Unwittingly, we now recognise that we have created ‘obesogenic’ environments that encourage both inactivity and overeating, writes Billie Giles-Corti.
Australians are global leaders in the obesity epidemic: two thirds of Australian adults, and one quarter of Australian children, are overweight or obese. Less than one half of adults do sufficient physical activity to benefit their health: this is as little as a ½ hour walk every day. It is easy to see this as the individual’s problem, but alarm bells are ringing in health circles in terms of the health impact of these trends on of all the major preventable diseases: type 2 diabetes, cardiovascular disease and cancer. These chronic diseases will get worse unless action is taken. The impact of the health budget will be massive: the South Australian government estimates that by around 2030, the health budget could outstrip state budget unless the chronic disease burden can be curbed.
What’s causing the problem? Insufficient physical activity, sedentary lifestyles and poor diet are main factors causing the obesity epidemic. You might say that people choose how active they are, and what goes into their mouth. But the environments where they live, work and play make it easy or difficult to choose a healthier lifestyle. Unwittingly, we now recognize that we have created ‘obesogenic’ environments that encourage both inactivity and overeating. There is also talk of socially isolating ‘depressogenic’ environments partly the result of the creation of ‘sub-eternity’ – suburbs that go on for eternity, with no local shops and services, no public transport and long commuter trips for residents.
Solving this problem goes well beyond the health sector with most of the solutions to preventing major chronic diseases lying in sectors outside of health. Decisions made by state and local government and the private sector create the conditions for good or bad health: For example, what and how foods are manufactured, sold and marketed; how easy or difficult it is to walk or cycle as part of a daily routine; whether there are places to go to, or things to do locally, which together help build community and local social support.
Where you live matters: recent research undertaken by a University of Melbourne and University of Western Australia team, found that even in car dependent Australian cities, people will walk more if they live in neighbourhoods that have places to walk to. In neighbourhoods with different types of destinations (a shop, newsagent, delicatessen, DVD store, post office, supermarket) people walked an additional 5.8 minutes per week for each one present. If they had access to local recreational destinations (e.g., a park, a sports field, a beach), people walked an additional 21 minutes per week for each type available.
Neighbourhoods can be designed to get people out of their cars by providing places to walk or cycle. Rather than designing low density suburban sprawl with poor access to local shops, services, jobs or public transport and big box shopping centres, we need to rethink and build compact pedestrian-friendly neighbourhoods with a mix of uses (shops, services, public open space plus houses) across the whole neighbourhood, and access to public transport and public open space. A key factor is increasing the number of people who live in suburbs so that more people will have accessible shops, services and public transport. Also how can more people move into established suburbs and still maintain a good quality of life for all residents – surely we have the creativity to make this a reality? We also need services in new communities when, or shortly after, people move in: people shouldn’t have to wait a decade (or two) to get their local shop, school, or public transport stop.
We couldn’t imagine building a new neighbourhood without roads, drains and sewerage: We need a paradigm shift in the way we build new communities: we need to get to the point where we couldn’t imagine building a new neighbourhood without timely delivery of all of the social infrastructure required to support health living.
The World Health Organisation has called for ‘health and health equity’ to be at the heart of the planning and governance of cities. The major factor influencing peoples housing choice is affordability. However in the desire to provide people with big houses they can think they can afford on the urban fringe, are governments condemning people with lower incomes to live in ‘obesogenic’ and ‘depressogenic’ environments and all the health impacts that is likely to bring? Surely in a civilised society we can do better than that.
Professor Giles-Corti, a NHMRC Principal Research Fellow, has recently taken on the role as Director of the McCaughey Centre at the University of Melbourne.