planning for health through the built environment

7/28/2019 Planning for Health Through the Built Environment

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Planning for health through the built environment: an introduction

Environments,Dec, 2008byBeth Dempster

To begin, consider the conception of planning as the link between knowledge and action

(Friedmann 1987). Or as the process and practice that mediates between past, present and

future (Dempster 1998). These notions indicate the essential nature of planning: to take what

we know and apply it towards improving our future by informing current actions. With respect

to public health, the relevant knowledge has primarily been medical knowledge, resulting in

actions ranging from surgery and antibiotics to fitness classes, food guides and anti-smoking

campaigns. An increasing amount of research, however, suggests that additional types of

knowledge are important and that the typical role of planning--shaping land use actions--also

has a significant influence on health.

Researchers and practitioners are drawing attention to the influence that the physical design of

our neighbourhoods, towns and cities has on public health (e.g. Transportation Research Board

2005, Frumkin 2004, Frank and Engelke 2001). Indicating some measure of significance, several

recent reports have been sponsored by key health and planning organizations such as the

Ontario College of Family Physicians (Abelsohn 2005), the Ontario Chief Medical Officer of

Health (Basrur 2004), the Canadian Institute for Health Information (2006), the Ontario

Professional Planner's Institute (2007), the Ontario Healthy Communities Coalition (Tucs and

Dempster 2007) and Smart Growth BC (Frank et al. 2006a).

This research shows that neighbourhoods designed for cars rather than people are strongly

correlated with less walking and more negative health impacts such as obesity and heart disease

(e.g. Abelsohn et al 2005, Fisher 2005, Frank et al. 2006b). Such neighbourhoods also increase

exposure to air pollutants, which subsequently leads to negative impacts on health (e.g.Smargiassi 2006, Finkelstein et al. 2005, Buckeridge et al. 2002). Aspects of the built

environment have also been shown to correlate with a variety of other health concerns,

including food choices and healthy eating (Apparicio et al. 2007, Smoyer-Tomic et al. 2006,

Popkin et al. 2005), traffic-related injuries (Litman, this volume, CIHI 2006), mental health (e.g.

Guite et al. 2006, Evans 2003) and coping with disability (Clarke and George 2005, Blackman

2003).

Agreeably, care must be taken in presuming causal connections between aspects of the built

environment and the correlated health impacts (CIHI 2006, Frank et al. 2006, Frank and Engelke

2003). Even if one could draw such connections, the synergistic complexity of influences andimpacts would make it difficult to specify which particular influences had an impact on which

particular health consequences. Nonetheless, researchers again and again note that there is a

sufficient amount of quality evidence to call for action (Frank et al. 2006, CIHI 2006,

Abelsohnetal. 2005):

The impact of the built environment on health is an emerging field
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of study and more rigorous research is needed, especially in Canada.

Despite this, the results of current studies clearly indicate that

serious public health problems will continue to escalate unless

decisive and immediate action is taken to control urban sprawl and

preserve sufficient greenspace, improve air quality, and protect

water sources (Abelsohn 2005: 5).

Planners, then, have a new task: to integrate knowledge about health impacts into the

development and regulation of actions that affect the design, construction and re-construction

of our built environments. Yet is this entirely new? Many point out that this 'new' linkage

between planning, health and the built environment is actually a return to the origins of

professional planning (Johnson and Marko, this issue, Corburn 2006). There is, perhaps, an irony

here, which provides a cautionary note: some of those original planning practices--separation of

land uses, for example--have led to the current design of cities and neighbourhoods that now

raise health concerns (Johnson and Marko, this issue.)

Along these lines, there is also research that explores the planning side of the health-built

environment connection. This includes a variety of policy analyses, one investigating the impacts

of municipal policy as a facilitator/ inhibitor of physical activity (Librett 2003), another looking at

the history of the National Capital Commission in Ottawa and its impact on health-related

design (Dube 2000) and another considering the capacity of water management policy to ensure

appropriate care of the water supply system in the Region of Waterloo, Ontario (Ivey et al.

2006). Other papers consider the role of planning as a more general process that can contributeto development of a healthier community (Corburn 2006, Hirschhorn 2004, Jackson et al. 2002).

Such work emphasizes that many types of knowledge are relevant: The breadth and complexity

of the issues point to the need to draw upon different types of knowledge--and to apply it

through land use planning--if we want to positively impact public health in our communities.

The papers in this volume provide a few examples of the relevant knowledges and the

subsequent actions. They are diverse, yet they provide a mere taste of what needs to be

considered. Land use planning--for which built environment is the domain--has a key role to play.

The papers in this theme issue touch on what some of these roles might be.

Before briefly describing each of the papers, I draw attention to my use of the term 'built

environment'. While this has often been used to refer primarily to building structures--and,

more specifically, the insides of them--recent use of the term encompasses a broader definition.

The built environment is part of the overall ecosystem of our earth.

It includes the land-use planning and policies that impact our


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communities in urban, rural, and suburban areas. It encompasses all

buildings, spaces, and products that are created or modified by

people. It includes our homes, schools, workplaces, parks/recreation

areas, business areas and roads. It extends overhead in the form of

electric transmission lines, underground in the form of waste

disposal sites and subway trains, and across the country in the

form of highways (Health Canada 1997).

It is this broadly defined built environment--and its impact on health and the subsequent

potential for planning to address concerns--that is the focus of this issue.

The papers

As something of a review paper, the work of Johnson and Marko paints a richer picture of the

context for the rest of the papers than the foregoing comments. They begin by noting the

common roots of public health and land use planning in the poor health conditions of 19th

century industrial cities. In describing many of the relationships between health concerns and

land use planning that have been found, they identify many of the topics discussed in other

papers. Consistent with my emphasis on the need for different knowledges to be drawn into

planning, they end the paper by emphasizing the need for public health professionals to be

involved in the planning process. This means there is a need to ensure health professionals have

the capacity and opportunity to contribute to decision-making on land use and the built

environment.

The next paper covers one of the better known and better documented influences of the built

environment on health: the impact of transportation systems. Providing a broad view of these

issues, Litman draws from numerous sources and studies to illustrate many of the impacts,

influences and challenges. He also draws attention to some of the ways in which current

approaches to researching, reviewing and deciding on transportation lack full accounting of the

challenges presented. Using the increasingly popular notion of "smart growth", he briefly

describes some of the planning approaches and directions that might assist in developing safer

and healthier communities.

The "obesity epidemic" among children in Canada and the US (Basrur 2004, Anderson and

Butcher 2006, Davison and Lawson 2006) is a key health concern that has gained recent

attention. Taking this as a starting point, McAllister raises questions around the presence of and

potential for child-friendly planning. Framing her arguments around four themes (safety,

greenspace, access and involvement), she discusses key aspects of the challenge. Then, using

the City of Waterloo, Ontario as an example, she considers the child-friendliness of planning


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policy and processes that are currently in place and considers planning approaches that might

make cities more child-friendly. The hope is that such an approach would also lead to

improvements in the built environment that will positively affect the health of children.

Given the range of knowledges and approaches that are relevant to planning for health through

the built environment, many efforts have taken a multi-sectoral approach. Drawing from theirrecent work investigating best and promising practices of multi-sectoral collaboratives,

Dempster and Tucs discuss some of the lessons relevant to applying such a planning approach.

While some of the lessons would be relevant to any collaborative endeavour, their examples are

from collaboratives aiming to improve public health through changes to the built environment.

Finally, Alexander takes a more speculative and reflective approach in his paper, raising

questions about the built environment and its influence on mental and spiritual health. The

paper weaves arguments for and against physical determinism, never quite settling on one or

the other. While basic concerns around health are considered, the paper also broadens the

discussion to raise bigger questions:

... research suggests that people can only adopt new roles and

behaviours to the extent that spaces or settings are created that

facilitate these new roles and behaviours. If we want to nurture the

emergence of homo sustinens--the sustainable human ... then we

need to create the spaces for him or her to flourish.

As McAllister notes in her paper, a broad definition of health--including the complete range of

physical, mental and social aspects of well-being--needs to be considered. Recognizing the

influential role of the built environment emphasizes the multiplicity of factors that impinge on

this well-being. Much of the discussion takes a preventative stance--encouraging the application

of land use planning to counter the negative health affects that are being identified. By opening

the discussion up to these broader questions, Alexander points to the potential for moving

beyond prevention toward more creative and proactive possibilities. Further, the reference to

homo sustinens opens the mind to considerations beyond even the broad definition of health by

including the health of the world we live in. This seems a fitting way to close a set of papers

drawing on current knowledge to discuss actions aimed at improving the future.

Closing comments

Through my involvement in a literature review on the linkages between health and the built

environment in a Canadian context (Tucs and Dempster 2007), I have been struck by the range

and diversity of research relevant to this topic--a range and diversity that necessarily points to

the multiplicity of knowledges that need to be integrated into planning and the subsequent

multiplicity of actions that will be required to positively impact public health. While there are a


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few crossovers and commonalities among the papers in this issue, they are perhaps more

notable for the differences in the knowledge they draw upon and the actions they promote. Yet

these papers represent only a small portion of the discussions relevant to this topic and

primarily in a broad and general way

Given the nature of the profession, good planners learn to deal with many, diverse issues--andthe trade-offs inherent in such multiplicity. Planning for health through the built environment

presents a 'new' challenge for planners--and for the people from the diverse disciplines and

professions that must be drawn in to facilitate healthier outcomes from planning. The papers in

this issue offer a small taste of both challenges and possibilities.

planning for health through the built environment

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