San Francisco Burden of Disease & Injury Study:
Determinants of Health
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Physical Inactivity: What Can Be Done?

The CDC-supported Task Force on Community Preventive Services has reviewed interventions to increase physical activity and identified public health interventions that work. Their report, Increasing Physical Activity, was published in MMWR in 2001 and is available on the Web. The following interventions were recommended (see the report itself for details):

  • two informational approaches,
    • communitywide campaigns and
    • point-of-decision prompts to encourage using stairs;
  • three behavioral and social approaches,
    • school-based physical education,
    • social support interventions in community settings (e.g., setting up a buddy system or contracting with another person to complete specified limits of physical activity), and
    • individually adapted health behavior change; and
  • one environmental and policy approach,
    • creation of or enhanced access to places for physical activity combined with informational outreach activities.

Physical inactivity is socially determined. An examination of specific social determinants might lead us to additional approaches toward the promotion of exercise. See "upstream causes" link on the right.

Population-based interventions designed to increase levels of physical activity vary in demonstrated effectivenss. CDC's Community Guide to Preventive Services has summarized their systematic review of selected population-based interventions.

Below are some examples of how the "spectrum of prevention" approach might be applied to improving physical activity in San Francisco.

Level of Spectrum


Influencing Policy and Legislation

Walk San Francisco is working for a safer pedestrian environment. Has successfully lobbied for increased fines for parking on sidewalks and is very active in promoting walking as a healthy activity.

See plans for mobilizing in the Mission during FY 2004-5, below (Level 6).

Mobilizing Neighborhoods and Communities

Team Up for Youth provides grants to community groups to improve and expand out-of-school sports in low-income neighborhoods.

SF's Neighborhood Parks Council is a coalition of neighborhood-based park groups who are actively involved in improving parks. They complement SF's Recreation & Park's Department.

During FY 2004-5, the San Francisco Department of Public Health will be facilitating community capacity in the Inner Mission to create changes that will make this neighborhood more conducive to physical activity. The CDC has found that there is strong evidence supporting this approach (PDF file).

Fostering Coalitions and Networks

Physical Activity & Nutrition: The Department of Children, Youth, and Families works with the SF Unified School District and various City Departments (including Public Health) to increase physical activity & improve nutrition among SF youth.

Changing Organizational Practices

Physical Activity & Nutrition: The inclusion of Body Mass Index (BMI) > 25 on the problem list of patients' charts might improve communication between providers and patients.

Promotion of stairway use at 101 Grove Street (SF Dept of Public Health).

Educating Providers

This website -- see also the links to diet and to obesity.

Promoting Community Education

Health fairs and health events work on a small scale. Media advocacy (which requires a newsworthy story) reaches large numbers of people. The CDC has found that there is strong evidence supporting intense, highly-visible community-wide campaigns [The Community Guide] when they are combined with another intervention, such as increased access to physical activity.

Strengthening Individual Knowledge and Skills

Encourage stairway climbing: see Health Canada's interactive web resource.

Kaiser Permanente offers weight and lifestyle classes to its members, Ocean Park Health Center offers Gentle Yoga, the Neighborhood Parks Council (see level 6) offers Tai Chi in the Parks, WalkSF organizes interesting weekend walks (follow the "Walk with Us" link on the left side of the WalkSF site), and there are many groups that provide regularly scheduled activities to help San Franciscans become more physically active: Seniors in Motion, San Francisco Mall Walkers, the Arthritis Self-Management Program, Newcomers Program's Russian Healthy Living Program, and others.

The CDC has found that there is strong evidence supporting individually adapted behavior change programs [The Community Guide] aimed at increasing physical activity.

Physical Inactivity


Contribution to overall disease burden in SF

Downstream (Health Consequences)

Upstream Causes

What can be done?

Web resources

MEDLINE strategies

Updated March 28, 2010

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