American Journal of Preventative Medicine & Robert Wood Johnson Foundation Childhood Obesity Challenge
Introduction
Cities hold vast potential for supporting healthy lifestyles. As urban populations continue to expand, utilizing urban infrastructure and designing cities to improve population health is becoming increasingly important. Designing Healthy Corridors is a plan we devised to transform popular city streets and avenues in order to boost children’s activity levels and consumption of healthy food as a way to fight the obesity epidemic in America. The plan is a series of incremental changes, starting with the least expensive, that could makeover the places families walk in their everyday lives. To make this plan realizable in any city, a series of interventions are proposed that cities can pick and choose from to introduce changes little-by-little, or implement more changes together as a comprehensive program.
Our plan – Designing Healthy Corridors
We intend to alter the existing street infrastructure in cities, including sidewalks, roadways, and public spaces to promote increased physical activity and consumption of healthier foods.
Step 1: Using community-based participatory methods to determine intervention locations likely to have the highest potential impact on families with children
Community members should be consulted from the beginning regarding program design and implementation. When respected as partners, community members can provide expertise about themselves, their lifestyles, and those of their peers, to guide the program towards success in their particular communities. One important design aspect the community can help determine is the best location for implementation. The program should be implemented on heavily traffic pedestrian routes, likely to be used often in the everyday lives of families. Community members, especially those with children, can help locate where children often walk, including routes to schools, near playgrounds, near child-focused stores or restaurants, near children’s museums, near theatres for children, or near grocery stores. Community participation in deciding program implementation details such as implementation sites builds community trust and personal investment in the program, which can help improve participation rate and therefore impact the program’s effect. Once popular routes have been chosen…
Step 2: Start transforming sidewalks, all you need is paint
Imagine walking down a city sidewalk; you will see children and their parents walking in a straight line with their main motivation to get to their destination with as little hassle as possible. Now imagine walking down a beach; you will see children running, jumping, playing, imagining, and parents often engaging in the same; they travel more distance in a shorter amount of time than families walking in a straight line on a city sidewalk. We envision many ways to transform sidewalks so that they resemble beaches by adding activities. Hopscotch courts can easily be painted on sidewalks. Foregoing the beanbag toss onto the court, jumping and hoping adds an extra level of fitness to walking down the sidewalk. Measurement rulers can be painted into sidewalks encouraging children to horizontally jump as far as they can. Cities could spin off the well-known children’s game of trying not to step on a crack and instead promote certain activities to happen on or around certain colored cracks, e.g. leap over this colored line, jump 6 times on this line, or bend down and touch your toes 5 times on this line. Also, alternating hand and foot prints can encourage lunging walks as if the children are climbing to some far off destination. Along sidewalks, the blank side of an existing building can become a Vertical Jump Wall. Children walking by could be inspired to jump as high as they can and post a marker with the name of their neighborhood or school to represent where they are from and promote a healthy sense of community participation through friendly competition.
Schools should be asked to support the city’s efforts, and one excellent way of encouraging the use of new sidewalk activities is to have school officials replicate these painted changes from city sidewalks in the schools’ hallways and outdoor pathways. If the activities are introduced in the more familiar school setting and reinforced in children’s school and out-of-school environments, the intervention has more potential for impact. These added bursts of whole-body activity can increase the energy expended by children walking their typical paths doing their typical activities. For this initial step in our plan, all a city needs is some paint. It’s a low cost intervention that is likely to help fight against childhood obesity.
Step 3: Transforming occasional parking spots for the greater good of the next generation
On current sidewalks when children see bollards placed to prevent vehicles from driving on walkways, some will instinctively choose to crawl under them, jump over them, or zigzag around them; and when they see ledges or flower beds children often walk balancing along the edge. Inspired by the PARK-ing day movement and the Parklet program by Pavement to Parks in San Francisco, we envision occasional single parking spots on city streets replaced with simple structures that resemble obstacle courses and encourage children to slightly detour and add active adventure spurts to their walk. Structures that could be easily and cheaply installed include parallel bars for children to hand-walk across, uniquely structured balance beams, multiple-height bollard-like climbing arches, and jumping polls. Each of these structures continues the child’s path forward without delaying their group’s travel.* This plan allows cities to take back some of their individual parking spots and repurpose them for the larger good – Making a statement in promotion of the population’s health and environmental sustainability over the convenience of a few individuals. Although slightly more expensive than paint, this step still does not require a great deal of funding. These structures can be built relatively cheaply, and would require no more maintenance than other standard city street furnishings.
We imagine corridors of city streets where the activities painted onto sidewalks are integrated with the PARK-ing activities and the Vertical Jump wall. Activities in each space feed into other activities, including enhanced parks and playgrounds where applicable, as described next.*
Step 4: Where the new Healthy Corridors meet city parks and playgrounds, enhancing the fitness-level of some of the play equipment available
In some cities like Philadelphia, small parks exist incredibly frequently as you walk along the street, which makes them prime venues for widespread impact on childhood obesity. Where parks and playgrounds fall alongside new Healthy Corridors, cities should put forth effort to increase children’s potential energy expenditure by installing playground equipment specifically built to enhance fitness level. Some existing examples of equipment designed with this higher level functioning are large wheel turning stations and machines that function similarly to an elliptical. In this way healthier sidewalks lead into healthier playgrounds, and parents might have an easier time dragging their children away from the playground when it is time to leave because of the activities to look forward to on the sidewalk going home.
Step 5: Increase families’ purchasing and children’s consumption of healthy foods by working with food trucks, convenience stores, and restaurants
Alongside boosting fitness, we feel it is important that healthy, fresh foods are available in a ready-to-eat form on these newly designed Healthy Corridors, and these should be supported by city administration. As a first step, food trucks, convenience stores, and restaurants that already provide healthy options can be given city-sponsored logos promoting their good business.[1] If feasible, stronger incentives could follow including financial benefits such as tax breaks. To encourage businesses with less healthy options to improve the quality of their store’s merchandise, many groups across the country are already working with convenience stores to improve their food offerings[2], which can serve as models for other cities trying to do the same while implementing our plan. The basic model involves demonstrating first that profits can be made on this merchandise, and second helping the stores to implement specific strategies for marketing more healthy options for their particular customer base.
Step 6: Engaging schools and neighborhoods in evaluating the program - Measuring and collecting information on energy balance in children while simultaneously funding the program
With creative new plans such as this, evaluation and monitoring is extremely important to collect data on the program’s effectiveness. For children’s programs with voluntary participation, it can be helpful to measure population effects rather than individual children, because children will likely feel less timid, self-conscious, or embarrassed about participating, and because tracking individual children brings about more ethical questions in program evaluation design. As population-level measuring, we suggest a school-to-school or neighborhood-vs.-neighborhood competition as a way to engage the community depending on which model would work best in various cities. Each school or neighborhood is awarded points for their children’s participation, and they can receive bonus points for implementing some of their own changes that replicate program steps such as the painted activities in Step 2.
How does the competition work? QR Codes (the black and white square icons now popular in advertising on merchandise for people to scan with their smartphones and be directed to a company’s website) can be inexpensively added to the end of each fitness activity along the sidewalk or in the parks, or the increasingly available healthy foods. A smartphone app could be developed to scan the specific QR codes, and preprogrammed with each child’s age and sex to collect basic demographic data. The children or their parents can simply scan the code after enjoying each activity or food, and this information could be transferred from the individual cell phones to the central database for their school or neighborhood. From here, reports can be used to track the success of our intervention, and progress in the competition. This could provide de-identified data demonstrating our program’s effects on the energy balance in children, and thus the childhood obesity epidemic.
What can the schools or neighborhoods win? The competition could be set up as a 50/50-type raffle where each school or neighborhood association buys into the program, adding money to the central pot. After each year the group with the highest participation rate receives 50% of the total collected funds, and the other 50% is put towards funding the sustainability of the program.[3] Though relatively less expensive than other obesity-related interventions, our program needs steady funding to sustain itself. Some of the costs include physical equipment installation and maintenance, technology applications, promotion costs, data reporting, and human resources. Additional resources that could be sought to support a program like ours include: utilizing students from a local university [e.g. urban planning students can help design the layout of PARK-ing activities and nutrition students can help audit the food offerings at venders]; Mayors and other elected officials can be asked to financially support the program to demonstrate their commitment to community health; and with fitness-oriented playground equipment available in various price ranges, local corporations and professional sports teams can be asked to demonstrate their social responsibility by sponsoring some of the equipment costs.
In conclusion we believe that Designing Healthy Corridors is a comprehensive and feasible incremental plan that could have great impact on children’s health.
* Images and diagrams depicting the design plan can be found at the end of this Technical Proposal.
[1] While contemplating this idea we came across the Golden Carrot Award program of Go for Health! in Santa Cruz County, CA, which is a similar awards program to encourage restaurants to improve the nutrition of their food.
[2] For more information please check out the Healthy Corner Stores Network.
[3] 50/50 is only meant as an example. The exact split in each city would depend on stakeholder input.