Opinion

Building health: Our communities' designs strongly influence our physical well-being

Since John Snow mapped where victims of a large cholera outbreak lived in London in 1854, it has been known that where we live, work and play strongly influences people's health.

Doctors, public health departments, developers and urban planners must work together to design cities

Health workers have an important role in advocating for and working with their urban planning colleagues to implement strategies that encourage things like active transportation. (Darren Bernhardt/CBC)

Since John Snow mapped where victims of a large cholera outbreak lived in London in 1854, it has been known that where we live, work and play strongly influence people's health.

The way our cities and towns are built plays a large role in many of the health conditions Canadians develop.

Cities like Montreal and Vancouver have been working in recent years to 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 countries in the Organization for Economic Co-operation and Development, Canada has one of the highest rates of obesity, with an alarming one in four Canadian adults affected.

Yet despite all that 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 do not reach the current physical activity recommendations, even though physical inactivity and sedentary lifestyles have been flagged as a priority focus for the Public Health Agency of Canada.  

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

So what can be done?

Current solutions are heavily focused on targeting individual behaviour change. A great deal of funding is spent on promoting exercise, the food guide, community weight-loss programs — all with a focus on individual behaviour.

Instead of simply telling people to spend more time exercising, we can incorporate exercise into their everyday lives

But evidence demonstrates that social marketing campaigns surrounding healthy eating and exercise are not sufficient to address the problem.

Instead of simply telling people to spend more time exercising, we can incorporate exercise into their everyday lives.

We can encourage stair use instead of elevators by making stairs easier to access. We could make it easier to walk and bike to work — forms of active transportation — or make cities more walkable in general.

This is an area where physicians and public health departments can collaborate with built environment 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.

Many studies have demonstrated that active transportation 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 together the results of multiple studies, also demonstrate that active transportation is associated with a reduced risk of obesity, type 2 diabetes and high blood pressure.

With the large health benefits that can be realized from encouraging more active transportation, 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 transportation decisions by working with public health departments.

The good news? This collaboration is already starting to happen in some places.

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

Furthermore, the Canadian Association of Physicians for the Environment has started a campaign to encourage governments to adopt a national active transportation strategy, which was one of the main recommendations in a reported released by the Canadian Public Health Association-Lancet Countdown Briefing for Canadian Policymakers.

The future of chronic disease and obesity prevention involves working together across silos to generate collaborative solutions.

We need to fight together for better places in which to live, play and work.


Kevin Lam is a second-year medical student at McMaster University. He has an interest in public health and its intersection with emergency medicine, with a special focus on improving health through urban design. He studied epidemiology and biostatistics in his undergraduate studies at Western University. Twitter: @KevinHLam.

Jean Zhuojing Wang is a second-year medical student at the University of Ottawa. She completed her bachelor of health sciences at McMaster University and has previously been involved in chronic disease management and prevention research.

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