Presentation on theme: "Design Matters: Planning for Healthy Communities"— Presentation transcript:
1 Design Matters: Planning for Healthy Communities Dr Trevor HancockPublic Health ConsultantPopulation Health and WellnessMinistry of Health Services
2 Cities and the health of the nation "Many would be surprised to learn that the greatest contribution to the health of the nation over the past 150 years was made not by doctors or hospitals but by local government. Our lack of appreciation of the role of our cities in establishing the health of the nation is largely due to the fact that so little has been written about it..."Jessie Parfitt, 1986Parfitt, Jessie (1987) The Health of a City: Oxford, Oxford; Amate Press
4 Manchester's River Irk in 1845 "...a narrow, coal-black, foul-smelling stream...in dry weather, a long string of the most disgusting, blackish-green slime pools are left standing...from the depths of which bubbles of miasmatic gas constantly arise and give forth a stench unendurable even on the bridge forty or fifty feet above the surface of the stream."Frederick EngelsFrom Chapter 12, "Manchester and the Industrial City" in Mark Girourd's book Cities and People.
5 Manchester, 1859"Earth and air seem impregnated with fog and soot. The factories extend their flanks of fouler brick one after another, bare, with shutterless windows, like economical and colossal prisons...Through half-open windows we could see wretched rooms at ground level, or often below the damp earth's surface. Masses of livid children, dirty and flabby of flesh, crowd each threshold and breathe the vile air of the street, less vile than that within...“ Hipployte TaineFrom Chapter 12, "Manchester and the Industrial City" in Mark Girourd's book Cities and People.
6 The health impactLife expectancy for mechanics and labourers in Manchester in 1842 was 17 yearsLife expectancy of a working man in Salford in the 1870s could be as little as 17 years.*********************************************In 1842 the reformer Chadwick reported that a Manchester worker's average life expectancy was 17 years, whereas that of an agricultural worker was 38.********************************
8 Health and urban affairs Renaissance Italy’s City States had Boards of Health1843/4 – Health in Towns Commission and Association, UK1875 – The ‘Great’ Public Health Act“Hygeia: A City of Health”1890s – Garden CitiesSourcesHancock, Trevor (1997) "Healthy Cities and Communities: Long tradition, hopeful prospects" National Civic Review 86(1): 11-21Hancock, Trevor (1993) "The evolution, impact and significance of the Healthy Cities/Communities movement" J. Public Health Policy, pp. 5-18, SpringReferencesArmstrong, Alan (1959) Thomas Adams and the Commission of Conservation Plan Canada 1(1), 14-32Ashton, John (Ed) (1992) Healthy Cities. Milton Keynes, UK. Open University PressButterworth, William (1930) Inter-Chamber Health Conservation Contest Am J Public Health p’sCassedy, James (1962) Hygeia: A Mid-Victorian Dream of a City of Health, J. Hist. Med. 17(2),“It is not so much the city beautiful as the city healthy that we want for Canada” - Dr Charles Hodgett, Public Health Advisor, Commission on Conservation, in Annual Report (p.270H) Ottawa: Commission on ConservationLeavitt, Judith W. (1982) The Healthiest City: Milwaukee and the Politics of Health Reform Princeton, Princeton University PressRichardson, Sir Benjamin (1875) Hygeia: A City of Health London: MacMillan
9 Health and urban planning Waste managementsolidliquidWater treatmentHousing conditionsZoningVarious City DepartmentsUrban planning in Canada
10 1912-21 Canada’s Commission on Conservation “The City Healthy”Thomas Adams and urban planning –1915 – Toronto is “The healthiest of large cities” - (MacLean’s Magazine)1929 –1938 – Milwaukee “The Healthiest City”, US Chamber of Commerce’s Inter-Chamber Health Conservation Contest
12 Urban planning and health in the 21st century: The emerging literature
13 3 recent books Health and Community Design Healthy Urban Planning Frank, Engelke and SchmidHealthy Urban PlanningBarton and Tsourou/WHO EuropeUrban Sprawl and Public HealthFrumkin, Frank and Jackson
14 Selected planning policy areas (Barton and Tsourou,WHO Europe, 2000) Selected planning policy areas (Barton and Tsourou,WHO Europe, 2000) Housing Economic Open Urban policy developm’t space Transport formPersonal lifestyles * * ** ** *Social/community * * * * **influencesLiving/workingconditionsHousing ** *Work ** * *Access ** * * ** **Food * * *Safety * ** *Equity ** * * ** **Other planning policy areas include building regulations; social services and benefits; energy, water and drainage; urban regenerationHugh Barton and Catherine Tsourou (2000) Healthy Urban Planning London: Spon Press and WHO Europe
15 Selected planning policy areas (Barton and Tsourou,WHO Europe, 2000) Selected planning policy areas (Barton and Tsourou,WHO Europe, 2000) Housing Economic Open Urban policy developm’t space Transport formGeneral socio-economic,cultural andenvironmentconditionsAir quality * ** * ** *Water &sanitation * *Soil &solid waste * *Globalclimate * ** * ** **
16 Social conditions associated with health outcomes Neighbourhood living conditionsOpportunities for learning and developing capacitiesCommunity development and employment conditionsPrevailing community norms, customs and processesSocial cohesion, civic engagement and collective efficacyHealth services, incl public healthThe Community Guide, CDC, 2003Anderson, Laurie et al (2003) “The Community Guide’s Model for Linking the Social Environment to Health” Am J Prev Med 24 (3S)This article also summarizes some 200 community-based interventions to promote health-enhancing social environments.
17 Urban Sprawl and Public Health Chapters in Frumkin, Frank and JacksonAir qualityPhysical activityInjuries and deaths from trafficWater quantity and qualityMental healthSocial capitalHealth concerns of special populations
18 Travel and other characteristics of four concentric parts of the Toronto region Core Inner OuterCore ring suburbs SuburbsResidential density(urbanized portion, 7,340 5,830 2,810 1,830persons/square km)%of householdsowning one or >cars 49% 75% 87% 96%Travel by car(km/person/day)Estimated CO2 emissionsresulting from travel 1,710 2,280 3,222 5,200(g/person/day)Source: Gilbert, 1997
19 Air pollution and health, Ontario, 2000 Economic costs$600 million in direct medical costs$560 million in direct costs to employers and employees for lost timepain and suffering - about $5 billion$4 billion for the value of the premature deathsHealth costs1,900 premature deaths9,800 hospital admissions13,000 emergency room visits47 million minor illness days
20 Olympic Games and Air Pollution, Atlanta, 1996 peak traffic count ß 22.5%peak daily ozone ß 27.9%asthma emergency events ß 41.6%other medical events did not dropSource: “Creating a Healthy Environment” Jackson and Kochtitzky, 2001
21 Diesel Exhaust Carcinogenic Accounts for 90% of air toxics cancer burden70-80% from vehiclesMay contribute to 125,000 lifetime cancer deaths in USA(STAPPA/ALAPCO, 2000)State and Territorial Air Pollution Program Administrators and the Association of Local Air Pollution Control Officials (2000) Cancer Risk from Diesel Particulate: National and Metropolitan Area Estimates for the United States Washington DC: STAPPA/ALAPCO
22 The built environment and climate change urban sprawlenergy-inefficient buildingsenergy-inefficient technologiesvehicle motors, pumps, lights etcNB - “pumps are the biggest users of motors, motors use 3/5 of the world’s electricity” - Amory Lovins, RMIAmory Lovins - “An Eight-Fold Way Towards Faster Energy Efficiency” - Keynote, the June 2001 Summer Study of the European Council for an Energy-Efficient Economy,
23 Climate change and health Direct effectsmore frequent heat events (which in urban areas will exacerbate air pollution)more frequent and severe extreme weather events, causing deaths and injuriesfloodingIndirect effectsa wider distribution of insect disease vectors (particularly mosquitos)disruption of ecosystems, particularly agro-ecosystems and oceanic ecosystemsEco-refugees, conflict over resources
24 Mortality by Mode of Transport in Great Britain, 1983 to 1993 MotorcycleFootBicycleWater*CarVanRailBus or coachAir*(death rates per billion kms travelled)Source: Central Statistical Office, 1996 * The data for water and air travel include Northern Ireland.
25 Urban design and traffic injuries 1 point increase in ‘sprawl index’ over 448 US metropolitan counties= 1.5% in traffic fatality rate= 10x higher in most v least sprawlingWalking and biking fatality rates are higher in sprawling countiesBUT lower in counties - and countries - where walking & biking is commonFrumkin, Frank and Jackson, 2004
26 Traffic deaths v violent deaths by stranger Risk of dying in 15 medium and large US metropolitan areas, over 15 yearsTraffic fatality rate much higher in suburbs than risk of death by a stranger in the central cityand this would likely be even more true in Canadaso are we really safer moving to the suburbs?Lucy, cited in Frumkin, Frank and Jackson, 2004
27 Physical Activity and Health Status “One of the strongest theories (to explain the radical changes in the health status of Americans) is the significant decline in activity levels today compared with levels from 50 or 100 years ago.”Jackson and Kochtitzky in Creating a Healthy Environment (Sprawl Watch Clearinghouse, 2001)
28 How (In)Active are Canadians? Only 11% do aerobic activity sufficient to gain cardiovascular benefit (30 minutes at 50% of individual capacity, 3-4 x/week)33% of Ontarians are inactive (energy expenditure <1.5 kcal/kg/day)
29 Economic Burden of Physical Inactivity in Canada The costs attributed to physical inactivity for just seven conditions for which it is a known contributor(coronary artery disease, stroke, hypertension, colon cancer, breast cancer, type 2 diabetes and osteoporosis)2.5 percent of direct health care costs10.3 percent of deathsNB Does not include indirect costs e.g. lost productivity and long or short-term disability.(Katzmarzyk, Gledhill and Shephard, 2000)
30 Why Are We Inactive? Sedentary jobs Inactive transport commuting, shopping, etcSedentary leisure/houseworkTV, internet, etcpowered vehicles (e.g., skidoo, seadoo, ATV, etc.)power tools (kitchen, garden, repairs, etc.)
31 Deterrents to cycling/walking Safety from other road trafficBarriers due to road systemUnpleasant exhaust fumesLack of secure facilities for bikerInconvenience eg., sweat, fatigue, painBased on Morton, 2000 andWHO Centre for Urban Health
32 Benefits of Physically Active Commuting to Work Among 68 inactive middle aged men and women in a RCT, 1 hour daily PACW for 10 weeks led to increases inVO2 max %Max treadmill time %HDL cholesterol %Source: Vuori, Oja and Paronen, 1994
33 The Benefits of Walking “Imagine if half the people in Canada who live within walking distance of their work left their cars at home. Their efforts would save approximately 22 million litres of gasoline per year!”Go for Green!
34 Costs of Transport/ Benefits of Walking Total external costs of transport, 17 European countries, 1995= 7.8% of GDPIf all sedentary adults in the US walked regularly, estimated savings could be $US billion/yearSource: WHO Europe, Centre for Urban Health
35 The Health Benefits of Active Living Reductions inCoronary heart diseaseCancer (colon, breast)Obesity (leads to diabetes)OsteoporosisArthritis Depression/ anxiety/stressCognitive impairmentInjuries related to MVAs/other power uses
36 Benefits of Parks and Recreation Personale.g. stress management, self-esteem, healthSociale.g. promotes involvement and interactionEconomice.g.productive work force, reduced vandalismEnvironmentale.g.improved environmental health and awareness
37 Commuting time & social capital A 1 hour commute each way= a 40 hour work week every 4 weeks, orwork weeks a yearThis is a large loss of family and community time= a large loss of social capital
39 Urban Design for Health Denser, mixed use/New Urbanismwalk to stores, amenitiesbike to work/school/ recreationsupport public transitBike/walk friendlysidewalksbike lanes/trailssnow clearing policy• Public transit designed in
40 A Medical Miracle?“At its best, Smart Growth is like a medicine that treats a multitude of diseases - protecting respiratory health, improving cardiovascular health, preventing cancer, avoiding traumatic injuries and fatalities, controlling depression and anxiety, improving wellbeing. In the medical world, such an intervention would be miraculous. In the worlds of land use and transportation, it is a thrilling, and attainable, opportunity.”Frumkin, Frank and Jackson, 2004
41 Encouraging physical activity Municipal governmentUrban planning/designHigher densityMixed land useBike/walk friendlyAccessible and attractive paths, trailsSafetyTransitParks and Recreation Services‘Active living’ programsServices for those with low incomesSeeFrumkin, Howard; Frank, Lawrence and Jackson, Richard (2004) Urban Sprawl and Public Health: Designing, Planning and Building Healthy Communities Washington DC: Island Press********************Prevention that works - Physical activityencouraging walking while not requiring attendance at a recreational facility;community-wide campaigns, involving large scale, high intensity, high visibility programsmodified physical education in schoolindividually adapted health behaviour changesocial support in community contextscreating or enhancing access to places for physical activityPrevention that works - Reducing obesityreducing sedentary behaviour (or promote active living) in obese childrenusing diet, physical activity and behavioural strategies for adults, in combination where possibleintegrating lifestyle changes over a long period of timeSource: - “Prevention that Works” – A Review of the Evidence Base for Chronic Disease Prevention ( Population Health and Wellness, Ministry of Health Services, 2004)
42 Encouraging physical activity/2 School boardsCurriculumMake exercise fun and normal‘Walking school bus’BusinessesEncourage ‘active commuting’Discourage free parking, esp downtownSupport active living (e.g stairs)Adopt & maintain trails
43 Encouraging physical activity/3 Community agenciesProvide active recreation servicesEncourage/support ‘walking clubs’ etcCitizensBecome activeAdopt & maintain trailsTurn off TV and get out!Ditto for your kids!
44 It takes a whole community to raise healthy people!
45 Municipal governments: Policy and environments Use the public health provisions of the Community Charter, e.g.Smoking by-lawsPublic works (drinking water, sewage, waste disposal)Traffic and roads (safety)Housing quality (health, safety)
46 and more Public transit (air quality, safety, physical activity) Parks and Rec (physical activity, mental health, environment/ habitat)Planning/Land use (air quality, physical activity, urban food systems)other examples?
47 Some emerging developments Public Health ActLinks to local governmentsRequirements for planning for healthCore public health functionsHealthy communities,Input to community planningHealthy Living AllianceRegional/local Alliances
48 Re-establish a BC Healthy Communities Network? Healthy Living Alliance?Legacies Now!
49 A global movement In every WHO Region EURO - more than 600 Healthy Cities programmesWPRO - approximately 170 citiesAMRO - estimated to be more than 300.EMRO - Many countries have established national Healthy Cities networks - Healthy village programmes are now very popular in the RegionSEARO - ongoing Healthy Cities programmes exist in all Member StatesAFRO - a number of cities have begun Healthy Cities activities.Source: Healthy Cities Projects in the WHO African Region - Implementation Manual World Health Organization, Regional Office for Africa Brazzaville, 2002
50 Ontario Healthy Communities Coalition, (Sept 2004 Update) Established in the late 1980s, and currently involves 166 active healthy community groups and coalitions within 98 locations.Mission - “to work with the diverse communities of Ontario to strengthen their social, environmental, and economic wellbeing”.
51 Villes et Villages en Sante (July 2002 update) There are currently some 150 municipalities that are members, covering some 50 percent of the population; most of Quebec’s big municipalities and many of its middle sized municipalities are members.Regular membership, with voting privileges, is restricted to municipalities and is based on the passage of an official resolution by the Municipal Council.
52 Lessons from the Quebec and Ontario experience Both organizations are based on the membership of communities, who constitute the majority of the Board of Directors of both organizations.Neither organization provides direct funding to communities, but instead provides a wide range of education, training and other supportive and capacity-building services and activities.
53 In Ontario, a key feature is that two-thirds of the staff are community animators based all around the province and providing services within defined regions.Both organizations rely on close collaboration and partnerships with other provincial organizations and networks that have shared interests.
54 Both organizations are heavily dependent on government funding, but at arms length (through the Institute of Public Health in Quebec, as a non-profit charity in Ontario).In neither case do provincial governments have members on the Board of Directors
55 A healthy city . . ." is one that is continually creating and improving those physical and social environments and expanding those community resources that enable people to mutually support each other in performing all the functions of life and in developing to their maximum potential."Hancock and Duhl, 1986
56 Healthy CommunitiesApplies the concepts of health promotion in the settings where people live, learn work and playHomesSchoolsWorkplacesHealth care facilitiesCommunities
57 Healthy Communities approach Community involvementThe bedrockPolitical commitmentLocal government is a key playerIntersectoral partnershipsIt takes a whole community . . .Healthy public policyCreates the conditions for health