I alone cannot change the world, but I can cast a stone across the waters to create many ripples. - -Mother Teresa

Obesity has become a national and international public health priority. Emerging research has indicated the role of the built environment in promoting sedentary lifestyles. The Community Guide for Preventive Services recommends changes to urban design and land use policies to increase physical activity.1 Some of the recommended areas for change include building codes, roadway design standards, improved street lighting, infrastructure projects to increase safety of street crossing, use of traffic calming approaches (eg, speed bumps, traffic circles), and enhancing street landscaping. This creates a dilemma for the public health practitioner. The majority of public health practitioners have no training in these areas although we receive good training in epidemiology, health education, behavior change theory, and program development. This has caused many practitioners to intervene in ways that they know that are not effective (eg, health fairs) or have minimal impacts on populations (eg, point of decision prompts at elevators). This brings us to the essential question of how do public health practitioners create Active Living Communities?

As Mother Teresa aptly points out, we cannot change the world ourselves, but we can influence others to create change. The means through which one achieves this end can be difficult in public health, although the experienced public health practitioner possesses many of the skills that are necessary to establish effective partnerships within the community. One of the areas that these skills are most valuable for the practitioner is the development of active living communities, because building such communities often takes functioning coalitions.2 Active living communities are those which support physical activity in various forms (eg, exercise, active commuting) through design and community planning.3 The achievement of such communities requires input from a diverse group of stakeholders from the planning, recreation, public health, transportation, and governmental communities. Because the public health practitioner cannot be expected to make the necessary changes in the community independently, he/she must be the catalyst that brings together these distinct constituencies as a working coalition with the unified cause of building and sustaining active living communities.

The act of building active living communities is long and resource intensive. For example, the recent passage of a "complete streets" and safe routes to school legislation in Hawaii required efforts of very diverse stakeholders.4 The efforts of physical activity advocacy groups, transportation planners, community coalitions, and ultimately legislators were required to successfully complete this 2-year process. Central to these efforts were public health practitioners who organized events, outreach, education sessions, and planning meetings to bring these diverse groups together. As this legislation leads to modifications of the built environment, a continued coordinated effort will be required. For example, the Hawaii Department of Transportation is tasked with administering the safe routes to school funds and the adoption of complete streets policies. As illustrated in this example, the public health practitioner can act as a "super connector" who serves to link the diverse stakeholders together around a common theme.2

Communities can be viewed as complex systems. To influence systemic change at the community level, a variety of actors and relationships need to be impacted. Unlike many traditional public health problems, most of the changes that need to be made in creating active living communities are outside of the traditional jurisdiction and responsibility of the health department. Systems thinking approaches can help provide a framework to state and local health departments that are trying to create these changes. The main goal of a systems approach is to understand the relationship between the actors, information and concepts in the system, and the communication and flow of knowledge between those points.5 Tools like network analysis and surveys of policy makers can be important in documenting the success of our efforts. Ultimately, it will be the practitioner's ability to conceptualize the complex systems that impact the built environment and identify opportunities for partnership that will determine their effectiveness in enacting change. Through systematic leveraging of these partnerships, change can occur, as evidenced by the Hawaii example. However, much work remains if all individuals are to live in communities that promote active living. The current issue highlights research in this area that must be translated for the various constituencies if the goal of active communities is to be achieved. This, as much as anything, is the job of the public health practitioner.

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