Creating Partnerships for Healthy Communities David L. Mowat, MBChB, MPH, FRCPC, FFPH Medical Officer of Health, Peel Region, Ontario Communities Putting Prevention to Work Built Environment Mentoring Project New York, New York November 4, 2011

Assumptions The science shows reasonably consistent relationships between built environment of outcomes of interest Outcomes include major chronic diseases, air quality, social connectedness, injuries North American built environment is sprawling, car dependent, not health-supporting The issue falls within the mandate of Public health

Scope “built environment” encompasses a range of issues, including:  Land use planning  Active transportation  Transportation demand management  School travel planning  Parks, trails and recreational facilities  Building design  Neighbourhood development  Streetscape

The Region of Peel Lake Ontario

Population1,261,0001,425,0001,571,000 Peel’s Population Growth is One of the Highest in the GTHA Population (Millions) PEEL York Durham Halton Hamilton million 1.6 million + 13% + 10%

The Region of Peel PEEL

The Region of Peel Early Healthy Built Environment Initiatives 1.Literature Review 2.Conceptual Models on relationship between health and planning 3.Peel Health position statement 4.Active Transportation Master Plan Steering Committee 5.Healthy policy development for Regional and Municipal Official Plan policies 6.Comments on Municipal Block and Secondary plans

Who we are Heart and Stroke Foundation of Canada Canadian Institute of Planners Urban Public Health Network National Collaborating Centres for Healthy Public Policy Six public health units: Montreal Peel Surrey Toronto Vancouver Victoria

Our goals Together, we are: 1.Piloting and evaluating different approaches to translating the latest research into the needed tools, policies and processes to support policy-makers and practitioners in creating healthier built environments. 2.Exchanging knowledge and lessons learned, and seeking out opportunities to adapt practices from one city or region to another. 3. Cultivating the building of a cross-sectoral community of practice.

National projects  Development of a software tool that would assess the health impacts of land use planning decisions  Administration of a residential preferences survey that would determine the demand for walkable communities, and the degree of discrepancy between current and preferred neighbourhoods, for residents of the Greater Toronto and Greater Vancouver areas

Site-specific projects  Inventorying, mapping and evaluating community-based interventions to promote greener, more walkable neighbourhoods in Montreal  Developing a framework for health background studies in Peel and Toronto  Developing processes for applying a Healthy Development Index to proposed and existing developments in Peel  Exploring relationships between socio-economic status, health outcomes, and the urban built environment in Toronto  Working with local governments to integrate a health lens into planning policy and practice in Surrey, Vancouver and Victoria

Peel Healthy Development Index Purpose: To evaluate development applications in a consistent manner and provide health-based rationale to inform planning decisions Process: 1. Review of academic and grey literature 2. Strength of evidence analysis 3. Extensive stakeholder consultation 4. Policy gap analysis 5. Geographic Information Systems (GIS)-based validation analyses The Region of Peel

Peel Healthy Development Index Output: Index consisting of seven built environment elements: – Density – Proximity to services and transit – Land use mix – Street connectivity – Road network and sidewalk characteristics – Parking – Aesthetics and human scale Elements are further broken down into measures, many of which are quantitative The Region of Peel

Peel Healthy Development Index – Examples The elements and measures were pulled from relationships documented in the literature, after strength of evidence analysis The Region of Peel

Peel Healthy Development Index Refinement Pilot Test the targets and ranges in the Healthy Development Index – 3 “new-urbanism-type” secondary plan sites – 2 “traditional suburb” sites in Peel. Refine/calibrate the Index to reflect each municipal context Develop an implementation plan unique to each municipal context to integrate the targets and ranges in the Healthy Development Index into existing development approval process. Now, Pilot Testing and Refinement The Region of Peel

Health Background Study Framework Developing the content and criteria for a health background study to be implemented at the municipal and/or regional levels: Purpose: To develop a framework for municipally- mandated Health Background Studies To design the framework to be applicable across a range of different contexts and allow developers to identify and pre-emptively mitigate any potential health hazards associated with their development proposals. Joint project between Region of Peel and City of Toronto The Region of Peel

Health Background Study Framework Rationale Description of the Core Element and why it is important from a community health perspective. Objective Statement of desired development objective. Standards Minimum development standards to be achieved by the proposed development. Key Questions List of key questions that should be considered in the planning and preparation of the development. Reporting/Content Requirements Description of the minimum reporting. The Region of Peel

Creating supportive policies at each level of the planning policy hierarchy M A C R O M I C R O Health Promoting Policy

Official Plan Policy DocumentPolicy #Intent Peel Regional Official Plan Amendment The Region will prepare an assessment tool to evaluate the public health impacts of development, jointly with the area municipalities The Region will work jointly with the area municipalities to raise public awareness of the health impacts related to planning through public and private partnerships Peel Regional Official Plan Amendment The Region may require health impact studies as part of a complete development application to amend the Regional Official Plan The Region may develop public health indicators to analyze the effectiveness of Official Plan policies and serve as a basis for policy adjustments Caledon Official Plan Amendment The Town will participate jointly with the Region of Peel and area municipalities in the preparation of an assessment tool for evaluating the public health impacts of development proposals The Town will work jointly with the Region of Peel and area municipalities to raise awareness of public health issues related to planning Mississauga draft Official Plan The City may require health impact studies as part of a complete development application The City requires all development applications to have regard for public health

1.Regional Council Supportive at every step (but there have been no challenges) 2.Local Planning Staff Timid support Seeking other jurisdictions doing similar work (fear of pioneering) Seeking Recognized Authorities to evaluate Health Assessments 3.Planning Consultants Open-minded Eager to contribute to new concepts Raised many questions and concerns on how assessment index might work (demonstrating index) Proposed no opposition Reactions so far…

4. Developers Progressive developers showed interest (do not wish stigma that their products are unhealthy) Indicate compliance w/ rules as long as they apply equally to all Transition considerations during initial start-up Noted that many of the ‘design attributes’ were outside of their ability to control 5. Engineers Resistant to modification of any engineering standard Safety considerations outweigh unproven health considerations

Provincial Advocacy PROVINCIAL BODYTOPICS FOR ADVOCACY Ministry of Municipal Affairs and Housing Review Municipal Act Require stronger adoption of urban design guidelines by municipalities Ministry of Energy and Infrastructure Participate in the review of the Growth Plan as it is implemented Ministry of Transportation Create a provincial Active Transportation Strategy Ministry of Environment Work with Ministry of Transportation on Active Transportation Strategy and Climate Change Ministry of Education Regulate site design for schools to improve access by pedestrians and cyclists A range of provincial sectors involved

Public, politicians Planners Public health Transportation engineers Architects Parks and recreation School boards Retailers Landscape Architects Conservation Utilities Developers Industry Finance Homebuyers Commuters Public Multiple Stakeholders

Changes to technical norms at Peel An example Recently, transportation engineers approved a decrease in road and median width on all Regional roads. In addition, they approved the placement of off-road bicycle lanes to improve active transportation opportunities in Peel.

Peel’s Transportation Trends At A Glance Average time spent commuting will increase from 82 minutes to 109 minutes Travel time by car from Hamilton to Downtown Toronto will take approximately 3 hours Annual cost of congestion to the GTHA economy will increase from $2.7 billion to $7.2 billion If Current Trends Continue………

The Region of Peel

THE DIABETES ATLAS FOR THE REGION OF PEEL: PREVIEW

The Number of Walkable Destinations and Diabetes

Challenges Complexity Long term vs. short term Concentrated and diffuse interests Large amounts at stake

Working Together Parallel interests, common goals Lending credibility Funding Recognition Support in approaching decision-makers Persistence