Social Determinants of Physical Inactivity

Physical Inactivity

Physical activity [PA] is known to have health benefits, including reduced risk of cardiovascular disease, Type 2 diabetes, several cancers and NCDs. Despite this, in many countries of the world a large number of adults are physically inactive and display sedentary behaviour [SB], spending a large proportion of their waking hours sitting: often at a desk at work, on a sofa at home, and on transport, whether public transport or private vehicle. These sedentary behaviours have low energy expenditure, and are associated with health risks, independent of PA levels[1].

Social Determinants of Health and Physical Inactivity

Factors in the social and physical environment which impose a direct influence on the opportunity to engage in physical activity include:

  1. Social inequality including income inequality and education inequality, both of which may have an effect on activity levels and SB.
  2. Community traits such as social cohesion, perceived benefits of PA and attitudes to age & gender restrictions may also play a role.
  3. Environmental determinants include access to public green areas, provision of safe areas to walking eg. on street, as well as the design of residential areas which may or may not include walkable neighbourhood routes[2], and provision of cycle routes.

For more information please see the Determinants of Health page.

Transportation

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Transportation provision can promote PA by providing safe and attractive routes to walk or cycle in, which may be combined with public transport. If government policy can lead to improved infrastructure which promotes PA as part of the commute to work or travel to school, then the health benefits for the community should be substantial[3].

Active transportation (walking and cycling) has significant health benefits, and can increase PA levels of whole populations[4][5][3].

A study of infrastructure changes (including traffic-free bridges and walking/cycling routes) at 3 sites in the UK demonstrated sustained use over the 2 years following construction[6]. However, despite this the authors caution "the infrastructure may primarily have attracted existing walkers and cyclists, and may have catered more to the socio-economically advantaged. This may limit its impacts on population health and health equity."

Many cities in the world have introduced bike-share schemes, but there is some evidence that for the scheme in London, UK. the majority of the users of the scheme were males living in socioeconomically advantaged areas where cycling was already very popular, concluding that the infrastructure "may primarily have attracted existing walkers and cyclists, and may have catered more to the socio-economically advantaged. This may limit its impacts on population health and health equity.[7]".

Neighbourhood Environmental Design

Creation of physical environments which promote and support PA[2][8] may include:

  • Provision of public open space, including parks
  • Improved footpaths and lighting (to promote use of footpaths at night)
  • Dedicated bike lanes on major roads
  • Signed walking/biking trails
  • Clean, attractive streets encourage people to spend time walking in them

WHO recommends adopting urban design solutions to promote physical activity in communities[9]. Activity-friendly neighbourhoods are likely to increase people's physical activity for up to 1.5 hours more per week. High density residential areas, parks and high number of public transport stops- lowering car-dependence ratios- were found to be associated with high levels of physical activities[10].

Addressing Social Barriers

A review by Ball et al[11] presented various approaches to tackle social inequities and challenges, here are some of the suggested solutions:

  • Government schemes to promote PA in organisations and institutions through policy actions and environmental changes. An example of such approach is the accessability of school and community facilities for PA to meet the needs of the whole community.
  • Community Campaigns, using media and community events to deliver the message to a wide sector of the community. This approach is supported by evidence, however, influencing disadvantaged groups has yet to be further studied[12].
  • Economic-related approaches: using tax reduction schemes on driving[13] or motivating individuals through incentives[14] have been implemented in different countries giving mixed results.
  • Transportation and infrastructure solutions: such as installation of shared trails; road closures/ restrictions, road tolls, cycling infrastructure and safe routes to schools[15].
  • Improving the daily living conditions through school, workplace and healthcare settings.

References

  1. Healy GN, Wijndaele K, Dunstan D,. Shaw JE, Salmon J, Zimmet PZ, Owen N. 2008 Objectively measured sedentary time, physical activity, and metabolic risk: the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Diabetes Care, 31, 369-371
  2. 2.0 2.1 Heath G W, Brownson R C, Kruger J, Miles R, Powell KE, Ramsey LT 2006. The effectiveness of urban design and land use and transport policies and practices to increase physical activity: a systematic review. Journal of Physical Activity and Health Vol 3, Issue s1, Pages s55-s76.
  3. 3.0 3.1 Pucher j, Dill J, Handy S. (2010). Infrastructure, programs & policies to increase bicyling: an international review. Preventative Medicine, 50, s106-s125.
  4. Ogilvie, D, Foster, CE, Rothnie, H et al.  Interventions to promote walking: systematic review.  BMJ. 2007; 334: 1204
  5. Yang, L, Sahlqvist, S, McMinn, A, Griffin, SJ, and Ogilvie, D.  Interventions to promote cycling: systematic review.  BMJ. 2010; 341: c5293
  6. Goodman A, Sahlqvist S, Ogilvie D. (2013) Who uses new walking & cycling infrastructure & how? Longitudinal results from the UK iConnet study. Preventative Medicine, Nov 2013, 57(5):518-24
  7. Ogilvie F1, Goodman A. Inequalities in usage of a public bicycle sharing scheme: socio-demographic predictors of uptake and usage of the London (UK) cycle hire scheme. Preventative Medicine, 2012 Jul;55(1):40-5
  8. Hunter RF, Christian H, Veitch J, Astell0Burt T, Hipp JA, Shipperijn J. The impact of interventions to promote physical activity in urban green space: A systematic review and recommendations for future research. Social Science & Medicine, Vol 124, Jan 2015, 246-256
  9. World Health Organization (2004). Global strategy on diet, physical activity and health.
  10. Sallis JF, Cerin E, Conway TL, Adams MA, Frank LD, Pratt M, Salvo D, Schipperijn J, Smith G, Cain KL, Davey R. Physical activity in relation to urban environments in 14 cities worldwide: a cross-sectional study. The Lancet. 2016 May 28;387(10034):2207-17.
  11. Ball K, Carver A, Downing K, Jackson M, O'Rourke K. Addressing the social determinants of inequities in physical activity and sedentary behaviours. Health promotion international. 2015 Sep 1;30(suppl_2):ii8-19.
  12. Bock C, Jarczok MN, Litaker D. Community-based efforts to promote physical activity: a systematic review of interventions considering mode of delivery, study quality and population subgroups. Journal of science and medicine in sport. 2014 May 1;17(3):276-82.
  13. Bergman P, Grjibovski AM, Hagströmer M, Patterson E, Sjöström M. Congestion road tax and physical activity. American journal of preventive medicine. 2010 Feb 1;38(2):171-7.
  14. Lambert EV, Kolbe‐Alexander TL. Innovative strategies targeting obesity and non‐communicable diseases in S outh A frica: what can we learn from the private healthcare sector?. obesity reviews. 2013 Nov;14:141-9.
  15. Pucher J, Dill J, Handy S. Infrastructure, programs, and policies to increase bicycling: an international review. Preventive medicine. 2010 Jan 1;50:S106-25.