Equitable and Inclusive Access
Equitable and inclusive access to safe places for physical activity is the foundation of all Active People, Healthy NationSM strategies. Every Active People, Healthy Nation strategy can be designed to support the goal of equitable and inclusive access to physical activity for all people regardless of age, race, ethnicity, education, socioeconomic status, disability status, sexual orientation, and geographic location.1
Racial and ethnic groups have unequal rates of physical activity.2 These disparities exist in part because many people live in neighborhoods with few safe spaces or other social or environmental supports to promote physical activity.3-7 This lack of access to opportunities to be active can be the result of historical disinvestment and persistent housing, transportation, urban planning, and land use policies at federal, state, and local levels—policies designed in part to segregate cities and communities by race and income.7-10
Even places with safe access to physical activity, some potential users may be left out. For example, recreation areas may not be designed for older adults or people with disabilities, and this can contribute to disparities in physical activity within these populations.11-13
People have more than one social identity, such as older age and ability status, race and gender, income level and religious affiliation. These intersecting social identities can change how people understand and live in their environment.14-15 In addition to physical barriers, these intersecting identities and historical contexts may interact with environments to influence feelings of safety, belonging, and inclusion.15 Not feeling safe or comfortable in public spaces may reduce opportunities to be physically active.16-18
Prioritizing Health Equity Can Improve and Expand Access to Safe and Convenient Opportunities for Physical Activity for People Most at Risk of Being Inactive
A commitment to equitable health outcomes calls for understanding, communicating, and addressing the factors that may prevent people or groups from getting physical activity. Engaging with people, groups, and organizations that experience inequities and disparities can improve understanding of the reasons for those experiences and gaps in efforts to change them.19, 21
Community engagement can include consulting with people from communities of focus, working with partners and organizations in coalitions that serve those communities, or both.20-21 The power to choose the best course of action for improving access to safe places for physical activity should be shared among those affected by decisions. Diverse input can help communities make better-informed decisions.19-20 For communities where health and safety have been undermined by historic disinvestment, these decisions may include prioritizing stability and neighborhood strengths while working to improve conditions for their residents.
Strategies for Improving Equitable Access to Safe Areas for Physical Activity
CDC’s Practitioner’s Guide for Advancing Health Equity provides concrete strategies—informed by evidence and practitioner experience across the nation—to incorporate health equity into foundational skills and practices in public health.21 It also includes specific strategies to achieve equitable and inclusive access to safe and convenient opportunities for physical activity. Broad health equity strategies include community engagement, building organizational capacity, and developing partnerships and coalitions. Below are some community examples of how health equity strategies were incorporated into physical activity strategies to increase equitable and inclusive access to safe places for physical activity.
- Safe and Accessible Streets for All Users [PDF-1.22MB]
Strategies and success stories on designing streets to improve access for everyone.
- Trails and Pathways to Enhance Recreation and Active Transportation [PDF-2MB]
Steps to prioritize health equity in implementing trails as a venue for physical activity and active transportation.
- Neighborhood Development that Connects Community Resources to Transit [PDF-2.6MB]
Examples of connecting physical activity infrastructure to transit and equitable community development to promote active transportation.
- Joint Use Agreements [PDF-1.36MB](also referred to as shared use)
Information on how joint (or shared) use agreements can increase access to safe places for physical activity.
- Preventing Violence [PDF-726KB]
Health equity-focused strategies to reduce and prevent community violence to promote physical activity and prevent chronic disease.
- Physical Activity Opportunities in School and Youth Programs [PDF-945KB]
Information on expanding physical activity opportunities for children and youth in educational settings.
These groups are prioritizing health equity as they work to increase physical activity in their communities:
- Park Updates Promote Physical Activity for Tribal Nation
The Menominee Nation updated a local park with culturally relevant renovations to promote park use and physical activity for tribal nation
- An Equitable Parks Plan Driven by Data
The use of data in New York City to improve access to parks and green spaces in the communities that need it most.
- Utah Communities Adopt Plans to Improve Spaces for Residents to Be More Active
Cross-sector collaboration among transportation and public health organizations to create safe, accessible trails for walking and biking.
- Complete Streets Help Kansas Communities Build Safe Spaces for Physical Activity
Collaboration between Kansas State Department of Health and community organizations to promote Complete Streets and activity-friendly planning.
- Health Equity Resources
This web page offers links to CDC and external resources to help communities, programs, and initiatives work to remove barriers to health and achieve health equity.
- Using a Health Equity Lens
Communication resources for equity-centered and inclusive health communication.
- Racial Equity Toolkit: An Opportunity to Operationalize Equity
A toolkit to help practitioners incorporate racial equity into programs, initiatives, and services to advance health equity. This toolkit can help practitioners integrate racial equity considerations into their work.
- Racial Equity Toolkit to Assess Policies, Initiatives, Programs, and Budget Issues [PDF-434KB]
This toolkit includes questions and provides a process for practitioners to prioritize racial equity in the development, implementation and evaluation of policies, initiatives, programs, and budgets.
- Race Matters: Organizational Self-Assessment [PDF-64KB]
This racial equity questionnaire can help organizations understand staff competencies and organizational operations related to racial equity.
- Increasing Physical Activity Among Adults with Disabilities
This web page provides resources for doctors and health professionals to promote physical activity among patients with disabilities.
- Small Town and Rural Multimodal Networks [PDF-39.9MB]
This Department of Transportation resource can help rural communities build and improve activity-friendly infrastructure.
- Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity. Strategies to Increase Physical Activity. Accessed October 3, 2022. https://www.cdc.gov/physicalactivity/activepeoplehealthynation/strategies-to-increase-physical-activity/index.html
- Centers for Disease Control and Prevention, Physical Activity. Adult Physical Inactivity Prevalence Maps by Race/Ethnicity. Retrieved October 3, 2022. https://www.cdc.gov/physicalactivity/data/inactivity-prevalence-maps/index.html
- Bantham A, Ross AT, Sebastião S, E., Hall, G. (2021). Overcoming barriers to physical activity in underserved populations. Progress in Cardiovascular Diseases. 2021;64:64-71.
- Rajaee M, Echeverri B, Zuchowicz Z, Wiltfang K, Lucarelli JF. Socioeconomic and racial disparities of sidewalk quality in a traditional rust belt city. Population Health. 2021;16.
- Kelly CM, Schootman M, Baker EA, et al. (2007). The association of sidewalk walkability and physical disorder with area-level race and poverty. Journal of Epidemiology & Community Health. 2007;61:978-983.
- Powell LM, Slater S, Chaloupka FJ, Harper, D. Availability of physical activity-related facilities and neighborhood demographic and socioeconomic characteristics: A national study.American Journal of Public Health. 2006;96(9):1676-80.
- Lopez RP, Hynes HP. Obesity, physical activity, and the urban environment: public health research needs. Environ Health. 2006;5(25).
- National Bureau of Economic Research. The origins of Urban Segregation in the United States. March 2018. https://www.nber.org/reporter/2018number1/origins-urban-segregation-united-states
- Hutch D, Bouye K, Skillen E, LeeC, Whitehead L, Rashid Potential Strategies to Eliminate Built Environment Disparities for Disadvantaged and Vulnerable Communities. American Journal of Public Health. 2011;101:587-595.
- Vojnovic I, Kotval Z, Lee J, Ye M, Ledoux T, Varnakovida P, Messina J. Urban Built Environments, Accessibility, and Travel Behavior in a Declining Urban Core: The Extreme Conditions of Disinvestment and Suburbinization in the Detroit Region. Journal of Urban Affairs. 2013;36(2): 225-255.
- Omura J, Hyde E, Whitfield G, Hollis N, Fulton J, Carlson S. Differences in perceived neighborhood environmental supports and barriers for walking between US adults with and without a disability. Preventive Medicine. 2020;134.
- Mathews AE, Laditka SB, Laditka JN, Wilcox S, Corwin SJ, Liu R, Friedman DB, Hunter R, Tseng W, Logsdon RG. Older Adults’ Perceived Physical Activity Enablers and Barriers: A Multicultural Perspective. Journal of Aging and Physical Activit 2010;18(2): 119-140.
- Centers for Disease Control and Prevention, Disability Inclusion. (2020). Common Barriers to Participation Experienced by People with Disabilities.
- Sabik NJ. The Intersectionality Toolbox: A Resource for Teaching and Applying an Intersectional Lens in Public Health. Front Public Health. 2021;9.
- Roberts J.D, Mandic S, Fryer C.S, Brachman ML,Ray R. Between Privilege and Oppression: An Intersectional Analysis of Active Transportation Experiences Among Washington D.C. Area Youth. J. Environ. Res. Public Health. 2019;16:1313.
- Wilson DK, Kirtland KA, Ainsworth BE, et al. Socioeconomic status and perceptions of access and safety for physical activity. Behav. Med. 2004;28:20–28.
- Rees-Punia E, Hathaway ED, Gay JL. Crime, perceived safety, and physical activity: A meta-analysis. Preventive Medicine. 2018;111: 307-313.
- Bennett G, McNeill L, Wolin K, Duncan D, Puleo E, Emmons K. Safe to Walk? Neighborhood Safety and Physical Activity Among Public Housing Residents. PLOS Medicine. 2007;4(10): e306.
- National Institutes of Health. (2011). Principles of Community Engagement Second Edition. [PDF-2.6MB]
- Centers for Disease Control and Prevention. A Practitioner’s Guide for Advancing Health Equity: Community Strategies for Preventing Chronic Disease. Developing Partnerships And Coalitions to Advance Health Equity. US Department of Health and Human Services; 2013.
- Centers for Disease Control and Prevention. A Practitioner’s Guide for Advancing Health Equity: Community Strategies for Preventing Chronic Disease. US Department of Health and Human Services; 2013.