Lesson 18: Healthy Community… Healthy You?

Background:

According to the Centers for Disease Control and Prevention, moderate physical activity such as walking and bicycling offers substantial health benefits. Unfortunately, the sprawl development patterns of the past half-century discourage people from walking as a form of transportation, because sprawl is characterized by isolated and separated land uses, often navigable solely by car. In contrast, Smart Growth and traditional development is characterized by an integrated mix of residential, commercial, office, and civic land uses, compact building design, multiple transportation and housing choices, and convenient access to open space, recreation, and other amenities. This development pattern creates a much more pedestrian-friendly environment. Unfortunately, a combination of factors—land use regulations, financial barriers make these Smart Growth developments very difficult to achieve.

But how is this important to the health of Marylanders? The statistics for the most serious public health concerns in Maryland – cardiovascular disease, diabetes, asthma, and obesity these health concerns are staggering. Increased physical activity can prevent or improve all of these conditions. Some of the health benefits of walking, for example, have been measured through diabetes prevention studies showing that participants who walked and followed a low-fat diet had a 58% reduction in incidence of Type 2 diabetes.

Diabetes

Diabetes is the sixth leading cause of death in Maryland.
The incidence of diabetes in Maryland increased by 42 % between 1990 and 1999; with an alarming increase in children and young adults of Type 2 diabetes (the most common form of diabetes that is often controlled with proper diet, exercise and some medicine).

Cardiovascular Disease

Cardiovascular disease, including heart disease and stroke, is the number-one cause of death in Maryland. More Marylanders die each year from cardiovascular disease than from all forms of cancer, AIDS, suicides, and traffic injuries combined.
Every year, 14,000 people die from cardiovascular diseases, and $2.25 billion is spent on health care related to cardiovascular disease.
Cardiovascular disease is a major cause of hospitalization in Maryland, accounting for 94,711 hospitalizations in 1999. Charges from these hospital stays totaled $890 million.
Cardiovascular disease is not just a disease of old age. One in five Marylanders who died from heart disease or stroke in 1999 was younger than 65 years of age. Much of this burden of premature death and disability is potentially avoidable.

Obesity

Approximately one-fourth of the nation’s children and adolescents are overweight and obese (over 30 lbs overweight). Ten- to thirteen-year-old obese children are reported to have a 70% likelihood of obesity persisting into adulthood. Preventing childhood obesity can prevent adult obesity, because the risk of adult obesity is increased markedly if one is obese during adolescence.
More Marylanders are less active now than 10 years ago, and more than half of Marylanders are either overweight or obese.

Asthma

Studies conducted by the National Center for Chronic Disease Prevention and Health Promotion, with their special focus on school health, show that chronic disease among children and adolescents is rising, specifically cardiovascular disease, diabetes, and asthma. Asthma alone accounts for an estimated 10 million lost school days annually among US children.

In 2001 the Centers for Disease Control and Prevention released a report recommending ways to increase physical activity. The report’s recommendations include environmental and policy approaches – such as zoning and land-use changes – to increase physical activity. Empirical evidence, moreover, demonstrates that communities designed with pedestrians in mind, such as Canton, Eastport, and Frederick, are more likely than communities designed for the automobile, to encourage people to walk as a form of transportation.

This lesson plan will encourage students to examine the relationship between their built environment and everyday physical activity, independence and mobility, public health, pollution.

The United States and Maryland have seen a decrease in the number of youth who are physically active and an increase in the number of youth who are overweight. Data from the Centers for Disease Control and Prevention show that nearly half of young people aged 12-21 years in the United States are not vigorously active on a regular basis, About 14% of young people report no recent physical activity, and over the past 30 years the percent of overweight children aged 6 to 11 years has more than doubled.

Health Benefits of Walking:
Can walking be the answer? Regular physical activity, like walking, substantially reduces the risk of dying of coronary heart disease, the nation's leading cause of death, and decreases the risk for colon cancer, diabetes, and high blood pressure. It also helps to control weight; contributes to healthy bones, muscles, and joints; helps to relieve the pain of arthritis; reduces symptoms of anxiety and depression; and is associated with fewer hospitalizations, physician visits, and medications.
The Centers for Disease Control and Prevention recommends 30 minutes of physical activity five or more times a week. This physical activity need not be strenuous to be beneficial, and even moderate increase in physical activity can bring benefits. Moderate physical activity, such as walking can provide important health benefits. Many walking advocates recommend walking of 10,000 steps a day. For many, it may not be easy to reach 10,000 steps a day, if a regular day includes driving from home to parking garage or lot, sitting at a desk or sitting in front of a computer or television. However, even small changes in everyday routines can make the difference and have cumulative health benefits. To increase the number of daily steps, people can take the stairs instead of the elevator, walk to the store or lunch instead of driving, park your car further away from your destination or walk your dog a little longer. You might be surprised how you can accomplish your recommended 30 minutes of daily activity without actually adding an extra activity to your already hectic schedule.
Community Benefits:

Encouraging walking as a form of transportation can also have beneficial consequences for communities. "Less driving, better public transport, well designed landscape and residential density will improve air quality more than will additional roadways," according to Richard Jackson, MD, MPH, director of the Center for Disease Control & Prevention's National Center for Environmental Health. Regulatory and design strategies, including traffic-calming measures, sidewalks, bike paths, underpasses or tunnels can make communities safer for pedestrians and bicyclists. For more information on pollution resulting from automobiles refer to lesson 7.

Activity 1. A Growing Problem
Have the students analyze the provided Maryland obesity maps (on CD) for both national and Maryland trends and the county obesity data provided by the Maryland Health Care Commission. Students should also review the Maryland Health Care Commission’s spotlight on obesity. http://www.mhcc.state.md.us/database/spotlight/obesity.pdf

Discussion Questions:

What are the trends in the maps?
What areas show highest signs of growing obesity?
Why do you think these trends are occurring?

Activity 2. Counting Your Steps
This exercise can be done with the use step counters (pedometers) to track the daily
activity levels of students, or by estimating total mileage walked by students. Pedometers can be purchased at most sporting goods stores or over the web.

Divide students into two groups to track daily step counts for one week. If possible divide student groups by walkers and drivers/bus riders. Use step counters to track how many daily steps the students take for one week. Students who are tracking steps should begin from the moment they start moving around in the morning until they go to bed at night. Remember- every trip starts and ends with walking. Calculate the average step count for both groups. Students can also calculate average miles walked and calories burned (conversions are listed on student handout). Compare the average step counts between the groups.

To Track Without Pedometers: Have students keep a daily walking log. Record how many minutes or distances (if known) walked throughout the day. Students should use a standard conversion for minutes to distance. (i.e. 15 minutes = ½ mile) This can be done at the end of the week, as long as all students use the same conversion rates. Be sure to have students include all walking in their log including walking around their houses, to the bus stop, car or walk to school, walking between classes. Anytime you are not standing still, sitting or sleeping should be counted.

Discussion Questions:

Which group walked more? Which group burned more calories?
Did either group reach the recommended daily levels of steps?
What obstacles to walking did either group encounter?
How could either group raise its daily step count, and why would that be important?
How could you increase your step count within your daily regimen?
Compare the calories burned in walking to other activities (listed on student handout). Does walking burn more or less calories than you expected?

Activity 3: Life imitating art? Or maybe not…

Discuss with students how children are portrayed in both classic literature and modern media as often having the mobility to move around their communities on their own. This phenomenon often occurs when children or youths not old enough to drive are the central characters to a story, and move around independent of the adults in their community. Some examples range from the children in Tom Sawyer to the young Harriet the Spy. This is also seen in many television sit-coms where the youths move easily between their homes, school, library, playgrounds, stores, restaurants, jobs and even the beach.

Read an excerpt from a novel with young characters. Lead a discussion with the students on the following questions.

Where is the story set? How does the physical setting affect the action in the story?
How did the main characters travel in their community?
Did they rely on adults for transportation?
Did they rely on public transportation and, if so, how did they get to and from the public transportation?
If the characters walked for transportation, were the destinations close together or long distances apart?

Activity 4. How independent are you (without a car)?

A walkable community has three important factors. It must be safe, convenient and have desirable walking destinations. However in more recent years, most communities have been designed around automobiles rather than walking. Due to the large scale of some shopping centers or other facilities, people are often forced to get in their cars to drive from one end of a shopping center to the other, or from their homes to the nearest grocery store etc.

Have students complete the survey from Lesson Eleven “Taking it Outside: A Walkability Checklist?” or answer the following questions about their communities.

Discussion Questions:

Can you freely move in your town or community without a car? Why or why not?
Could you walk or bike to school? If not, why not?
Could you walk or bike to the movies or a job?
Analyze projected population pyramids for Maryland (on CD). How important will walkability become as a larger segment of population ages?
In your community, can senior citizens walk to get their own groceries, or buy clothing or even go to the movies or doctor appointments?
Discuss factors such as safety (both crime and traffic safety) and community design. Design features may include a major highway between the McDonalds and the playground/ movies or other walking destinations. Are there desirable destinations such as walking paths or streets with visual interest, street level services restaurants and shops.
What kind of design features could improve the walkability of a community or make it more desirable to walk or bike somewhere?

Extending the Lesson:
Organize a “Walk to School Day” for your community. Nationally, only 13% of trips to school are made by walking and bicycling. The CDC KidsWalk-to-School program encourages students to travel to school actively and safely by foot or bicycle to promote physical activity and decrease air pollution. For more information visit: www.cdc.gov/nccdphp/dnpa/kidswalk/index.htm

Organize a “Park Your Car Day” Encourage students to make changes to their transportation routine for one day. Carpool, ride transit, bike, or walk and increase your step count and activity level. Using the “tailpipe tally” in Lesson 7 to calculate how much pollution you prevented from entering the air in just one day.

Conduct a school survey: How many cars does each student’s family own? How many are driven to school daily in cars (as opposed to school buses)? How many students drive their own car to school? What do students think about riding a bus? What do they think about riding a train? Is it still “cool” to ride a bicycle? How many car trips a day does each student’s family takes? For what purposes? How far do they drive? Etc.

Additional Resources:

Maryland Smart Step Forward Coalition www.smartstepforward.org
National Center for Bicyling and Walking bikewalk.org
Centers for Disease Control and Prevention, Active Community Environments www.cdc.gov/nccdphp/dnpa/aces.htm
National Coalition for Promoting Physical Activity www.ncppa.org

Recommended Reading:

Maryland Health Care Commission Report on Obesity. http://www.mhcc.state.md.us/database/spotlight/obesity.pdf
“Challenges in Health, Getting America Moving Again” www.bikewalk.org
NCBW: Why Transportation is a Health Issue (2002)
www.bikewalk.org/assets/pdf/Why_Transportation_is_a_Health_Issue.pd