Jim Sallis has a unique presentation opener: he asks his audience to immediately get out of its chairs.
"Sitting is not that great for you!" Sallis proclaimed to a packed Council Chamber at Metro Regional Center on Tuesday, Oct. 7. With that, he politely requested that everyone stand up and start applauding.
The distinguished professor of family and preventive medicine and director of Active Living Research at the University of California-San Diego looks at nearly every place – whether a city street, a building or a lecture at Metro – as an opportunity to get people more active, and thus healthier.What Sallis calls "active applause" is the first clue that he takes healthy environments very seriously. (He also clearly enjoys a standing ovation.)
Sallis was kicking off a statewide tour for the Healthy Community Speaker Series, sponsored by several public and nonprofit planning and health agencies. As he does wherever he speaks, he arrived with a stark message: the shape of American communities is literally making people sick. But he also presented a silver lining: the cure could be all around us.
Here are five key messages Sallis delivered:
What Sallis calls the "Great Physical Activity Elimination Project" has been dangerously successful.
Americans get far less physical activity today than previous generations. Why? In part, because we've designed activity out of nearly every aspect of our lives. Television and other devices make up more of our leisure time. Many people work largely sedentary jobs. Labor-saving devices have made chores less physical.
But most importantly, we've stopped being active when we get around. Most American kids used to walk, bike or take the bus to school; now most are driven in cars. The vast majority of adults drive to work, drive to shop and drive home. Even those who want to walk or bike often live in neighborhoods where it is too dangerous or too far to access key destinations by any mode other than driving.
In short, most Americans sit when they travel, sit at work all day and sit when they get home again. In our culture, "you just don't need to be active anymore," Sallis said. "Unless you want to be healthy."
It's making us sick.
"Most people are not active enough, and it's not getting better," Sallis said. Physical inactivity is the number-four cause of premature death nationally. People are often surprised to learn how many chronic diseases are related to inactivity: diabetes, yes, but also breast cancer, colon cancer and heart disease. Moreover, some places suffer more than others. "There's no equal access to activity-friendly environments," Sallis said. Lower-income and older adults often experience even less physical activity than their wealthier and younger counterparts – and as a result face more chronic diseases.
Places that are good for walking, like downtown Milwaukie, help more people stay active and healthy.
The cure could be all around us.
Despite the dire picture, Sallis is not dour. "The positive way to spin this is to say we have a huge opportunity," he said. "Our solution is to have more fun getting around, and to make it easier for more people to have fun," he added cheerfully.
For Sallis, this means beginning with how we plan and design communities. "Physical activity happens in places," he said. Places where it's easier to walk or bike are also places where people are more active – even incrementally so – and thus they are healthier.
Sallis cited a study comparing very walkable and less walkable neighborhoods in Seattle and Baltimore. Researchers found that in neighborhoods that were more walkable, people got five to seven more minutes of activity a day, regardless of income and other factors. That may not sound like much, but over the course of the year it adds up to as much as additional 10,000 calories burned, the equivalent of three pounds of body weight – far more than the average American gains in a year. And indeed, obesity rates are significantly lower for residents of walkable neighborhoods than less walkable neighborhoods.
There is no single fix.
Sallis emphasized that encouraging activity in daily life depends on a comprehensive approach to rethinking a community's form. "It's about putting the pieces together," Sallis said. While studies from around the globe have indicated that mixed use development, sidewalks, lighting, street furniture and safe crossings all make a place more conducive to walking, for instance, it's only when several of these features are present simultaneously that researchers see really significant increases in daily physical activity. Studies, have made similar discoveries about getting more people on bikes. No single element makes the difference. It takes a holistic approach to get more people walking or biking more often, Sallis said.
Sallis (left) joined city of Tigard officials for a walking tour that included the Fanno Creek Trail.
Later in the day, Sallis saw such a holistic vision in action when he took a walking tour of Tigard, where city officials have released a strategic plan seeking to make Tigard the most walkable city in the Pacific Northwest. The tour, which included the Fanno Creek Trail, ongoing pedestrian improvements in downtown Tigard and a more traditional suburban neighborhood, provided many opportunities for Sallis to highlight the importance of an integrated approach to making neighborhoods more walkable.
Among the more innovative elements he noted – local art along the Fanno Creek Trail that adds visual interest for people walking. It takes many pieces to make the puzzle work, Sallis noted.
Melissa Baker, asset manager for Tigard-based nonprofit Community Partners for Affordable Housing, was also on the tour and agreed with this perspective. "It is tempting to consider large-scale work in increasing physical activity and community connectivity," she said. "But it takes a series of small activities and improvements to create sustainable transformation."
No one can do it alone.
Above all, Sallis said, professionals in the planning and public health fields need to get out of their silos. "Partnerships are essential," he said. "Working together is not optional."
Noting that the healthcare industry has no direct control of places but must deal with their impacts on health, Sallis urged health professionals to learn more about how land use and transportation decisions are made and dollars are allocated. And planners should consider the long-term health effects of their plans, too, he said. In the long run, he said, communities will find that thinking about health in planning also helps them meet other goals, including economic development, equity and reducing pollution.
Oregon Public Health Division director Lillian Shirley told the Metro audience that collaboration is essential.
In this, Sallis echoed a theme emphasized in introductory remarks by both Metro Councilor Bob Stacey and Lillian Shirley, director of the Oregon Health Authority's Public Health Division, one of the co-sponsors of Sallis' tour.
"The relationship is simple," Stacey said. "Places where people can walk, bicycle or take transit easily are also places where people find it easier to be healthy."
"Sometimes we make things more complicated than they need to be," Shirley agreed. "We need to think about each other's goals as complementary." Five of the Center for Disease Control and Prevention's top ten strategies for getting people more active are things that planners help shape, she noted. "If you're in charge of these [planning] agencies," she added, "you're a health director too."
Tigard city councilor Marc Woodard, who joined Sallis for the afternoon tour in Tigard, emphasized that his city is working for exactly this integration – and hoping to reap rewards in more than just health. "[Tigard] has made walkability a centerpiece of its strategic vision," Woodard said. "This vision will impact city land use and transportation planning, and promote a culture that helps our residents and businesses live healthy, productive and interconnected lives, where everyone benefits for the long haul."
As for Sallis, he'll continue whipping up "active applause" as he discusses healthy places all over Oregon. After a Tuesday evening presentation in Beaverton, his tour moved on to Salem, Eugene and Bend.
Find a healthier way to take your next trip