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Communities can play a leadership role in CVD prevention. Research shows us that one of the most effective ways to have measurable impact on our communities is to target all levels of social structure with behavioral and environmental change strategies. The purpose of this section is to help guide the choice of community changes that your group will seek in each relevant sector of the community. To address the mission of reducing risks for CVD, your group may seek to change programs, policies, and practices within schools, health care settings, worksites, or the broader community.
Why Policy and Environmental Approaches:
Public recognition of the importance of and a desire for physical activity are high. However, physical inactivity is a complex habit that has proved difficult to modify by using individually focused approaches to behavior change. Policy and environmental approaches may arguably have a greater impact because they influence the whole culture and are less costly and more enduring.
Public health policies that invoke passive intervention are often more successful in achieving population wide changes than those requiring active decision making by individuals. Examples of passive approaches to promoting physical activity include restricting downtown centers to foot or bicycle traffic, placing parking lots a suitable distance from buildings, and making stairways more convenient and as safe as elevators or escalators. Also, new communities can be planned with businesses and schools built adjacent to residential areas and connected by networks of bicycling and walking paths as well as public transportation.
Zoning and Land Use:
Physical activity can be fostered through public policies that enhance recreational space outdoors. Increased environmental awareness has led to zoning restrictions in many communities to protect open spaces for recreational use. The Intermodel Surface Transportation Efficiency Act (ISTEA) provides federal funds for bicycle/pedestrian transportation projects. Authority is given to states to dispense funds, and each state is required to assign a coordinator. West Virginia has been the recipient of ISTEA funding in the past; however, reauthorization of ISTEA from Congress will need to be established for continued support for future trail development.
The West Virginia Trails Coalition has been active in promoting trail development across the state. The coalition is beginning the coordination of a statewide trails plan. This collaboration of resources toward trails development in our state is a great example of nontraditional partners working towards policy and environmental changes for physical activity.
Building Construction and Facilities Development:
Facilities to promote physical activity can take two general forms: those made available for participation in programmed or discretionary physical activity during leisure time and those that encourage increases in more routine forms of physical activity. Facilities should be convenient, affordable, comfortable, and safe to encourage regular physical activity. Proximity to home or worksite is particularly important, as is the availability of on-site showering and changing facilities.
Regulations governing building construction can be used to encourage increases in energy expenditure. Examples of "physical-activity-friendly" (energy-expenditure-inducing) buildings include those that make stairs attractive, safe, and readily accessible. Similarly, buildings that provide nearby walking paths or par courses, well-lighted and secure parking lots at a distance, and easy to use areas for securing bicycles are measures that promote physical activity.
A missing, but critical aspect of legislative policy is an overarching, long-term plan on which to build and direct state and national policy initiatives in the physical activity arena. Such a policy or plan would focus on developing an infrastructure to support sustainable increases in routine, transportation-based, or task-oriented forms of physical activity.
Schools are a key intervention channel for influencing healthier behaviors in a positive way. Elementary and secondary schools provide a structured opportunity to reach youth with interventions and health messages that can set the stage for a healthy lifestyle now and in the future.
Health care settings have the unique opportunity to promote positive lifestyle behaviors. Role modeling of positive lifestyle behaviors could perhaps be the most influential role a provider can have on clients.
The worksite channel is composed of those activities through which employers, unions and insurers try to influence the health of workers in a positive fashion.
All these "channels" together are parts of the broader community. The community as an entity can, in turn, promote health for all its members. The above listed channels are only a few examples of channels for which interventions can take place.
Published July 1997
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