Promoting Active Environments: A Public Health Approach to Large-Scale Behavioral Change

Background

The public health profession has developed theories and methodologies to promote behavior change on both the individual and population level. From reducing tobacco use to encouraging seat belt acceptance, many behavioral change campaigns have been successful.  This paper suggests ways these theories and methodologies could be used to create large-scale, nationwide change to promote active living.

Active living environments is used here to mean communities that foster walking, biking, and public transportation through mixed use, compact and dense development forms, and transportation systems that reduce car use. The alternative is conventional development: large lot zoning, strict separation of land uses, and streets heavily engineered for cars.

Evidence suggests that active environments promote physical activity, reduce obesity, improve mental health, and strengthen social capital.  These may increase health and reduce morbidity and mortality.

 

Objectives

This analysis aims to provide the beginning of a discussion of what a broad public health campaign to promote the creation and use of active living environments might look like.  Objectives include:

  • Identify models of behavioral change that might assist policy makers and advocates to promote active living environments with an emphasis on families with children and communities of color.
  • Encourage efforts to change social norms that prioritize active communities.
  • Propose strategies for advancing the preference for active living.

Two outcomes were prioritized:

  • Increase demand.  How might we encourage individuals and families to choose to live in active environments?
  • Increase supply. How might we encourage governments to implement changes to codes and development guidelines that would result in more active communities?

 

Methods

This analysis included a scan of the public health literature on promoting behavior change.  In addition to broad theoretical models of change, it drew on experiences including reducing tobacco use as models for promoting change at both the individual and community level.

 

Results

Traditionally, public health has focused on promoting behavioral change on the intrapersonal, interpersonal, and population level.  All these levels must be addressed if we are to increase both the supply of and demand for active environments.  Specific examples include:

Intrapersonal Level. Health belief models of change suggest that public health efforts include working with individuals and families to help them understand that by living in active environments, they can increase physical activity and reduce obesity risk. Thus they should be educated regarding the ways that conventional environments can pose barriers to health, particularly for children, and that health may improve by living in active environments. These campaigns should utilize planned behavior theory and encourage changes in attitudes toward living in active environments, increase perceptions that moving to these environments would mean adopting new social norms that prioritize active living, demonstrate that families with children have the ability to live in these communities in ways that would enhance their health and well being, and identify specific neighborhood attribute choices that would promote health.  Stages of change theory suggest encouraging families to the point where they contemplate moving to an active environment and then help them make that move (a priority target would be people of color most at risk for obesity).  It also suggests that strategies to help those who already live in active environments not to leave (perhaps targeting inner-city residents considering moves to the suburbs).

Intrapersonal Level. Social cognitive theory suggests that campaigns to promote active living environments should aim to change expectations regarding the kinds of neighborhoods people should live in (for example, currently many families believe that conventional neighborhoods are the only appropriate place for children).  It would communicate the idea that individuals and families have the ability to demand and choose healthy neighborhood designs. Social network theory suggests changing norms of behavior so that conventional environments are seen as less desirable.  At the same time, living in active communities would be promoted as more healthy.

Population Level.  Communication theory suggests that information campaigns are necessary so that the public understands the health consequences of conventional development with special outreach to linguistic minorities.  Diffusion of innovation models would imply the targeting of key individuals (particularly in minority communities) as the starting point in changing social norms and behavior.  Community mobilization experience demonstrates the need for planning, coalition building, and action.

 

Conclusions

If we are to move towards having a sizable portion of the US (and other countries) living in active environments, then there is a need to initiate large scale attitude and behavioral change strategies. These initiatives should include working with individuals to increase the number of people who desire to live in active environments and to develop a constituency that supports changes in zoning and development guidelines. On the community level, these strategies would have the ultimate goal of creating more opportunities for active living.  Together, they may move societies toward better health.

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