1. Making the Connection The Role of Public Health and the Built Environment Myrna Wright, MHSc & Megan Williams, MPH Simcoe Muskoka District Health Unit 2 February 2007

2. Quote Public health officials need to view the built environment as having as much influence on public health as vaccines. Richard Jackson, MD, MPH Former Director Centers for Disease Control

3. Introduction  In 2006, the SMDHU embarked on a journey brought about by: A Call to Action – Grade 1 survey PA & HE air quality concerns –  smog days in cottage country  growth in Simcoe Muskoka – Places to Grow  Should we be involved in the built environment, and if so, how? Create agency committee Consult other health units Consult the literature

4. Connections Between the BE and Health Source: Yates, Thorn & Associates 2004

5. Factors Shaping the BE  Political – policy, agendas  Economic – land values, taxation  Legal – regulations, zoning  Population – demographics, mobility  Social – safety, equity  Cultural – values, preferences  Environmental – geography, climate  Aesthetics – design, functionality (Frank et al. 2005, Frumkin et al. 2004; TRB & IOM 2005 )

6. Planning Issues Relevant to Public Health  Population  Housing  Economic development  Social support systems  Natural environment  Community facilities and services  Land use and future land use  Transportation  Sustainable local food systems (Atlanta Regional Health Forum & Atlanta Regional Commission, 2006)

7. Role of Public Health in the BE  To ensure the community’s land use planning decisions promote and protect the public’s health  To protect the population from health risks resulting from land use planning, community design & development (Atlanta Regional Health Forum, Atlanta Regional Commission, 2006)

8. Public Health Practice From the Literature 1. Educate  Public health staff & board about health impacts and what role PH can play  Stakeholders, partners and public about health impacts and how to get involved 2. Research  Provide evidence to decision-makers – reports, statistics,  Indicate health impacts of planning decisions 3. Collaborate  Build relationships with planners, elected officials  Develop partnerships with coalitions, agencies and interested individuals (Atlanta Regional Health Forum, Atlanta Regional Commission, 2006; Bray et al. 2005)

9. Public Health Practice From the Literature 4. Practice Emphasize prevention through programming, interventions, education Utilize health impact assessment tools with measurable indicators to judge the effects of policies or programs on health outcomes 5. Advocate  For health to be explicitly stated & defined as a goal in the planning processes 6. Influence  Become part of the land use decision-making process  Provide submissions/input, attend meetings, participate on committees

10. Ontario Public Health Unit Involvement in BE  Building relationships with key individuals, e.g. planners, elected officials  Providing health evidence for planners  Conducting social marketing campaigns to communities  Commenting on official plans  Engaging other stakeholders

11. Lessons Learned Insights  Planners are onside conceptually & welcome health evidence  Initiate joint discussion using succinct research & reports  Identify the costs of inaction on planning rec. (including medical care)  Become involved with the community as opportunities arise  PH can change public opinion successfully Insights  Planning is a very political process & relationships are key  Understand the overview of planning process  Different interests: Benefit of provincial legislation is on managing growth yet municipalities not compensated for the prov. restrictions on land use & sales.

12. Lessons Learned Challenges  Takes time for both planners and public health to learn each other’s language (up to a year)  Discrepancies exist between Official Plans and “what really happens” Challenges  Approved plans later receive amendments which dilutes intended impact  Literature/Research/ Resources primarily American  Development patterns differ bet. Can & US

13. Plans for Action  Increase Awareness Provide local data to inform politicians, planners, citizens about health impacts of built environment Raise profile - feature topic at conferences Share strategies & info with other HU’s  Make It Easy Send Board of Health Reports to surrounding municipalities/HU’s to spark ideas

14. Plans for Action  Be Involved Identify key decision-makers and champions among Council & municipal staff Work with existing players – OHCC, Cdn. Mortgage and Housing  Speak Out Impact local politicians with deputations to Council Engage media & community through use press releases Re-introduce origin of zoning – to protect public’s health

15. Quote There are two causes of disease, One is pathological… The other is political. Dr. Rudolf Virchow 1821 - 1902

16. References Atlanta Regional Health Forum & Atlanta Regional Commission 2006, Land Use Planning for Public Health: The Role of Local Boards of Health in Community Design and Development. National Association of Local Boards of Health (NALBOH), Bowling Green, Ohio. Bray, R., Vakil, C. & Elliott, D. 2005. Report on Public Health and Urban Sprawl in Ontario – A review of the pertinent literature. Ontario College of Family Physicians, Toronto, Ontario. Frank, L., Kavage, S. & Litman, T., 2005. Promoting public health through Smart Growth – Building healthier communities through transportation and land use policies and practices. Smart Growth BC, Vancouver, BC. Frumkin, H., Frank, L. & Jackson, R. 2004, Urban Sprawl and Public Health – Designing, Planning, and Building for Healthy Communities, Island Press, Washington, D.C. Transportation Research Board & Institute of Medicine of the National Academies 2005. Does the Built Environment Influence Physical Activity? Examining the Evidence. Transportation Research Board, Washington, D.C. Yates, Thorn & Associates, 2004, Population Health and Urban Form – A Review of the Literature. Smart Growth BC, Vancouver, BC.

17. Ontario Public Health Experience Region of Waterloo Public Health Regional municipality Haliburton, Kawartha, Pine Ridge District Health Unit Board of Health