City design is intrinsically linked to health, experts told a Hamilton conference Tuesday.

"The biggest threat to health is obesity," Dr. David Mowat, medical health officer for Peel Region, said at the Association for Commuter Transportation of Canada summit on sustainable transportation.

The cause is not necessarily genetics, Mowat said.

'We need to get more people to realize that it is our environment... social, political, built," he said. "It's the key to getting us to live healthy."

Dr. Karen Lee was born in Edmonton but works now as the director of New York City's department of health and mental hygiene. She said NYC is seeing a drop in obesity rates, a decrease in traffic fatalities and a whopping 236 per cent increase in commuter cyclists. All because of a new planning strategy.

Second to tobacco use, obesity is the second leading cause of death in the U.S., Lee said. And she adds, "Canada is parallel."

In Hamilton, according to the city's latest vital signs report released by the Hamilton Community Foundation, 60 per cent of people aged 12 or older are overweight or obese.

Lee said NYC developed Active Design Guidelines about five years ago with input from community stakeholders.

Five principles for designing urban environments

The guidelines show five principles for designing urban environments to promote a healthy lifestyle: access to transit, access to supermarkets, farmer's markets and drinking water, parks and plazas, pedestrian-friendly spaces and bicycle networks.

"Sometimes there is an assumption that doing something new and better costs more... or people might oppose it," she said. "That's not the case."

Lee said, for example, some paint and plant potters help create an easy pedestrian plaza.

Not only do cities need healthy infrastructure, there needs to be attractive places to go.

"If you don't have anywhere to walk to, no destination, then people just do recreational walking and not everyone has time for that," she said.

Make better use of the waterfalls and the harborfront

In Hamilton, Lee sees potential. Linking the city with its environmental assets, like waterfalls, is a good start.

"Part of the active transportation corridor could link to these sites, so if people are going to work or school they could use part of these corridors, but it could also potentially be used to create a tourism industry," she said. "Why do people just have to drive to these locations?"

Lee said building this infrastructure would create jobs and build on local economic growth.

There's an opportunity at the harborfront, too.

"It's thinking through and ensuring that the waterfront is not just an isolated place you go to for recreation, but used by active commuters where relevant," she said. "So ensuring it's connected to an active transportation network so people who live near that area could use that as a wonderful commute."

NYC used its abandoned buildings and old railways to create recreation and "greenways," transportation corridors for pedestrians and cyclists.

Dr. Ninh Tran, Hamilton's associate medical officer of health, said the city has a long way to go to have a design that works in favour of health.

"I do think the way the city was designed originally is contributing to the obesity rate," Tran said, adding that Hamilton has neighbourhoods that are simply not walkable.

Tran said public health is working with the city's planning department on strategies to improve modes of active transportation: walking, cycling and using public transportation. City officials are looking at adding more pedestrian walkways and cycling lanes.

"We can't change what's already been done," he said, "but there is opportunity to do some retrofitting."

Though in its early stages, Tran said public health is also working through ways to improve access to healthy foods in all neighbourhoods.

Lee said much of the U.S. is no longer funding health education because research shows it is not making a difference.

"If we want to change people's behavior, ultimately environment is key."

In areas under-served by subways, Lee said NYC is building rapid transit lines and bike infrastructure. "Complete streets is what we're aiming for on all streets," she said.

In the U.S., NYC's guidelines are spreading. About 50 communities were provided with federal money to work on environmental changes to reduce tobacco use and obesity rates, she said.

"We know you can't just educate to make these changes," she said. "[Canada] could start the discussion about environmental changes to achieve sustainability in our health care."