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Technology, urbanization, increasingly sedentary work environments and automobile-focused community design have engineered much physical activity out of daily life.

The Toronto Charter for Physical Activity1

Humans have become increasingly vulnerable to poor health behaviours since the industrial revolution. The environment in which we live governs the lifestyle choices we make, and modern environmental development has driven a global pandemic of physical inactivity,2 as outlined in Chapter 1.

Reversing physical inactivity relies on creating activity-permissive environments through a whole-of-system approach that employs evidence-based interventions and cultivates innovation. The ‘Best investments for physical activity’ (Fig. 27.1)3 and the World Health Organization (WHO) Global Action Plan on Physical Activity 2018–2030 (GAPPA)4 identify key action areas to increase population health through physical activity. While healthcare and health education are well represented in the GAPPA, clinicians need to understand the other important factors that influence people’s behaviour. This public health lens provides a complementary perspective to the clinical lens, where the patient is in the office. The different perspectives provide different opportunities to intervene; for example, footpaths are important in the public health context, whereas specific brief advice (Chapters 3 and 4) is key in the clinical setting.

Urban design and infrastructure that promote activity are closely linked to action on transport and the environment. Good urban design influences the way people choose to travel—it encourages more active transport modes such as walking and cycling. In addition to promoting physical activity and clean air, good community and building design promotes social integration and community cohesion, and even improves quality of life.5 The promotion of physical activity through environmental design also has other important benefits for economic and sustainable development, as summarised in the Bangkok Declaration, 2016,5 and the GAPPA.

This chapter highlights good practice principles for town planning and building design, and the opportunities for healthcare professionals to promote such good practices. Healthy community design creates streets and public spaces that offer attractive places to live and empower people to live healthy lives.

Good design principles include:

  • compact and mixed land use

  • residential density

  • connected street networks for walking, cycling and use of other wheeled transport

  • provision of footpaths and safe crossings

  • access to parks and open public spaces

  • public transport links

  • policies that create safe environments.

Schools and workplaces are ideal places to improve building design because children and adults are in those settings for long hours. Good building design can enable both purposeful and incidental physical activity, through actions such as promoting stair use (such as point-of-decision prompts or improvements to stairwells) and providing end-of-trip facilities for cyclists and other active commuters, as well as supportive indoor and outdoor ...

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