Physical activity promotion and the United Nations Sustainable Development Goals

In this article, we examine the potential benefits of large-scale physical activity promotion strategies on the Sustainable Development Goals (SDGs). We do this by

• describing the unresolved global pandemic of physical inactivity;
• identifying plausible linkages between physical activity promotion and SDG achievement and summarizing the existing evidence and gaps;
• exploring, through an agent-based simulation model, the possible impact of at-scale physical activity promotion strategies on SDG-related outcomes across high-, middle-, and low-income country city types;
• and synthesizing our results through a set of sector-specific recommendations to guide future policy, research, and community action for physical activity promotion and SDG achievement.

Background

The health of humans and our planet hangs in the balance. The United Nations (UN) SDGs lay out objectives for saving the planet and enhancing quality of life by 2030, including a goal for ensuring health and well-being for all (SDG 3). The World Health Organization (WHO) has recognized the link between public health efforts and multiple SDGs as the UN sustainable development agenda addresses the multilevel drivers of public health across sectors. Physical inactivity remains a major, unresolved public health challenge, which contributes to an estimated 5 million deaths per year and a large proportion of noncommunicable diseases, costing societies billions of dollars. Recent findings have also unveiled physical activity’s protective effects on infectious disease outcomes (including COVID-19). Effective strategies to promote physical activity can not only reduce disease burden and health care cost but could also offer untapped opportunities for achieving multiple SDGs. However, such synergy has not been explored systematically within a global context.

Because most of the known solutions for addressing the physical inactivity pandemic operate across multiple sectors, large-scale implementation of physical activity promotion strategies could contribute toward the achievement of some of the broader societal, economic, humanitarian, and planetary global priorities of our time. Physical activity promotion may provide much-needed “small victories” for the sustainable development agenda. Unveiling the benefits that physical activity promotion could have for SDG achievement may represent a powerful strategy for achieving the promise of “health in all policies” worldwide.

Keypoints

• There is strong synergy between physical activity promotion and SDGs, presenting unique opportunities to simultaneously address multiple population health priorities and for achieving several SDGs.
• Synergies between physical activity promotion and meeting several of the SDGs are conceptually coherent and supported by scientific evidence. The evidence is strongest for physical activity promotion strategies involving transport policies, urban design infrastructure, and community-based programs, with observed benefits for SDGs 3 (good health and well-being), 9 (industry, innovation, and infrastructure), 11 (sustainable cities and communities), 13 (climate action), and 16 (peace, justice, and strong institutions).
• Socioeconomic and gender-based inequalities (SDGs 10 and 5) are interrelated with physical activity promotion. Resolving socioeconomic and gender-based inequalities could help improve population levels of physical activity. Conversely, physical activity promotion strategies have the potential to reduce inequalities.
• We present new evidence supporting at-scale physical activity strategies centered on transport systems that prioritize walking, cycling, and transit and on activity-promoting urban design. These strategies can help improve both physical activity and achievement of SDGs. For physical activity, benefits accrue from increases in both the recreational and transport domains. For SDGs, benefits are achieved through improvements in traffic safety (SDG 3), transportation mode share (SDG 9), air pollution (SDG 11), equitable access to public transport and public open spaces (SDG 10 and SDG 11), and reductions in carbon emissions (SDG 13).
• The effects of these strategies are context specific. Cities in low- and middle-income countries (LMICs) may reap more health-related benefits from scaled-up physical activity promotion strategies than cities in high-income countries (HICs) with high car dependency. Car-dependent cities in HICs are responsible for a large proportion of global carbon emissions. In these settings, physical activity promotion policies may help in reducing traffic-related deaths and improving air quality, but to attain meaningful improvements in physical activity levels and climate change, policies may also need to include strategies that reduce car dependence.
• The most effective strategies for increasing physical activity and achieving SDGs are multicomponent and multisectoral. A systems approach is strongly recommended to minimize the risk of unintended consequences and maximize the positive impact of these strategies on physical activity and SDGs.
• Important evidence gaps remain. There may be benefits of physical activity promotion strategies on additional SDGs beyond those we have identified; however, the evidence is currently weak or limited. Determining to what extent physical activity promotion strategies can have additional benefits for SDG achievement in different contexts will be key for supporting broader scale-up of physical activity promotion strategies around the globe.