Running Head: Development of Walking Paths
Addressing Physical Inactivity Through the Development of Walking Paths
Cindy Earle
MPH 584 Community Health
Fall B 2015
Dr. Kelly Wheeler
December 10, 2015
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Physical inactivity is listed in Healthy People 2020 as one of the major health concerns in
the United States and is more prevalent in the lower income and under-served populations.
(Department of Health and Human Services [DHMH], n.d.). For years, physical activity was an
integral part of our healthy lifestyles- there was less technology and less reliance on
transportation; and more reliance on physical labor and activity. Today less than 48% of adults
meet the 2008 Physical Activity Guidelines of 150 minutes weekly of moderate-intensity aerobic
activity such as brisk walking (Centers for Diseases Control and Prevention [CDC], n.d.).
However, research has shown that increasing access to places for physical activity in small
geographic areas through urban design and policies increases participation in physical activity
and ultimately improves health outcomes (The Community Guide, n.d.)
Community Link: Literature Review
Physical inactivity combined with overeating has created an obesity epidemic (Roerty,
Carapella, Plotz & Williams, 2002). The incidence of obesity in adults has risen from 47 percent
in 1976 to 56 percent in 1994, and 68 percent in 2007 and has tripled to 20 percent in children
and adolescents during that same timeframe (Roerty et al., 2002). There is a significant economic
burden to our society from obesity, physical inactivity, and poor diet because these risk factors
put persons in jeopardy for developing many chronic conditions including coronary heart
disease, cancer, diabetes and stroke (CDC, n.d.). In 2008, direct health care costs of obesity in
the United States was estimated at $80 to $ 90 billion dollars (Roerty et al., 2008).Unfortunately,
these chronic conditions can ultimately create loss of work, disability and premature death
placing more demands on the government payment systems (Macera,n.d.).
Even though physical activity is one of the major preventative and treatment aspects of
chronic conditions, for multiple reasons it is also one of the most neglected (Dutton, Johnson,
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Whitehead, Bodenlos & Brantley, 2005). According to the U.S. Department of Transportation’s
National Household Travel Survey, the average adult walks only 8 percent of their trips (Roerty
et al., 2008). The number of children walking to school has declined from 41 percent in 1969 to
15 percent in 2008 (Roerty, et al., 2008). Unfortunately, the increase in obesity follows the
decline in walking (Roerty, et al., 2008).
Locally, of the 149,573 residents in Washington County Maryland, 27% admit living a
sedentary lifestyle compared to 23% of the state of Maryland’s population with a higher
incidence of physical inactivity noted within the cities of Hagerstown, Williamsport and
Hancock (DHMH, n.d.). Mental ill- health, obesity and diabetes are the top three community
health issues that were identified through the county’s 2016 Community Health Needs
Assessment (FY 2016 Community Health Needs Assessment, [CHNA], 2015). The incidence of
heart disease and hypertension is higher than the state average and is listed as the sixth
prioritized health need within the assessment. Health needs of lower income and African
American populations are the greatest in all of these rankings (CHNA, 2015). African Americans
also have higher rates of obesity and lower rates of physical activity (Coulon, et al., 2012).
Unfortunately these statistics confirm that our county residents are not physically active to reap
the health benefits.
Overall, physical activity promotes physical and psychological well-being. Physical activity
helps to control weight; reduce high blood pressure; build and maintain healthy bones, muscles,
and joints; and reduces the risks of premature death; heart disease; diabetes; high blood pressure;
colon cancer; depression and anxiety (CDC, n.d). Walking is an easy way to be physically active
and also has additional benefits such as transportation; socializing; and the promotion of overall
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physical and psychological well-being. It is a cheap form of exercise, easily accessible to every
population, and can make a significant positive impact on health.
This paper will address this public health challenge by proposing the development of safe
walking paths in a rural community for the purpose of increasing physical activity for those with
the greatest health and social need: the low income under- served populations in the towns of
Hagerstown, Williamsport and Hancock located in Washington County Maryland.
Program Strategic Plan: Development of Vision, Mission, Objectives, Strategies and
Actions
Mission Statement

To promote walking focusing on high-priority populations through the provision of
improved walking access and increased awareness of its health benefits.
Vision Statement

Everyone walking.
Identifying Stakeholders and Their Role
Multiple stakeholders from all levels of government and community organizations will need
to collaborate to accomplish the goal of encouraging walking for county citizens of all ages.
Inviting persons of influence from multiple organizations will leverage the ability to achieve a
successful outcome (Community Tool Box, n.d.). Those with expertise and an interest in our
community’s health would include funders, health and education systems, city planners,
engineers, and organizations and representatives from the high risk populations. Stakeholder
decisions were based on those persons and organizations that would have the potential for
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funding; for the development of walking paths; for specific expertise (policy, health, physical
activity); and for cultural awareness.
Stakeholders
Maryland Department of Health and Mental Hygiene
Washington County Public Schools
Washington County Recreation and Fitness Department
Washington County Division of Engineering and Construction
Washington County Health Dept.
Meritus Health
Maryland Department of Planning
City of Hagerstown Department of Parks and Engineering
City of Hagerstown Parks and Recreation Division
Family Healthcare of Hagerstown(FQHC)
Tri-State Community Health Center (FQHC)
H.E.A.L. (Healthy Eating Active Lifestyles) Coalition
Community Representatives (#2) from high-risk population
Goals and Objectives
To identify project challenges, a survey “was taken” of the stakeholders to evaluate their
opinions and assess barriers to increasing physical activity through walking. Listed in order of
priority, are items that were acknowledged as barriers to walking followed by the percentage of
votes received from the stakeholders:

The lack of safe sidewalks and paths in our rural community (100%)

Lack of information about benefits of walking (100%)
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
Intersections that are difficult to cross (100%)

A culture of driving or inactivity (100%)

Concerns about traffic safety (100%)

A lack of information about places to walk (80%)

Concerns about personal safety (80%)

Recreational facilities that are not available to the general public (70%)

Few destinations within easy walking distance (70%)

Parks or other recreational facilities are too far to drive to (30%)
Restrictions to accomplishing the goals also include available funding and limits to establishing
walking paths within an already developed neighborhood.
Based on the top six barriers identified from the survey, the goals, objectives and strategies
were prioritized and developed:
Program Objective: By the year 2021, a pedestrian friendly street/streetscape design will increase the number of walkers
by 30%
Action Steps and Timeframes:
Implementation Partners:
Add/improve lighting, landscaping, and amenities, such as
City engineers and planners
benches and drinking fountains. (1-3 yrs.)
Adopt a street policy (0-1 year)
City Council
Apply for federal, state, and local grant funding for design
DHMH
plan and implementation. Establish fund raising
Community Foundation
opportunities targeting private donors. (0-1 Yr.).
Slow motor vehicle traffic (0-2 yrs.)
City Planners
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Program Objective: By the year 2021 50% of surveyed residents will identify one or more walking route.
Action Steps and Timeframes:
Implementation Partners:
Develop maps of walking routes/locations (0-1 year)
City and County government
Employers
Parks and Recreation
Install direction and distance signage (0-3 years)
City and County Government
Parks and Recreation
National Park Service
Conduct promotional activities, such as kick-offs and 5K’s
HEAL
to encourage use of walking paths (0-5 yrs.)
Program Objective: By the year 2021 land use regulations that support walking will be adopted.
Action Plan and Timeframes:
Implementation Partners
Require developers to provide sidewalks as part of a new
City and County Government
development or redevelopment. (0-5 yrs.)
Adopt regulations that encourage pedestrian friendly
City and County Government, planners, and engineers.
environments such as mixed-use developments; storefronts,
porches; walls with windows, landscaped yards (3+ years).
Require paved shoulders on rural roads (3-5 years).
City and County Government, planners, and engineers.
Program Objective: By 2021 50% of county employers will promote walking in the workplace.
Action Plan and Timeframes:
Implementation Partners:
Organize workplace walking challenges (-5 years).
HEAL
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Health Dept.
Employers
Encourage walking meetings and walking to meetings (0-5
HEAL
yrs.).
Health Dept.
Employers
Promote walking routes/locations near work (0-5 yrs.).
HEAL
Health Dept.
Employers
Work with employers to permit their employees more time to
HEAL
exercise (2-4 years).
Health Dept.
Employers
Establish indoor and outdoor walking groups where persons
HEAL
have the ability to walk at varying speeds. (0-3 years).
Health Dept.
Employers
Pursue agreements with universities/colleges, schools, parks,
HEAL
etc. that will allow community members to use walking
Health Dept.
facilities (2-4 years).
Employers
Program Objective: By 2021 improved walking conditions will increase the number of walkers by 30%.
Action Steps and Timeframes:
Implementation Partners:
Conduct a community audit and develop a pedestrian master
City and County Government, planners, and engineers
plan. (0-3 yrs.)
Develop a trails master plan. (0-3 yrs.)
City and County Government, planners, and engineers
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Conduct a study to determine which parks and
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City and County Government, planners, and engineers
recreational areas might benefit most from additional
walking paths. (0-1 year).
Construct more sidewalks, paths and facilities to walk on (3-5
City and County Government, planners, and engineers
years).
Create walking routes that provide easy and direct access to
City and County Government, planners, and engineers
multiple points of interest (3-5 years).
Create safe and convenient crossings and safe routes to
City and County Government, planners, and engineers
schools (0-3 yrs.)
Program Objective: By 2021 improved walking access to public transportation will increase the number of walkers by
30%.
Action Plan and Timeframes:
Implementation Partners
Develop a plan for improving pedestrian access to bus stops
City and County Government, planners, and engineers
and transit stations. (3-5 years).
An ecological framework was used as the theory to develop the interventions since the
purpose of the project is to increase physical activity and behavioral change is best attained
through the use of multi-level interventions (Coulon et al., 2012). Those interventions included
intrapersonal, interpersonal, organizational, community, physical environment, and policy
elements. The use of this ecological framework focused on three primary aspects 1) access for
walking 2) safety perceptions and practices and 3) social connectedness (Coulon et al., 2012).
For instance, access to walking included a plan to improve pedestrian access to bus stops;
construction of more walkways, and employer buy-in. Safety interventions included lighting,
convenient crossings and safe routes to schools; and social connectedness included the
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development of walking groups and campaigns to increase awareness of the health benefits of
walking.
Evaluation
Process evaluation will be completed to evaluate whether or not the project was
implemented as planned. Some of the questions that will be examined are: Were the appropriate
stakeholders involved? Was the criterion to select areas for targeted walking paths helpful? What
were the barriers to the selection of paths? Was there adequate funding? Was the project
completed within the allotted time frame? If not, why not?
Outcome evaluation will be completed several months after the project is completed in order
to evaluate the effectiveness of the walking program in producing change in the physical activity
and if the objectives were met (Milstein & Wetterhal, n.d.). The delay in evaluation will help in
obtaining a more accurate measure of regular walkers once the novelty has worn off. This data
will be helpful to stakeholders to see the value of the project and its influence on becoming a
healthier community. Some of the questions that will be examined are: How many people walk
regularly? Has frequency of physical activity increased among the targeted population? Have
there been any additional health improvements made as a result of this project such as a cleaner
community?
The Walking Path logic model will have these components:

Inputs: financial, organizational, policy, stakeholder

Output Activities: community assessment, planning, design, and health promotion
activities; organizational collaboration; education

Output Participation: signage and maps; construction of walking paths; group walks
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Short Impact Outcomes: policy development; safety measures; increased awareness of
health benefits and walking routes

Medium Impact Outcomes: more access to walking paths; more walkers

Long Impact Outcomes: better health
Conclusion
Innovations
The entire community- men, women, and children of all ages- will not only be affected by the
policy and environmental changes needed to bring this project to fruition; but also by the positive
health changes that will be made. As a stakeholder and major grantor, the Maryland Department
of Health and Mental Hygiene has the political power needed to deliver and push the project plan
to acceptance by the local government. Once adopted, the plan can be incorporated into other
plans such as the County Comprehensive Plan and used to guide funding decisions for years to
come. Communities are always evolving, so even if there are limitations to the amount of
adaptations that can be made to the current infrastructure, there will be opportunities to influence
future environmental conditions.
Limitations
Changing a community is a complex process and will take a lot of years, a lot of
organizations, a lot of people and a lot of patience to accomplish. This project involves changing
people’s behavior through infrastructure change. Many of the interventions may seem farreaching but they are not impossible. Some of the limitations to this public health initiative
include the resources needed to implement it: time, personnel, and money. Competition for
funding can be fierce, and even when it is granted, it is never guaranteed. Funding for walkways
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can come from multiple sources, such as the federal or state government or local developers.
Community support, professional expertise, and coordination of efforts between multiple city,
county departments and organizations are difficult and staff personnel can come and go (CDC,
2008). It will be important not to lose momentum and to have the right stakeholders and right
leaders heading the initiative. A project of this magnitude must have public health practitioners
who are skilled at facilitating change through political means and have the ability to rally people
together after a common cause.
It is the responsibility of public health practitioners to lead preventative initiatives that
promote healthy living within the community. Advocating for the development of communities
that promote health and support wellness is a preventative strategy that has the potential to
reduce the incidence of chronic disease. However, it takes a community to build a community.
Health, physical activity, and community design are inseparable and through collaborative
efforts neighborhoods can be made livable once again.
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