around Australia, in capital cities, regional centres and rural towns, were designed with one thing in mind: the private car. According to many in the health industry, building car dependency into Australian suburbs means kids are heading for a health crisis.

Professor David Crawford, from the Deakin University Centre for Physical Activity and Nutrition Research, is investigating why our suburbs are failing our health.

“The short answer is we don’t really know,” he says.

“At one level it’s really kind of obvious but the kind of neighbourhoods we live in and neighbourhood design is terribly important in terms of the specific impact it has on people’s opportunities to be physically active or their risk of obesity, [but] within Australia and also internationally we don’t have very good evidence about what is important within suburbs that might improve or increase people’s opportunities to be active and reduce their risk of obesity.”

Nearly everything that is known about the link between urban design and health is couched in terms of adults and walkability, rather than about physical activity in general or even how this relates to children’s health.

“Some of the work that we’re doing suggests that the issues that are important for children are different than those that are important for adults,” Professor Crawford says.

“For example, we know that suburbs that have more connected street networks, grid-like suburbs, tend to be more walkable [than] those suburbs that are designed with lots of cul-de-sacs.

“The converse of that is that for children we know that cul-de-sacs are terribly important places for them to play and be physically active, so we have a contradiction here immediately.”

Current guidelines recommend adults get at least 30 minutes of moderate intensity physical activity on most or all days of the week, totalling at least 150 minutes each week.

However, a study of women across Melbourne revealed only 44 per cent were doing this, and women living in socioeconomically disadvantaged neighbourhoods were less likely to be active."

Professor Crawford was involved in the Socioeconomic and neighbourhood inequalities in women’s physical activity, diet and obesity study, and says one reason for measuring women’s physical activity levels is because much of the available information about socio-economic inequalities and health is focussed on men.

“We also thought it was important to look at women because, certainly within families, they tend to be the gatekeeper in terms of family health,” he says.

“Having an understanding of women’s health and women’s physical activity begins to tell us something quite important about the family as a whole.”

The first stage of the study surveyed about 2000 women in areas of high, medium and low socioeconomic status, looking at the influences on their physical activity. The second stage involves assessing those neighbourhoods for the opportunities for people to be physically active.

“We’re looking at things like the presence of public open spaces and recreational facilities like ovals, sporting clubs, gymnasiums, sports centres, swimming pools and so forth,” Professor Crawford says.

“And that will allow us to look at how people’s attitudes, beliefs and knowledge interact with their personal neighbourhood environment to determine whether someone is active or inactive. It allows us to say something about the relative importance about the kind of neighbourhood you live in versus your own motivation to be physically active.”

While it is still an emerging area of research, and experts like Professor Crawford are hesitant to talk about what works and what does not until more research has been done, there are some resources available to help create more walkable and liveable communities.

Healthy by Design is produced by the Heart Foundation (Victoria division) for town planners, developers, urban designers, engineers, landscape architects, land surveyors and health planners.

It contains small-scale initiatives for creating local neighbourhoods that foster community spirit, such as using schools and libraries for adult education classes in the evenings, providing shade in playgrounds and picnic areas, and installing exercise equipment and seating for rest breaks along walking paths.

Other suggestions include multiple entry and exit points for parks, public transport that is accessible, reliable and inexpensive, and secure places to keep bikes at places people are encouraged to ride to.

Planning for change
Researchers on the Victorian Lifestyle and Neighbourhood Environments study are working with the Victorian Local Governance Association, Brimbank City Council and Knox City Council to come up with ways to include health considerations in councils’ planning activities.

Knox is an outer suburban area in the east of Melbourne with a population of about 150,000 consisting mainly of families with children. Wendy Smith, coordinator of social planning and research at Knox City Council, says the idea that the built environment could cause people to be less active and less healthy was really intriguing.

“We wanted to explore that issue a bit further given the central role that council has in relation to the built environment,” she says.

“Previously we tended to focus on the broader determinants of health and wellbeing, so we’d look at housing and education, but this allowed us to start thinking about physical activity. We’ve [also] been able to develop some really good partnerships with local health agencies.”

Ms Smith says the study revealed that people in Knox, particularly those in the 35-50 age group, are more likely to be sedentary than people in other municipalities. Another interesting finding was that children are a bit of a barrier to their mothers being physically active, and so council worked with the community health service to establish a walking school bus for older children and pram groups for the mothers.

“We have a whole project based around women going out with their prams and their babies and walking, and not only getting the physical activity but it also leads to more social connections, so there’s less isolation,” she says.

Knox has only been involved with the project for about seven months so it’s still in the early stages, although it’s clear the program is already having an impact on the way council approaches planning.

“If there’s a lot of fast food outlets it’s likely that people are going to eat a lot more junk food and going to have higher BMIs,” she says.

The body mass index (BMI) is recognised internationally as the standard for classifying weight in adults and is calculated by dividing a person’s weight in kilograms by the square of their height in metres. A BMI of 25 or more is considered overweight, and 30 or more is considered obese.

“From a social planning perspective, we’d like to see what can we do about getting the planning scheme changed so we have some sort of controls about the location of fast food outlets, and how can we work with our economic development unit in terms of business development, getting fresh food outlets back and getting a local fruit and vegetable store,” Ms Smith says.

New urban spaces
Reinventing established suburbs into urban villages that are better places to live is called ‘new urbanism’. These urban villages tend to be compact and walkable, with good pedestrian, bike and rail links to the wider city.

Kelvin Grove is reportedly the first development of this kind in Australia, planned by the Queensland Government and Queensland University of Technology to combine a town centre with a mix of cafes, restaurants, businesses and a health centre, with university facilities, a range of housing stock, open spaces and landscaped areas.

The $800 million community is 2km from Brisbane’s CBD and is designed for residents to be able to walk to work, the city or university.

“There’s no doubt whatsoever that the provision of opportunities to be physically active are likely to be important, but on their own they’re not going to be sufficient to influence activity,” Professor Crawford says.

“They need to be there, but simply the presence or absence of, say, a walking trail does not influence whether people are going to use it.”

Dr Tony Capon is a visiting fellow at the National Centre for Epidemiology and Population Health, at the Australian National University. He works with researchers to try and improve the understanding of the relationships between the built environment and health.

He says at the micro level, whether or not a footpath is paved and well maintained will affect how often people use it for recreational walking or purposeful walking to a destination.

Paths should be wide enough to allow multiple users, and of a quality that allows wheelchairs, people with prams and learner cyclists to navigate it. Adequate lighting is important because if people do not feel safe they are less likely to walk around their neighbourhood, although low level or in-ground lighting makes it difficult for pedestrians and cyclists to see further down the path.

Tunnels and underpasses should be limited for safety reasons, and while low vegetation offers clear sightlines for walkers, some trees are essential to provide shade. Another benefit of having more people out and about, and knowing other people in their neighbourhood, is that it reduces general crime levels.

Dr Capon says that while Australian cities are not as spread out as some of the large North American cities, such as Atlanta which is “the capital of urban sprawl internationally”, they are not as compact as some of the good examples in Europe.

“Big cities like Sydney, Brisbane, Melbourne and Perth can sometimes be inefficient for people who live in them,” he says.

“If you live in the outer metropolitan areas, you often end up spending quite a lot of your day traversing the city to get to and from work, to and from university, to and from school, to the recreational things you want to do. And if you’re doing that in a car, in a passive way, that’s effectively lost time because you can’t do much else in that circumstance.

“So there is a distinction between a car-reliant city and a city that provides a range of other transport options. On the whole, where there is a range of transport options whether they be active transport like walking or cycling or whether they be other mass transit options like buses, rail and light rail, they’re healthier options because you get more physical activity doing them.

“They’re better for the environment in the long term, so there’s less air pollution and they’re also more efficient cost-wise for people as well, particularly with the rising fuel prices internationally, so there’s more money left to do other things.”

One of the key ways to create urban villages, Dr Capon says, is to increase the densities in areas of the city that have reasonable public transport infrastructure, as these areas also tend to be better served with shops and other services.

However, governments have a responsibility to increase public transport once an area’s population grows, because “you don’t just plonk more people in and not improve services”.

“Densification has been controversial in some parts of the country, and a good example of that would be the north shore of Sydney, where many people have been reluctant to embrace it because they fear that it might impact on what they really like about the area, the fact that there’s lots of trees and open spaces on the north side,” Dr Capon says.

“So it’s important to do this densification in a way that is sensitive to what communities want, but importantly also there has to be a dialogue with the community to improve understanding that there can be benefits too. If you get more people living in a locality, the downsides might be some increase in traffic if there isn’t appropriate public transport, but an upside can be an improvement in services in that community because if you have more people then there is going to be increased demand for services and you can justify them more.”

The other benefit from densification is that it increases the diversity of housing stock, so adding apartments and town houses to areas that have traditionally comprised large family homes means the area will suit people of all ages. It also means older people would not have to move away from their established social networks when they need to downsize once the kids have left home.

“Like anything there’s always a balance,” Dr Capon says.

“There can be positives, there can be negatives and it needs to be done in the best way it can with the support of the community. Obviously there’s going to be an element of NIMBYism [Not In My Backyard] in many communities.

“On the whole in Australia, cities are not particularly unhealthy environments, but that’s not evenly distributed across cities. Some parts can be very nice places to live, but other parts don’t necessarily have that essential infrastructure that’s needed for a healthy way of living.

“And that’s the message we’re trying to give, that Australian cities can be great, they already are right up there among the best cities internationally, but if we keep increasing our reliance on the motor vehicle in particular, then we run the risk that they will no longer be such healthy places to live, and that’s what we all want to avoid.”

Want to know more?
For more information on creating environments that promote health and wellbeing, visit:
o Healthy by Design: A planners’ guide to environments for active living,
o Leading the way: councils creating healthier communities, parts 1 & 2,
o Creating Community Friendly Environments for Physical Activity,
o Local streets for cycling and walking,
o Kelvin Grove Urban Village,

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