In June, I asked “does it matter where we live?” in view of the increasing urbanisation and ageing of the world’s population.
Around three quarters of Europe’s population live in urban areas and the world’s urban population stands today at almost 4 billion. This has been a massive degree of urbanisation for the world given that world urban population amounted to less than ¾ billion in 1950. Roughly another 2.5 billion people will swell the numbers living in urban areas around the world by 2050.
The world is ageing too, both at an individual and population level. At an individual level, life expectancies at birth have increased at the global level from 48 years in the mid-20th century to around 70 years today, and are expected to rise to 76 years by the mid-21st century. At the population level, the proportion of the world’s population aged 60 years and over has increased from 8 per cent in the mid-20th century to 11 per cent, and by 2050, it is expected to reach 21 per cent, equating to more than 2 billion people. By 2030 the number of people aged over 60 years is estimated to increase by 38 per cent in the United Kingdom, from 14.7 million to 20.2 million.
Sight and hearing impairments – as well as physical impairments – affect people in later life disproportionately. For example, over 80 per cent of the almost 2 million people with sight loss in the United Kingdom are aged over 60 years, and 44 per cent of over 70 year-olds have moderate to profound hearing loss. Given the increase in numbers of people in later life in the United Kingdom, it is not unlikely that these numbers of people in later life with sight and hearing and other physical impairments will increase as the population ages.
Clearly, whether we live in urban or rural areas, whether we are younger or older, mobility and access to services and local resources are crucial dimensions of modern life. Without mobility and without access to services and local resources, there is a risk of social isolation and all that this brings with it in terms of health and social well-being. So does it matter where we live in respect of walking?
Apparently, and in fact obviously, yes it does.
A neighbourhood’s walkability can determine whether or not citizens are able to combine a desire to walk as a form of activity and a need to access local services and resources. A shortfall in walkability can be down to the built environment, but also the social environment of a neighbourhood.
Recent studies (for example, Tacken & van Lamoen, 2005) indicate that the most common reasons for people in later life to leave their home and enter public spaces are shopping (31 per cent), socializing (21 per cent) and walking (11 per cent), so street spaces play an important role in maintaining access to services, maintaining exercise levels and decreasing social isolation for people in later life, all of which impact on their wellbeing. But are these street spaces attractive and welcoming, or are they less attractive – perhaps even downright unattractive – and daunting in terms of overcoming barriers to comfortable walking such as uneven pavements, proximity to threatening traffic? Is the street lighting adequate and reassuring, or do they encourage a mad rush to get back in-doors before dusk?
In addition, walking is good for us and good for the National Health Service bottom line (Jarrett et al 2012; Lancet) and so promoting walking is a key element of any public health campaign to enhance our well-being in (an increasingly long) later life. The benefits of physical activity on our health and mortality have indeed become an everyday chorus of health specialists and governments wanting to cut back on health care costs. The number one global killer cardiovascular disease (CVD) was responsible for 31 per cent of deaths globally in 2012 according to the WHO, and already towards the end of the 20th century, and the link between physical activity and the prevention of CVD is well-established (for example, Sesso et al 1999). Similarly, the evidence linking physical activity and the prevention of coronary heart disease (CHD) – which accounts for more than half of CVD deaths – is equally convincing (Sofi et al 2008). Physical activity, both regular and infrequent, appears to postpone mortality (Lee et al 2004) and it also protects against mental and cognitive decline (for example, Sofi et al 2010; Hamer, Stamatakis & Steptoe 2009).
The positive impact of physical activity (even at moderate and infrequent levels) seems unquestionable. But does my environment encourage or discourage me from taking even infrequent and gentle exercise? Am I unable for environmental reasons to walk that extra mile? Am I even able to get out of my home? Dare I leave my home? What is wrong with our environment that prevents us from engaging in these life-saving and death-delaying activities? Beard et al (2009) link these negative neighbourhood environmental characteristics with both physical disability and what they call a “going outside the home” disability.
So, are our own lifestyles turning that extra mile into a marathon?
The evidence would suggest so.
For example, the link between watching television on the one hand and inactivity and increased risk of obesity on the other hand has been the subject of research for some time (Ainsworth et al 1993; Lank et al 1992; Dietz & Gortmaker 1985; Hu et al 2001; Hu et al 2003), and the research evidence suggests that watching television leads to a lower metabolic rate than other forms of inactivity such as sewing, reading, writing, driving (Ainsworth et al 1993), while the exposure to television commercials for food results in unhealthy dietary habits (Lank et al 1992; Dietz & Gortmaker 1985; Hu et al 2001). Perhaps television is being eased out of our lives, but it is being replaced by equally sedentary technologies providing us with the same inactivity, and exposure to food seems omnipresent.
Lovasi et al (2009) found a link between obesity and the built environment in disadvantaged populations, and there is now an understanding that residential neighbourhood resources supportive of physical activity along with access to healthy food choices are likely to impact on the risk of obesity in populations (Larkin 2003).
These issues – and many more related issues – will become more relevant as our streets and cities are inhabited by growing numbers of older people. Clearly, health and well-being and the environments in which we live are linked. But can we design and build age and health friendly environments which encourage healthy behaviours – both in respect of physical activity and dietary habits?
About the Author
Dr. George W. Leeson is Co-Director of the Oxford Institute of Population Ageing, University of Oxford.
Opinions of the blogger is their own and not endorsed by the Institute
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