The Anthem Foundation is embedded in communities across the country where it supports programs that build awareness about the importance of active lifestyles and healthy behaviors. One of the many ways we are helping to increase awareness and improve overall health is through our partnership with the American College of Sports Medicine (ACSM). Since 2006, Anthem Foundation has granted over $1.2M to ACSM as a founding partner in an effort to establish the American Fitness Index, a tool and resource for community stakeholders to address conditions in the environments that negatively affect a person’s overall health and identifies to create healthier, more active communities.

For the second year in a row, Arlington, VA received the title of ‘Fittest City’ in America in the 2019 American Fitness Index rankings. The findings of the 2019 Fitness Index are not only a great indicator of how well communities are encouraging fitness among their residents, but also reveal how social, economic and physical conditions of health within communities directly impact the health and fitness levels of America’s largest cities.

According to Healthy People 2020, a science-based initiative launched by the U.S. Department of Health and Human Services, nearly everyone is impacted by conditions in the environment that negatively affect a wide range of health, functioning, quality of life outcomes and risks in one way or another. A way to look at the health of individuals and our communities starts in our homes, schools, workplaces, neighborhoods and communities. By taking a deeper look into these areas, we can understand why some Americans are healthier than others, and focus on interactions and relations to address why other Americans are not as healthy, and come up with opportunities and solutions on how to improve the problematic areas.

Part of our ongoing strategy at the Anthem Foundation is to create meaningful partnerships with organizations, targeting specific, preventable health concerns and addressing the conditions in our environments’ social determinants that can negatively impact them. Together with the ASCM and the Fitness Index, we can continue to look toward a brighter future by providing the necessary tools and resources to benefit people of all ages and backgrounds within our communities.

Author: Stephen Friedhoff, MD, Chief Clinical Officer, Anthem, Inc.

Two criticisms of the first decade of the ACSM American Fitness Index^®and its annual report were that it was limited to only the 50 most populated cities in the USA and that the entire metropolitan area was counted among the data. These two observations had some merit. Cities protested that a certain suburb was not really a suburb (but based on the federal government definition of Metropolitan Statistical Area it was) and smaller cities like Arlington, Virginia and Madison, Wisconsin said “what about me?” The original approach to the rankings provided important and valuable general messages but limited the ability to provide targeted assistance to city and community leaders.

That all changed when the 2018 Fitness Index was released. The number of cities reported on grew to the top 100 largest cities based on population, and the definition of “city” was limited to the city limits. The updated approach provides city leaders with the local data that they need to make changes. The data are more in line with governing structures within a city and acknowledge the differences in health behaviors and community-level infrastructure between the city and surrounding suburban areas. The expanded rankings also provide a more inclusive approach by adding cities in states that weren’t previously represented.

With this new definition of city and the inclusion of the top 100, there are still opportunities for the Fitness Index to consider with future updates. For example, in my own hometown of Atlanta (ranked #20 in 2018), the reported population is 473,000 although there are three times that number working within the city limits each day (don’t try driving a car during rush hour!).

Some people might say that the Fitness Index should include the “near” suburbs. This idea may have merit, but the Fitness Index faces challenges with every update. For example, there is not a standardized approach for defining “near” suburbs. Absent of any way to standardize that approach for all cities (and to make fair comparisons), the definition of city was established for the 2018 report. Additionally, changes made to the Fitness Index must have reliable, regularly updated data sources. Currently there are limited data sets that include “near” suburbs.

The methodology for the 2019 rankings remains the same as was used in 2018. There are still 33 indicators divided almost equally between personal health indicators (health behaviors and health outcomes) and community/environmental indicators (built environment, recreational facilities, policy and funding). The city definition has not changed since 2018.

Effect on the rankings

Interestingly, while direct comparisons cannot be made between rankings for MSAs and the city proper, the 2018 rankings found that most cities ranked similar to their MSA ranking from 2017. The 2018 rankings indicate that for MSAs ranked high in the 2017 Fitness Index, the central cities of those MSAs also ranked high in the 2018 rankings. The 2017 rankings for MSAs in #1 Minneapolis, #2 Washington, D.C. and #3 San Francisco remained highly ranked after the 2018 expansion.

A similar pattern appeared in low ranking MSAs and their central cities. The cities ranked toward the bottom of the 2017 Fitness Index when 50 MSAs were reported included #48 Indianapolis, #49 Oklahoma City and #50 Louisville. In 2018, these cities remained among the lowest ranked cities (#98 Louisville, #99 Indianapolis and #100 Oklahoma City). Although these cities continue to be ranked the lowest among the top 100 most populated cities in the USA, there are some grassroots programs starting to take hold and some success has been achieved.

Author: Walt Thompson, Ph.D., FACSM

The American College of Sports Medicine launched the American Fitness Index (Fitness Index) in 2008. The Fitness Index ranks the 100 largest cities in the United States according to variables that reflect and affect physical activity, physical fitness, health and quality of life of community members. Public health databases serve to develop the Fitness Index and include such components as: percent of adults exercising in the last 30 days, percent with obesity, percent who live within 10 minutes of a park and percent walking or biking to work. The Fitness Index provides information to civic and public health leaders regarding the “health” of their city and citizens and serves as a baseline or benchmark for cities to aspire and measure progress.

When it comes to changing health behaviors and health outcomes, those efforts that influence policy and environment are the most important levers to pull (think Clean Indoor Air Act). Since implementation of tobacco legislation, we’ve seen the rate of tobacco use decrease by about half, from 30+ percent of adults, to 14 percent of adults. Not surprisingly, the decrease in tobacco use in the United States is paralleled by an observed decrease in cardiovascular disease 507 deaths/100,000 to 273 deaths/100,000 people.

Physical activity and resultant physical fitness have a profound influence on health. The recently released 2018 Physical Activity Guidelines for Americans highlight the importance and influence of regular physical activity on health. To have the greatest impact, efforts that aim to promote physical activity in communities should address policy and environment, for example: school physical education requirements, bicycle lanes, public transportation infrastructure and farmers’ markets.

As a result of the Fitness Index, several cities have undergone significant efforts to address community infrastructure and policy with remarkable results!

Let’s take Oklahoma City for example. Under the leadership of their mayor, Mick Cornett, the city collectively lost one million pounds! They made the following changes to achieve these phenomenal outcomes: installed 400 miles of new sidewalks, over 100 miles of new jogging and biking trails, built a downtown park, built all new gyms in all the inner-city grade schools and removed fried foods from the school lunchroom.

We’ve watched other cities make meaningful improvements in their communities and in the health of their populations. It is important to continue these gains in cities, towns and communities across the country. We spend nearly 18 percent of our GDP (gross domestic product) on healthcare. These costs are largely driven by chronic diseases such as type 2 diabetes, which is most often related to unhealthy diet, insufficient physical activity and subsequent obesity.

Now more than ever, we need the American Fitness Index to help raise awareness and motivate, nudge, maybe even jolt community leaders to address infrastructure, environment and policy that allow community members to live their healthiest lives possible.

Author: Elizabeth Joy, MD, MPH, FACSM