olga l.sarmiento . md, mph, phd adriana díaz del castillo h. md, ma
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Olga L.Sarmiento. MD, MPH, PhD Adriana Díaz del Castillo H. MD, MAEthel Segura Durán. Arq., MG
Bogotá
A City with a Built Environment that Promotes Physical Activity. Promoting Healthy Living in the Americas: Multisectoral Interventions to reduce health risks factorsWashington, DC, November 18th, 2013
Photo: Diana Fernández
Context: physical inactivity and chronic diseases
Objectives Methods Case results: Ciclovía
Recreativa, CicloRutas, TransMilenio & Outdoor gyms
Lessons learned and recommendations
Agenda
Photo: Ethel Segura
26% 35%
Prevalence
Wen et al. 2012 ; Lee et al. 2012 ; Lobelo 2006
5.1 5.3
Annual deaths (global)
5.3MILLION
Deaths attributed to physical inactivity (PI) worldwide
Deaths attributed to PI in Colombia11.7
%
The burden of physical inactivity
All cause mortality attributed to PI in Bogotá
7.6%
Deaths due to NCD attributed to PI in Bogotá
20.1%
Ensin 2010 Sarmiento et al
Physical activity in Bogotá
Total Leisure time Walking for transport
Cycling for transport
0
10
20
30
40
50
60
7057.8
18.3
40.5
4.3
Meeting PA recommendations
%
objectives
Photo: Ethel Segura
Objectives
Describe the processes and stakeholders that led to the design and implementation of: Ciclovía Recreativa, CicloRutas, TransMilenio and
Outdor gyms as promising programs or infrastructures to promote physical activity in Bogotá.
Provide recommendations for the developing of similar policies, programs, and infrastructures in other cities.
methods
Photo: Olga Sarmiento
Literature review of the policy processes.
Document analysis of policies, regulations, legislative acts, and district development plans.
Semi-structure interviews. Secondary analysis of population
surveys (2005, 2010, 2011).
Methods
Photo: Ethel Segura
results
Photo: Ethel Segura
Ciclovía, CicloRutas, TransMilenio, and Parks Users’ Average Number of PA Minutes per Week
Ciclovia CicloRuta TransMilenio Park users Bogota0
50
100
150
200
250
300
350
400
450
500
202.4
142.7
303.3323.1
222.3
98.6
469.7
17.1 29.2 27.8
132.1102.3
70.2 79.6
23.3
Walking transport Cycling transport Leisure time moderate PA
Ciclovía
Week day Ciclovía
-113 km of streets-~70 events per year-600,000-1,200,000 participants per event
Sarmiento et al 2010; Montes et al. 2012; Torres et al 2013
Photo: Olga Sarmiento
Ciclovía & Physical ActivityAdults (18-64 yrs)
• 9.8% of the population reported participating in the last month • 59.5% of users meet PA recommendations (for leisure) • Ciclovía participants vs. no participants are more likely to meet PA
recommendations (POR:1.7; 95% CI 1.1-2.4); (POR: 7.4; 95% CI 4.0-13.8).• Ciclovia participants are more likely to bike for transportation OR 2.28
(1.32-3.94)• The cost–benefit ratio for health benefit from physical activity was 3.23–
4.26Older Adults (60-98yrs)• Access to Ciclovía was associated with having walked at least 150
minutes in a usual week (POR:1.29, 95% CI1.0, 1.7).Children (9-10 yrs)• 31.8% of the children reported participating at least once a month in the
Ciclovia• Ciclovia users have higher mean minutes of MVPA vs. non Ciclovia users
Beta= 3.047 p=0.03 Sarmiento et al 2010; Montes et al. 2012; Torres et al 2013; Gomez 2010
Ciclovía
Week day Ciclovía
-1974, started promoted by activists-1995, District Institute of Recreation and Sports-Program to reduce NCD in National Public Health Plan - Law on Obesity (1355) as a strategy to promote PA
Sarmiento et al 2010; Montes et al. 2012; Torres et al 2013
Photo: Olga Sarmiento
Stakeholders Activists-bike enthusiasts City government– mayors Transport Police Ministry Education IDRD Urban planning Health City residents Congress- City Council Private vehicle owners Businesses
Transport priorities Businesses Changed
government priorities
Favorable context Political will Alignment with
government plans Community
participation Multi-sectoral work Lead entity
BarriersFacilitators
Ciclovía
Multi sectorial Network of the Ciclovia
Meisel et al. 2013
Open Streets in the Americas
CicloRutas
Torres et al 2013; Ricaurte 2010
Photo: Ethel Segura
-Bike paths-344km in the network-Longest network in Latin America-83,436 users per day -Law on Obesity (1355) as a strategy to promote PA
CicloRutas70.5% of users meets PA recommendations (for transport)
Torres et al 2013; Ricaurte 2010
The cost–benefit ratio for health benefit from physical activity was 2.8
Photo: Ethel Segura
CicloRutasStakeholders BarriersFacilitators
City government JICA Urban planning (IDU) Public utility
companies: EAAB – ETB – Codensa
IDRD Police Bike activists
Non-integrated interventions Lack of comprehensive policies Lack of a lead entity Imbalance of transport priorities Low status of bicycles Circuit interruptions Road insecurity and crime Funding for maintenance
Favorable context Vision of the city:
sustainable transport Budget allocation Changes to roads
that supported the new infrastructure
TransMilenio-30% of the trips in Bogotá are made by public transport (9% TransMilenio)-TransMilenio buses operate in exclusive lanes with fixed stations ~500m-Average of 1.2million passengers per day-The fastest mode of transport 28km/h
Cervero et al. 2009
Photo: Andrea Ramírez
TransMilenio
Adults living in a neighborhood with 1 or 2 TM stations are more likely to walk for transport and meet PA recommendations than those who live in neighborhoods without TM stationsCervero et al. 2009
Photo: Andrea Ramírez
Physical activity &TransMilenio
0 1 2 3 4 5 6 7 8 9 10111213141516171819202122230
0.51
1.52
2.53
3.54
Predicted MVPA minutes TM users
Predicted MVPA minutes non TM users
Hour
MVP
A m
inut
es p
er h
our
Relation between moderate and vigorous physical activity (MVPA) minutes per hour and time of day for users and nonusers of TransMilenio (N = 250).
>22 minutes daily of MVPA (PR = 1.36, CI = 95% [1.08-1.63]
Stakeholders BarriersFacilitators City government Urban planning Public transport
operators Private
concessionaires Media Urban planning
experts and academics
City residents
Problems in execution and operation
Reduced user satisfaction
Cost of the fare
Favorable context Political will Unsuccessful earlier
experiences Fixed stations
TransMilenio
• 120 cities• 280 corridors• 4,300 Km• 6,700 stations• 30,000 buses• 28 million
passengers/day
24
BRT around the world
Source: Hidalgo, D., & Gutiérrez, L., BRT and BHLS around the world: Explosive growth, large positive impacts and many issues outstanding, Research in Transportation Economics (2012)
Outdoor gyms
Among adults and older adults, park density and frequent use are associated with
meeting PA recommendations during leisure time
Gómez et al. 2010 (a) (b)
Photo: Olga Sarmiento
Outdoor gymsStakeholders BarriersFacilitators
Private company City residents IDRD
Funding Vandalism
Public-private partnerships with benefits for all
Community participation
Lessons learned
Multi-sectoral work. Use of existing infrastructure
to promote PA to optimize resources
Comprehensive interventions. Health sector needs to build
on other sectors initiatives. To promote sustainability—
common goals and active interactions among institutions.
Community participation & political will: both are necessary but neither is sufficient on its own.
Photo: Diana Fernández
Include the health sector in urban planning processes.
Include health indicators in the design, evaluation and monitoring of urban development programs.
Promote different dimensions of PA through comprehensive approaches.
Recommendations
Photo: Olga Sarmiento
Thank you
Photo: Ethel Segura
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