Joao Breda, Jo Jewell, Francesca Racioppi, Lea Nash and Stephen Whiting (WHO Regional Office for Europe).
Louise Vogel Kielgast, Shin-pei Tsay (Gehl Institute)

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Insufficient physical activity is a growing challenge that directly and indirectly impacts the health of individuals and communities in Europe. Increasingly sedentary lifestyles also contribute significantly to the obesity epidemic and high rate of noncommunicable diseases, such as cardiovascular diseases, cancer, chronic respiratory diseases and diabetes. This creates a substantial burden on society through growing costs to the health system and lost labour productivity. Around 80% of European citizens are expected to live in urban areas by 2030 as the populations of cities expand. Urbanization often leads to a heavy reliance on motorized transport and this, combined with limited access to green spaces and recreational areas, reduces opportunities for physical activity.

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There is a need for innovative approaches aimed at increasing the ability of people living in dense urban areas to be physically activity. The relationship between physical activity and environments has been the focus of many studies and the built environment has consistently been shown to be a key factor that influences physical activity levels among local populations. However, the health sector alone lacks the capacity to implement interventions at the scale required for the population to be able to meet the recommended levels of physical activity. Support from other sectors, such as transport, urban planning and education, is therefore required to support the integration of physical activity into people’s daily lives.

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Planning and designing for physical activity can provide multiple co-benefits. Cities seek solutions that achieve multiple objectives simultaneously, such as integrating sustainable transportation, land use and urban development. For decades, urban planning was dominated and driven by a strong focus on cars, but fortunately the focus is now shifting towards creating cities for people, in which active mobility is encouraged. Considering the needs of walkers and cyclists through better transport planning (e.g. well-connected and attractive footpaths combined with traffic-calming measures) can encourage more active transport, and at the same time, improve traffic safety. Likewise, more people walking or cycling also provides more eyes on the street, which enhances the sense of security and livability and may also contribute to crime reduction.

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Another co-benefit of designing physical activity promoting cities is the impact on the environment. Air pollution is the greatest environmental health risk for European cities. Sustainable transport strategies, such as those aiming to increase cycling and walking, can reduce congestion and emissions of pollutants due to the reduced need to travel long distances, ultimately leading to health benefits.

The quality of the urban environment can both increase and minimize health inequalities. Growing inequalities are a global problem found at country, city, and even neighborhood levels. Interventions, such as increasing or improving green spaces in cities, can deliver positive health, social and environmental outcomes for all populations, but particularly among lower socioeconomic groups. Similarly, active transport measures, such as building paths for walking and cycling, or redesigning abandoned spaces, can increase physical activity levels in populations that most need it, especially if implemented in combination with a more integrated public transport system that considers people’s needs

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While there are many opportunities, there are also challenges when it comes to promoting more physical activity across all cities. While smaller cities can more readily find a balance of sustainable transportation and quality public spaces to promote physical activity, this can be a challenge in larger cities. Megacities face difficulties to accommodate the diverse travel demands of large populations across a much larger land area, and integrated public transit options need to play a significant role along with walking and cycling. While this is often a matter of responsibility of local authorities, cities are often in the driving seat to initiate change. Intergovernmental coordination between cities, surrounding regions, and national governments can maximize opportunities for action, facilitate the exchange of knowledge and experiences, increase access to the necessary resources and capacities, and ensure policy coherence across all levels of government.

If any of these strategies are to have a real impact on people’s patterns of physical activity, it is vital that these plans set clear goals and success criteria which can be monitored and evaluated. Such mechanisms can inform future projects and help build the political courage to continue into the future. Because the issue of physical inactivity represents only one of the many challenges cities are facing worldwide, these changes will require an integrated approach in which physical activity promotion is not seen in isolation but allows cities to simultaneously achieve multiple objectives through cross-sectoral collaboration. Lastly, understanding people’s needs and the way in which behaviours are affected by the quality of the urban environment are crucial elements for the success of these initiatives.

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The cities that are most successful in promoting physical activity have a strong vision of the kind of city they want to be, allow pragmatic solutions to be adopted along the way and identify specific measures to be implemented. Encouraging more physical activity does not necessarily mean that cities have to draw up specific planning documents for this purpose; it is generally just as effective to integrate considerations for physical activity into existing urban planning initiatives. In some cities, however, a more radical change in overall vision and policy is required.