Roadmap For Action Research Articles

Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low- and middle-income countries.

Vitamin D is an essential nutrient for bone health and may influence the risks of respiratory illness, adverse pregnancy outcomes, and chronic diseases of adulthood. Because many countries have a relatively low supply of foods rich in vitamin D and inadequate exposure to natural ultraviolet B (UVB) radiation from sunlight, an important proportion of the global population is at risk of vitamin D deficiency. There is general agreement that the minimum serum/plasma 25-hydroxyvitamin D concentration (25(OH)D) that protects against vitamin D deficiency-related bone disease is approximately 30nmol/L; therefore, this threshold is suitable to define vitamin D deficiency in population surveys. However, efforts to assess the vitamin D status of populations in low- and middle-income countries have been hampered by limited availability of population-representative 25(OH)D data, particularly among population subgroups most vulnerable to the skeletal and potential extraskeletal consequences of low vitamin D status, namely exclusively breastfed infants, children, adolescents, pregnant and lactating women, and the elderly. In the absence of 25(OH)D data, identification of communities that would benefit from public health interventions to improve vitamin D status may require proxy indicators of the population risk of vitamin D deficiency, such as the prevalence of rickets or metrics of usual UVB exposure. If a high prevalence of vitamin D deficiency is identified (>20% prevalence of 25(OH)D <30nmol/L) or the risk for vitamin D deficiency is determined to be high based on proxy indicators (e.g., prevalence of rickets >1%), food fortification and/or targeted vitamin D supplementation policies can be implemented to reduce the burden of vitamin D deficiency-related conditions in vulnerable populations.

Social determinants of health in the Human Services: a conceptual model and road map for action

ABSTRACTThe Social Determinants of Health Framework is well known as a reliable way to understand and predict poor health outcomes and health inequities among individuals who are disproportionately impacted by poverty, discrimination, residential segregation, and other social problems. Since becoming recognized by the public health profession as key to addressing the root causes of poor health among these individuals, integration of social determinants of health (SDOH) interventions in the health-care industry has become a national and global priority. This essay offers a theoretical and practical explanation of the integration of the SDOH in the Human Services by proposing key recommendations and strategies for Human Services Organizations (HSOs) and providers to implement new practices, policies, and research methods that may ameliorate the conditions that create inequities in health.

Universal newborn screening: A roadmap for action

Newborn screening (NBS) prevents morbidity and mortality by screening babies for selected disorders in the first days of life so that early diagnosis and treatment can be initiated. Congenital disorders impact an estimated 8 million or 6% of annual births worldwide, and of the top five that contribute 25% to the global burden of these disorders, three can be identified and managed by NBS. There are determined pockets of activity in Latin America, Sub-Saharan Africa, and the Asia Pacific region, where partnerships among government, non-governmental organizations, academia, the private sector and civil society are developing novel NBS programs that are both saving lives and preventing disability in those who survive.

5.5-O8HIV and mobility in Australia: creating a coalition and a road map for action

5.5-O8HIV and mobility in Australia: creating a coalition and a road map for action

The values and vulnerabilities of ‘Star Wars Island’: exploring tensions in the sustainable management of the Skellig Michael World Heritage Site

ABSTRACTThis paper explores challenges in reconciling the cultural, economic and ecological pillars of the sustainable development concept. It does so by examining how conflicts in the management of an island off the Irish coast called Skellig Michael, which has been internationally designated for its significant cultural and ecological attributes, have been intensified by: (a) increasing tourist numbers; (b) a re-framing of the site’s identity and (c) changing visitor motivations. These have resulted from the amplified attention the island has received following the release of Star Wars: The Force Awakens and The Last Jedi in which it features prominently. Following a critical identification and discussion of the fault lines between different stakeholders involved in the conservation and use of the island, the paper advances a roadmap for action to help resolve animosity in the governance of the site and facilitate its sustainable management in the context of changing visitor numbers and profiles.

Improving maternal folate status to prevent infant neural tube defects: working group conclusions and a framework for action.

As infectious disease control programs achieve increasing success, further reductions in child mortality in low- and middle-income countries (LMICs) will require focused prevention strategies for birth defects and other noninfectious diseases. Neural tube defects (NTDs) can cause early death or lifelong disability. Preventing NTDs provides a feasible, significant opportunity to decrease the toll of birth defects and contribute to further reducing child mortality globally. The Micronutrient Forum convened a technical consultation on Folate Status in Women and Neural Tube Defects Prevention to develop a roadmap to inform and prioritize investments in NTD prevention in LMICs; help guide implementation efforts in terms of the feasibility of interventions and the potential for acceleration; and identify research and knowledge gaps. Here, we describe the impetus for and approach to the consultation and present the conclusions and a framework for developing a roadmap for action to accelerate NTD prevention in LMICs. The framework (1) provides options for action on folate status assessment; (2) outlines a way forward to develop and implement a time-bound global action plan for NTD prevention; and (3) identifies common impediments to NTD prevention, broad strategies to overcome or minimize these impediments, and basic building blocks necessary to accelerate action.

Civil society and democratic transformation in Mauritania: the paradigm of transition and the antecedents of political change

Mauritania is among the poorest of the world’s nations due, in good measure, to its itinerant Bedouin population that has moved gradually towards urbanization in accordance with the new world order. The country has undergone extensive transformation in the face of international pressure and influence that were brought to bear on it, and their effects have affected the process of transformation, especially those pertaining to the acknowledgement of human rights and freedoms of citizens. The democratic transformation of Mauritania has to be understood in the context of factors interplaying between the social and cultural spheres, in particular the tribal nature of Mauritanian society which, in a de facto sense, designs the roadmap for action on the basis of the citizen’s perpetual tribal affiliation and belonging, as well as the interaction between economic and political reform conforming to economic demands. This study clarifies the democratic transformation that has taken place in Mauritania through particular phases. Although the transformation did not necessarily bring about change in the prevailing political modus operandi of the state, it did, nonetheless, change the balance of the ‘powers that be’ in favour of reform. The latter arose through the role played by political parties that enabled the development of civil society and the possibility for political reforms in future. The study analyses the Mauritanian experience with regard to the success of civil society institutions in furthering their goal of complete reciprocity between the people and their members, and in placing these issues at the heart of the discussion and achieving pioneering successes.

The Knowledge of Romani and School Readiness of Roma Children

The paper presents results from an international research project looking at Roma children between the ages of 3 and 6 years old. Thirty Roma children from Southwest Bulgaria and 30 Roma children from East Slovakia were tested with a psycholinguistic test in Romani language, measuring the knowledge of different grammatical categories. In most East European countries, the children are tested employing psychological/IQ tests in the official languages of the country and if the child does not understand the test task, because of a lack of knowledge in that language, s/he is deemed to have “light mental retardation”. The knowledge of the children on different grammatical categories in their mother tongue is not taken into account. For the first time in Europe, a psycholinguistic test was developed for measuring the knowledge in Romani (comprehension and production). Categories such as wh-questions, wh-complements, passive verbs, possessiveness, tense and aspect, learning new nouns and verbs are measured with newly developed test. The knowledge of the children is connected with two theories: the ecological theory of Ogbu (1978) and the integrative theory of child development (García Coll et al. 1996). Ogbu’s theory stresses the importance of the home culture in the development of the children and the theory of García Coll and her collaborators presents the home environment and the SES of the families as an important predictor for language development and school readiness of the minority/migrant children.&#x0D; References&#x0D; &#x0D; Bafekr, S. (1999) Schools and their undocumented Polish and “Romany Gypsy” pupils.International Journal of Educational Research, 31, 295-302.&#x0D; Bakalar, P. (2004) The IQ of Gypsies in Central Europe. The Mankind Quarterly, XLIV,(3&amp;4), 291-300.&#x0D; Berko, J. (1958). The child’s learning of English morphology. Word, 14, 150-177.&#x0D; Bronfenbrenner U (1979). The ecology of human development: Experiments by nature anddesign. Cambridge, MA: Harvard University Press.&#x0D; Bronfenbrenner U (1986). Ecology of the family as a context for human development:Research perspectives. Developmental Psychology, 22, 723-742.&#x0D; Cvorovic, J. (2014) The Roma: A Balkan Underclass. Ulster: Ulster Institute for SocialResearch.&#x0D; Forget-Dubois, N., Lemelin, J.-P., Perusse, D., Tremblay, R. E. &amp; Boivin, M. (2009). EarlyChild Language Mediates the Relation Between Home Environment and SchoolReadiness. Child Development, 80 (3), 736-749.&#x0D; García Coll, C., Lamberty, G., Jenkins, R., McAdoo, H. P., Crnic, K., Wasik, B. H. andGarcía, H. V. (1996) An Integrative Model for the Study of Developmental Competenciesin Minority Children. Child Development, 67 (5), 1891-1914.&#x0D; Han, W.-J. (2006) Academic Achievements of Children in Immigrant Families.Educational Research and Review. 1 (8), 286-318.&#x0D; Hollo, L. (2006) Equality for Roma in Europe. A Roadmap for Action. Budapest: OSI&#x0D; Kezdi, G. and Kertesi, G. (2011) The Roma/non-Roma test score gap in Hungary.American Economic Review, 101 (3), 519-525.&#x0D; Kyuchukov, H (2006). Desegregation of Roma schools in Bulgaria. Sofia: SEGA&#x0D; Kyuchukov, H. (2014) Acquisition of Romani in a Bilingual Context. Psychology ofLanguage and Communication, 18 (3), 211-225.&#x0D; Kyuchukov, H., Kaleja, M. &amp; Samko, M. (2016) Roma parents as educators of theirchildren. Intecultural education, 26 (5), 444-448.&#x0D; Neuman, S., &amp; Marulis, L. M. (2010). The Effects of Vocabulary Intervention on YoungChildren’s Word Learning: A Meta-Analysis. Review of Educational Research, 80 (3),300-335.&#x0D; Ogbu J. U. (1978). Minority Education and Caste: The American System in Cross-culturalPerspective. New York: Academic Press.&#x0D; Ogbu J. U. (1981). Origins of human competence: A cultural ecological perspective. ChildDevelopment, 52, 413-429.&#x0D; Ogbu, J. U. (1988). Cultural diversity and human development. In: D. Slaughter (Ed.),Black children and poverty: A developmental perspective. San Francisco: Jossey-Bass.11-28.&#x0D; Parsons, Talcott. (1940). An Analytical Approach to the Theory of Social Stratification.American Journal of Sociology, 45 (6), 841-862.&#x0D; Roskos, K., &amp; Neuman, S. (2005). The state of pre-kindergartens standard. EarlyChildhood Research Quarterly, 20, 125-145.&#x0D; Rushton, J. P. Cvorovic, J. and Bons, T. A. (2007). General mental ability in South Asians:Data from three Roma (Gypsy) communities in Serbia. Intelligence, 35(1), 1-12.&#x0D; Rydland, V. (2009). “Whow-when I was going to pretend drinking it tasted coke for real!”Second-language learners’ out-of-frame talk in peer pretend play: A developmental studyfrom preschool to first grade. European Journal of Developmental Psychology, 6 (2), 190-222.&#x0D; Tomasello, M. (2003). Constructing a Language: A Usage-Based Theory of LanguageAcquisition. Cambridge, MA: Harvard University Press.&#x0D; &#x0D;

South Africa's salt reduction strategy: Are we on track, and what lies ahead?

On 2 September 2016, 25 local and international participants from various sectors met in Cape Town to take stock of South Africa (SA)'s progress in salt reduction and develop a roadmap for action. SA is centre stage on salt reduction globally, being the first country to mandate salt reduction across a wide range of processed foods. Excessive salt intake contributed by processed foods and discretionary sources motivated SA to implement a public awareness campaign in parallel with legislation to reduce salt intake to the World Health Organization target of 5 g per day. Five priority areas were identified for continued action on salt reduction, including obtaining research funds for continued monitoring and compliance of salt reduction targets. Determining the contribution of foods eaten out of home to total salt intake and implementing strategies to address this sector were also highlighted as key actions. Lastly, implementing the next stage of the Salt Watch awareness campaign to change.

Planning for Computer Games Research and Industry: A Structured Dialogue Design Approach

A games industry can help improve a country’s financial situation by increasing its GDP through the creation of many new job opportunities. Cyprus may be a suitable location for such an industry, mainly because of the high availability of graduates, and its strong service industry. In this work, results from a study on the feasibility of creating both a computer games industry and research sector are presented. Key stakeholders including students, and representatives from government ministries, academics, incubator companies and other companies were brought together to evaluate the current Cypriot economic situation, and to create a roadmap of actions required to create a successful computer games industry. The methodology included a Structured Dialogue Design Process that was used to identify requirements. The findings from this study include categories of essential requirements identified by the stakeholders. The data in this study could be used to plan for and devise a comprehensive roadmap for creating a computer games sector that includes games companies and research centers.

Advancing Interprofessional Collaborative Teams in the Winnipeg Health Region.

This project developed an evaluation platform aimed at diagnosing team functioning using evidence-informed, measurable indicators to provide an actionable roadmap to guide teams in improving their interprofessional collaborative team performance. A scoping literature review, stakeholder consultation, survey and focus groups were conducted to inform both the final selection of eight indicators of effective, high-performing teams and the process to assess and evaluate teams against these indicators. The program was piloted with two interprofessional teams in the Winnipeg Health Region. Focus groups and questionnaires were used to evaluate the program.

Antimicrobial resistance in the WHO African region: current status and roadmap for action.

The high burden of communicable diseases in African countries engenders extensive antimicrobial use and subsequent resistance with substantial health, financial and societal implications. A desktop analysis to ascertain whether countries in the WHO African region have implemented the WHO Policy Package to combat antimicrobial resistance (AMR) revealed that just two countries (4.3%) have national AMR plans in place, 14.9% (7) have overarching national infection prevention and control (IPC) policies, 93.6% (44) have essential medicines lists and 91.5% (43) have national medicines policies and treatment guidelines intimating rational use. None currently have representative national surveillance systems nor do any incentivize research and development into new medicines and diagnostics. A regional situational analysis to identify scalable good practices within African, resource-constrained country contexts under the auspices of WHO-AFRO is a necessary initial step towards the development of national and regional action plans in concert with incremental progress towards achieving the objectives of the policy package and global action plan. While it is clearly the responsibility of governments to develop, resource and implement plans, regular reporting to and/or monitoring and evaluation by an overarching body such as WHO-AFRO will ensure persistent incremental progress within continuous quality and accountability improvement paradigms.

Creating Change in Health Care: Developing a Shared Understanding and Roadmap for Action.

The Patient and Family Engagement Framework and the Roadmap for Patient and Family Engagement in Healthcare Practice and Research are tools designed to create a shared understanding of what patient and family engagement is and how it can be translated into concrete action.

Synthesis of many different types of organic small molecules using one automated process.

Small-molecule synthesis usually relies on procedures that are highly customized for each target. A broadly applicable automated process could greatly increase the accessibility of this class of compounds to enable investigations of their practical potential. Here we report the synthesis of 14 distinct classes of small molecules using the same fully automated process. This was achieved by strategically expanding the scope of a building block-based synthesis platform to include even C(sp3)-rich polycyclic natural product frameworks and discovering a catch-and-release chromatographic purification protocol applicable to all of the corresponding intermediates. With thousands of compatible building blocks already commercially available, many small molecules are now accessible with this platform. More broadly, these findings illuminate an actionable roadmap to a more general and automated approach for small-molecule synthesis.

A roadmap of actions aiming at ensuring furniture industry production growth: panel analysis

This paper investigates European Commission necessary conditions for competitive industry in the context of furniture manufacturing. Namely, in the Industrial Strategy of the Republic of Croatia 2014–2020, the manufacture of furniture was assigned a strategic role. However, Croatia continues to underperform in comparison with the European Union member states in terms of return to pre-crisis levels. Accordingly, using the system of generalised method of moments estimators in two steps with robust standard errors, the panel model was estimated. Econometric analysis indicates that a better access to markets, higher investment, and stable macroeconomic environment are significant conditions for achieving production growth. Moreover, the results suggest that a furniture manufacturing sector would profit from lower energy prices.

Consensus building and outcome mapping techniques can achieve an integrated roadmap for action to improve the physical health of people with severe mental illness

Introduction: The poor physical health of people with severe mental illness (SMI) is often attributed to lifestyle, disease-related medication side effects and disparate healthcare provision. The complex and inexact nature of this interaction between physical and mental health leads to uncertainty and imprecision about the most appropriate action required to address the problem. One proposed solution is to integrate care by using collaborative processes across multiple organisations. Theory / Methods: Consensus building was combined with an outcome mapping process, which has previously been used to facilitate health system integration. Eighteen participants from a service catchment area in Australia were involved in a consensus-building workshop. Data from the consensus-building workshop were thematically analysed and used to create an outcome map. Results: Participants identified that accessible, continuous, holistic, consumer-driven, recoveryoriented care was required if the physical health of people with SMI were to be achieved. However, this all-encompassing care was dependent on a wide-ranging philosophical shift in two areas, namely societal stigma and the dominance of pharmacological approaches to care. Discussion: No single organisation, team, disciplinary group or individual practitioner had the entire suite of knowledge and skills to deliver all components of the identified strategies. Therefore, networks and networking were essential, and integrated solutions that facilitated program and service coordination needed to be developed. In response, we created an outcome map to capture both the higher-level outcomes that participants were striving to achieve and the processes and actions that had been agreed by participant stakeholders. The outcome map visually represented both the socially defined meaning of the problem of the poor physical health of people with a severe mental illness and the multiple action pathways required. World Congress on Integrated Care 2014, Sydney, November 23-26, 2014. International Journal of Integrated Care – Volume 14, 8 December – URN:NBN:NL:UI:10-1-116602– http://www.ijic.org/ Conclusions: We used a consensus building approach to generate solutions, actions and goal statements, which were then used to create a visual map that provided a purpose and signposts for action, thereby maximizing the potential for cohesive action across sectors. Lessons learned: Consensus-building workshops are practical and useful ways of developing pathways for action that include multiple sectors in integrated approaches to improving the physical health of people with SMI. Limitations: Although participants identified the need to work across sectors, important sectors such as law enforcement, housing and employment were not included in the consensus development process. However, including these sectors was beyond the scope of this project. A further limitation to this research is that the research was conducted in a defined geographical area and might therefore, not be transferable to other contexts. Future research: Including a broader range of stakeholders, including consumers and carers, should be considered in future research that is seeking to address complex issues. Further research is also required using identified implementation theories to facilitate the adoption of the action strategies identified in the outcome map into routine practice.

Structuring the patient–physician encounter: Joint creation of an actionable roadmap to health

The patient׳s experiences and costs related to their care are largely dictated by each patient–physician interaction along the continuum of care. However, the amount of time that a physician spends with a patient creating a medical action plan is highly variable and often not related to the severity or complexity of the patient׳s condition. Adding a structured process to guide and inform patient–physician encounters, including outlining expectations and follow-up by both sides is needed. Addressing these barriers to the physician–patient relationship would reduce variation in care, minimize unnecessary trial and error tactics and instead focus on predicted cost effective actions.

Ecological Suffering: From a Buddhist Perspective

Ecological Suffering:From a Buddhist Perspective Sulak Sivaraksa “There will be great suffering caused by our human-created climate change, but we may need to go through this process in order to see the ‘light.’” —Nigel Crawhall (IUCN, CEESP representative, South Africa) Ecological suffering is the result of centuries of abuse of our Earth and environment. It is the effects of numerous overlapping developments that are unsustainable for the most part. It results from violent actions, whether in the shape of colonialism, industrial development, wars, economic growth, the arms race, or capitalist competition between states. More importantly, it is a flaw inherent in the global capitalist system—which is nevertheless seen as the best system to organize human life—and will bring down both capitalism and human survival if we act as if we don’t know about it. I explicitly name capitalism because without doing so any critique will be simply abstract, moralistic, and toothless—such as blaming greed in general or on particular greedy individuals, on human nature, on civilization, and so on. No. Ecological suffering is the result of systemic violence rooted in the global political economy. Although our world cherishes diversity and choice, it is increasingly intolerant of any form of living that resists free market fundamentalism. Ecological suffering is happening on a daily level even if we feel that nothing is happening. Ecological suffering sustains the normalcy of our everyday life as we drive to work, eat our lunch, talk on our mobile phones, connect to the Internet, and so on. It is woven into our daily existence. As such, we don’t want our daily life to be disturbed and often act as if we don’t know about ecological suffering. But it is also experienced unevenly: the poor majority more so than the rich minority, who for now could still buy their way out of the problem; developing societies more than developed ones; and so on. One thing is certain: Our ecosystem is crashing. What should be a circle of life, of interconnected life forms, has already started to work as individual parts going in different directions, leading to malfunctions and negative consequences in many parts [End Page 147] of the system. At the Inter-Religious Dialogue on Climate Change and Biodiversity Conservation in September 2012, a conclusion that was arrived at the conference was a simple but profound one: It is all connected; we are all connected. As I mentioned in my latest book, Wisdom of Sustainability,1 our world and nature works in the same way as the wheel of Dhamma. The wheel of Dhamma can be used to countenance the wheels of state and systemic violence. This is why tackling the environmental problem needs a religious or spiritual dimension. Below, I will reflect on the problems and challenges we face in coping with the impending ecological catastrophe. I link the postponement of the crisis and sustainability with the cultivation of spirituality in ourselves—that is, to search for what has been uprooted and what we need to reclaim or retrieve. Bringing in Buddhist ethics, I will tease out how an interfaith approach to problem solving can benefit our environment by pointing to some concrete suggestions. The starting points of this talk are drawn from The Wisdom of Sustainability and the conference overview of the Inter-Religious Dialogue on Climate Change and Biodiversity Conservation, and I will alternate between these two points, which also structure my talk. The dialogue was held in Sri Lanka in September 2012, at the Islander Center. It was organized by the International Network of Engaged Buddhists (INEB), the Sewalanka Foundation, International Union for the Conservation of Nature (IUCN) Sri Lanka National Office, and Commission on Environmental Economic and Social Policy (CEESP). At this conference faith leaders, environmental and climate scientists, conservationists, and social activists from all over the world gathered to collaboratively explore the scientific foundations of climate change and biodiversity loss; its social, political, and economic drivers; the impacts of climate change on human societies and the environment; and the underlying human behaviors that contribute to climate change.2 The conference used three levels of engagement to frame the creation of a roadmap for action...

Requirements for vocabulary preservation and governance

Purpose – The paper seeks to analyze the health of the vocabulary ecosystem in terms of requirements, addressing its various stakeholders such as maintainers of linked open vocabularies, linked data providers who use those vocabularies in their data and memory institutions which, it is hoped, will eventually provide for the long-term preservation of vocabularies. Design/methodology/approach – This paper builds on requirements formulated more tersely in the DCMI generic namespace policy for RDF vocabularies. The examination of requirements for linked open vocabularies focuses primarily on property-and-class vocabularies in RDFS or OWL (sometimes called metadata element sets), with some consideration of SKOS concept schemes and Dublin Core application profiles. It also discusses lessons learned through two years of development of the linked open vocabularies (LOV), of which main features and key findings are described. Findings – Key findings about the current practices of vocabulary managers regarding metadata, policy and versioning are presented, as well as how such practices can be improved to ensure better discoverability and usability of RDF vocabularies. The paper presents new ways to assess the links and dependencies between vocabularies. It also stresses the necessity and importance of a global governance of the ecosystem in which vocabulary managers, standard bodies, and memory institutions should engage. Research limitations/implications – The current paper is focused on requirements related to a single type of vocabulary but could and should be extended to other types such as thesauri, classifications, and other semantic assets. Practical implications – Practical technical guidelines and social good practices are proposed for promotion in the Vocabulary Ecosystem (for example, by vocabulary managers). Originality/value – This paper brings together the research and action of several important actors in the vocabulary management and governance field, and is intended to be the basis of a roadmap for action presented at the Dublin Core conference of September 2013 in Lisbon (DC 2013).

Prevalence of physical activity and obesity in US counties, 2001–2011: a road map for action

BackgroundObesity and physical inactivity are associated with several chronic conditions, increased medical care costs, and premature death.MethodsWe used the Behavioral Risk Factor Surveillance System (BRFSS), a state-based random-digit telephone survey that covers the majority of United States counties, and the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of the US civilian noninstitutionalized population. About 3.7 million adults aged 20 years or older participated in the BRFSS from 2000 to 2011, and 30,000 adults aged 20 or older participated in NHANES from 1999 to 2010. We calculated body mass index (BMI) from self-reported weight and height in the BRFSS and adjusted for self-reporting bias using NHANES. We calculated self-reported physical activity—both any physical activity and physical activity meeting recommended levels—from self-reported data in the BRFSS. We used validated small area estimation methods to generate estimates of obesity and physical activity prevalence for each county annually for 2001 to 2011.ResultsOur results showed an increase in the prevalence of sufficient physical activity from 2001 to 2009. Levels were generally higher in men than in women, but increases were greater in women than men. Counties in Kentucky, Florida, Georgia, and California reported the largest gains. This increase in level of activity was matched by an increase in obesity in almost all counties during the same time period. There was a low correlation between level of physical activity and obesity in US counties. From 2001 to 2009, controlling for changes in poverty, unemployment, number of doctors per 100,000 population, percent rural, and baseline levels of obesity, for every 1 percentage point increase in physical activity prevalence, obesity prevalence was 0.11 percentage points lower.ConclusionsOur study showed that increased physical activity alone has a small impact on obesity prevalence at the county level in the US. Indeed, the rise in physical activity levels will have a positive independent impact on the health of Americans as it will reduce the burden of cardiovascular diseases and diabetes. Other changes such as reduction in caloric intake are likely needed to curb the obesity epidemic and its burden.