Public Policies, plans, and programs to promote physical activity in the urban population of low- and middle-income countries

Oral Presentation C7.5

Abstract

Background: Physical inactivity is high in low-, middle-, and high-income countries, according to the World Health Organization, about 60% of the population worldwide does not perform enough physical activity (at least 150 minutes per week of moderate physical activity) and 80% of these inactive people live in low- and middle-income countries (LMICs). According to United Nations (2018), 55% of the global population currently lives in urban areas and by 2050, this percentage will grow to 68%. For these reasons, it is necessary to take action in the reduction of physical inactivity of at least 15% by 2030, in accordance with the goals of the Global Plan of Action to Prevent and Control NCDs. LMICs must promote the practice of physical activity through policies, programs and guidelines that high-income countries already have. The implementation of policies that alter the built environment, especially those that reduce inequalities in access to: transportation, recreational areas and facilities, green areas, and public infrastructure (such as sidewalks, streetlamps, and public transportation), can have an effect on levels of physical activity. These relationships of changes in the urban environment and increased physical activity have been supported by research in high-income countries. It is therefore important for researchers and planners to demonstrate to decision makers the impact that interventions, especially built environment interventions, have on physical activity in LMICs. In the American region 36% have a standalone plan for PA compared to European (11%) and African (17%) regions (GoPA). Purpose: To study the above, we focused on all interventions in urban Latin American LMICs that measured changes in physical activity that were related to the usage and/or construction of: 1) the built environment or 2) transportation. These types of environments are accessible to all of the population and permit equal and just use of public spaces. In terms of the type of physical activity that take place in these environments, these could be more standard types like walking, running, or cycling, but may also include other kinds of physical activity like dancing, aerobics, or use of outdoor gym equipment. Methods: We conducted a topic review to find examples of how public policies have intervened in the practice of physical activity in LA LMICs. We reviewed the country cards in the Global Observatory of Physical Activity for LA LMICs that had a national physical activity policy or plan and had research related to physical activity. For these countries, we searched for further information on these physical activity policies, programs, and any related research – we included grey literature and government web pages in this part of the search. Results: We were able to find information on and analyze public policies, plans, and programs to promote physical activity in the urban areas of Colombia, Mexico, Brazil, Argentina, and Ecuador. We found that communities in LA LMICs were able to change their physical activity levels through interventions in the built environment, as demonstrated in programs such as Recreovia (Colombia), Academia da Cidade (Brazil), Estaciones Saludables (Argentina) and Ecuador Ejercítate (Ecuador). In terms of transportation infrastructure, we found evidence of a positive link of physical activity and transportation interventions in Bogota, Colombia and and Guadalajara and Mexico City, Mexico in the form of Ciclovias. Recommendations: Accessibility is important for programs and should be in all areas of the city covering different socioeconomic statuses for reducing inequalities and allowing those who most need these programs to access them. In addition, programs should offer diverse options for PA for different age groups and different target audiences centered on their abilities and health status. Also, effective programs should be adapted to and adopted by other cities in the same country at least. For example in Colombia only a few of the departments/states have the Ciclovia program while it’s already been adopted in cities of other countries like Mexico and the US. If there is a policy in a country, there may need to be a push to have a program/intervention, for example in the Dominican Republic and Paraguay. Likewise, if there is a program, then it needs to be evaluated, for example the ciclovias in Peru, Bolivia, and Venezuela. We would recommend in order for this to happen that governments and funding bodies evaluate their program/interventions and prioritize funding evaluations. Finally, we recommend standardization in PA measurement across countries for evaluations, perhaps using the IPAQ, to allow for detailed cross-country comparisons. If possible, even better would be including quantitative measurements of PA using pedometers or accelerometers or measurements from participants’ smartphones or smartwatches.