Blueprint For An Active Australia - Heart Foundation

Where we work, play,learn and live interact tohave significant impacton our health.THE POLICY CONTEXTAustraliaPolicy priorities across sectors and related fundingdecisions at the federal, state and local levels canhave a direct impact on opportunities to be activeand on access to environments and facilities thatenable active living. Coordination is vital as there is nosingle solution to increasing physical activity or sectorthat can do it on its own.Federal leadershipThe federal government plays a key role in supportingstrategic investments that enable the delivery ofphysical activity policies and initiatives. Nationalpriorities among these are: the Australian Government to fund developmentand implementation of a National PhysicalActivity Action Plan to implement the actions inthe Blueprint for an Active Australia and committo an active and healthy future for all Australians. support regular monitoring and robust evaluationand research develop, regularly update and implementnational physical activity and sedentary behaviourguidelines for adults and children ensure a process for securing high-level expertadvice, including establishment of a cross-sectorcommittee for national leadership and physicalactivity policy coordination.10 Blueprint for an Active Australia NATIONAL HEART FOUNDATION OF AUSTRALIAThe Heart Foundation welcomes the recent policyleadership developments at a federal level includinglaunch of the National Sports Plan which includesa bold commitment to reduced inactivity amongAustralians by 15% by 2030.[1]However, to achieve this goal will require sustainedinvestment to 2030 in a funded National Action Planthat sustains current initiatives and extends initiativesacross sectors including health, education, sport,environment, transport and regional development.State and territory leadershipState and territory governments have a key role insupporting local strategic investment through relevantdepartments under their jurisdiction. State and territorydepartments of health, education, planning, transportand sport and recreation all have key roles in enablingpolicy and programs to support physical activity incommunities. Many of the actions recommendedin this document are the responsibility of state andterritory governments.Local government leadershipLocal government is the closest tier of government tocommunities and has a vital role in physical activityservice provision and in providing and maintainingphysical activity infrastructure such as walking andcycling paths, sport and recreation facilities, localcommunity parks, open space and local naturalareas.

Global leadershipThere have been significant recent advances in globalphysical activity policy. The endorsement by the WorldHealth Assembly, in May 2018, of the WHO GlobalAction Plan on Physical Activity is a critical globalmilestone.[2]The Global Action Plan is highly complementary to theAustralian Blueprint. It presents updated guidance anda framework of effective and feasible policy actions toincrease physical activity at all levels. It provides globalleadership in describing a whole-of-society responseto increasing physical activity levels across societyaccording to ability and across the life course.It is not enoughto say “eat better andget more exercise”.It is the wider systems thatfacilitate or limit behavioursthat cause chronichealth problems.Australia has ranked in the bottom half of 168 countriesinvolved in a 2018 World Health Organization studymeasuring insufficient levels of physical activity inadults around the globe. Published in 2018 in TheLancet, the study looked at self-reported activity levelsin 1.9 million people aged 18 years and over.[3]The Australian Government must respond byinvesting in a robust and funded National PhysicalActivity Action Plan.This third edition of the Blueprint for an Active Australiaprovides timely high-level Australian evidence andguidance regarding areas for investment that, whenimplemented with sufficient weight, can lead toincreases in population levels of physical activity.SUMMARYThe Blueprint contains 13 action areas; they eachcontribute to the central objective of increasing theamount of time that people in Australia spend beingphysically active.This is an objective worth pursuing. This Blueprint callsfor change.This document recommends many approachesto overcome barriers to physical activity, reduceinequity and provide opportunities and incentives toincrease participation. The recommended initiativescontained in the action areas represent an investmentin improving the health of Australians and contributingto reducing the burden of cardiovascular disease andrange of other chronic diseases.The WHO and the United Nations have committed toreducing physical inactivity across the world by 15% by2030. To achieve this target, member states, includingAustralia, are being encouraged to establish a multisectorial national committee or coalition to providenecessary leadership and coordination. Investmentand leadership by the Australian Government is vital.In addition, there are roles and activities throughoutthe Blueprint for each level of government and for thenon-government, business and community sectors.Blueprint for an Active Australia NATIONAL HEART FOUNDATION OF AUSTRALIA 11

The 13 action areas share a similar format, each exploring the case for change under the heading‘Why is this important?’, followed by the presentation of recommended initiatives and approaches in‘What must be done?’. The action areas are:Action area 1 - Built environments (page 14)explores how the neighbourhood context permeates our lives, from childhood to older age. Community andneighbourhood design impacts on how frequently we walk, cycle or use public transport and also on ourparticipation in recreational walking and physical activity.Action area 2 - Workplaces (page 22)discusses how to create healthy workplaces through initiatives such as better workspace design, progressiveoccupational health and safety approaches and workplace physical activity programs.Action area 3 - Health care (page 28)presents the case for integrating physical activity into chronic disease treatment and risk-reduction strategies usedby general practitioners and other primary-care staff.Action area 4 - Active travel (page 34)recommends reprioritising transport and urban planning to reduce car dependency and increase theopportunities to ride, walk or use public transport.Action area 5 - Prolonged sitting (sedentary behaviour) (page 42)examines how prolonged periods of sitting occur in many settings – in schools, in workplaces, at home in front ofthe television or other screen-based devices, and during travel – and recommends interventions to reduce theoverall amount of time that is spent sitting.Action area 6 - Sport and active recreation (page 48)highlights that participation in sport and active recreation offers social, developmental and health benefits acrossall age and population groups.Action area 7 - Disadvantaged populations (page 54)explores barriers and the actions needed to overcome them in disadvantaged populations. People who aresocioeconomically and geographically disadvantaged experience unacceptable levels of health inequities.We want to helpcreate communities inwhich healthy behavioursare the easier, moresustainable choices.12 Blueprint for an Active Australia NATIONAL HEART FOUNDATION OF AUSTRALIA

The Blueprint foran Active Australiatakes a ‘systems approach’- each of the 13 key actionareas address the complexitythat sits behind Australia’sphysical inactivityproblem.Action area 8 - Aboriginal and Torres Strait Islander peoples (page 60)explores the delivery of culturally suitable and accessible physical activity programs to promote higher levels ofparticipation among Aboriginal and Torres Strait Islander peoples.Action area 9 - Children and adolescents (page 64)discusses the inadequate rates of physical activity participation among children and adolescents; highlights thenumerous physical, developmental and social benefits of participation; and recommends actions to increaseparticipation levels.Action area 10 - Older people (page 72)reminds us that sustaining, and even increasing, physical activity as we age benefits mental and physical health,and recommends interventions that can be implemented, taking into account different physical capacities.Action area 11 - Financial measures (page 78)acknowledges that economic measures will influence the choices people make and details useful incentives toincrease rates of active travel and physical activity.Action area 12 - Mass-media strategy (page 82)covers the role of mass-media strategies in increasing people’s awareness and motivation to increase their rates ofphysical activity. This action area recognises that media, including social media, is part of our daily lives and is anessential component in increasing Australia’s rate of physical activity participation.Action area 13 - Research and program evaluation (page 86)outlines the types of research and evaluation required to monitor, measure and guide the multi-level interventionsfeatured in the Blueprint. It explores general themes in evaluation, monitoring and research rather than individualstudy areas.REFERENCES1. Commonwealth of Australia. Sport 2030. 2018 07/03/2019]; Available from: /featured/download/Sport 2030 - National Sport Plan - 2018.pdf.2. World Health Organization, Global action plan on physical activity 2018–2030: more active people for a healthier world. 2018.3. Guthold, R., et al., Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-basedsurveys with 1·9 million participants. Lancet, 2018. 6(10).Blueprint for an Active Australia NATIONAL HEART FOUNDATION OF AUSTRALIA 13

ACTION AREA 1– Built environmentsCreate built environments to support active livingAuthorsB Giles-Corti,1 H Badland,1,2 P Hooper,3A Timperio,4 T Sugiyama,5 S Foster,11 Centre for Urban Research, RMIT2 Australian Health Promotion AssociationThinker in Residence3 Centre for the Built Environment andHealth, University of Western Australia4 Institute for Physical Activity andNutrition, Deakin University5 Mary MacKillop Institute for HealthResearch, Australian Catholic UniversitySuggested citationGiles-Corti, B., Badland, H., Hooper, P. etal. Action area 1: Built environments. In:Blueprint for an Active Australia. 3rd ed.Melbourne: National Heart Foundation ofAustralia, 2019.More than 75% of thepopulation of Australia’slargest cities continue to livein suburbs. The implicationsinclude reduced opportunitiesfor physical activity, socialinteraction, access to publictransport & high motor vehicledependency.14 Blueprint for an Active Australia NATIONAL HEART FOUNDATION OF AUSTRALIA

WHY IS THIS IMPORTANT?The design of the built environment can increase daily physical activitylevels by increasing the opportunities to make healthy and active lifestylechoices.However, motor vehicle-oriented land-use and transport policies in citiesare contributing to global epidemics of non-communicable diseases andinjuries. The health impacts create an imperative to make use of researchevidence to move city planning and transport policies in directions thatare health promoting.(1)Urban design and planning that considers health, in both greenfield andinfill/retrofit development, can ensure increased opportunities for regularphysical activity. This includes walking, cycling and public transportuse, as well as access to recreational physical activity, sports and evencommunity gardening.Furthermore, for decades, concern has been growing about the unsustainability ofpost-war planning principles adopted in Australia, with segregatedland use, disconnected streets, and low residential density suburbs:more than three-quarters of the population of Australia’s largestcities continue to live in suburbs.(2) The implications for this type ofdevelopment include reduced opportunities for physical activity,social interaction, access to public transport, as well as high motorvehicle dependency.These settlement patterns do not support active living choices andare also likely to be negatively impacted by changing environmentalconditions linked to climate change, global warming, energy andfood insecurity the importance of built environments to Australian population healthis underlined by the high proportions of Australians who live in urbanenvironments. Currently, over 85 per cent of Australians live in urbanareas and nearly 70 per cent in the capital cities(3, 4) the Australian Parliament has recognised the importance of builtenvironment planning in the context of population growth withBuilding Up & Moving Out, Inquiry into the Australian Government’s rolein the development of cities.(5) This was informed by Planning Instituteof Australia (PIA)’s Through the lens: The tipping point(6) emphasising urban resilience, through inclusive, safe and sustainabledesign is critical to addressing climate change. Also, the nationaland international uptake of renewable energy can also help propela required energy efficiency mode-shift toward more public transportand active transport modes, and creating opportunities to lead more active, healthier, lifestyles relieson good planning and design as well as the timely provision oninfrastructure in both new and existing communities.Blueprint for an Active Australia NATIONAL HEART FOUNDATION OF AUSTRALIA 15

Planning for health and wellbeing:built environment design considerations ensuring that the design of streets and publicspace prioritises the needs of people over motorvehicles. About 80% of the public realm of a cityis made up of roads.(7) Streets should be plannedand designed according to their role as a“place” as well as their role in “movement”. As aplace, a street is a destination in its own right andthe design should consider the needs of peopleand active travel over car use(8) higher levels of active travel, including walking fortransport are found in ‘walkable’ neighbourhoods,with higher-density mixed-use zoning, connectedstreet networks and access to public transport,and a balance of jobs to housing(9). Creatingpedestrian-friendly streets has also been shown tobe good for supporting local economies(10) recreational walking is associated with thepresence, proximity and quality of green openspace.(11) The presence of trees encouragespeople to walk for both exercise and transportand is associated with reduced incidence of heartattack and type 2 diabetes(12) providing diverse housing in walkableenvironments can help older adults to ‘age inplace’. Safe neighbourhoods with connectedstreet networks and local shops, services andrecreational facilities are associated with morewalking in older adults and may protect against adecline in physical activity over time.(13-16) Physicalactivity can help people maintain independence,recover from illness and reduce their risk of diseaseat all stages of life. As people age, physical fitnesscan have a major impact on wellbeing(17) optimising neighbourhood walkability is desirableinbuilt environments. However, due consideration isrequired to minimise increased exposure to trafficrelated air pollution(18), which increases the riskof several acute and chronic diseases, includingcardiovascular disease(19) lower density development is associated withlower levels of walking for transport which islikely to contribute to poorer cardiovascularhealth outcomes(20). Living in more walkableneighbourhoods is associated with lowercardiovascular disease risk factors in men(21) children are more likely to be physically active inmore walkable neighbourhoods with access torecreation facilities close by(22), and to walk toschool in neighbourhoods with connected streetnetworks, low traffic speeds and volume(22). Foradolescents, physical activity is associated withhigher land-use mix and residential density.(23)Having access to a range of local recreationaldestinations also appears to limit sedentarybehaviour in young people(23) evidence suggests that lack of personal safetycan restrict adults’ walking(24) and their children’sindependent mobility(25). Lower speeds will improveliveability, improve road safety and contribute toincreased rates of walking and cycling(26) there appears to be growing consumer demandfor more walkable neighbourhoods.(26) Thisincreasing demand is across a wide range ofage groups and sections of society: from youngerpeople who increasingly cannot afford to run aprivate vehicle, and/or prefer not to have privatevehicles as they opt for active travel and/or publictransport; through to older people who requirefacilities and services to be within walking distanceto enable continued access and interaction intoolder age when community facilities, such as schools, sportand recreation facilities, are all located near tohomes and each other - and ideally within cyclingor walking distance - it enhances opportunities forphysical activity, wellbeing, sports participation,community interaction and social cohesion(27, 28) the relationship between food and health canbe improved through planning and design. Atthe local level, this means ensuring healthy foodoptions are available within walking distance ofhouses, as well as in schools and workplaces.On a broader social level, improving transportand accessibility to healthy food options promoteshealthy eating, particularly to the disadvantaged(29) the physical characteristics of an environmentcan support or inhibit a sense of place. Effectiveplacemaking considers the uses, activities,comfort and sociability of a space. Furthermore,social connection and enjoyment of a space canbe enhanced through inclusive, well connected,pedestrian friendly spaces.(27, 28)16 Blueprint for an Active Australia NATIONAL HEART FOUNDATION OF AUSTRALIA

WHAT MUST BE DONE?To reshape communities and neighbourhoods,leadership and action are required by government,civil society and the private sector. Integration ofurban planning, urban design, and transport policiesand practices is needed, at both local and regionallevels.(1) integrate healthy planning principles in urbanplanning, design and development policies, codesand regulations that support people across the lifecourse(30)The following interventions are recommended toenable more active and liveable environments: develop policies, standards and planning codesthat ensure residents have access to a range ofquality open spaces for both active and passiverecreation within walking distance of homes,accessible by pedestrian-friendly routes(31) implement policies that create communitiesand neighbourhoods that support active living,particularly walking require health and environmental impactassessmen

Blueprint for an Active Australia NATIONAL HEART FOUNDATION OF AUSTRALIA 3 FOREWORD It gives me great pleasure to introduce the third edition of the Heart Foundation's Blueprint for an Active Australia. This publication is the result of collaboration between the Heart Foundation and Australia's leading experts on Physical Activity.