IT IS 8:20 A.M. on a weekday and I’m at a public school in a wealthy suburb of New Jersey. Not a single child here has walked to school, not even the ones who live next door. In much of the town, there are no sidewalks.
Every morning, the school’s occupational therapist runs a special class for the kindergarteners in the lunchroom, which also functions as the school’s all-purpose room. The gray laminate tables where the children will eat have been folded up and placed along the walls. Fluorescent lighting shines from the ceiling, mixing with the sunlight coming in through two large windows on the back wall. Long gray curtains hang on each side of the windows.
The children’s homeroom teacher enters the room. Her charges file in behind her, one by one. Johnny walks straight as an arrow, with Radhika following. Alexei is behind her, out of line and looking at the ceiling. Next comes Joan. She barely lifts her feet as she takes her small steps, appearing lethargic despite the fact that she’s only five years old and it’s first thing in the morning. And on and on, until eighteen students have entered and taken a seat on the floor facing the therapist and teacher.
The class begins. The occupational therapist tells the children they are going to learn how to crawl like a baby and walk like a bear. She asks for a volunteer to do the bear walk. Radhika’s arm shoots straight up. She puts her hands to the floor, straightens her legs behind her, and moves herself forward without letting her knees touch the ground. The next two children who try are not as successful. They are uncoordinated. They don’t have enough strength. In fact, about half the children are unable to do the bear walk.
It is for exactly these reasons that the school introduced this class a few years ago. We live in an age when many children spend much of their time playing inactively on screens and tablets. Children who play predominantly on such devices are losing touch with the spontaneous jumping, running, crawling, tree-climbing, throwing, and digging that came with active play and being outside And they might need to be taught again how to play actively with their bodies, using gross motor skills. They may also need help developing their fine motor skills. Since some of the children are no longer outside playing in the sandbox, no longer picking up pieces of toys or insects or sticks and stones with their fingers and thumbs, they have trouble picking up their pencils and erasers. The next morning, the occupational therapist has them practice picking up small balls and blocks that they then place in a cup.
This is the state of children’s play today. The transition from active outdoor and indoor play to increasingly sedentary, screen-based activities is negatively affecting our children’s health. Not so long ago, we equated screen time with television viewing; these days, it also includes time spent on computers, tablets, smartphones, and other electronic devices. Today, more than 30 percent of children in the United States and Canada are overweight or obese. As Bill Dietz’s research has shown since 1985, and as other research has confirmed, television viewing and screen time are associated with obesity in children. According to statistics provided by the ParticipACTION program in Canada, today, 95 percent of children do not meet the daily physical activity recommendation for sixty minutes of moderate- to vigorous-intensity activity. And their parents are not exactly setting a good example. Adults, too, spend more time on screens than outside, more time sitting than walking. According to ParticipACTION, an estimated 85 percent of Canadian adults do not meet the adult physical activity recommendation of 150 moderate-intensity activity (or 75 vigorous-intensity) minutes per week.
The bottom line is this: we all need to move more. And one of the easiest ways we can do that is by embracing play—by getting out into the world on bikes, on rollerblades, or just on our own two feet; by fitting recreational activity into our day-to-day lives; and by taking that very necessary time to have a bit of fun. Unfortunately, this isn’t always easy to do. Many cities don’t have safe or accessible recreation areas. Parks and playgrounds are too few and too far between. Bike paths are poorly maintained, or precariously positioned along the sides of busy streets designed only for fast-moving cars. Green spaces are hard to come by in cities already full to bursting with buildings. For city planners and designers, public health professionals and community groups, it’s a challenge, to be sure. We want our cities to support a good quality of life, to encourage healthy lifestyles, but how do we make that happen when space is at such a premium?
Well, as I’ve seen so often since I began this work, where there’s a will, there’s almost always a way.
Taking It to the Streets
I’m excited about this trip to Bogotá, though a bit nervous about my wardrobe selection. As soon as the plane touches down, I notice that the residents of this Latin American city—perched nearly nine thousand feet above sea level—are wearing leather or even down-filled jackets. Unlike the tropical beach cities not so far away, Bogotá’s air is dry and cool. I wonder if I’ve brought a warm enough coat.
It’s October 2012, and I’m in town to deliver a keynote address at a conference organized by the Pan American Health Organization (PAHO) for delegates from several Latin American countries. Because of our success in implementing innovative policies and programs for improving the built environment and chronic non-communicable diseases in New York City—and the resultant reversals in childhood obesity and increases in life expectancy, among other favorable outcomes for businesses, safety, and pollution—my New York colleagues and I have been getting more and more invitations from organizations around the world that want to hear about this work. Given that my Spanish is less than fluent, I am grateful for the two-way translation services PAHO is providing: we won’t necessarily be speaking the same language, but we’ll all understand each other.
I’m always happy to speak to other public health professionals about the work that we do. But there’s something else I’m eager to check out in the Colombian capital—the famous ciclovía and recreovía that I’ve heard so much about over the years. Okay, “famous” might be an overstatement as far as the general population is concerned, but it’s completely accurate for those of us working in the realm of physical activity and non-communicable diseases, and among the increasing number of cities around the world that are adopting the concept for their own streets.
Bogotá’s ciclovía—or “bike way”—dates back to the 1970s, when a group of local cycling enthusiasts successfully lobbied to have certain main streets closed to traffic, and open to bikes, on set days and times. The idea got a boost in 1976 when Mayor Luis Prieto Ocampo made the ciclovía an official municipal program, promoted by the city’s transportation department, and again in 1998 with the election of Enrique Peñalosa, a young, energetic mayor who supported the idea that citizens, not cars, should own the city’s streets, at least for one day each week. Peñalosa once stated that “a citizen on a $30 bicycle is equally important to one in a $30,000 car”—music to the ears of public health professionals everywhere! On taking office in 1998, Peñalosa cancelled plans for a new highway and invested the money instead in bike lanes and the city’s TransMilenio rapid transit system.
These days, the ciclovía is alive and well. Every Sunday, and on public holidays as well, Bogotá closes approximately seventy miles of roads to motor vehicles from 7:00 a.m. to 2:00 p.m. During these times, about a million of the city’s eight million residents can be found out and about on the ciclovía, in one way or another. Some cycle, of course. Others walk or rollerblade. Some are on their way to one of the thirty or so free recreovía, or recreation stations, set up along the route by Bogotá’s recreation department.
On this particular Sunday, my group gathers at the edge of a large public park where a recreovía has been set up. There’s an instructor on stage with a boombox, and the music is blaring. For a while, I watch as a large group takes part in an aerobics class, smiles on their flushed faces. I turn to check out the street behind me. It’s packed with cyclists, runners, rollerbladers, and parents pushing strollers. Some have the determined look of an athlete in training. Others are strolling and rolling along at a leisurely pace, enjoying conversations. Car traffic is relegated to the other side of the median, where what would normally be two lanes of one-way traffic has been converted to one lane each of two-way traffic. Military trainees and volunteers assist with the street closures, making sure things run smoothly. Never one to let an opportunity pass, I suggest to my guide—who works with the city’s health department—that more attention might be paid to the many stands along the route, which sell beverages so high in calories and sugar that they largely negate the calories being burned by the physical activities.
Bogotá may have been one of the first places in the world to embrace the possibility of something like the ciclovía—a low-cost innovation that allows people to move more and in better ways—but the idea has spread. These days, similar initiatives can be found in, among other places, Australia, Argentina, Brazil, Belgium, Canada, India, Mexico, and the United States.
For the past decade, New York City has run a ciclovía-like event of its own. Inspired by what she saw in Bogotá and elsewhere, Transportation commissioner Janette Sadik-Kahn worked with numerous government departments and partners—including City Planning, Building, Sanitation, Health, and the NYC Fire and Police Departments, to name a few—and got the buy-in and cooperation she needed to launch Summer Streets.
On three consecutive Saturdays in August 2008, approximately seven miles of Park Avenue were closed to cars, allowing walkers, runners, cyclists, and families to experience this main thoroughfare in an entirely new way. From the Brooklyn Bridge to Seventy-Second Street on the Upper East Side, people cycled and rollerbladed, scootered and skateboarded, or just walked along, taking it all in and stopping at the recreation stations set up along the way. Kids played on climbing walls or splashed in dumpster pools. In tunnels under Grand Central Station usually reserved for cars, art installations drew excited crowds. Free bike rentals, free exercise classes, and jump-rope competitions took place along the route, while mini tennis courts were set up for children by laying down artificial turf over the pavement. It was truly an event that celebrated active transportation and play, and it was a roaring success. That first year, fifty thousand people took part in Summer Streets. In 2016, that figure was closer to three hundred thousand.
In the busy days before the event launched, however, we had no idea what to expect. The Department of Transportation knew from the very early stages of planning that it wanted to assess attendance, traffic flows, and economic impacts. I was curious about that too, but I had my own list of questions. Topping that list: What kind of impact could Summer Streets have on health, particularly physical activity? I asked the DOT if we could work together to answer all of our questions. They responded with an enthusiastic “Yes!”
We got busy. DOT sent out an email blast to its staff, asking for volunteers who would be willing to work the first two or three Saturdays in August (the third Saturday was a “rain date” for the purposes of our evaluation). I did the same at the Department of Health and Mental Hygiene. By a week before the inaugural event, we’d trained our team of volunteers in data-collection methods. We gathered in a conference room at DOT’s office, reviewed the data-collection forms, and answered questions. We went over what we would be doing at the event. On August 2—launch day—clipboards, pens, and clicker-counters were handed out. Last-minute preparations were made. We were ready to go.
Vicky Grimshaw and Sarah Wolf—the two staff members who had helped me get the Built Environment and Active Design Program off the ground—were on hand. We positioned ourselves at the three points where recreation stations had been set up—uptown, midtown, and downtown—and where crosstown traffic was being allowed by the New York Police Department. Along with our volunteers, we would be intercepting walkers, rollerbladers, and cyclists when they stopped at a traffic light. We’d ask them about their health status, their age, their home zip code, and their physical activity levels outside of the event, as well as the distances they’d traveled along the Summer Streets route.
The pilot evaluation on August 2 went well. But just as we had in West Virginia—my first experience with this type of “boots on the ground” work—we discovered that a few details of our procedure needed tweaking. It appeared we should stand on the side of the street where people were stopped at a red light, not on the other corner trying to stop them when they were already roaring forward on a green. If there were groups, we learned to survey all of them at once, or else the one person approached would likely say no to us and hurry to catch up with the others. And so we refined our methods and were ready to hit the streets again the following Saturday. I couldn’t wait until the evaluations were complete and the results tabulated. I was so eager to learn what a program like Summer Streets could do to help get us moving.
The results were beyond encouraging. The fifty thousand people who took part in that inaugural event represented a healthy number for a new project. But I was even happier with the revelation that 87 percent of those who traveled to Summer Streets did so by walking, cycling, or taking public transport—all active modes of transportation. We also learned that about a quarter of those who attended were insufficiently active outside of Summer Streets. The event, then, was providing a much-needed opportunity for physical activity among those who didn’t get enough in their daily lives. Score one for health. We also found that those who came out were getting about half of their weekly recommended physical activity at the event. In other words, Summer Streets was providing a significant opportunity to get physical activity, whether attendees chose to walk, cycle, rollerblade, or play. Chalk up another point for health. The outcomes that concerned the DOT—primarily, what impact the event would have on traffic congestion—were also positive: DOT assessments found no significant traffic delays created by the event!
I’d been a supporter of the Summer Streets idea from the moment I learned of it, and the evaluations we conducted that first August only heightened my enthusiasm. But having spent so much time “behind the scenes,” I was eager to experience the event the way other New Yorkers did—by hitting the streets myself. And so the next year, and every year after, I set off on as many August Saturdays as I could, weather and schedule permitting.
In 2015, I enlisted other enthusiasts and made a trek through Summer Streets to the Brooklyn Bridge Park—one of several new green spaces opened during Mayor Bloomberg’s administration. We’d been looking forward to this outing, and we weren’t disappointed. On the wide sidewalks of South Harlem, we walked our bikes for the first five minutes to get from my apartment to Central Park. Then, entering the park at its north end, we hopped on and made the first strenuous uphill climb, slow and panting. The effort paid off, though, when we got to enjoy speeding downhill, wind against our faces, into the west side of the park and the Seventy-Second Street park road. We followed that road until we hit Park Avenue, where, even though it was only 8:00 a.m., the street was already jammed with “traffic”: bikers, runners, rollerbladers, skateboarders, and walkers; men and women, boys and girls, parents with strollers. We passed people of all ages and races enjoying their Saturday morning with healthy, free activities. We rode quickly through intersections where the cross streets were barred by police, and stopped at red lights at the few large intersections that remained open. We gawked at the long lines of people waiting to be fitted for their new bicycle helmets being given out for free by DOT staff.
As we neared the Brooklyn Bridge, we stopped for a moment on the Manhattan side. Free drinking water was on offer from the New York City Department of Environmental Protection, which had hooked up their Water-on-the-Go fountains to hydrants. In Foley Square, flanked by the courthouses that viewers of Law and Order know so well, a “beach” had materialized out of thin air, complete with chairs, game stations, and a giant sixty-foot inflatable water slide. We stopped for a picture and a drink of water.
Then we were off again. We’d cycled about nine miles already, though it felt like nothing at all, with all the things to see along the way. We made our way onto the Brooklyn Bridge pedestrian and bicycle paths, following the cyclists in front of us in a single file and riding past the pedestrians on the right, many stopping for photographs of the Manhattan skyline or the Statue of Liberty in the distance.
Finally, Brooklyn. We made our way off the bridge, past a Citi Bike share station, and onto bicycle lanes on the quiet side streets of Brooklyn Heights. Finally, we arrived at Brooklyn Bridge Park. As we rode along New York’s East River, with views of the newly finished Freedom Tower in front of us, we passed children’s playgrounds, beach volleyball courts, a kayaking station, basketball courts, ball hockey play areas, and even exercise equipment, all free for public use. We were tempted to give a few a try, but we decided that our ride was enough for that day, and there were plenty of other people who wanted a turn. We stopped instead to grab a bite of lunch at a nearby restaurant—fuel for the ride back home. A perfect day.
Summer Streets is special—a limited opportunity to see and enjoy New York in a different way, during a typically warm month when people are looking for any excuse to get out and enjoy all that the city has to offer. But what about everyday needs? What about those kids we read about at the beginning of the chapter—the ones who have lost fine- and gross-motor skills because they head home and plant themselves on the couch after school rather than kicking a ball around with their neighbors?
A century ago, children used to play on the street: hide-and-seek until the streetlights came on; games of tag that lasted for hours; stickball and ball hockey; jump rope and hopscotch and hula hoops. They played baseball on the streets, to the consternation of neighbors whose house or apartment windows would sometimes be broken. Those days are largely gone, it would seem. Other, more sedentary activities—notably the lure of screens, or perhaps the demands of excessive homework—seem to be impinging on this active play time. Or maybe it’s happening in a more regimented, less spontaneous way, in the form of sports and organized activities for the children whose parents can afford the time and money to involve their children in such. Additionally, outdoor space is often at a premium, and what little is available is frequently given over to cars. In any case, what seems apparent is that our kids are forgetting how to play—and becoming less healthy in the process.
Perhaps my estimate of a century was optimistic. Maybe it’s been longer than that since kids could play safely on our city streets. It was way back in 1914, after all, that New York’s Police Athletic League (PAL) created a program to make street play safe for kids. At the time, there were more than thirty parks in Manhattan, but very few were found in low-income neighborhoods. In a move designed to address that situation, Police Commissioner Arthur Woods conducted a “play street” experiment. In July of that year, Eldridge Street between Rivington and Delancey was closed to traffic. The Parks Department pitched in with two street pianos, and the Eldridge Street Settlement organized a folk dance festival. All at once, a busy commercial block had morphed into a place for play. The idea took off, and before the end of the year, twenty-nine additional play streets could be found around the city. By 1924, the program was operating in the Bronx, Brooklyn, and Queens.
The idea behind Play Streets was simple: single blocks of city streets would be closed to cars at certain hours of certain days so that children could come out to play. The Police Athletic League still runs Play Streets in New York in the summer months, offering spaces for children to engage in both structured and unstructured play. Programming exists to engage children, but they are also free to ride their bicycles, practice their two- or three-wheeled scootering, or just run around.
As wonderful as the PAL program was, it wasn’t enough. By 2009, PAL funding for Play Streets was shrinking, and the number of Play Streets each summer was shrinking with it. It was a concern to those of us in the Built Environment and Active Design Program, and also to our new commissioner of Health, Tom Farley, who’d joined us when President Obama appointed Tom Frieden director of the CDC. Farley, formerly the dean of Public Health at Tulane University, had been working alongside his predecessor for about a year at the time and was familiar with the city’s public health landscape. Not long after the changes took effect, Assistant Commissioner Lynn Silver passed along a message: our new commissioner wanted to see kids playing on the quieter streets of New York. “He’s envisioning parents and neighbors sitting on their apartment stoops watching the kids play on the streets in front of their building,” Lynn told me. “Can you make this happen?” I was certainly determined to try—and I knew exactly where to start.
For some time, the Department of Health and Mental Hygiene had been hearing from various community groups who were interested in hosting Play Streets of their own. For example, several farmers’ markets thought it would be helpful to have Play Streets adjacent to their markets so that while the parents shopped for fruits and veggies, the children could play. What a perfect combination for health—if only we could find a way to give community groups the right to close off streets to cars and use them for children and families to play!
Our first call was to the Street Activity Permit Office, responsible largely for one-time events like neighborhood block parties. Sure, they said when we asked, community groups could apply for a Play Street event permit, “but only once a year.”
Once a year? Children taking part in physical activity once a year was precisely the problem we were trying to remedy. We needed to find a way to allow children space to get physical activity on a much more regular basis: preferably multiple times each week or, best of all, daily. I turned next to my colleagues at the Department of Transportation. If we were talking about closing off streets, why not go directly to the source?
Andy Wiley-Schwartz had been an assistant commissioner hired by Janette Sadik-Khan, and he shared her commitment to creating vibrant public spaces in our cities. Andy came from the world of advocates, specifically a non-profit organization called Project for Public Spaces, which pushed for improvements to public spaces. Janette had put Andy in charge of the Plaza Program, and Andy was asking residents to propose new pedestrian spaces they wanted to see in their neighborhoods. I asked Andy if his staff could work with mine to set criteria for DOT approval of the closing of quieter streets to cars so children could use them for play at set days and times. He agreed to work with my team on a standardized application process—and gave his word that if the application was completed and the street and programming criteria were met, whether by a community group or a school, the Play Street would be approved.
And so, with DOT’s help, the Play Streets program was expanded. Community groups like interested farmers’ markets were now able to host Play Streets that PAL didn’t have the capacity to run. And schools without enough play space for physical education or for active recess were also able to run Play Streets during set days and times on weekdays each week.
Play Streets was conceived of as an on-again, off-again program, but in some neighborhoods, Play Streets have become an everyday thing—an accomplishment that demonstrates just what can happen if a community comes together to fight for a common goal.
One evening during the summer of 2011, I attended a community board meeting in Jackson Heights. I was there to present information about the health benefits of physical activity—and physical activity spaces—for children. I was pleased to see that the meeting was well attended, with some parents even bringing along their five- and six-year-olds, some of whom were carrying banners asking for a place to play every day. Located in Queens, Jackson Heights is included on a list of areas in New York City’s five boroughs with the least green space per capita. There was a playground in the neighborhood, but it was often overcrowded, and the adjacent street, although quiet, offered no help: children were not permitted to play there. The parents at the meeting wanted to access that additional space.
Thankfully, the community’s voices were convincing, and so I was delighted to be able to return for the ribbon-cutting for the Jackson Heights Play Street. It was a hot summer day, and as we waited for some local politicians to arrive I took in the scene around me. Children and their parents gathered on the artificial turf laid in one corner of the street block where the children were playing with building blocks, unknowingly practicing their fine motor skills and burning calories as they stretched, stood up, and sat down again to stack the blocks. Kids stood in line, talking noisily as they waited their turn to climb inside the colorful bouncy castle, where each child was given time to jump on the air-filled nylon platform inside its netted space. Parents ran alongside children learning to ride small bicycles, or balancing on their two- or three-wheeled scooters and skateboards. Adults from the surrounding homes stood in small groups, chatting.
On August 13, 2011, The New York Times published an article by Alec Appelbaum entitled “Presto, Instant Playground.” Likening Play Streets to today’s trendy pop-up retail stores, Appelbaum described the initiative as pop-up playgrounds. In October of that same year, the Chicago Tribune’s Blair Kamin included Play Streets at number four in his “10 Steps to Begin Correcting Chicago’s Open Space Shortage,” citing New York City’s efforts as an example for Chicago to follow.
Not long after, I spoke to Chicago’s Department of Public Health about their desire to do just that. On a conference call, I discussed with them and their funder, Blue Cross Blue Shield of Illinois, how they could re-create Play Streets in their city. In 2012, the city launched PlayStreets Chicago. In the first year alone, the initiative attracted ten thousand attendees and hosted more than fifty events; by 2014, more than 140 events were organized. Sixty-four percent of attendees reported that they would have engaged in sedentary activity had it not been for the PlayStreets—a number that matched our findings in New York, where the majority of parents surveyed on site reported that their children would have been inside or watching television had the Play Street not been available. Evaluations at these Play Street sites showed that children were staying at Play Streets for between an hour and two and a half hours, on average.
As with so many successful initiatives, this one took a combination of need (a safe place for children to play), inspiration (a great idea that was being underutilized), and cooperation (between various government departments and community groups) to come to fruition. A generation of children in Jackson Heights, in Chicago, and beyond will be happier, and healthier, for the effort.
Move to Improve
In addition to play space creation in and around schools and neighborhoods, which was the purview of the Built Environment and Active Design Program, the Department of Health and Mental Hygiene wanted to make sure our schools were following through on healthy activity initiatives within their own walls.
While working with New York’s bodegas to increase healthy food offerings in some of the city’s highest-needs neighborhoods (see chapter 2), the Physical Activity and Nutrition Program initiated by Candace Young and her deputy, Sabrina Baronberg, also created a program that would eventually come to be called Move to Improve. Early on, Candace found state funding that could be utilized to provide daycares and schools with health programming assistance. As she and her staff plowed through the scientific literature, looking for programs they could adopt, SPARK and CATCH both caught their eye. Called “a school-based solution to our nation’s healthcare crisis” in the Surgeon General’s Report, SPARK is designed to get children more active during their school days. It provides a curriculum package—complete with training, follow-up support, and equipment—to teachers and recreation leaders serving the pre-kindergarten through grade twelve community. For example, CDs and simple equipment like satin ribbons might be provided to teachers to “spark” physical activity even within limited classroom spaces. Peek in during one of these sessions and you might see kids following along after their teacher, moving their arms up and down to music as their little hands grip the flowing ribbons. Some might be giggling and having a good time, while others might be concentrating hard, and slightly flushed from the physical exertion.
CATCH—which stands for Coordinated Approach to Child Health—takes a wider approach by aiming to help children make healthy food choices and increase the amount of physical activity they get each day. Consider a community baseball game. Jose’s up to bat, and he gets a hit! In a CATCH program, all of the children, rather than Jose alone, would run the bases.
Candace was intrigued by these programs and the possibilities they presented. Initially, she’d use the funding she’d found to create a training program for daycare workers and elementary school teachers in SPARK—and later Move to Improve (a very similar program adapted from SPARK)—and to purchase the necessary CDs and accompanying activity supplies. Evaluations would eventually find that the Move to Improve program introduced into daycares and elementary schools in New York would add an average of twelve minutes of physical activity to each school day, an hour more activity to the school week.
Participation Marks
Summer Streets, Play Streets, Move to Improve—I was so excited to see these programs up and running, and growing in popularity. They were important weapons in the battle we were waging against obesity and its many consequences. And they had all, in various ways, proven just how effective alliances between different government departments and with non-government entities could be. Community groups, non-profits, corporations: all had roles to play. That realization got those of us in the Built Environment and Active Design Program at the health department thinking about what other innovative partnerships could be created for the expansion of healthy opportunities and options. As Sarah Wolf and I brainstormed, we kept coming back to a group that we hadn’t yet consulted: students. Could we somehow partner with students themselves? Could students—particularly high schoolers, but even middle schoolers—be engaged in helping us identify and make changes within their schools or communities to support a more healthy lifestyle?
It’s 4:00 p.m. on a school day, and I am making my way to the YMCA in Long Island City, Queens. It has been a year or so since the Active Design Guidelines were published, and Sarah Wolf, who assisted me in writing the first chapter on health and the built environment, and in corralling our various partners to write their pieces too, has made a transition from Built Environment Coordinator to Community Engagement Coordinator for our Built Environment and Active Design Program. Like the rest of our program’s team, Sarah was still responsible for Active Design in New York City, but her work now focused on the public engagement aspects. The day is gray and chilly, and I’m wearing a down coat, hat, and gloves as I walk across the bridge from my office—recently relocated from downtown Manhattan—over the train tracks to the other side, where LaGuardia Community College and the YMCA are located. As I enter the building through automatic sliding doors that open as I approach, I revel in the warmth. The woman at the front desk directs me to a room down the hallway to the right. I open the door and inch my way in.
Sarah waves to me from the far side of the room by the windows, where she is sitting at one of the student desks that have been arranged in a large circle. The desks are filled with middle school students who are participating in this YMCA after-school program on civic engagement. I’ve arrived just in time to hear the student presentations—a practice session for the real presentations they’ll be giving, along with students from other YMCAS, to public officials who have volunteered for a student civic engagement event that’s coming up soon.
This particular YMCA after-school program is brainstorming and identifying improvements that could be made to the surrounding neighborhood to improve health. Early on, Sarah had spoken to the students about the epidemics of obesity and diabetes in the United States and in New York in particular, and about the evidence for addressing physical activity and healthier diets through interventions to the built environment, including those for improving active transportation, active recreation, active buildings, and actively promoting healthy food and beverage access. Over the years, these four components have become the pillars of our work in the Built Environment and Active Design Program of New York City’s Department of Health and Mental Hygiene. Now, these students are applying this knowledge.
Several groups have decided to take on active transportation, and the first has chosen to consider the intersection just outside this YMCA. It features a crisscross pattern of diagonal crosswalks, with a triangle of unmarked space in the center that neither cars nor pedestrians can use. “We would like to make a pedestrian plaza here,” says a presenter, a girl of about thirteen, with long dark hair, jeans, and black sneakers with neon pink laces, who is wearing her short ski jacket even though we are inside the warm classroom. An earlier presenter has already cited the dangers of the intersection, along with accident statistics. She goes on to describe the features of the pedestrian plaza they have in mind: “Chairs and tables, pots of plants to put around the plaza, a painted floor to make it visible.” A third presenter takes over and lists the various groups they’d need to try to engage in order to create the plaza.
I am so impressed by these young men and women. Not only have they taken in what Sarah has told them about our work, but they’ve also applied it to their own lives and experiences in a meaningful way. I leave the meeting that day feeling inspired and hopeful; if we can get the next generation of activists, architects, doctors, lawyers, and government leaders on board at such an early age, how can we not succeed in changing our cities—and our health outcomes—for the better?
Over the next few years Sarah would invite me to see similar presentations by other youth. One came from high school students whose teachers worked with the Built Environment and Active Design Program to integrate our content on active transportation, active buildings, active recreation, and actively increasing access to healthy foods and beverages—in other words, Active Design—into their classes. This classroom brainstorming would eventually lead to successes such as those taking place in Harlem.
Harlem, New York, is a neighborhood in transition. Two decades ago, it was a dangerous spot, best avoided by anyone who didn’t live there. Today, Harlem is a hip and diverse place to live, with young singles and young families moving in in recent years. New cafés and their bustling patios pop up practically weekly, and celebrity chefs like Marcus Samuelsson, born in Ethiopia and raised in Scandinavia, are opening more and more trendy restaurants that attract local and international foodies alike.
Harlem is also home to Innovation High School—an educational facility that clearly highlights the important role students themselves can play when it comes to improving their schools. Through implementing workshops there that Sarah and I had previously created for youth and community residents, the students identified elements in the physical environment that presented barriers to healthy lifestyles: difficulties accessing stairways, for example, or a lack of access to drinking water. This in itself is great news—awareness is half the battle—but in Innovation High School, the students took things a step further by actively engaging in making the physical changes happen. They painted and installed murals on their stairwell walls, making the stairs an inviting space. They advocated for funding for new water fountains, and then decorated the spaces around them. And they created point-of-decision messages to remind their classmates to undertake healthy behaviors, like choosing water over a sugary drink. Evaluations conducted by my team and our partners in the initiative, including Mount Sinai Hospital, showed that healthy behaviors increased after the interventions.
As the kids themselves had correctly identified in our workshops, the environments outside their schools were also critical in terms of impacting their health. Did the sidewalks in the neighborhood make it possible to walk safely to and from school? Were there options for biking? What food sources could be found in the surrounding neighborhood? While the students have learned to look for and identify issues like these, they are aware that they have less agency outside their school walls. They need help, from community organizations and others who can think creatively about ways to get us all moving.
Playful Cities
I met Dr. William Bird for the first time in 2009, at New York City’s Walk21 Conference—an international conference devoted to walking and achieving livable, sustainable cities—where he was giving a keynote speech on health. His “day job” is as a family physician in London, but in spite of his trademark conservative suit, plain white shirt, and dark tie, William is no ordinary clinician. In addition to seeing patients, he is also the founder of Intelligent Health, a company dedicated to promoting physical activity. William is particularly interested in promoting walking. In fact, the company has an initiative—called Beat the Street—that turns walking into a bit of competitive fun. Working in tandem with a city’s transportation department, the company supplies devices that can be installed on street signs and other street structures. Working solo or in teams, participants pick up a Beat the Street card, which contains radio-frequency identification (RFID) technology, and then taps it against sensors called Beat Boxes when they are out and about. They receive points for each box they tap, and prizes for tapping the most boxes. The end result: schools, community groups, and businesses get motivated, and an entire community gets more active. In 2016, more than two hundred thousand people engaged in the program in the U.K. and beyond, and 78 percent reported becoming more active.
Programs like Beat the Street are particularly intriguing when it comes to enticing more children to walk to school—and for parents to let them. In 2005, a report from the CDC stated that only 15 percent of children in the United States walk to school. This contrasts with the 50 percent who walked to school in 1969 (a figure that rose to 87 percent for those living within a mile from the school). According to the CDC report, the barriers most commonly cited by parents with children aged five to eighteen years old were distance, traffic dangers, and weather. Weather clearly hasn’t changed significantly since 1969, but we are certainly building larger schools to serve larger areas, which increases walking distance. And wider roads designed for more and faster cars are also a modern trend.
William’s company is well aware of these dangers. And so, his scanning devices are installed on safe walking routes that have been mapped out for the schoolchildren. In some of his pilot sites in the U.K., “walking school buses” were created. These adult-supervised walks to and from school along safe routes have been tried and studied in other communities around the globe, including in North America, reassuring parents. With Beat the Street, everyone wins.
William Bird is certainly not alone in his goal of making physical activity fun and of getting cities involved. In November 2013, I traveled to San Francisco to attend the Design Like You Give a Damn conference, organized by Architecture for Humanity. Before it filed for bankruptcy in 2015, Architecture for Humanity was a Bay Area non-profit whose mission was to find architectural solutions to humanitarian issues globally. I had been invited to moderate a panel on Design and Health, which is where I met fellow panel member Darell Hammond. Darell spoke passionately about the importance of play for children—and for adults. He spoke about the loss of play within our society and our lives. He spoke about bringing play back. It was a pleasure to listen to him speak so passionately about a topic of shared interest.
Darell’s quiet manner can be deceptive; it belies a determination that has convinced many corporations to donate significant sums of money. When he’s not speaking at conferences, Darell is the CEO and founder of KaBOOM!, a non-profit organization that helps build playgrounds. Using a participatory design process, KaBOOM! elicits input from the community and even erects their playgrounds with the help of community members. One success story involves a community of just a few thousand people that was coping with several teen suicides every year. With funding in hand from their corporate donors, KaBOOM! got to work, making sure they engaged the community’s teens in the building process. In the year after the playground was constructed, there were no additional teen suicides. It’s a situation, I’m told, that the organization continues to monitor. Sometimes, play can be about much more than physical health.
I’d known about KaBOOM! for a few years by the time Darell and I met in person, but we hadn’t had yet found a way to work together. That changed a few months after the San Francisco conference, when I received an email from James Siegal, KaBOOM!’s chief administrative officer. He was going to be in New York City. Could we meet? Over iced lattes in Times Square on a hot summer afternoon, James got straight to the point: Would I like to take part in a summit that KaBOOM! would be hosting that fall?
As adults, few of us expect to attend work conferences on play—and yet, that’s exactly what KaBOOM!’s event turned out to be. In late October 2014—after several months of advisory discussions with KaBOOM!—I touched down in Chicago for the Playful Cities USA Conference. The next day, KaBOOM! staff dressed in purple and orange T-shirts greeted the organizers, advisers, and participants outside the venue, which was festooned with purple and orange balloons. They ushered us into a conference room, where chairs had been set up as usual at large, round tables. But there were signs that this conference was going to be something out of the ordinary: six-foot-tall “palm trees” lined the walls of the room, made out of more purple and orange balloons.
Darell stood on the stage at the front of the room. Once everyone was seated and the lights were dimmed, he began his welcome. Next, the CEO of Humana, the health insurance company that was sponsoring the conference, made his remarks. Soon enough, we were on to the highlight of the event. The attending cities, twelve in all, were there to share their play-related projects with one another, and to get advice from the panel of advisers (myself included). The idea was to talk about creating more playful cities in the United States. Over the course of the next several hours, we heard from Bloomington, Indiana; Brownsville, Texas; Chicago, Illinois; Durham, North Carolina; Memphis, Tennessee; Ottawa, Kansas; Pittsburgh, Pennsylvania; Providence, Rhode Island; San Francisco, California; Spartanburg, South Carolina; Washington, D.C.; and York, Pennsylvania.
It turned out, though, that Playful Cities USA was not the only conference dedicated to play. In fact, there is an International Play Association (IPA), and even a Triennial International Play Association Conference, which has convened nineteen times, to date. The IPA was formed more than fifty years ago in Denmark as the International Association for the Child’s Right to Play. Since then, more than forty countries have signed on to support the 1959 United Nations Declaration of the Rights of the Child, which includes the statement: “the child shall have full opportunity for play and recreation which should be directed to the same purposes as education.”
In 1989, the General Assembly of the United Nations affirmed these rights in its Convention on the Rights of the Child—“the right to rest and leisure, to engage in play and recreational activities, appropriate for the age of the child”—in addition to the rights to a name, nationality, health care services, education, protection against discrimination, protection against abuse/neglect/injury, and protection against economic exploitation.
In May 2014, the 19th International Play Association Conference was held in Istanbul, Turkey, and focused on the reasons for play, play spaces, and play and the media. In 2017, Calgary, Alberta, hosted the twentieth conference.
I learned that Calgary would be hosting the 2017 conference back in 2013, when I attended a roundtable there hosted by Vivo, a local recreation center whose vision and work has transcended its physical boundaries. Once known as Cardel Place, the center was renamed to allude to the life and living that can be fostered by play, recreation, and physical activity. Since 2013, Vivo has held two such roundtables to promote play and active recreation, both within its own walls and outside of them.
At that first gathering, Vivo had rallied a range of stakeholders—recreation department staff, non-profit organization representatives, and key political figures, including then premier Jim Prentice—to speak. In a keynote presentation, I shared my work with other cities and the lessons that could be learned around physical activity and play. The roughly two hundred participants actively discussed the state of play in Calgary and in the province of Alberta, and brainstormed the next steps needed to promote improvements in the paltry levels of physical activity seen in children and adults. Participants identified who was there and who was missing. Although many recreation professionals were present, it became clear after my keynote that there were others who needed to be engaged—planners, for example, and transportation professionals, without whom recreation and play facilities may remain less accessible for large numbers of children and adults. Calgary was off to a great start. In 2015, Vivo would host its second roundtable, again with its key partners the City of Calgary and Mount Royal University.
But Vivo’s commitment goes beyond dialogue. In the days following the first roundtable, Vivo asked me to meet with the architecture team from the design firm (aptly called Dialog) that was helping with their recreation center expansions. Vivo emphasized the need and desire for greater influence in the neighborhood and community. I suggested a model that would take them into the community as well as bring community members into their facility. We discussed such concepts as permeability and transparency of space and programming, where the community flowed into Vivo’s space and Vivo’s staff and programs flowed, in turn, into the community.
This idea of permeability is taking hold more and more, with greater efforts to bring play and activity programming outside the walls of formal recreation organizations. South of the Canadian border, the U.S. Centers for Disease Control and Prevention has provided funding to entities like the YMCA to stretch their play and recreation programs beyond their walls and into communities, particularly to try to connect with hard-to-reach populations, including the many people who have no desire to go to a gym. Other cities have taken a less formal approach, relying on programming delivered in a more ad hoc way, by residents.
The persistent buzz of the alarm pulls me from sleep. Groggy and disoriented, I squint at the clock: 4:00 a.m. A knock on my door startles me and I sit bolt upright and look around. It’s my second day in Taipei, and clearly, the jetlag hasn’t worn off quite yet. I call out to Radha Chaddah, on the other side of the hotel room door, that I will be ready for breakfast in fifteen minutes. I rush to put on my jeans and T-shirt and throw on a sweatshirt to protect me against the morning chill. I head to Radha’s room, where we both wolf down our room-service breakfast of eggs and fruit.
Radha and I are in Taiwan’s capital city because of a conversation we had several months earlier in Shanghai. Radha is in her mid-forties, a medical doctor, lawyer, and public health professional by training. We became friends in New York. She moved to Taipei, briefly, before relocating to Shanghai, where she and her husband now make their home. During her time in Taipei, Radha observed a phenomenon that aroused her insatiable curiosity—the use of public parks by seniors. During our Shanghai visit, after a morning tour of the newly renovated Bund walking path, Radha wondered if we could study the seniors in Taipei. “It’s amazing how they swarm the public parks every morning,” she said. “From my window, I could see every corner of the park across from our apartment filled with seniors exercising. Every day.”
Less than a year later and here we are. After Radha had proposed the idea, I started to look for funding. I’d been recently appointed an adjunct professor of the newly formed School of Public Health at the University of Alberta. A longtime colleague mentioned that he had some leftover funding. Dr. Don Schopflocher is a biostatistician who worked for many years with the Alberta Ministry of Health; he’d been my co-chair for a provincial chronic disease risk factor surveillance working group during my years as deputy medical officer in Edmonton, prior to my move to Atlanta. At the same time, Sylvie Stachenko, the new dean of Public Health at the University of Alberta, had asked me to assist her in the advancement of global initiatives for chronic disease prevention. Sylvie’s wish, Radha’s idea, and Don’s funding came together perfectly. If we could understand the phenomenon in Taipei, we reasoned, perhaps we could apply the lessons learned to promoting more play among the seniors in North America, too.
After our quick breakfast, Radha and I make our way to the lobby to meet Irene—our guide, translator, photographer, and videographer. It’s still dark outside when we climb into Irene’s car for the short drive to a nearby public park. We arrive a little before 5:00 a.m. The sun has only just begun to rise, but we can see from the pink and orange hues in the sky that it’s going to be a beautiful, sunny day. Radha and I clamber out of Irene’s hatchback. The early morning air is chilly; dewdrops still cling to the roofs of the cars parked overnight nearby.
From the park entrance we see that the space is already filling up. Men and women—elderly but agile—are everywhere. On the paths around the rim of the park we see some joggers, but mostly walkers. We wait for several seniors on bikes to ride past, conversing with each other while riding at a leisurely pace. As we cross the path and enter the park, we notice a large group to our right. Music plays as the paired men and women sway back and forth. Ballroom dancing. To our left is a playground, where seniors are using the equipment. One lifts his right leg onto a step leading up to the slide and leans into a stretch. Another hoists herself onto the monkey bars, swings her legs up and over, and drops from the bar to hang upside down. “Good for circulation,” a senior walking by tells Irene, who translates for me.
The number of seniors stretching and hanging off the children’s playground equipment is stunning. And straight ahead of us are even more. A large group of women move in step with each other as they follow a leader in the moves of a traditional Chinese dance. Next to them, another group of men and women lift their arms in unison in qi gong exercises to improve the circulation of their qi, or energy. Another group is two-stepping to country music, some with cowboy hats on. In the distance, seniors are playing Frisbee. It isn’t easy to make our way across the park through the crowds. Chinese dancing, western dancing, ballroom dancing, aerobics, tai chi, Frisbee, badminton, ball playing, walking, running, karaoke—groups stretch across the park lawn for as far as I can see.
After that first eye-opening morning, we settled into a regular routine. Irene would head off to take photographs and record video footage to document the incredible phenomena we were witnessing between 4:30 and 10:00 a.m. daily. Radha and I would use a data collection instrument called SOPARC to capture user counts and activity levels. We would each mark our observations on our own SOPARC forms and then compare them later. And when Irene was ready to translate, we would approach seniors and ask if we could interview them about their use of the park.
We visited five parks during our week in the city. We learned that seniors use the parks daily or nearly daily. They come to exercise but, just as important, to meet their friends. Most live near the park, although some travel by bus from farther away. Almost all said they felt safe, even at 4:00 a.m. when the sky was still dark. It was easy to see why. The presence of so many eyes in the park—watching from exercise groups, from their walks, from their bikes; watching upside down from the monkey bars—helped to ensure that unsavory activities didn’t occur. The group instructors (also seniors) told us they volunteered to lead the classes. They had a skill and time on their hands, they said, so why not share it with others? Why not contribute to their neighborhoods and communities? Those who took the classes often donated money to help the instructors pay for music CDs and boombox batteries, and the instructors told us they got a free permit from Taipei’s parks department to teach their classes. We asked if it was hard to get the permit. Not at all, they would reply. “We apply, and three days later we get the permit.”
Back in our hotel, poring over the day’s photos and footage, Radha and I would compare what we’d seen to the situation in North America, where so many seniors are isolated, forced into dependency on others by stiffening bones and joints exacerbated by the lack of movement and play, and, in many cases, by the lack of opportunities to move anywhere without a car. Even those who might live within walking distance of a park find themselves at a loss for company in these facilities that are too often empty of people on weekdays. Play is not a part of their lives. We’d ask ourselves: What can we learn from Taipei? How can we bring more play into the lives of adults, and particularly seniors, in North American cities?
Seven years have passed since our study in Taipei. Our paper was published in 2014, along with a YouTube video entitled Understanding Older Adults’ Use of Green Spaces in Taipei, Taiwan, put together from Irene’s footage. The response has been encouraging. Parks and recreation departments across North America have joined the discussion, asking how we can bring more play into the lives of adults, children, and seniors.
Creating Space for Play
My visit to Taipei underlined something I’d known for a long time: while it’s absolutely wonderful to give children and families an opportunity to play safely on city streets, and to ensure that physical activity is a part of the day from the earliest years right on through to adulthood, progress on that front doesn’t negate the need for open spaces, green spaces, and dedicated play spaces in our cities. In 2010 developer Jonathan Rose described to Fit City 5 attendees the ideal developments for people and the environment. What we should strive to achieve, he said, is “density with green spaces, density with spaces for respite.” With density, achieved by mixing a variety of housing types, comes a sufficient number of people to make amenities nearby such as stores, schools, and parks possible and affordable. That’s a good thing. But density is also…crowded. All of those people whose purchasing power and taxes support amenities can be a bit much at times, and we can find ourselves needing a break. That’s where space for play—in one form or another—comes in.
But in cities like New York—ones that are very nearly fully built, with boundaries that prevent further geographic area growth—building such spaces is not always an easy feat. An important driver of the innovations for open spaces, green spaces, and play spaces in New York City has been PlaNYC 2030—the same plan that helped to drive the expansion of bicycling infrastructure, pedestrian amenities, and Bus Rapid Transit. On the green space front, the stated goal was for every New Yorker to live within a ten-minute walk of a park or playground. Areas without space for new parks and playgrounds—and where residents lacked access to them within a ten-minute walk—would be targeted for new parks through renovations of and community access to schoolyards, or through the creation of pedestrian plazas that could function as pocket parks. The expansion of the Play Streets programs was introduced as one way to reach the “ten-minute access” goal. In 2011, an updated version of PlaNYC was released. With the work I had been coordinating across different New York City agencies, we were able to integrate public health as a PlaNYC goal in and of itself (as opposed to a pleasant offshoot of other goals).
With PlaNYC offering a roadmap of sorts, the Department of Parks and Recreation has been working with organizations such as the Trust for Public Land to convert schoolyards into community playgrounds. Since 1996, more than 180 playgrounds have been built in New York City schools by this partnership, adding up to 150 additional acres of play space serving 4.5 million additional residents. The spaces are used by the school during school hours and remain open for community use during non-school hours and on weekends. Community participation has been a vital part of the process, with input from school staff, students, parents, and residents gathered during three months of participatory design. The resulting spaces have transformed barren asphalt into brightly painted track facilities, with athletic and play amenities and equipment desired by students and nearby residents.
The parks department has been busy in other ways as well. An initiative that began during Mayor Michael Bloomberg’s administration and continues today has seen more than 850 acres of new parkland added to the city, much of it along the waterfront. New recreational facilities were opened in all five boroughs. New York City beaches have become more accessible, with mats placed on the sand to allow those in wheelchairs to move themselves to the water’s edge. And residents and tourists alike can now bicycle, rollerblade, run, or walk nearly the entire length of the west side of Manhattan alongside the Hudson River on a greenway protected from car traffic. The hope, moving forward, is to encircle Manhattan in a continuous greenway loop that features a variety of amenities: tennis courts, basketball courts, art installations, free kayaking, restaurants, and water fountains.
To attract users of different types, with different interests and different needs, a variety of types of parks and play spaces is important. So, in addition to community playgrounds and large parks with facilities for team or individual sports, it’s great to have parks for walking or bicycling to and then simply hanging out. One of the crowning achievements of Bloomberg’s administration was the creation of just such a space: the now world-renowned High Line Park.
Perched above the city streetscape on the west side of lower Manhattan, and in part inspired by Paris’s Promenade Plantée, the High Line is a walking park that opened in June 2009. It’s a wonderful space, nearly 1.5 miles of a linear path that takes you under buildings, through ever-changing art installations next to the path and sometimes painted or projected onto housing and commercial buildings that abut the pathway, through landscapes and skylines; a view of the Empire State Building is available from one angle, and the distant Statue of Liberty can be seen from another. You can walk through grassier areas, areas with more vegetation and trees, areas with more buildings around you, areas with water features where you can remove your shoes and dip your feet in summer, areas with drinking fountains that also water the plants around you, areas with benches made from the wood of the old railroad tracks and placed right onto the metal tracks left behind on the path. There are amphitheaterstyle seats with a rectangular frame suggesting a screening you should watch, but in place of a screen, you see the street life of the city below and in front of you. And it all sits, believe it or not, on abandoned elevated railway tracks.
Opened in 1934, after street-level tracks were deemed to be causing too many accidents, the elevated High Line tracks connected freight trains directly to factories and warehouses. Raw and manufactured goods, as well as meat, produce, and dairy products, could be transported and unloaded without disturbing street traffic. For a time, the practice was revolutionary, but as truck transport increased throughout the United States, rail traffic dropped, and after the last train rumbled through in 1980, the tracks fell into disrepair. Demolitions were petitioned for and expected, but in 1999, two friends, Joshua David and Robert Hammond, discovered the abandoned tracks and decided a different outcome was possible. They founded the conservancy organization called Friends of the High Line, and soon after, pictures of the abandoned tracks began to surface—overgrown with native grasses and weeds, but with the beautiful New York skyline above, and the Hudson River just to the west. It didn’t take long for the movement to save the High Line to gain momentum.
Soon after Mayor Bloomberg was elected, Amanda Burden was appointed commissioner of New York City’s Department of City Planning. Amanda quickly became a Friend of the High Line, and along with the conservancy founders, began to envision a new amenity for the far west side of the Chelsea neighborhood. They pictured a world-class park perched above the city’s streets, with vistas of the Hudson River and views of New York’s greatest landmarks, from the Statue of Liberty to the Empire State Building. With Amanda’s urging and support, the City of New York got on board.
The process wasn’t easy. Complex and creative zoning methods were used to compensate the developers who’d purchased the property below the tracks with an eye toward developing it following demolition. The City transferred the property rights to other available City-owned lands, nearby but away from the tracks. Though the Friends of the High Line worked hard to raise money, the City of New York also invested dollars—in the nine-figure range—into the redevelopment project.
In 2006, breaking ground for the tracks’ conversion began with landscape architecture firm Diller Scofidio + Renfro and planting designer Piet Oudolf. The parks department’s Charles McKinney and I worked with Claire Weisz of WXY Studio to design and place new and innovative health- and environment-enhancing elements within the park space (including those innovative water fountains without drains described in chapter 2). Users would never have to shy away from drinking zero-calorie healthy tap water from a clogged fountain, and the water draining off the front of the fountain would run into the ground to quench the surrounding plants. Since the High Line’s opening, residential and commercial real estate development and retail business around the park has boomed. The City has recouped its investment dollars many times over to the tune of billions, and now, with Phase 2 opened in 2011 and the third and final phase opened in 2014, both financial returns as well as users of the park continue to soar. As of July 2014, over twenty million people had visited the High Line.
The use of old railway tracks and unused and abandoned lands to create rejuvenated spaces is not unique to New York City. Many other cities have embraced rails-to-trails projects. In the United States, a national non-profit organization, the Rails-to-Trails Conservancy, based in Washington, D.C., is working to create a network of trails on unused tracks across the country.
My old haunt, Atlanta—home of the Centers for Disease Control and Prevention, and the birthplace of this work for me—has also been busy on this front. The Atlanta Beltline is a greenway trail being developed from a twenty-two-mile abandoned railway track encircling downtown Atlanta. The development is far-ranging and includes considerations for transit connections, housing (including affordable housing), and green space, as well as a greenway that connects forty-five different neighborhoods in town. It was conceived in 1999 by Georgia Institute of Technology student Ryan Gravel as the work of his master’s thesis. Though far from a done deal (2030 is the anticipated date of completion), four sections of the Beltline and six new or renovated parks are now open.
And then there’s Seoul, Korea. The Cheonggyecheon area in downtown Seoul was named after a stream, though until recently you’d have been hard-pressed to figure out why. For many years, that beautiful stream—which had once run near several historical palaces—was covered by a highway. In 2003, Mayor Lee Myung-bak began a massive undertaking to remove the fifty-foot-wide highway built in 1976, and to pump 120,000 tons of water back into the dried-up streambed. The huge undertaking was part of an effort to revitalize the downtown economy, to restore the area’s connections to Korean culture and history, and to introduce greenery into a concrete urban jungle.
In 2006, the newly restored stream and a series of pedestrian paths were opened to the public to great acclaim and delight. But this wasn’t the only good news associated with the project. As Mayor Myung-bak had hoped, there were environmental and economic benefits as well. Temperatures in nearby areas, which had previously been heat islands due to all the concrete and steel, cooled to healthier levels. Cheonggyecheon is now listed as one of the major tourist attractions in Seoul. Within a decade, it had become a cultural and economic center for the city—proving once again that public health and economic health need not be mutually exclusive, and that all of our cities have something to gain by embracing play.
Sharing Knowledge
The topic of play was front and center at the 2013 Active Living Research (ALR) Conference in sunny San Diego. That’s where I met Suzanne Davies, who was working with Nike on their Designed to Move project. Nike had created Designed to Move as a vehicle for working with partners to promote physical activity. At the time, they were deep into the first component: Active Schools. They were, however, interested in a second component: Active Cities. At the ALR Conference, Suzanne heard all about the growing research showing the strong links between how we design our cities, buildings, streets, neighborhoods, and their amenities, and physical activity levels in our children, adults, and seniors.
Soon after Suzanne returned to Portland, Oregon, where Nike was headquartered, she asked me to take part in a conference call with some of her staff. Designed to Move wanted to use the available evidence on the built environment and physical activity to transform cities around the world. Nike certainly knew how to do marketing. So, how could we combine those marketing skills, the available evidence being generated by researchers around the world, and my experience helping municipal governments to make more cities more active?
Together we would embark on a journey, along with other partners, to create Active Cities: A Guide for City Leaders. Designed to Move began by convening a group of experts in New York City in the fall of 2013. Researchers from the United States, Brazil, China, and beyond took part, along with non-profit organizations focused on play, like KaBOOM! and the Trust for Public Land. Dr. Jim Sallis of Active Living Research and I were asked to facilitate discussions that would summarize both the research and the processes and strategies for action. During a break, I intercepted Jim at the coffee station. Something was on my mind. Why stop at physical activity outcomes? I wondered. Wouldn’t it be helpful to policy-makers, like the ones I worked with in cities around the world, to know about the other outcomes that could result from interventions to improve our buildings, streets, and neighborhoods for physical activity? Outcomes related to the environment and the economy, for example? I told Jim that I’d encountered a few studies on the topic, but nothing more. “To have all of this summarized in one place would be amazing,” I said. Jim agreed.
Published in 2015, Active Cities did just that: in the very first section of the guide, we summarized the multiple outcomes and benefits cities could reap if they designed their environments to promote physical activity. The paper I’d released—along with the team from the Johns Hopkins Center for Injury Research and Policy and the Society for Public Health Education—had already demonstrated the overlap of strategies for physical activity and injury prevention. Now we’d have a document that showed a host of other important benefits to community leaders.
The guide’s second section showed city leaders what to do—step by step. In my experiences across multiple cities, key actions had emerged. First was to prioritize physical activity by creating visible leadership on the issue; integrating physical activity directly into the goals of a city’s master plan and guiding documents; and aligning city departments on the issue. Next, city leaders needed to think about making existing resources in their city active resources. All cities have streets, so it would be important to ensure that these streets accommodated active transportation modes such as walking, cycling, and transit, not only sedentary ones like the car. And since all cities have buildings, ensuring that physical activity opportunities are built into the building’s amenities for occupants, such as the ability to use pleasant and safe stairs, would be crucial. Active play resources could be made even more accessible and safe: schools could open up their playgrounds and play spaces for the community to use after hours; play amenities could be lit at night to extend the hours of play.
It was also crucial for city leaders to design for people to be active. To do that, city leaders needed to find out what their residents wanted and to design for them; they needed to ensure everyone would be included, especially those most vulnerable to inactivity, such as those who might have disabilities, the elderly, and teenage girls, among others. Affordable access also must be considered and improved for those whose incomes may make it challenging to access costly recreation programs and facilities. And physical activity considerations had to be integrated into all city policies. Finally, city leaders needed to create a legacy of physical activity by activating public demand for it, and by leaving behind lasting infrastructures and policies that would promote physical activity.
The group that met in New York in the fall of 2013 to discuss Active Cities had also recommended including case studies from around the world. To keep the guide from getting too big, it was decided that ten case studies would be used, reflecting cities of different sizes and cultures: Hernando, Mississippi (population 15,000); Buenos Aires, Argentina (population 3 million); New York, New York (population 8.2 million); Copenhagen, Denmark (population 2 million); Rio de Janeiro, Brazil (population 12 million); Medellin, Colombia (population 3.7 million); Red Deer, Canada (population 100,000); Bristol, U.K. (population 437,000); and Adelaide, Australia (city population 22,200; state population 1,685,700).
The range of sizes and types of cities was a testament to the progress feasible across the globe. In Hernando, Mississippi, with a population of 15,000, there were many streets that were wider than necessary, and the city used the opportunity to paint bicycle lanes on them. Highway underpasses, previously used to move cattle in the 1960s, were repurposed into safe pedestrian and cyclist crossings. Empty pastures were transformed into fields for youth soccer programs. Medellin, Colombia, a city of nearly 4 million residents, was featured for its public parks with free exercise equipment as well as its cable-car system created to connect people without access to other transportation to public parks and even to jobs. Red Deer, Canada, with its approximately 100,000 people, was featured for its new sidewalk-clearing policy standard, as well as for making better connections between recreational paths and on-street bicycle lanes and better connections between transit stops and sidewalks and trails.
One of my favourite parts of Active Cities, though, is likely something few others would even notice. In the last few pages of the guide—after the resource section and several pages of citations—is an impressive list of key contributors and participants. The National League of Cities in the United States is there, along with the Urban Planning Society of China and EMBARQ Brasil, an organization dedicated to improving urban planning and transportation issues in Brazilian cities. The United Nations Development Program, which helps to build cities in under-resourced countries, is also noted. Even now, a few years after the guide’s publication, I smile when I look at this page. To me, this list represents support and buy-in. It represents like-minded organizations, cities, and governments. It’s an enormously satisfying list for someone who has devoted her career to exploring the links between how we build and design our cities and our health. These organizations and governments—these people—are allies in the fight to use much-needed interventions to improve our health outcomes.