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Olga L.Sarmiento. MD, MPH, PhD Adriana Díaz del Castillo H. MD, MA Ethel Segura Durán. Arq., MG Bogotá A City with a Built Environment that Promotes Physical.

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Presentation on theme: "Olga L.Sarmiento. MD, MPH, PhD Adriana Díaz del Castillo H. MD, MA Ethel Segura Durán. Arq., MG Bogotá A City with a Built Environment that Promotes Physical."— Presentation transcript:

1 Olga L.Sarmiento. MD, MPH, PhD Adriana Díaz del Castillo H. MD, MA Ethel 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 factors Washington, DC, November 18th, 2013 Photo: Diana Fernández

2  Context: physical inactivity and chronic diseases  Objectives  Methods  Case results: Ciclovía Recreativa, CicloRutas, TransMilenio & Outdoor gyms  Lessons learned and recommendations Agenda Photo: Ethel Segura

3 Prevalence Wen et al ; Lee et al ; Lobelo 2006 Annual deaths (global) 5.3 MILLION 5.3 MILLION Deaths attributed to physical inactivity (PI) worldwide Deaths attributed to PI in Colombia 11.7% 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%

4 Ensin 2010 Sarmiento et al Physical activity in Bogotá Physical activity in Bogotá

5 objectives Photo: Ethel Segura

6 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.  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.

7 methods Photo: Olga Sarmiento

8  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

9 results Photo: Ethel Segura

10 Ciclovía, CicloRutas, TransMilenio, and Parks Users’ Average Number of PA Minutes per Week

11 Ciclovía Week dayCiclovía -113 km of streets -~70 events per year -600,000-1,200,000 participants per event -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

12 Ciclovía & Physical Activity Adults (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 ); (POR: 7.4; 95% CI ). Ciclovia participants are more likely to bike for transportation OR 2.28 ( ) The cost–benefit ratio for health benefit from physical activity was 3.23–4.26 Older 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= p=0.03 Adults (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 ); (POR: 7.4; 95% CI ). Ciclovia participants are more likely to bike for transportation OR 2.28 ( ) The cost–benefit ratio for health benefit from physical activity was 3.23–4.26 Older 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= p=0.03 Sarmiento et al 2010; Montes et al. 2012; Torres et al 2013; Gomez 2010

13 Ciclovía Week dayCiclovía -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 -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

14 Stakeholders  Activists-bike enthusiasts  City government– mayors  Transport  Police  Ministry Education  IDRD  Urban planning  Health  City residents  Congress- City Council  Private vehicle owners  Businesses  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  Transport priorities  Businesses  Changed government priorities  Favorable context  Political will  Alignment with government plans  Community participation  Multi-sectoral work  Lead entity  Favorable context  Political will  Alignment with government plans  Community participation  Multi-sectoral work  Lead entity Barriers Facilitators Ciclovía

15 Multi sectorial Network of the Ciclovia Meisel et al. 2013

16 Open Streets in the Americas

17 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 -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

18 CicloRutas 70.5% 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

19 CicloRutas Stakeholders Barriers Facilitators  City government  JICA  Urban planning (IDU)  Public utility companies: EAAB – ETB – Codensa  IDRD  Police  Bike activists  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  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  Favorable context  Vision of the city: sustainable transport  Budget allocation  Changes to roads that supported the new infrastructure

20 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 -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 Photo: Andrea Ramírez

21 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 stations Cervero et al Photo: Andrea Ramírez

22 Physical activity &TransMilenio 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% [ ]

23 Stakeholders Barriers Facilitators  City government  Urban planning  Public transport operators  Private concessionaires  Media  Urban planning experts and academics  City residents  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  Problems in execution and operation  Reduced user satisfaction  Cost of the fare  Favorable context  Political will  Unsuccessful earlier experiences  Fixed stations  Favorable context  Political will  Unsuccessful earlier experiences  Fixed stations TransMilenio

24 120 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)

25 Outdoor gyms Among adults and older adults, park density and frequent use are associated with meeting PA recommendations during leisure time Gómez et al (a) (b) Photo: Olga Sarmiento

26 Outdoor gyms Stakeholders Barriers Facilitators  Private company  City residents  IDRD  Private company  City residents  IDRD  Funding  Vandalism  Funding  Vandalism  Public-private partnerships with benefits for all  Community participation  Public-private partnerships with benefits for all  Community participation

27 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.  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

28  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.  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

29 Thank you Photo: Ethel Segura


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