Transportation & Chronic Disease

Living in the Bay Area, I am comfortably mobile via foot or by bicycle, which significantly contributes to my overall health and wellness. My life in Trujillo fell to the other side of that extreme because Trujillo is a city with such poor walkability and bikeability. While much of my project focuses on nutrition and caloric input, caloric output (i.e. physical activity) should command equal attention. In the United States, the American Heart Association recommends 30 minutes of physical activity a day, five times a week for adults. (1) In order for the residents of Trujillo to benefit from a similar set of guidelines, the built environment must be assessed and restructured so people can get more exercise through habitual activities such as commuting to and from work.

As a pedestrian in Trujillo, crossing the street mimics a game of tetras. Traffic lights are rare and loosely obeyed; traffic signals for pedestrians are nonexistent. The majority of sidewalks in Trujillo are extremely narrow and riddled with potholes and deep fissures. Moreover, these hazardous crevices are not designated with any marking or warning signs, and most have no timeline for being repaired. Stray dogs and cats linger and dominate the sidewalks, forcing pedestrians into the street so as not to disturb the unpredictable animals. One must also take caution not to step into the fecal material of both wild and domesticated animals who roam the streets unattended. Trash lingers in the street in “designated” pick-up spots (trash collection bins are not distributed to residents), which leaves a retched perfume in the surrounding ambient air. The spot where I placed my trash always has trash sitting there from the previous pick up; it seems as though someone arbitrarily decides what to collect and what to leave sitting on the sidewalk. Thus, walking in Trujillo is neither safe nor inviting.


Biking in Trujillo is also not a feasible option for moving around. There are no bike lanes in Trujillo, so bicyclists must share the same traffic lanes as cars. Even if separated bike lines existed, they would likely not be obeyed because buses and combis (local taxis) are constantly moving in serpentine lines to load and unload passengers, as well as to pass other vehicles. In Trujillo, the rules of the road are not well enforced. In the rare event of being pulled over, a bribe can oftentimes remove the traffic offense.

General safety is also of great concern in Trujillo. The city’s reputation for thievery and crime keeps locals and visitors from moving around freely, particularly at night. Nicole Ferrera, the Executive Director of Walk San Francisco (a pedestrian advocacy group in San Francisco, CA) who has a dual degree Masters of Public Health and Masters in City Planning from UC Berkeley, says, “rates of walking are directly linked to feelings of safety in the street. If people perceive that streets are dangerous, whether from traffic, or violence, or both, it becomes isolating and unhealthy.” Living in Trujillo, I experienced the pangs of isolation as I generally retreated to my mini room where I would work in solitary after dusk (6pm) almost every night because I did not feel safe going out. On the rare occasion that I did go out, I always left with an acquaintance and took a “secure taxi” door to door.

Though evidence linking the built environment to physical activity in developed countries exists, such data is lacking in less-developed countries such as Peru. (2) Before beginning an initiative to improve the transportation system, culturally sensitive and city specific initiatives should be kept in mind. For example, the majority of people from Trujillo live outside of Avenida España, a road that circumvents the center of the city. The daily traffic movements are complex and mimic a funneling effect of people moving towards the Avenida España to head to work. Thus, there would likely be some variation in city planning techniques amongst the different cities of Peru.

“Good city planning by public agencies is critical to creating an environment that promotes health through active forms of transportation,” says Joe Steinberger, a Principal Environmental Planner for the Bay Area Quality Management District and the Treasurer of Walk SF. "When public agencies fail to adopt policies and implement projects and programs to create these environments, local public activism can be a powerful force to empower these agencies to transform cities with improvements to promote active transportation." With diseases associated with poor diets and lack of exercise, such as obesity and Type II diabetes, steadily increasing in Trujillo, local advocacy groups and governments should look towards improving the built environment as a potential remedy to improve the public’s health.


The work of local advocacy groups will also benefit from collaboration with the local government in Trujillo to effectively and expeditiously improve pedestrian and bicycle mobility.  For example, local advocacy groups can develop and advocate for policies that can later be adopted and funded by local government. Walk SF is an example of a local advocacy group that has designed campaigns such as “Vision Zero”, which is a plan to eliminate traffic deaths in San Francisco by 2024. Walk SF has created a four step process to achieve this goal. The first step is educating the public on effective safety education to create a set of expectations that can change traffic behavior. (3) The second step is engineering streets for safety by calming traffic, enhancing visibility, and improving the organization of the streets. (4) The third step is enforcing traffic laws, particularly in busy intersections and cross walks. (5) The fourth and final step is evaluating and monitoring the progress of the proposed initiatives to ensure that the resources are effectively being used. (6) Ferrara believes that “advocacy organizations and government have complementary roles to play in terms of improving the walking environment. Government generally takes the lead on programming funds, designing and implementing improvements and engaging the public, whereas advocacy groups engage constituents to push government to do more, better, and faster. The most significant change is made when both government and advocacy is strong.” Thus, the symbiosis between local advocacy groups and local government can improve the built environment, and hopefully encourage physical activity to better the public’s health in Trujillo.



1.     "American Heart Association Recommendations for Physical Activity in Adults." American Heart Association, Feb. 2014. Web. 19 July 2016.

2.     Adlakha, Deepti, J. Aaron Hipp, and Ross C. Brownson. "Adaptation and Evaluation of the Neighborhood Environment Walkability Scale in India (NEWS-India)." International Journal of Environmental Research and Public Health. MDPI, 2 Apr. 2016. Web. 19 July 2016.

3.     "Educating the Public." Vision Zero SF. Walk SF, 02 Jan. 2015. Web. 20 July 2016.

4.     "Engineering Streets for Safety." Vision Zero SF. Walk SF, 02 Jan. 2015. Web. 20 July 2016.

5.     "Enforcing Traffic Law." Vision Zero SF. Walk SF, 02 Jan. 2015. Web. 20 July 2016.

6.     "Evaluating & Monitoring Our Progress." Vision Zero SF. Walk SF, 02 Jan. 2015. Web. 20 July 2016