Planning for Healthy Cities: Approaches to Strengthen Active Living in City Anjana Murali, M4 Planning (Housing), Department of Architecture, College of Engineering Trivandrum (CET), Dr. Priyanjali Prabhakaran, Associate Professor, Department of Architecture, College of Engineering Trivandrum (CET), Thiruvananthapuram

Abstract

Planning for healthy city is very important to improve community health by shaping the environments where people live, work, and play. Globally about 23% of adults and 81% of adolescents (aged 11- 17 years) do not meet WHO recommendations on physical activity for health (World Health Organisation, 2019). Regular physical activity is a necessary factor to prevent the leading non- communicable diseases (NCDs) and also improve mental health, quality of life and well-being. The focus of this study is on the application of detailed framework developed for the domain- Active living. Active living is identified as one among six domains derived from various literature studies (active living, healthy food system, social cohesion, health status, environmental exposure and emergency response) to evaluate a healthy city. For the application of framework developed, an area is selected and assessed on different scale (city level, neighbourhood level and on individual scale) so as to evaluate the level of physical activity and built environment conditions provided for sub- domains derived for planning for active living- active transportation, walkability/ bicycle friendly, recreation and safety. Kollam city is selected for the application, because of its highest prevalence of non-communicable diseases in the wards ( and ), mainly due to lack of physical inactivity as reported by the National Health Mission of Kollam and Kollam Urban Primary Health Centres in 2018-2019. The assessment of the area involves data collected from secondary source as well as from primary study, which includes a questionnaire survey to understand the level of physical activity among randomly selected 180 respondents in the ward. The study intend to identify challenges and opportunities to provide supportive built environments that encourage physical activity among individuals in the area. Accordingly, the study suggests necessary interventions/ recommendations to be done at city level, neighbourhood level and at ward level so as to support physical activity that can strengthen active living in Kollam.

Keywords: Healthy city, physical activity, active living, non-communicable diseases, framework.

1. INTRODUCTION

With an unprecedented increase in urbanization, there is rise in health challenges like non communicable diseases such that cities be places that help to determine health and well- being of majority of population. Health is not only limited to infrastructure like- clinics or hospitals, the social and physical environment of communities has an impact on their health and well-being. Health issues are intricately with the environment we live and work. The lack of effective planning results in unhealthy places, but if well-planned, cities can avoid unhealthy outcomes and can help in to promote safe, better opportunity for all. Planning can promote healthy behaviours, environmental health, mental and physical well-being, and health equity (RTPI, 2014). Cities are to be planned more

2 / Procedia Economics and Finance 00 (2012) 000–000 effectively so as to enhance their benefits and reduce the threats to healthy development. Large number of people are being physically inactive and majority prefer sedentary lifestyle. Many find it difficult to engage in physical activity with poor conditions of built environment for active living. There is a need to promote physical activity through planning for active living to reduce the risk of increasing cases of non- communicable diseases. Planning is required to provide supportive built environment and opportunities to ensure active living for all (Edwards. P and Tsouros. A.D, 2008). The research aims to evolve approaches in strengthening active living in Kollam city. The following objectives are formulated for this study: • To identify supportive built environments and determinants of active living to promote public health • To develop a framework to evaluate the study area on basis of active living • To identify available opportunities to promote active living in the delineated area • To identify issues and give necessary solutions to strengthen active living for the study area 1.1 Methodology

The study is based on the conceptualization of literature available on planning for healthy cities, which includes the determinants that promote health and well-being as well as key domains with its indicators which has been identified through various studies and from tools to evaluate a healthy city. The domain focused for this thesis is Active Living. The first stage of this research involves the development of framework based on literature and tools studied. The framework involves indicators of active living: Active transportation, recreation, walking/bicycling and traffic safety: which has been identified through various studies. Along with the indicators are its sub indicators which are measurable and can be used to evaluate in different scale: city, neighbourhood and individual (housing) level. Data for each indicator can be derived from primary or secondary source accordingly. The next stage is the application of framework for active living, for which an area is to be selected. For this research area selected is Uliyakovil ward of Kollam city, as it has the highest prevalence to non-communicable diseases (NCDs) in the city reported so far (according to the reports from UPHC centres of Kollam dated from 5/4/2018 to 22/2/2018). Non-communicable diseases are considered for this study as the prevalence is due to lack of physical activity, which is one of the fundamental to active living and we as planners must provide supportive built environment to reduce the risk to non- communicable diseases. Third stage involves the assessment of area selected using the framework developed, where few of data are collected through secondary sources, such as land use map of Kollam developed by District Town and Country Planning Office of Kollam in 2015, City Development Plan for Kollam, 2041 prepared in 2014 and NATPAC studies for Kollam in 2011. Few of indicators are assessed through site observations, rest of the indicators are evaluated through primary survey (questionnaire survey). The main objective of the survey is to understand the pattern of physical activity and to identify opportunities and challenges in providing supportive conditions to strengthen active living. For the survey, sample size is of 180 individuals belonging different age groups (from 13 years and above) and different income groups), which includes 30 random samples from five out of thirteen resident associations in Uliyakovil ward and 50 individuals who frequently visit public areas within and around the ward to conduct physical activity (mainly taken from Asramam Maidanam, Adventure

/ Procedia Economics and Finance 00 (2012) 000–000 3

Park and Children’s Park area). In the fourth stage, with the results from primary survey and from secondary study, the framework is analysed and is compared to benchmark required for each indicator. The indicator which is not up to the standard is differentiated and interventions are made only to the domains that require necessary action. 1.2 Scope

The purpose of the study is to provide comprehensive approach in planning for healthy cities focusing on the domain active living. This approach can be beyond the traditional domains of healthy urban planning. The study can provide guidance to formulate policies so as to reach public health goals and safer communities, further helping to create a built environment for community that promote health. Furthermore, this study intends to develop a framework for improving the way decisions are made for planning to improve health and well-being through active living. 1.3 Limitation

The study is limited to area delineated and the framework developed. The evaluation of the study area is limited to ward selected according to the highest prevalence to NCDs in the city and assessment with questionnaire survey are limited to 180 respondents belonging to age group 13 years and above.

2. PLANNING FOR HEALTHY CITIES

Health is one of the important factor for both conceptualization and development of policies. Initial approach towards town planning started by considering health as a major factor. Our environment is a key determinant of health (Lalonde, 1974) and (Marmot M and Wilkinson R, 1999) . Today, the focus and importance of health in urban planning is because of the initiative of World Health Organization (WHO) for Healthy Cities Movement to recognize the complex issue of public health. Improving public health and well-being is not only the job of health care professionals but also for us planners (Barton et al, 2000). World Health Organization defines healthy city as one that is continually creating and improving those physical and social environments and strengthening those community resources which enable people to mutually support each other in performing all the functions of life and achieving their maximum potential (Hancock et al, 1988). A Healthy city aims to (WHO, 1996):  To create a health-supportive environment  To achieve a good quality of life  To provide basic sanitation & hygiene needs  To supply access to health care The movement has acknowledged that built environment and urban planning plays very important role in shaping healthier cities. Various studies has shown that quality of urban environment and its development are major components of health (Barton et al, 2000). The four factors that determine health are: environment, lifestyles, human biology and health care systems (Barton et al, 2000). From these factors both environment and lifestyles have significant role in determining health,

4 / Procedia Economics and Finance 00 (2012) 000–000 were planners role can influence these factors. Healthy city focuses on environmental and social determinants of health and includes strong empowerment and participation of individuals to lead a healthy life. It is recognized through various studies that there are many factors that can influence an individual’s health and urban planning tends to shape individual’s lifestyle so as to make better health choices and lead healthier way of life. (Barton et al, 2000) Summarizes following ways in which built environment and urban planning can determine a person’s health, namely: Individual’s behaviour and lifestyle; social and community influences; local structural conditions; and general socio-economic, cultural and environmental conditions. Urban planning can act as form of initial prevention and contributor to both positive and negative health outcomes. Where holistic approach in building cities is the key, planning revolves in designing and creating places for people, planning and health are linked to bring better outcome. Collaborative work between planning and health care professionals are required to bring up effective measures for better public health and urban development (Duhl L.J, Sanchez A.K, 1999). Healthy cities and SDGs agenda of 2015 by UN work mutually, where all 11 qualities of healthy city developed by WHO matches all 17 SDGs. This could help cities to overcome barriers to development and improve public health and well-being. Among the SDGs, goal 3 for good health and well-being is a major contributor to human development, for which health is beneficial for all sectors to succeed in implementing health policies, goals and activities. For instance, goal number 11 for sustainable cities and communities focuses on making cities and human settlements inclusive, safe, resilient and sustainable. Healthy cities approach and initiative views for better housing and sanitation, and also to reduce overcrowding and upgrade slums. Substandard housing and sanitation increase the risk of ill health and spread of diseases. Healthy cities encourage better urban planning to prioritize access to safe transport systems, green and public spaces, and emergency responses to natural disasters, which together reduce road traffic deaths, improve air quality, promote physical activity and save lives from disasters (Global Healthy Cities., 2017). The SDGs provide an imperative to action than the science of health determinants. One vital dimension of SDG implementation is universal health coverage (UHC) (UHC World Health Organisation , 2018), meaning access to quality essential healthcare services, medicines and vaccines for all, including financial risk protection.

2.1 Healthy City Scenario in In India, increase in urban population and change population dynamics are major implications for health and well-being (Samarth, A). Challenges that India face in development of healthier cities and communities are, one is rapid growth of urban population and second being the pressure on basic infrastructure like housing, water, sanitation, transport, green cover, education, employment and health services (Mc Kinsey Global Institute, 2010). About half of India’s population will be living in cities by 2030, where it is estimated that 68 cities in India will have more than one million population (Census of India, 2011). In India, increase in urban population has caused concerns in both built environment and public health. Urban environments are affected by air pollution, water pollution and improper waste management system and providing basic amenities is difficult in many cities. Urbanization is also accompanied by social polarization, there is rapid economic transition and changes in lifestyle having influenced change in pattern of diseases (Butsch et al, 2012). The growing population of middle class is estimated to be at 300 million, where they face higher risk through non-infectious disease mainly

/ Procedia Economics and Finance 00 (2012) 000–000 5 caused by “modern” nutrition, lifestyle patterns, and socio-cultural practices (Shetty, P, 2002). A study in Delhi shows that fat is consumed more by wealthier family than urban poor and rural populations, which puts to higher risk in obesity, diabetes and other chronic diseases (Shetty, P, 2002). There is lack of walkable neighbourhood and physical inactivity among the population and people depend more on private modes for transportation. As people spend their time on crowded roads or traffic, it is expected to have negative health outcomes. Longer travel-time to one destination from another reduces time available for work, leisure, and family. Those families who cannot afford housing to live in city suffer from distress that can cause negative impacts on community’s overall health (Ewing, R, 2008) and (Mieszkowski, P; Mills, E. S, 1993). In 2017, The Challenge Initiative for Healthy Cities (TCIHC) was launched in Delhi for public and private resources to implement health solutions for urban poor that will assist local bodies to manage capacity building, implement and monitor its responses to health issues (Kim, 2018). In future, most of population will be living in mega cities and India’s unhealthy urban growth will transform rapidly so as to provide healthy cities as living environment for at least half the population. An effective measure is required in planning policies to overcome poor urban health and health inequalities.

2.2 Healthy City Indicators There are numerous studies on Healthy Cities developed by WHO, International declarations and agendas and guidelines prepared by different countries to achieve healthier cities. Within the limited time, literature studies are listed in Table 1. The extraction of healthy cities evaluating indicators and planning factors are collected from different studies and are summarized in Table 2.

Table 1 Reference studies on factors related to Healthy cities

Researchers/ Year Titles

WHO (1997) Healthy City Indicators City Health Profiles: how to report on health WHO (1988) in your city Regional Guidelines for Developing a Healthy WHO (2000) Cities Project-Western Pacific Healthy Urban Planning London: Spon and Barton & Tsourou (2000) Copenhagen: WHO WHO (2002) Healthy Cities Initiative in the Africa Region Korea Health Industry Development Institute A Guideline for Planning a Healthy City (2005) Building Healthy Cities-Guidelines for Hong Kong Department of implementing a Healthy Cities Project in Hong Studies on Indicators Health (2007) Kong Urban HEART: Urban Health Equity WHO (2010) Assessment and Response Tool WHO (2012) Indicators for Health in Sustainable Cities US Department of Health Healthy People 2020 Leading Health and Human Services Indicators: Progress Update (2014) London Healthy Urban Healthy Urban Planning Checklist Development Unit (2014) City Leadership for Health and Sustainable Tsouros (2017) Development : Critical issues for successful Healthy Cities Projects, Global Healthy Cities American Planning Metrics for Planning Healthy Communities Association (2017)

6 / Procedia Economics and Finance 00 (2012) 000–000

Table 2 International declarations related to Healthy cities Source: Author generated from literature, 2018

From the literature review and analysis of indicators studied from different researches, a framework of key indicators or domains are developed that would result to promote healthier cities through these set of domains. Each domains are factors that are frequently considered to plan for healthy cities with includes indicators that is responsible for better health outcomes and can result in the policies or frameworks that to be yet developed.

/ Procedia Economics and Finance 00 (2012) 000–000 7

Figure 1 Identification of key elements for planning of healthy city Source: Author developed from different studies on Healthy cities, 2018

Figure 2 Process to identify domains for built environment and health Source: Author developed from different studies (refer Error! Reference source not found.) on Healthy city indicators, 2018

Figure 3 Framework of domains (set of indicators) to evaluate Healthy City Source: Author developed through literature studies mentioned in Table 1 and 2, 2018

8 / Procedia Economics and Finance 00 (2012) 000–000

Active Living: Active living is to incorporate physical activity into ones daily lifestyle. An individual achieve active living through daily routine through exercise, walking, etc. WHO defines active as “A way of life in which physical, social, mental, emotional and spiritual activities are valued and are integrated into daily living.” Urban planning should ensure active living through shaping built environment that supports active transportation, promote recreation and includes road safety. Healthy Food System: It refers to a whole system that involves food production, processing, distribution, preparation, consumption and disposal of waste that can also ensure individuals access to healthy and nutritious diet. Environmental Exposures: It is the interaction between human and environment where these interactions can affect one’s well-being. Planners can help to promote natural resource management by ensuring better air and water quality and reduce soil contamination Emergency Preparedness: It refers to the mitigation and adaptation to hazards or any disease outbreaks that impacts on humans life and creates public health emergencies. It is very necessary to be prepared for such events because natural hazards can occur without any warning and significant change in climate. Social Cohesion: Social cohesion is about sense of belonging and social interaction within the communities. A cohesive community in social aspects have strong bonds and mix within the community and planners have play in providing availability, accessibility, maintenance green and open spaces, housing and community development and ensuring individual’s safety and equity so as to promote vibrant and healthier neighbourhoods. Health Services: It involves services targeting individuals for health development. Health is holistic approach with physical, mental and social dimensions.

3. ACTIVE LIVING Active living is a way of life that integrates physical activity into ones everyday routines, such as walking to the store or biking to work. Active lifestyle includes recreational opportunities (parks, fitness centres etc.) close to the home or workplace, walking trails and bike lanes for transportation. Active living is a combination of physical activity and recreation activities aimed at the public to encourage a healthier lifestyle (Government of Alberta, 2011). A healthy, active city is one that is continually creating and improving opportunities in the built and social environments and expanding community resources to enable all its citizens to be physically active in day-to-day life (WHO, 2008). The health benefits of physical activity are well known, where, regular moderate physical activity promotes mental, physical and social well-being that helps to prevent illness, disability and obesity. In addition to improving health, cities that invest in physical activity policies (including active transport) can:  save money on health care and transport services;  have more productive citizens and workers;  be more livable and attractive to residents, employers and visitors;  have less air and noise pollution;  better access to green spaces;  enhance neighborhood revitalization, social cohesion and community identity; and  Expand social networks.

/ Procedia Economics and Finance 00 (2012) 000–000 9

The built and social environments are the key focal points. The built environment includes land-use patterns, transport systems, urban design, green spaces and all buildings and spaces that are created for the people (including schools, homes, workplaces and recreation areas). Elements in the social environment can influence the involvement in physical activity- income, equity, culture and social support. A comprehensive approach to active living can aim to develop opportunities for all population groups, paying special attention to children and youth, older people, and neighbourhoods with low socioeconomic status, employees, people with disabilities and other ethnic minority and at- risk groups. Planners can involve to boost active living by making changes in the built environment that support active transport, promote recreation, and reduce or eliminate injuries.

ACTIVE TRANSPORTATION

WALKABILITY/ BICYACLE FRIENDLY

RECREATION ACTIVE LIVING ACTIVE SAFETY

Figure 4 Indicators for active living (Source: Indicators identified by author based on various literature and tools to evaluate healthy city)

Active transport: Active transport (or transportation) discusses to any form of self-propelled, human-powered mode of transportation- walking, bicycling, or skateboarding. It is often called non- motorized transportation in the urban planning and transportation literature. Active transport can be for leisure and non-leisure purposes. Recreation: Recreation refers to opportunities for exercise- playing sports (whether organized or informal), taking a fitness class, playing on the playground, and walking in or to a park. Recreation can also occur near the home, in parks and community centres, or in private facilitated areas or on school grounds. Walking and bicycling are also kind of recreational activities if the purpose of the trip is not to travel to a new destination (such as to school or work). Traffic Safety: pedestrians and bicyclists are those who are physically active—are also at a greater risk of injuries from traffic collisions. Therefore, there is a need to design public infrastructure that can promote safety requirements with understanding of where the most accidents or fatalities occur.

Insufficient physical activity are major risk factor for increasing death worldwide and increasing prevalence to non- communicable diseases (NCDs) such as cardiovascular diseases, cancer, stroke, etc. According to WHO, globally one in four adults are not physically active and more than 80 percent of world’s adolescent population are insufficiently physically active. Physical activity is fundamental to active living as it promotes health and wellbeing of our community. Regular physical activity is also associated with healthy weight, improved mental health, and decreased risk of non- communicable diseases- stroke, heart disease, type 2 diabetes, depression, and some cancers. It also promotes social well-being by improving social cohesion, and economic well-being by reducing

10 / Procedia Economics and Finance 00 (2012) 000–000 health care costs (Carlson et al. 2015) and transportation costs. Planning for active living can make a place more liveable and attractive to residents and employers. It can also help to preserve the natural environment by boosting active transport and reducing air pollutant emissions. Supportive en- vironments, such as facilities for walking and bicycling that are safe, accessible to all users and distributed fairly among all are most likely to help in attaining an active living lifestyle.

3. FRAMEWORK TO EVALUATE ACTIVE LIVING IN A CITY AND ITS APPLICATION

The development of framework is based on literature and tools studied. The framework involves indicators of active living: Active transportation, recreation, walking/bicycling and traffic safety: this has been identified through various studies. Along with the indicators are its sub indicators which are measurable, these indicators can be used to evaluate in different scale: city, neighbourhood and individual (housing) level. Data for each indicator can be from primary or secondary source accordingly. Secondary source of data can be collected from various literature related to subject area and primary source of data involves survey at different level, where it requires: interview with officials, field survey, primary survey for understanding the level of physical activity and environment supporting them, etc. This framework developed to evaluate active living can be applied in the area selected and the assessment of each set of indicators can be made through primary study involving questionnaire survey and site study and also secondary source of data.

Table 3 Framework to evaluate active living along with benchmark to each set of indicators (Source: Author developed through various literature studies, 2019)

/ Procedia Economics and Finance 00 (2012) 000–000 11

3.1 Methodology to apply the framework developed to evaluate active living for a selected area An area has to be selected for the application of framework of active living and it is selected on the basis of highest prevalence to non- communicable diseases in the state of , where in Kerala, even with its strong performance in providing healthcare services, it lacks in providing better facilities for encouraging physical activity among people. According to the studies of Arogyakeralam in 2016, surveys for the occurrence of NCDs are majorly done in Thiruvananthapuram and Kollam. In Kollam, although it tops in better health services in the state, the conditions of mental health and cases of NCDs are high (Kollam Municipal Corporation, 2014). From the reports of National Health Mission Kollam and reports of Urban Primary health

12 / Procedia Economics and Finance 00 (2012) 000–000 centre (UPHC) located in Uliyakovil, Vady and centres of Kollam (dated from 5/4/2018 to 22/2/2019), it is identified that Uliyakovil UPHC has highest number of cases of NCDs. Henceforth, the framework is applied in the urban area- Uliyakovil, Kollam (wards10- Asramam,11- Uliyakovil east and 12- Uliyakovil) to assess the indicators of active living and supportive built environment that is provided to enhance physical activity among residents of these wards. Though parks and open spaces for the city are dedicated in these areas (ward 10-Asramam), it lacks in providing accessibility to people to involve in physical activity in these areas. The framework is applied in the site selected- where few of indicators are assessed through secondary studies available and rest of them required to be collected from site observations and primary survey which was conducted through questionnaire survey. Primary survey was conducted among individuals of age group 11 years and above-  to understand the level of intake of moderate to vigorous exercise every day,  to understand the challenges and opportunities in the area to promote active living,  to identify the barriers in providing supportive conditions to promote active living,  to assess the accessibility and availability of facilities that can generate active transportation, active recreation and walkability in the selected area. From the assessment of framework the challenges and opportunities are identified, and necessary planning interventions are made to make the area selected as a model neighbourhood that promote active living.

4. AREA SELECTION Area Selection for the application of framework is done on the basis of prevalence to non- communicable diseases, which is one of the major concern caused due to lack of physical inactivity and walkability in the area selected. Non-communicable diseases (NCDs) are leading cause of adult mortality and morbidity worldwide. NCDs are rapidly increasing globally and it has also become a growing concern in India. The major NCDs are cardiovascular diseases, diabetes, cancer and chronic respiratory diseases. Usage of tobacco and alcohol, unhealthy diet, physical inactivity, high blood pressure and obesity are also major risk factor to many non-communicable diseases. In Kerala, majority of health surveys regarding to NCDs are conducted in Thiruvananthapuram and Kollam (Arogyakeralam, 2016). From the survey of Kerala State Mental Health and National Health Mission for depression (2015-2016) , among the 5 districts surveyed (Kollam, Idukki, Palakkad, Wayyanad, Kasargod), Kollam stands highest in cases with depression (38.8%). According to city development plan for Kollam 2041, 30 -60 yrs. old age group have 30 % of death cases due to NCDs and 38.8% of suicidal death. From the reports of Arogyakeralam in 2018, Kollam tops in its number of primary health care centres in the district located at average distance of 1-2 km, and according to studies of Department of Economics and Statistics in Kerala, 2017- Kollam Municipal Corporation also leads in its average percentage of old age in household. This shows that Kollam city has its ageing population, who are unhealthy in terms of mental and physical health. Even with more number of health services in Kollam, it has increasing cases of NCDs which may be due to lifestyle and poor built environment to provide better health and well- being. According to the reports (5/4/2018 to 22/2/2019) of National Health Mission of Kollam And from the three Urban Primary Health Centres located in the city- Uliyakovil, Mundakkal and Vady- highest number of cases of prevalence to NCDs (hypertension, cholesterol, heart diseases and stroke) are in

/ Procedia Economics and Finance 00 (2012) 000–000 13

Uliyakovil centre of 3.65% of cases compared to rest of cases reported in other two sub centres. Hence the study area is delineated to Uliyakovil and Asramam ward.

Figure 5 Area Selection- wards 10, 11, 12 under high risk to NCDs in Kollam City

4.1 Walkability Walkability for the area selected is measured using Walk Score. Walk Score measures the walkability of any address using a patented system. For each address, Walk Score analyses hundreds of walking routes to nearby amenities. Points are awarded based on the distance to amenities in each category. Amenities within a 5-minute walk (.25 miles) are given maximum points. A decay function is used to give points to more distant amenities, with no points given after a 30-minute walk. Walk Score also measures pedestrian friendliness by analysing population density and road metrics such as block length and intersection density. Data sources include Google, Open Street Map, and places added by the Walk Score user community. Using this system in Kollam city, the walk score of area delineated is of range 43 in Uliyakovil ward to 67 in Asramam ward. This shows that area delineated are more of car dependant and most of errands or to reach amenities require own vehicle.

14 / Procedia Economics and Finance 00 (2012) 000–000

Figure 6 Walk score of Uliyakovil ward (Source: Walk score, 2019)

5. SITE CHARACTERISTICS

Area selected for the study, i.e. Uliyakovil and Asramam ward of Kollam city is an urban area and thickly populate ward of the city (Kollam Municipal Corporation, 2014). The ward is bordered by at its northwest and Kadapakkada and Asramam ward where the junctions leads towards Kollam town which is at 6km SW. Kadapakkada is the major junction for these wards with commercial and transportation facilities to meet their daily needs.

/ Procedia Economics and Finance 00 (2012) 000–000 15

Figure 7 Study Area Profile

5.1 Land Use

• Only 6% of the total land use is dedicated for transportation; however, as per URDPFI guidelines, it has to be 12-14 %. Land acquisition is inevitable for improving transport infrastructure. • Only 3 % of total land use is available for park and open space and it has been reduced to 1.05%- conversion of land for other public purposes – also neighbourhood parks are not maintained periodically

16 / Procedia Economics and Finance 00 (2012) 000–000

5.2 Transportation Network

PUBLIC TRANSPORTATION SYSTEM, (Source: (CDP for Kollam 2041, 2014) and NATPAC 2011)

Dependence on Public Transport 5% BUS 15% TRAIN

80% INTERMEDIATE PUBLIC TRANSPORT (taxi/autorickshaw) NON MOTORISED TRANSPORT (NMT) is not prominent in the city: only 0-10% of bicycle users, there are no bicycle lanes in the city PEDESTRIAN TRAFFIC: is seen in the core city area: , Beach Road, Railway station, TAXI/auto stand • Very few pedestrian pathways in the core city area but most of wards have narrow walkways but often shared by parking/encroachment

5.3 Opportunities and Challenges of Active Living at City and Ward Level 5.3.1 Location of Public Spaces Even though parks and open spaces in the city are few in proportion, these recreation facilities are located on or near the area delineated that is with 4-8 km radius and are not at walkable distance according to the standards that has to be provided with 400-800m of walkable distance. 5.3.2 Health Facilities Kollam city is sufficient with health care and other social infrastructure. National Health Mission along with Urban Primary Health Centre are located within the city. The city has its District hospital and Government Victoria Hospital near to the city core and well equipped with other private hospital and clinics within the city. Health care facilities like gym, sports club are at proximity to the area delineated that is with 4km radius but not at walkable distance. These facilities are not well maintained and are not accessible for all, hence discouraging to promote active lifestyle for all.

/ Procedia Economics and Finance 00 (2012) 000–000 17

18 / Procedia Economics and Finance 00 (2012) 000–000

5.3.3 Pedestrian network and Active Transportation

Figure 1 Map showing designated pedestrian path in the area delineated

/ Procedia Economics and Finance 00 (2012) 000–000 19

5.4 Analysis Potential: -Study area is located near to major node and have mixed land uses- commercial, residential, public and semi-public and vacant lands -majority of vacant land are along lake edge which are shady and green: suitable environment for site development

Issues: -unavailability of public lands within the ward -Location of small scale industries along lake side- cement and timber: threat to Lake Ecosystem -road network or movement pattern within the study area are more considered to cater vehicular traffic -lack of pedestrian facilities and connectivity, illegal on street parking - Only second order roads are provided with pedestrian tracks From the above studies of area selected and site characteristics, the information is updated to framework developed for active living as shown in figure below. Rest of indicators for the framework mentioned in Figure require further study, which is derived from primary survey.

Figure 9 Assessment of indicators for active living using secondary data collected

6. PRIMARY SURVEY Primary study for this survey includes questionnaire survey (as shown in Error! Reference source not found.. Appendix) among individuals who frequently visit the dedicated recreational area in the city, among individuals who visit the parks or open spaces within selected wards and individuals who

20 / Procedia Economics and Finance 00 (2012) 000–000 live in the delineated area having higher prevalence to Non- communicable diseases. Primary survey also includes reconnaissance survey to find out pedestrian conditions, walkability and accessibility to recreational facilities, proximity to nearest public transit stops and identifying availability of vacant land within the delineated area to enhance with supportive built environments that can promote physical activity. About the survey The main objective of the primary survey are: -To understand resident’s general health and lifestyle pattern -To identify issues to be addressed to enhance active and healthy living -To identify opportunities to walkable neighbourhood -To validate- prevalence of NCDs in ward is lack of engagement in physical activity Target group  individuals belonging to different age group from 13 yrs. old to above, different income group  individuals within the delineated area of highest prevalence to NCDs  individuals who frequently visit the recreational facilities within area delineated and in the city Sample Size: Number of participants- 150 (30 from each ward) (8.2%) + 30 participants (randomly selected from Asramam ward and people visiting major recreational area) =180 individuals Total ward population of Uliyakovil (ward as per Census of India: 7,876) and Average no.of households: 1,832

6.1 SURVEY DETAILS and ANALYSIS

1. Active Transportation Work classification and proportion of annual income spend on public transportation in a month It is noted that proportion of average income spend on transportation is between 3.33% - 9.2%, which is comparatively less to the suggested proportion by United States Department of Transportation, 2018. 2. Active transportation and walkability within the area delineated Distance to work place from residence-Majority of individual’s work place is within proximity of their residence (, Uliyakovil) and Kollam town (within 6km) Accessibility to local facilities  Majority find easier to walk to local grocery, health care facilities and places of worship and are satisfied with its conditions but find difficult to walk to leisure or sports facilities/parks, etc. and services provided are just satisfactory.  Community meeting spaces are not provided as such- most of meeting or gathering would in temple precinct or under shady trees  There is frequent bus services  In city level: - Children’s park and Adventure Park have issues regarding accessibility- location, entry fee are not affordable for majority, and hence visit is not frequent (rs.25 for adult, rs.12 for children) -pedestrian movement inside these spaces are satisfactory or good -lack of connectivity between these spaces, dependence on car-require parking facilities, lack of drinking water and toilet facilities Car dependency and mode of transportation to school or work place from home (key

/ Procedia Economics and Finance 00 (2012) 000–000 21 destinations)-Most of them use their own vehicle to reach their work place/school/college. Those who own their own vehicle use them frequently or rarely for long distance travel. Majority of them prefer to walk or use auto rickshaw to reach destinations within 1.5km Neighbourhood safety and other issues in walkability within local area- it is noted that 100% of respondents feel safe in living in their area with frequent bus service and accessible bus stops. Issues are regarding the street infrastructure for pedestrians with lack of shade/ canopy and street lighting. 3. Social well-being Community participation are generally found less among individuals surveyed. Within the neighbourhood individuals find issues regarding disposal of solid waste along lake edge and increasing vehicular traffic towards junction. 4. Active lifestyle The level physical activity undertaken by individuals surveyed are comparatively low. The level of undertaking moderate exercise everyday are only among 36% of individuals surveyed and 67% of individuals never undertake vigorous exercise. This is due to lack of interest, lack of time and involving in more of sedentary lifestyle and lack of accessibility and provision of facilities to promote physical activity within the area delineated.

Risk to Non communicable diseases Among the individuals surveyed 52.67% of individuals belonging to age group 35 and above are prone to NCDs. Non communicable disease that are majorly found are hypertension, cholesterol and

22 / Procedia Economics and Finance 00 (2012) 000–000 diabetes. Among which 38% are having risk to hypertension and these individuals have to incorporate physical activity into their daily life to reduce the threat.

Among the individuals belonging to age group 44-64 have high risk to NCDs in both cases of male and female groups. Even individuals of age group 31-43 years have risk to NCDs such as cholesterol and hypertension. The concern is that necessary action has to be taken in planning the delineated for such individuals within the proximity to provide necessary supportive environments to encourage active lifestyle.

/ Procedia Economics and Finance 00 (2012) 000–000 23

7. EVALUATION OF AREA DELINEATED USING DEVELOPED FRAMEWORK

From the above evaluation only few of indicators to each parameters are not according to the studied

24 / Procedia Economics and Finance 00 (2012) 000–000 standards and are found to be major areas of concern, and following are suggested to improve the supportive environment to facilitate active living: Indicators of active Sub-Indicators of major concern Suggested supportive built living environment to improve active living Active - access to transit options are just at -commute mode share Transportation convenient distance (above benchmark) - last mile connectivity - more car dependency is seen due to - pay parking distribution of work and facilities within -inter modal transit hubs (reduce area dependence of private vehicles) - residents not near half mile distance to frequent-service transit stops Walkability/Bicycle - no dedicated pedestrian zone seen- -improvements to sidewalks, friendly width range 1-1.8m which is less intersections and streetscapes compared to benchmark -Need for cohesive system of - no dedicated bicycle trails and neighbourhood parks and paths to infrastructure- lack bicycle use within connect homes with schools, workplaces study area and shop -separate lanes and tracks for pedestrians, cyclists and cars on busy streets Recreation - lack of undertake of physical activity -Provide easy access to lake, parks and (moderate to vigorous exercise) open spaces - lack of parks and open spaces within -Conserve and develop green spaces the city- only 3.25% of total area - Community “pocket” parks - lack of connected parks -green network accessible to all - sufficient number of sports and health residents complemented by a network of facilities within the area but are not squares and other outdoor places for accessible for all active living.

8. DESIGN INTERVENTIONS Design interventions are suggested at city level, neighbourhood level (ward level) and at individual level for different age group for each parameters for active living that is concerned in the study area evaluated. From the assessment using framework it is found that necessary supportive environment are there for indicators and parameters of Active transportation. Only concern there is to reduce overall car dependency, this can be achieved by providing necessary facilities of last mile connectivity to key destinations. The major concern in the study area is for the indicators for the parameters walkability and recreation respectively. Where the area delineated require or need enhancement in facilities that support safe and convenient walkability to key destinations and providing necessary infrastructure for physical activity to promote active living within the area delineated, thus making it as a model of active living neighbourhood within the city. Design proposals that can promote physical activity are formulated according to the facilities available within the area delineated. Proposals are made at city level, neighbourhood level- institutions and at individual scale accordingly. Interventions are done for each set of parameters of active living from the framework evaluated, accordingly strategies are adopted for each parameters for individuals of different age group to support with active recreation and walkable environment.

/ Procedia Economics and Finance 00 (2012) 000–000 25

Strategies involve:  To redesign existing pedestrian tracks- giving dedicated pedestrian path way without any obstructions as seen now in the site, that is narrow walk lanes, poor pavements, illegal on street parking and street vending along Kadapakkada- Asramam road.

Figure 10 Existing Pedestrian Network

26 / Procedia Economics and Finance 00 (2012) 000–000

Figure 11 Proposed Pedestrian Network

 On street parking along Kadapakkada- Asramam road must have pay and park system and separate parking area have to be allotted for trucks that are parked along Asramam Maidan which is obstructing continuity of pedestrian activities.

Figure 12 Example of street infrastructure to promote walkability/bicycling

 Pedestrian pathways along Asramam maidanam and other recreational facilities connecting to key destinations have to be provided with proper street infrastructure- lighting, shades, including by roads to residential areas- Uliyakovil road and by road to different residents association.

/ Procedia Economics and Finance 00 (2012) 000–000 27

Figure 13 Proposals for pedestrian trails and green corridor

 Within the neighborhood vacant open spaces and lake edge have to be utilized to provide pocket parks or other recreational facilities- open gym, lake side walking/cycling that promote physical activity. School grounds in the locality can be availed to public.

Figure 14 Proposed plan for active recreation

28 / Procedia Economics and Finance 00 (2012) 000–000

 Within individual scale, resident can start practice of kitchen/terrace gardening to produce healthy food. This can also be practiced within the community that is to identify land availability to practice community gardening and develop farmer’s market to sell fresh organic fruits and vegetables.  Individual houses should practice solid waste segregation and disposal, also utilize bio-waste system.

8. CONCLUSION AND FURTHER STUDIES The study mainly aimed to evaluate a study area with framework developed to assess active living conditions with identified set of indicators in each parameters- active living, recreation and walkability. Application of the framework developed has helped to identify the challenges and opportunities to provide supportive environment for active living that can increase physical activity. Opportunities are there within the site but only thing is refocus and renew these conditions to support active recreation among individuals to their key destinations, which can make it a model for healthy active neighbourhood. What is complicated here to strengthen active living for the study area is individual’s behaviour to environment. What people do is based on wide variety of connected factors- physical, mental health, age, ethnicity, socio- economic status etc. and built environment is one among the major factor. Designing this built environment to enhance active living, is to provide social connection and provide safe and accessible environment conditions. For the area selected, the study considers health in neighbourhood planning to reduce the risk to NCDs and attain physical activity to one’s daily lifestyle. This research is relatively young and it is a challenge to transfer findings into action. To make these interventions robust, government at different levels, especially the local government must uptake policies for health by collaborating with urban planners and must engage with people to understand the situation of health and promote physical activity. The study has identified and proposed few areas to be supported with built environment for active living, which requires few changes in the development plan for Kollam in the areas for active recreation and walkable neighbourhood. Initiatives for planning for healthy city and active living can help to transfer the concepts into reality- sustainable future city starting from the ground level which is planning for a healthy active neighbourhood.

Acknowledgements First and foremost, I would like to thank the Almighty for all the opportunities he has opened for me and by whose grace this research would not have been a success of this extent. I extend my deep gratitude to the Department of Architecture, College of Engineering Trivandrum for giving me an opportunity to do this study as part of my thesis. I express my deepest gratitude to my guide Dr. Priyanjali Prabhakaran for her valuable guidance, constant encouragement, suggestions and supervision throughout the study process. I also wish to express sincere thanks to Prof. Kasturi Rangan and Dr. Shailaja Nair for their valuable suggestions during review meetings. I extend my sincere thanks to our Ex-Thesis Coordinator Prof. Suja Kumari L and the review panel for their guidance and suggestions. I acknowledge Srim. Shary M.V, Town Planner of Kollam and Department of Town and Country Planning of Kollam for providing necessary information for my secondary study. I also acknowledge Srim. Chintha P, ward member of Uliyakovil; ASHA workers- Srim. Ramlath and Srim. Rejani; and National Health Mission of Kollam, for providing necessary information about area selected for this research. I also appreciate and sincerely thank the individuals who have participated in the questionnaire survey. I express my thanks to my parents and friends for their support and motivation for successful completion of this research work. ANJANA MURALI

/ Procedia Economics and Finance 00 (2012) 000–000 29

References Active Living Resource Center. (n.d.). (2011). Retrieved from http://www.activelivingresources.org/assets/ Aslesh OP, et.al. (2016). Level of Physical Activity in Population Aged 16 to 65 Years in Rural Kerala, India. National Center for Biotechnology Information (p. 28). U.S. National Library of Medicine. Awofeso, N. (2003). The Healthy Cities approach — reflections on a framework for improving global health. World Health Organisation. Barton et al. (2000). Healthy Urban Planning: a WHO guide to planning for people. Europe: World Health Organisation. Barton, H. (2016). City of Wellbeing – A radical guide to planning. Routledge. Barton, H. and Grant, M. (2006). A health map for the local human habitat. The Journal for the Royal Society for the Promotion of Health. Boozani, H. (2013). Retrieved from Diva Portal: https://www.diva-portal.org/smash/get/diva2:833298/FULLTEXT01.pdf Butsch et al. (2012). Urban Health in India. Internationales Asian forum. Census of India. (2011). Census of India. Government of India. Duhl L.J, Sanchez A.K. (1999). Healthy Cities and the City Planning Process. Copenhagen: World Health Organization:Regional Office for Europe. Duhl, L. (1986). The healthy city: its function and its future. Heal Promot. Edwards. P and Tsouros. A.D. (2008). A healthy city is an active city: a physical activity planning guide. Europe: World Health Organization. Ewing, R. (2008). Characteristics, causes, and effects of sprawl: A literature review. Berlin: Springer: Urban ecology. Global Healthy Cities. (2017). City Leadership for Health and Sustainable Development. Kuwait: Ministry of Health, Kuwait and Agris D.Tsouros. Hancock et al. (1988). Promoting Health in the Urban Context. Copenhagen: WHO Healthy Cities Pap. No. 1. Kim, M. (2018, November 28). The Challenge Initiative for Healthy Cities. Retrieved from https://tciurbanhealth.org/indias-challenge- initiative-for-healthy-cities-to-provide-high-quality-health-services-in-urban-slums/ Kollam Municipal Corporation. (2014). City Development Plan for Kollam 2041. Kollam. Lalonde, M. (1974). A New Perspective on the Health of Canadians. Ottawa: Healthy and Welfare Canada. Marmot M and Wilkinson R. (1999). Social Determinants of Health. Oxford: Oxford University Press. Marmot, M. S. (2008). Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. The Lancet 372 (9650), 1661–69. Matlawski, B. (2013). Towards Healthy Cities: A Planning Perspective. Australia: UNSW. Mc Kinsey Global Institute. (2010). India’s Urban Awakening: Building Inclusive cities, Sustaining Economic Growth. Mc Kinsey & Company. Mieszkowski, P; Mills, E. S. (1993). The causes of metropolitan suburbanization. The Journal of Economic Perspectives, 7, 135–147. Mumford, L. (1961). The city in history: its origins, its transformation and its prospects. New York: Harcourt, Brace and World Inc. Rajiv. (2017, December 12). Retrieved from The Times of India: https://timesofindia.indiatimes.com/city/kochi/heart-disease-top-cause- of-death-in-kerala-study/articleshow/62032232.cms RTPI. (2014). Promoting Healthy Cities: Why planning is critical to a healthy urban future. Planning Horizons (pp. 5, 14-15). Glasgow: Royal Town Planning Institute (RTPI). Samarth, A. (n.d.). Promoting and Health and well-being in India: Towards Healthy Cities in India. p. 44. San Francisco Department of Public Health. (2007). Healthy Development Measurement Tool (HDMT). San Francisco: San Francisco Department of Public Health. Schroeder, S. A. (2007). We Can Do Better—Improving the Health of the American People. New England Journal of Medicine 357(12), 1221–28. Shetty, P. (2002). Nutrition transition in India . Public Health Nutrition Vol. 5, No. 1A, 175–182. Talen et al. (2013). The Walkable Neighborhood: A Literature Review. International Journal of Sustainable Land Use and Urban Planning, ISSN 1927-8845, Vol. 1 No. 1, 42-63 . Tarlov, A. (1999). Public Policy Frameworks for Improving Population Health. Annuals of the New York Academy of Sciences. Tsouros, A. (1995). The WHO healthy cities project: state of the art and future plans. Heal Promot. U.S. Department of Housing and Urban Development. (2016). Healthy Communities Assessment Tool (HCAT). Washington: U.S. Department of Housing and Urban Development. WHO. (1991,1999,2010,2018). Europe: World Health Organization Regional Office for Europe. WHO. (1996). Healthy Cities - Healthy Islands. Malaysia: World Health Organization:Western Pacific Regional Environmental Health Centre (EHC). WHO. (1999). HEALTH21—the Health for All Policy Framework for the WHO European Region. Copenhagen: WHO Regional Office for Europe. WHO. (2010). Urban Health Equity Assessment and Response Tool. Kobe: WHO Library Cataloguing-in-Publication. WHO. (2018, February 23). Physical Activity. Retrieved from World Health Organisations: https://www.who.int/news-room/fact- sheets/detail/physical-activity WHO Healthy Cities Project Office. (1955). City health planning: the framework. Copenhagen: WHO Regional Office for Europe. World Health Organisation. (2019, February 23). Non communicable diseases and risk factors. Retrieved from World Health Organisation: https://www.who.int World Health Organization Regional Office for Europe. (2018, September 02). Retrieved from http://www.euro.who.int/en/health- topics/environment-and-health/urban-health/who-european-healthy-cities-network/healthy-cities-vision

30 / Procedia Economics and Finance 00 (2012) 000–000

APPENDIX

/ Procedia Economics and Finance 00 (2012) 000–000 31

32 / Procedia Economics and Finance 00 (2012) 000–000

/ Procedia Economics and Finance 00 (2012) 000–000 33

34 / Procedia Economics and Finance 00 (2012) 000–000

/ Procedia Economics and Finance 00 (2012) 000–000 35

36 / Procedia Economics and Finance 00 (2012) 000–000