Stepping Into Healthier Communities

Vivek H. Murthy, MD, MBA

VADM, US Public Health Service

Surgeon General

More than 1 year ago, I urged Americans to lead more active lives by walking or wheelchair rolling. Step It Up! The Surgeon General’s Call to Action to Promote Walking and Walkable Communities ¹ was a triumph of collaboration between my office and partner organizations ranging from nonprofits and industry to government. I still vividly remember the event that we held in the fall of 2015 at the Kaiser Permanente Total Health Center in Washington, DC. As I prepared my remarks that morning, I reflected on my personal journey in staying active and the journeys of my family and friends. For example, my mother always puts others first, but I encourage her to take better care of herself by adding activity into her daily routine. In fact, I called my mother the night before the Call to Action was released. I could not feel confident telling the nation about the importance of walking without knowing that my own mother was putting that same belief into practice. She heard me and decided that the next morning she would go on the first of many future walks around her neighborhood.

Walking, as simple as it may seem, is an easy way to build physical activity into our lives. As little as 2.5 hours of brisk walking a week—which is just 22 minutes per day—can substantially reduce the risk of heart disease and diabetes. ¹ In fact, even more physical activity has been shown to reduce the risk of colon and breast cancers. ² Chronic diseases are the leading causes of death in the United States and a major factor in rising health care costs for Americans. ^3,4 However, half of adults aged 18 or older do not meet the current guideline for aerobic physical activity. ⁵ Participating in regular physical activity can reduce the risks of chronic disease, lessen the severity of disease symptoms, and improve quality of life and emotional well-being. ²

Physical activity offers a powerful solution to improve health across the life span. Physical activity such as walking supports brain health related to academic performance in children ⁶ and healthy aging in older adults. ^7,8 Brisk walking is a simple way to meet the US Department of Health and Human Services’ 2008 Physical Activity Guidelines for Americans that does not require special skills, training, or equipment and can be done almost anywhere. ² Despite the known health benefits of physical activity, too many communities lack safe or accessible spaces for people to walk or wheelchair roll. In 2013, 4735 pedestrians were killed in motor vehicle–related crashes, and an estimated 66 000 people were injured in motor vehicle–related crashes on public roadways. ^9,10 Much can be done to make communities safer for walking or wheelchair rolling. Communities can change the design of streets to provide safe spaces where people can walk and use wheelchairs—space that is separated from motor vehicles. They can use design features to slow traffic and increase the number of safe pedestrian crossings. ¹

Creating walkable communities is not only about traffic safety, however. Space design and perception (eg, perceived safety and curb appeal), neighborhood maintenance, and other built environment features can affect people’s willingness to be physically active. ¹¹ Communities that are safe for walking also can reduce air pollution and greenhouse gases, as residents choose to walk or bike rather than drive. ^12,13 Walkable communities are also attractive to businesses, which can help local economies thrive. ^14,15 Everyone deserves a safe place to walk, and more communities recognize the multiple benefits of designing walkable and inclusive spaces.

Organizations and communities across the country responded to my 2015 Call to Action and are working to improve their neighborhoods’ walkability. The following are a few of my favorite examples:

America Walks (americawalks.org)—the only national organization devoted exclusively to walking—works with more than 700 local, state, and regional organizations to build walkable neighborhoods and improve the environment so that walking is safe, convenient, and accessible to all. After the release of my 2015 Call to Action, America Walks began working with regional offices of federal agencies, including the US Department of Health and Human Services, the US Department of Transportation, and the US Environmental Protection Agency, to develop events and policy initiatives related to the promotion of Step It Up! America Walks also conducted a nationwide survey of more than 300 organizations about how they were implementing the Call to Action. America Walks and the Every Body Walk! Collaborative partnered to create a casebook called America’s Walking Renaissance: How Cities, Suburbs and Towns Are Getting Back on Their Feet. ¹⁶ The casebook highlights examples of local advocates’ efforts to make communities more walkable.

Walk With a Doc (walkwithadoc.org) is a national organization in which doctors and other medical professionals lead walks in their communities. Since the release of the Call to Action, Walk With a Doc has received 612 requests for walks and added 115 chapters to its roster, which is an average of 1 new walking community started every 2.5 days—an increase since the Call to Action launch. These requests have come from hospital systems, medical associations, universities, parks, physicians, residents, and medical students. Medical student requests have even led to a successful new branch of the organization, called Walk With a Future Doc.

GirlTrek (www.girltrek.org) is a nonprofit organization dedicated to improving the health of black women and girls across the country. GirlTrek’s mission is not just to walk for exercise; it is about coming together and walking to heal, inspire, empower, and take ownership of neighborhood streets and communities. In a few short years, GirlTrek has grown to a force of more than 65 000 black women and girls who walk daily in local parks, trails, and streets to exercise and to reclaim community space. In partnership with the Sierra Club, GirlTrek recently trained 13 women to become outdoor trip leaders. From Sacramento, California, to Chattanooga, Tennessee, these women lead nature walks and hikes in their hometowns. In 2016, GirlTrek invested $10 000 to support volunteers who walk their neighborhoods to identify areas in need of improvement in their communities. The results included a rooftop school garden in Houston, Texas; support for the nation’s oldest black-owned swim club in Yeadon, Pennsylvania; and a mural project in Baltimore, Maryland.

Since I announced Step It Up! in 2015, many other organizations have promoted the Call to Action. I have participated in more than 30 events across the country in which communities have invited me to showcase their work to make communities walkable. I partnered with Pandora, the music streaming service, to launch a Surgeon General’s Walking Playlist to make walking fun with music.

The impact of the Call to Action goes beyond the United States. The Physical Activity Network of the Americas (RAFA/PANA)—a network of national organizations from Canada, the United States, Central America, South America, and the Caribbean—is working to improve the health quality of life in member countries through physical activity (www.rafapana.org). RAFA/PANA is modeling its efforts after the sectorial approach outlined in the Call to Action by expanding Ciclovía—the regular closing of major streets to encourage active transport and walking opportunities—and by focusing on the roles that health care, education, and the workplace can have in promoting physical activity.

Our efforts to increase physical activity through simple solutions such as walking did not stop with the release of the Call to Action. As I travel the country, I am encouraged to see communities that make walking a top priority. These changes do more than just create healthier lives; they also create more equitable communities. I am further encouraged by the employers and health plans that have created more incentives for active living. Even my mother has become a convert: she started a walking club in her neighborhood. It is small steps like these that make a big difference in our nation’s health. I encourage and challenge America to Step It Up! and be physically active every day.