Reflections on the first nine years of a program to create environments more conducive to routine physical activity and health.

The authors, three members of Robert Wood Johnson Foundation's Active Living by Design’s (ALbD) first national advisory committee, reflect on the first nine years of the RWJF national program. They note some of the successes, challenges, and opportunities in the national movement for healthy people in healthy places.

Some of the contributions made by ALbD:

• Lead the framing of active living (and healthy eating) as an alternative to medical approaches to combat obesity and other chronic health conditions.
• Embedded a policy, systems, and environment change operating system into place-based investments.
• Engaged leaders in collaborative problem-solving and innovation.
• Served as the “birthplace” for the National Convergence Partnership, which has helped guide community investments and health and wellness-related policies.

They also raise three concerns about the nature of the public health establishment in the United States as it affects active living. First is that public health’s focus on evidence-based science cannot capture the valuable qualitative connection between the design of communities and the health of people. Second, while acknowledging that policy change is needed to create active living environments, public health shuns “lobbying” for such change. Third, the insularity of the public health establishment creates barriers to forging ongoing collaborations with nonprofit activists.