Does HRM* Provide a Healthy Environment for its Citizens? Michael Goodyear Department of Medicine, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Dalhousie University, Halifax, Nova Scotia, Canada Ecology Action Centre May Conversations III *Halifax Regional Municipality

It All Depends… 1. What do we mean by Health? 2. What do we mean by Environment? 3. How does Environment impact Health? 4. Can you measure health? 5. How healthy should we be? 6. Whose responsibility is it anyway?

1. Health A Multidimensional Construct “State of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” World Health Organization Preamble to Constitution of WHO 1946

Health “An individual or group must be able to identify and to realize aspirations, to satisfy needs and to change or cope with the environment. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy lifestyles to well being.” WHO: Ottawa Charter for Health Promotion 1986

Healthy Communities Social, environmental and economic factors are important determinants of human health and are inter-related. Social, environmental and economic factors are important determinants of human health and are inter-related. People cannot achieve their fullest potential unless they are able to take control of those things which determine their well-being. People cannot achieve their fullest potential unless they are able to take control of those things which determine their well-being. All sectors of the community are inter-related and share their knowledge, expertise and perspectives, working together to create a healthy community All sectors of the community are inter-related and share their knowledge, expertise and perspectives, working together to create a healthy community Ottawa Charter 1986

Health From: Health Care to Health From: Measuring Illness and Disease to – Determinants of Health Asclepius to Hygiea

Sir Michael Marmot Chair, WHO Commission on Social Determinants of Health “What good does it do to treat people’s illnesses, and then send them back to The conditions that made them sick?”

Determinants of Health Peace Peace Shelter Shelter Education Education Food Food Income Income Stable Eco-system Stable Eco-system Sustainable Resources Sustainable Resources Social Justice, and Equity Social Justice, and Equity Ottawa Charter

Canadian Institute for Advanced Research Canadian Institute for Advanced Research Attributing Health Attributing Health 25% Health Care System 15% Biology and Genetics 10% Physical Environment 50% Social and Economic Environments

2. Dimensions of Health Role of environment Individual characteristics Individual characteristics Social and Economic Environment Social and Economic Environment –Living environment –Social network –Society norms, values and ideologies Local Physical Environment Local Physical Environment

3. Health and Physical Environment Natural –Air –Water –Food (availability, price, quality) –Climate Urban Form –Built Environment –Open Spaces

Health Promotion Int. 1993

Healthy Cities and Villages WHO 1986

Healthy Communities

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Challenges Teasing out effects of separate factors Teasing out effects of separate factors –Local, larger territory* Determining extent of contribution Determining extent of contribution Determining mechanisms Determining mechanisms Evaluating outcomes Evaluating outcomes * Very different associations in Scottish v Canadian cities. K Wilson Health Place 2010

Urban Form Urban Design as tool to optimise Urban Form Urban Design as tool to optimise Urban Form

Urban Form and Urban Design Built Environment and Open Spaces Built Environment and Open Spaces Previous Emphasis on Built Environment Previous Emphasis on Built Environment Incorporates Healthy Planning Incorporates Healthy Planning

Healthy Communities, Sustainable Communities Land use planning decisions shape us in ways that we are only just beginning to appreciate …where we work, live, and play is vitally important to the quality of our lives. Our built environments are not addressing emerging public health issues well and are resulting in a less than optimum human environment. These issues are not minor and for the first time in many decades, our children's life expectancy may not exceed our own. We need to reconsider our built environment expectations to better address emerging public health issues.

4. Measuring the Health of a Community Developing Indices IncomeIncome Social NetworksSocial Networks EducationEducation EmploymentEmployment EnvironmentEnvironment DiseaseDisease etc. etc.

5. How Healthy is Healthy? “Partnership with the community implies that the community has a voice in problem definition, data collection and the interpretation of results, and the application of the results to address community concerns.” Institute of Medicine. Promoting Health, 2004

Genuine Progress Index Atlantic Ron Colman, Nova Scotia (King’s County, Glace Bay) Jobs and Income security Jobs and Income security Safety from Crime Safety from Crime Air and Water Quality* Air and Water Quality* Population Health & Education Population Health & Education Balance between work and family Balance between work and family Community values Community values Activities for youth* Activities for youth* Aesthetic quality of urban space* Aesthetic quality of urban space* *least agreement as to how to measure

Problems with Measuring and Standards Existing data insufficient to measure or create standards Existing data insufficient to measure or create standards Unclear whether has to be community specific Unclear whether has to be community specific Subjective (e.g. Not just Crime Statistics, but feeling safe) Subjective (e.g. Not just Crime Statistics, but feeling safe)

6. Whose Responsibility? Clearly not HRM – alone Clearly not HRM – alone –Yet has input at many levels Requires multi-level coordination Requires multi-level coordination Community input and participation Community input and participation Need for Health Impact Analysis in policy Need for Health Impact Analysis in policy

Research PracticePolicy After Dr Carolyn Bennett

Research PracticePolicy KT* *Knowledge Translation

Research PracticePolicy KT Political Will

Research PracticePolicy KT Political Will Applied Research

PracticePolicy ENGAGED CITIZENS KT Political Will Applied Research

Healthy Communities Incorporate health into all public policy Incorporate health into all public policy Committment to creation and preservation of physical and social environments that support and promote better health Committment to creation and preservation of physical and social environments that support and promote better health Intersectoral collaboration Intersectoral collaboration Community participation Community participation Action plan Action plan Evaluation Evaluation

Healthy City WHO 1988