Neighbourhoods influence health; we should plan accordingly

KEVIN LAM AND JEAN WANG

SINCE John Snow mapped out the large cholera outbreak in London in 1854 relative to where people lived, it has been known that where we live, work and play strongly influences people’s health. The way our cities and towns have been built plays a large role in many of the health conditions Canadians develop.

Cities such as Montreal and Vancouver have been working to create better cycling infrastructure and public transit, with the goals of improving the quality of life and health of their citizens.

It’s a good start, but is it enough?

We need a systemic collaboration between physicians, public health departments, developers and urban planners to help Canada design the cities we want — ones that can keep us healthy.

Let’s take obesity as an example.

Among Organization for Economic Development and Co-operation (OECD) countries, Canada has one of the highest prevalence rates of obesity, with an alarming one in five Canadian adults affected. Yet despite all Canada is doing to address the lifestyle factors that contribute to obesity, many public health goals are stubbornly hard to reach and nowhere near close to targets. Ninety per cent of Canadian children don’t reach the physical activity recommendations, despite physical inactivity and sedentary lifestyles being flagged as a priority focus for the Public Health Agency of Canada.

It can be difficult tomake healthy choices in certain contexts. If our daily lives are surrounded by cities without green spaces to play or where public transit is difficult to access, it can be hard to make healthy choices in spite of all the health promoting.

So what can be done?

Current solutions are heavily focused on changing individual behaviour. A great deal of funding is spent on promoting exercise, the food guide, community weight loss programs — all with a focus on individual behaviour. But evidence demonstrates that social marketing campaigns surrounding healthy eating and exercise aren’t sufficient to address the problem.

Instead of simply telling people to spend more time exercising, we can incorporate it into their lives. We could encourage stair use instead of elevators by making stairs easier to access. We could integrate walking and biking to work — forms of active transport — or make cities more walkable in general.

This is an area where physicians and public health departments can collaborate with builtenvironment experts to influence health.

Urban planners are the experts at improving the livability of towns, cities and regions. Meanwhile, physicians see the downstream effects of a poorly built environment in their clinics, operating theatres and emergency rooms every day — from chronic diseases to motor vehicle collisions.

The future of chronic disease and obesity prevention involves professions working together to generate collaborative solutions — to create better places to live, play and work.

Many studies have demonstrated that active transport is associated with a decreased risk of developing chronic illness. Physical activity reduces the risk of cardiovascular disease, including a reduction in heart attacks, strokes and heart failure, by up to 11 per cent. Systematic reviews, which pool the results of multiple studies, also demonstrate that active transport is associated with a reduced risk of obesity, Type 2 diabetes and high blood pressure.

With the many health benefits that can be realized from encouraging more active transport, health workers have an important role in advocating for and working with their urban planning colleagues to implement these ideas.

How can we take action?

It’s time for health workers to speak up and get involved to help improve neighbourhoods for everyone. Urban planners can also help with determining the health impact of land-use and transport decisions by working with public health departments.

The good news is that this collaboration is already starting to happen in some places.

Various areas across Canada, including in Toronto, Vancouver and the Region of Peel, are employing urban planners to examine the impact of different developments on the health of a community. This means new developments are being built to encourage more active transportation and existing ones are being altered to the same end.

The Canadian Association of Physicians for the Environment has started a campaign advocating governments to adopt a national active-transport strategy. Such a strategy was one of the main recommendations in a reported released by the CPHA-Lancet Countdown Briefing for Canadian policy-makers.

The future of chronic disease and obesity prevention involves working together to generate collaborative solutions. We need to fight together for better places in which to live, play and work.

*Jean Wang is a second-year medical student at the University of Ottawa who has been involved in chronic disease management and prevention research. Kevin Lam is a second-year medical student at Mc Master University who has an interest in public health and its intersection with emergency medicine, with a special focus on improving health through urban design. They are both contributors to Evidence Network.ca, which is based at the University of Winnipeg.*

— Troy Media