HEALTHY URBAN LIVING AND AGEING IN PLACE: PHYSICAL ACTIVITY, BUILT ENVIRONMENT AND KNOWLEDGE EXCHANGE IN BRAZILIAN CITIES (HULAP)

Brazil has one of the most rapidly ageing populations in the world and non-communicable diseases are emerging as the main national public health priority. These include increasing levels of obesity and other conditions associated with a lack of PA. There is emerging evidence on the impact of increased PA on health, particularly amongst older adults, although this is not as well developed as for other demographic groups, despite them being the least active and most sedentary. It is also becoming clear that, set within a wider ecological model, the form of the built urban environment can influence levels of PA, suggesting that interventions in this area could provide a useful role in supporting long-term strategies for public health. There are very few studies on PA amongst older adults in Brazil, although there is some evidence that suggests it is associated with improved quality of life and health, irrespective of age, education and socio-economic status. Therefore, an enhanced understanding of PA behaviour of older adults in Brazil, the role of urban design in facilitating this and improved policy effectiveness will benefit the economic development and well-being in Brazil, through healthier ageing in place, reduction in future health burdens and enhanced institutional capacity.

The project integrates three themes highlighted in the call specification related to: Urban Design/Planning/Housing/Infrastructure; Health/Inequalities/Justice; and Leadership/Governance/Institutions.

This project will develop policy tools, partnerships and evidence for increasing PA levels of older adults in Brazilian cities, by bringing together a multi-disciplinary team of Brazilian/UK researchers drawn from public health, geography, planning and management studies, as well as a range of key stakeholders that are central to promoting this policy agenda in Brazil, the UK and Europe. We take a comparative Brazil-UK approach that builds on research previously funded by the ESRC, CAPES, CNPq and others. We aim to capture the PA of a sample of older adults in Curitiba (Brazil) and Belfast (UK) and measure a range of attributes of the built environment which may influence this. We will develop and test new methodologies and protocols for doing this, which will contribute to new methodological approaches of wider international relevance, including IPEN protocols and tools for rapidly evaluating the built environment for its walkability. We will investigate the associations between objective and perceived environmental measures with the physical functioning of older adults. We will also comparatively map the Brazil and UK institutional and governance contexts involved in ageing and walkable environments, evaluate the capacity of this to assimilate evidence and bring together examples of innovative practice. The project will result in a range of policy guidance and toolkits to enhance future policy approaches. Key project partners include Embarq (Brazil) and Belfast Healthy Cities (UK), who will coordinate input to the project's Impact Advisory Groups from a wider range of stakeholders involved in the healthy ageing arenas in Brazil and the UK. This will involve joint Brazil-UK impact workshops, will ensure that the project remains focused on delivering valuable societal impact and in turn will influence future approaches to research in this field to create a virtuous circle of research-implementation-feedback-research.

The project aims to deliver a wide range of bi-lingual outputs which will include: project website, video content and social media; peer-reviewed papers; presentations to local policy networks and conferences in Brazil and the UK; working papers and lay summaries, policy briefing papers; a revised protocol for capturing older adults PA data; a new knowledge translation self-assessment tool; revised tools for auditing the built environment and an Older-Adults Walkability Toolkit.

This project is aimed at improving the levels of PA amongst older adults in Brazilian cities, which will have a key role in ensuring the country's rapidly ageing population remains healthier and more independent for longer; it will promote 'ageing in place'. It will contribute to the economic development and welfare of Brazil by promoting well-being through preventative and cost effective intervention in the built environment, potentially offsetting substantial future costs from health and social care services. It has been designed to maximise the impact of the research already undertaken by those involved and to specifically deliver policy-relative outcomes for older adults, a relatively marginalised group. The project builds on established partnerships and aims to create new international collaborations. Initial discussions with our partners have identified a wide range of impacts on policy, decision-making, capacity building and awareness raising in relation to enhancing understanding of and effectiveness of interventions related to older adults' PA and the built environment. The project will increase the effectiveness of interventions in the built environment to support healthy ageing and help target resources in a more efficient way. We have identified the key stakeholders in the project as being older adults in Curitiba and Belfast, along with their advocacy groups; city planning authorities and public health agencies, academic researchers and international networks, including WHO Healthy Cities. The impact strategy is built upon a strong record of engagement of the research team, who have extensive experience in such collaborative projects and in communicating with an array of government, business and civil society stakeholders in public health and spatial planning.

The impact derived from each of the work packages are described in Pathways to Impact, and this includes: spatial data on the walkability of the case study cities and how this relates to the needs of older adults, which is of value to public health and planning agencies; overall levels and patterns of PA behaviour in the case study cities, allowing the first effective evaluation of their needs, from which more effective strategies can be developed; development of international protocols for measuring PA in older adults allowing broader insights to be derived; measures of walkability for older adults linked to new policy tools that will increase the effectiveness and efficiency of policy development; a review of innovative practice in healthy ageing; an evaluation of the capacity of Brazil/UK institutions to deliver healthy ageing programmes; the development of a self-assessment tool for knowledge translation; and the creation of guidance and toolkits to promote responses to how best to address this important challenge. Combined, this package of work offers an effective response to this substantial long-term challenge, which could substantially be influenced by improved evidence and strategic intervention. Although this project is primarily focussed on opportunities for Brazil, global challenges of healthy ageing and increasing population-wide sedentary behaviour means that the project has significant potential to create impact at a range of different geographic scales and demographic groups.

Project impacts are maximised through a robust communication, dissemination and monitoring strategy. This will include strategic advice from an Impact Advisory Group in both Brazil and the UK. The project also includes proposals for a wide range of outputs aimed at maximising impact of the research, which include websites and social media, information sheets, audit tools, policy briefings and an Older Adults Walkability Toolkit.