Making the Connection

The Role of Public Health and the

Built EnvironmentMyrna Wright, MHSc & Megan Williams, MPH

Simcoe Muskoka District Health Unit2 February 2007

QuotePublic health officials need to view

the built environment as having as much influence on public health

as vaccines. Richard Jackson, MD, MPH

Former DirectorCenters for Disease Control

Introduction In 2006, the SMDHU embarked on a journey

brought about by: A Call to Action – Grade 1 survey PA & HE air quality concerns – smog days in cottage country growth in Simcoe Muskoka – Places to Grow

Should we be involved in the built environment, and if so, how? Create agency committee Consult other health units Consult the literature

Connections Between the BE and Health

Source: Yates, Thorn & Associates 2004

Factors Shaping the BE Political – policy, agendas Economic – land values, taxation Legal – regulations, zoning Population – demographics, mobility Social – safety, equity Cultural – values, preferences Environmental – geography, climate Aesthetics – design, functionality

(Frank et al. 2005, Frumkin et al. 2004; TRB & IOM 2005 )

Planning Issues Relevant to Public

Health Population Housing Economic development Social support systems Natural environment Community facilities and services Land use and future land use Transportation Sustainable local food systems

(Atlanta Regional Health Forum & Atlanta Regional Commission, 2006)

Role of Public Health in the BE

To ensure the community’s land use planning decisions promote and protect the public’s health

To protect the population from health risks resulting from land use planning, community design & development

(Atlanta Regional Health Forum, Atlanta Regional Commission, 2006)

Public Health PracticeFrom the Literature

1. Educate Public health staff & board about health impacts and what

role PH can play Stakeholders, partners and public about health impacts and

how to get involved

2. Research Provide evidence to decision-makers – reports, statistics, Indicate health impacts of planning decisions

3. Collaborate Build relationships with planners, elected officials Develop partnerships with coalitions, agencies and interested

individuals

(Atlanta Regional Health Forum, Atlanta Regional Commission, 2006; Bray et al. 2005)

Public Health PracticeFrom the Literature

4. Practice Emphasize prevention through programming, interventions,

education Utilize health impact assessment tools with measurable indicators

to judge the effects of policies or programs on health outcomes

5. Advocate For health to be explicitly stated & defined as a goal in the

planning processes

6. Influence Become part of the land use decision-making process Provide submissions/input, attend meetings, participate on

committees

Ontario Public Health Unit Involvement in BE

Building relationships with key individuals, e.g. planners, elected officials

Providing health evidence for planners Conducting social marketing campaigns to

communities Commenting on official plans Engaging other stakeholders

Lessons LearnedInsights Planners are onside

conceptually & welcome health evidence

Initiate joint discussion using succinct research & reports

Identify the costs of inaction on planning rec. (including medical care)

Become involved with the community as opportunities arise

PH can change public opinion successfully

Insights Planning is a very political

process & relationships are key

Understand the overview of planning process

Different interests: Benefit of provincial legislation is on managing growth yet municipalities not compensated for the prov. restrictions on land use & sales.

Lessons LearnedChallenges Takes time for both

planners and public health to learn each other’s language (up to a year)

Discrepancies exist between Official Plans and “what really happens”

Challenges Approved plans later

receive amendments which dilutes intended impact

Literature/Research/ Resources primarily

American Development

patterns differ bet. Can & US

Plans for Action Increase Awareness

Provide local data to inform politicians, planners, citizens about health impacts of built environment

Raise profile - feature topic at conferences Share strategies & info with other HU’s

Make It Easy Send Board of Health Reports to surrounding

municipalities/HU’s to spark ideas

Plans for Action Be Involved

Identify key decision-makers and champions among Council & municipal staff

Work with existing players – OHCC, Cdn. Mortgage and Housing

Speak Out Impact local politicians with deputations to Council Engage media & community through use press releases Re-introduce origin of zoning – to protect public’s health

Quote

There are two causes of disease, One is pathological…

The other is political.

Dr. Rudolf Virchow1821 - 1902

ReferencesAtlanta Regional Health Forum & Atlanta Regional Commission 2006, Land Use Planning for

Public Health: The Role of Local Boards of Health in Community Design and Development. National Association of Local Boards of Health (NALBOH), Bowling Green, Ohio.

Bray, R., Vakil, C. & Elliott, D. 2005. Report on Public Health and Urban Sprawl in Ontario – A review of the pertinent literature. Ontario College of Family Physicians, Toronto, Ontario.

Frank, L., Kavage, S. & Litman, T., 2005. Promoting public health through Smart Growth – Building healthier communities through transportation and land use policies and practices. Smart Growth BC, Vancouver, BC.

Frumkin, H., Frank, L. & Jackson, R. 2004, Urban Sprawl and Public Health – Designing, Planning, and Building for Healthy Communities, Island Press, Washington, D.C.

Transportation Research Board & Institute of Medicine of the National Academies 2005. Does the Built Environment Influence Physical Activity? Examining the Evidence. Transportation Research Board, Washington, D.C.

Yates, Thorn & Associates, 2004, Population Health and Urban Form – A Review of the Literature. Smart Growth BC, Vancouver, BC.

Ontario Public Health Experience

Region of Waterloo Public Health Regional municipality

Haliburton, Kawartha, Pine Ridge District Health Unit Board of Health