Finding the Common Road to Health in North Carolina:

1. Finding the Common Road to Health in North Carolina: Opportunities for Public Health and Planners September 26, 2013 Ruth Petersen, MD, MPH Section Chief Chronic Disease and Injury NC Division of Public Health, NC DHHS Active Living Healthy Eating Clinical Preventive Services Tobacco Free Living

2. Two-thirds of NC Adults are Obese or Overweight

3. One-third of NC Youth are Obese or Overweight

4. One in 10 North Carolinians have Diabetes

5. Public Health: Need to Address Link Between Health Status & Behaviors Top Chronic Disease Burdens in NC • Overweight/Obesity • Type II Diabetes • Heart Disease • Stroke • Hypertension • Colon, breast cancers Inactivity = a strong independent risk factor Source: U.S. Department of Health and Human Services, 2008

6. Preventable Causes of Death in NC (2009) Source: Health Profile of North Carolinians: 2011 Update

7. Physical Activity Recommendations • Adults needs a minimum of 150 minutes of moderate physical activity each week • Can be obtained in small doses • Generally, the more you do, the more benefits you receive

8. Physical Inactivity • US DHHS Recommendation: • Adults: 30+ min. X 5+days/week., moderate; can be 10 minute increments • Children and adolescents: 60+ min. of physical activity daily BRFSS 2007, Centers for Disease Control and Prevention; Be Active NC, 2008 2007 Physical activity levels: US: 49% NC: 44% Unhealthy Lifestyles NC: $57.36 billion Inactivity Alone Cost NC: $11.9 billion

9. Obesity Trends Among US Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

10. Obesity Trends Among US Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

11. Obesity Trends Among US Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

12. Obesity Trends Among US Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

13. Obesity Trends Among US Adults BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

14. Obesity Trends Among US Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

15. Obesity Trends Among US Adults BRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

16. Obesity Trends Among US Adults BRFSS, 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

17. Obesity Trends Among US Adults BRFSS, 2009 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

18. Obesity Trends Among US Adults BRFSS, 2010 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

19. Children today may be the first to have a shorter life span than their parents, chiefly because of their growing weight and sedentary lifestyle.

21. Culture and Norms Cheerwine and Cheeseburger donut

22. How do we fix it? Broaden the Approach and the Partners • CDC: Pyramid of Health Informed Community Transformation Grant Opportunity

23. How do we fix it? Broaden the Approach and the Partners • Bring Planners Back into Public Health Rich historical history

24. Common Roots ofPlanning and Public Health • John Snow- 1800’s; link between poor housing and public health • Plotting techniques for contaminated well in Cholera outbreak • In last decade, planning and public health joining forces to deal with negative consequences in suburbanization (cars, pollution, obesity) • APA and CDC messaging we must address built environment to address obesity

25. Community Transformation in North Carolina State Policy and Systems Changes Local Policy, Systems and Environmental Changes

26. North Carolina Community Transformation Collaboratives

27. NC CTG Project Active Living Strategies • New or revised comprehensive plans that include health considerations • Organizations that increase access to physical activity facilities through joint-use agreements or community use policies

28. Why these strategies? A substantial body of research shows that certain aspects of the transportation infrastructure – public transit, greenways and trails, sidewalks and safe street crossings near schools, bicycle paths, traffic-calming devices, and sidewalks that connect schools and homes to destinations are associated with more walking and bicycling, greater physical activity and lower obesity rates. -Robert Wood Johnson Foundation

29. The Challenge A transportation network that favors vehicles has contributed to a decline in more physically active modes of travel. • Of commuters in NC, 1.9% walk; 0.2% bike • 68% reduction in school age children nationwide who commute to school by walking or bicycling (1969 to 2001) • Rank of outdoor recreational activity in NC • #1 Walking • #18 Biking • Guess what number driving a car ranks?

30. The Opportunity Transportation +28% +55% • People who report havingaccess to sidewalks aremore likely to be active • People reporting access to walking/jogging trails are more likely to be active Brownson, Ross et al., American Journal of Public Health (2001), Vol. 91, No. 12; Humpel, et al. 2002

31. Land Use The more facilities that are available and destinationsthat are close by, the more people walk People who live within walking distance of trails, parks or stores report higher walking than those who do not The Opportunity King, W., Am. J. of Public Health 2003

32. Communities that Support Active Living could… Generate 2 more walk/bike trips per person per week Prevent up to 1.7 pounds of weight gain per year; 35% lower risk of obesity Increase total minutes of physical activity(40% more) Increase life expectancy by 4 years The Opportunity Ewing et al 2003, Saelens et al 2003, Giles-Corti 2003, Frank et al 2003, Sturm et al 2004, Frank et al 2004, Lopez 2004

33. Public Transportation- Benefit to Health • Most trips begin and end with small doses of activity. • People who used public transportation for any reason were less likely to be sedentary or obese than adults who did not use public transportation. • According to one study of obesity-related medical costs, the extra walking related to transit use was estimated at a lifetime savings of $5,500 per person in 2007 dollars. –Robert Wood Johnson report

34. Light Rail- Benefit to Health • Surveyed 498 people living in one mile radius of South Corridor Light Rail line in Charlotte • Light Rail users experienced significant reduction in BMI and were less likely to become obese compared to those in the study area who did not use Light Rail. - American Journal of Preventative Medicine, August 2010

35. DOT Investments Pay Off As funding for bicycle and pedestrian facilities has increased… …biking and walking have ALSO increased.

36. Moving Forward-Comprehensive Plans and Implementation Learning Partnerships (Region 5 examples) • Alamance County – City of Mebane, City of Burlington, City of Graham, and Alamance County Trail Plans being drafted with Health Considerations. • Chatham County – Siler City Pedestrian Plan draft completed with a Healthy Living Supplement component funded by Region 5 CTG. • Guilford County- Southeast Trail Plan being drafted with health considerations focusing on bike and pedestrian access. • Rockingham County – Town of Stoneville currently discussing the specificity of including health considerations.

37. Moving Forward-Joint Use Agreements Learning Partnerships • Durham County- Durham Public  Schools Hub Farm has created a joint use agreement between the hub farm and organizations that use the farm.  The farm features a walking trail along the property.

38. Conclusion: All Good News Public Health and Planners back together CDC putting resources in CTG to promote effective active living strategies that are boldly transforming communities in NC