Chronic diseases and health promotion

Part Three. What works: the evidence for action

Chapter Two. Review of effective interventions

Improving the built environment

There are a growing number of examples to show that changing the built environment can lead to increased physical activity. Providing access to exercise facilities, walking and cycle ways, along with compact urban planning, increase the opportunities for, and reduce barriers to, physical activity. In the Americas, rates of walking and cycling in older neighbourhoods with high population densities, mixed land use, and well-constructed interconnecting footpaths are 30-50% higher than in low-density neighbourhoods typical of suburban sprawl. The use of stairs instead of lifts or escalators in public places can be increased by means of signs, posters and music, although the effects are relatively small and short term.

Spotlight: Improving the built environment in Colombia

Over the past 10 years, the city of Bogotá, Colombia, with almost 8 million inhabitants, has made significant progress in promoting physical activity. Safe spaces specifically set aside for leisure activities are now provided, including 128 km of streets exclusively for recreational and sports activities on Sundays and holidays. The city also provides parks, public aerobics classes, a 300 km network of bike paths and a large network of pedestrian-ways. Policies limiting the use of private cars have also been implemented.


Advocacy interventions use information in deliberate and strategic ways to change decision-makers' perceptions or understanding of an issue and to influence decision-making. They can also shape public perceptions and behaviour and build popular support for policy-making. A vast array of communication methods is available, the choice depending on the desired outcome. Communication methods range from one-to-one conversations to mass media campaigns and often work better together than individually. They must be selected for their ability to deliver the message effectively and should be tailored to the specific advocacy objective. Common communication methods include information campaigns, publications and web sites, press releases, lobbying and peer-to-peer communication. Health education on cardiovascular risk factors via broadcast and print media has been shown to be very cost-effective in all regions by the WHO-CHOICE project.

Spotlight: Advocating for physical activity in Brazil

The Agita São Paulo programme promotes physical activity among the 37 million inhabitants of the state of São Paulo, Brazil. The programme, launched in 1996, organizes "mega-events" such as the Agita Galera Day. In addition to such large-scale events, the programme has over 300 partner institutions, whose main mission is to disseminate the message through their own networks.

Direct costs of the programme are covered largely by the São Paulo State Health Secretariat, with a budget of roughly US$ 150 000, representing an investment of less than US$ 0.5 per inhabitant per year.

Surveys of representative samples of the São Paolo population show that the prevalence of respondents engaging in regular physical activity rose from 55% in 1999 to 60% in 2003. Targeted subgroups showed much more dramatic improvements. For example, of a group of people with high blood pressure and diabetes who received education sessions and personalized advice, there was a reported 96% increase in those who participated in regular physical activity.