Social Determinants of Physical Inactivity
Original Editor - Wendy Walker
Physical activity [PA] is known to have health benefits, including reduced risk of cardiovascular disease, Type 2 diabetes, several cancers and NCDs. Despite this, in many countries of the world a large number of adults are physically inactive and display sedentary behaviour [SB], spending a large proportion of their waking hours sitting: often at a desk at work, on a sofa at home, and on transport, whether public transport or private vehicle. These sedentary behaviours have low energy expenditure, and are associated with health risks, independent of PA levels.
Social Determinants of Health and Physical Inactivity
Factors in the social and physical environment which impose a direct influence on the opportunity to engage in physical activity include:
- Social inequality including income inequality and education inequality, both of which may have an effect on activity levels and SB.
- Community traits such as social cohesion, perceived benefits of PA and attitudes to age & gender restrictions may also play a role.
- Environmental determinants include access to public green areas, provision of safe areas to walking eg. on street, as well as the design of residential areas which may or may not include walkable neighbourhood routes, and provision of cycle routes.
For more information please see the Determinants of Health page.
Transportation provision can promote PA by providing safe and attractive routes to walk or cycle in, which may be combined with public transport. If government policy can lead to improved infrastructure which promotes PA as part of the commute to work or travel to school, then the health benefits for the community should be substantial.
A study of infrastructure changes (including traffic-free bridges and walking/cycling routes) at 3 sites in the UK demonstrated sustained use over the 2 years following construction. However, despite this the authors caution "the infrastructure may primarily have attracted existing walkers and cyclists, and may have catered more to the socio-economically advantaged. This may limit its impacts on population health and health equity."
Many cities in the world have introduced bike-share schemes, but there is some evidence that for the scheme in London, UK. the majority of the users of the scheme were males living in socioeconomically advantaged areas where cycling was already very popular, concluding that the infrastructure "may primarily have attracted existing walkers and cyclists, and may have catered more to the socio-economically advantaged. This may limit its impacts on population health and health equity.".
Neighbourhood Environmental Design
- Provision of public open space, including parks
- Improved footpaths and lighting (to promote use of footpaths at night)
- Dedicated bike lanes on major roads
- Signed walking/biking trails
- Clean, attractive streets encourage people to spend time walking in them
WHO recommends adopting urban design solutions to promote physical activity in communities. Activity-friendly neighbourhoods are likely to increase people's physical activity for up to 1.5 hours more per week. In high density residential areas, parks and high number of public transport stops (lowering car-dependence ratios) were found to be associated with high levels of physical activities.
Addressing Social Barriers
A review by Ball et al presented various approaches to tackle social inequities and challenges, here are some of the suggested solutions:
- Government schemes to promote PA in organisations and institutions through policy actions and environmental changes. An example of such approach is the accessibility of school and community facilities for PA to meet the needs of the whole community.
- Community Campaigns, using media and community events to deliver the message to a wide sector of the community. This approach is supported by evidence, however, influencing disadvantaged groups has yet to be further studied.
- Economic-related approaches: using tax reduction schemes on driving or motivating individuals through incentives have been implemented in different countries giving mixed results.
- Transportation and infrastructure solutions: such as installation of shared trails; road closures/ restrictions, road tolls, cycling infrastructure and safe routes to schools.
- Improving the daily living conditions through school, workplace and healthcare settings.
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