Tools for healthier built environments

Two BC tools for healthier built environments

Dr. Trevor Hancock

24 July 2018

699 words

We are lucky in BC to have two useful initiatives to help us create healthier built environments. The first, which I described briefly last week, is the Healthy Built Environment Linkages Toolkit. The second is a BC Ministry of Health funded initiative, PlanH, which “facilitates local government learning, partnership development and planning for healthier communities”. I will describe them both here. (Full disclosure: PlanH was developed and is implemented on behalf of the Ministry by the non-profit BC Healthy Communities Society, of which I am Vice-Chair of the Board.)

For each of the five key elements of the built environment that the Toolkit considers – neighbourhood design, transportation networks, natural environments, food systems and housing –it provides a chart showing the impact on the built environment and the strongest research correlations found in evidence reviews. I briefly covered the first two elements last week, so here I want to examine the others.

For the natural environment element, the focus is on preserving and connecting environmentally sensitive areas, expanding natural elements across the landscape and maximising the opportunity for everyone to access these natural environments. By doing so, we can increase the tree canopy, reduce urban air pollution and create cooler urban areas. (For a great discussion of the health benefits of trees and urban forests see the book Planet Heart by Dr. Francois Reeves, an interventionist cardiologist in Montreal.)

Among the health benefits identified in the Toolkit for which there is strong evidence are reduced deaths from heart and urban heat events; improved mental health and social wellbeing; increased physical activity and improved respiratory health. Other benefits include reduced health care costs, energy savings, reduced pollution control costs and increased recreation and tourism.

Turning to food systems, the Toolkit focuses on increasing equitable access to affordable and healthy food options, protecting agricultural land, increasing the capacity of local food systems and supporting community-based food programs such as community gardens and community kitchens.

The health-related impacts of these approaches include improved diet quality and social wellbeing. Evidence suggests community kitchens, such as the Shelbourne Community Kitchen in Saanich, are particularly useful. This small NGO provides small-group cooking, pantry, and gardening programs which help participants from low-income families acquire food skills and learn to access nutritious food affordably, while at the same time building community.

Finally, the Toolkit looks at four approaches to creating healthy housing, particularly through prioritizing affordable quality housing options, especially for marginalised groups. The evidence supports the need for diverse housing forms and tenure types, located so as to avoid environmental hazards. There are multiple health benefits, including improved overall health and social wellbeing and reduced domestic abuse, crime and violence. (I will return to the topic of healthy housing in a future column.)

While the Toolkit provides evidence and is intended primarily for planners, PlanH is more concerned with how to bring the health implications of decisions to the attention of municipal governments and citizens to support “leading-edge practices for collaborative local action”. It focuses on three key interconnected themes: Healthy people, a healthy society and healthy environments.

In considering healthy people, PlanH emphasises that our health behaviours and choices are shaped by local social and environmental conditions; we need to create “vibrant places and spaces [that] cultivate belonging, inclusion, connectedness and engagement” in the context of “well-planned built environments and sustainable natural environments”.

To do so, PlanH helps local governments and their citizens learn about these issues and provides action guides and other practical resources and tools. It helps them connect and build relationships with community partners in other sectors (including regional health authorities) and with other local governments. And it helps them innovate with a funding program to support action, and by sharing success stories from around BC and beyond.

Together, these two initiatives give municipal governments, urban planners and citizens powerful support to help them make decisions that will improve the health and wellbeing of their citizens, which is surely one of their most important roles. So if you want healthier built environments in which to lead your life, raise a family and grow old, you may want to talk to your local government, community association and neighbours about the Toolkit and PlanH.

© Trevor Hancock, 2018



We can create healthy built environments

We can create healthy built environments

Dr. Trevor Hancock

17 July 2018

698 words

The BC Healthy Built Environment Alliance was established by the Provincial Health Services Authority in 2007 to provide leadership and action for healthier, more livable communities. The key purpose of the Alliance is to foster the partnership between urban planning and public health, which I wrote about last week. Members are drawn from the health, planning, NGO, municipal and academic sectors as well as from Ministries working in this area.

One of the problems with cross-disciplinary work such as this is that we all have our own language, so getting urban planners and public health professionals to understand each other and recognise each other’s skills and areas of focus and concern is key to taking joint action. Accordingly, one of the first things the Alliance did was to organise ‘Planning 101’ workshops for public health professionals, so they could develop a better understanding of urban planning. This was followed by ‘Health 201’, a guide, toolkit and self-assessment tool for the design professions.

Ongoing discussions both at the Alliance and through its network of members help keep this interaction and shared learning alive. This work is supported by the publication of case studies and best practices that highlight good examples across Canada of public health and urban planning collaborating alongside municipalities and communities to create healthier built environments.

But one of the most important things the Alliance has done has been to create a Healthy Built Environment Linkages Toolkit that makes clear the links between design, planning and health. While it is designed primarily for public health professionals, its clear, simple design and graphics means it can be used by anyone – including the development industry and the general public – who is interested in creating healthier built environments (and it’s easy to find – just Google the title).

The Toolkit is intended to provide all the participants in the planning process with evidence of the health implications of different aspects of planning and design. Its earlier version has been used by healthy built environment specialists in health authorities – yes, there are such beasts in some health authorities – and other public health staff to work with local municipalities on official plans, helping them to consider the health impacts and benefits of their policies and planning decisions.

But there is no reason why the Toolkit could not be used by community associations and other citizen groups to argue for better, more health-conscious planning decisions in their own neighbourhoods, or by private sector planners and developers to create healthier communities that would be more attractive to potential purchasers.

The Toolkit examines five key elements of the built environment that affect our health: Neighbourhood design, transportation networks, natural environments, food systems and housing. For each of them, the Toolkit provides evidence of the key health benefits that can result from applying the principles and measures that are included. So what are some of the key features of healthy built environments?

The Toolkit states that “healthy neighbourhood design is facilitated by land use decisions which prioritize complete, compact and connected communities”. By ‘complete’ they mean having a mix of residential, commercial, institutional and workplace sites so you can live, learn, work, shop and play largely in your own community. These mixed-use neighbourhoods are also more compact, which makes it easier to meet the need for transportation networks that prioritize and support active transportation such as walking, biking and public transit. In fact, neighbourhood design and transportation – and indeed all the key components of healthy design – are complementary and often positively reinforce each other.

We can also achieve significant health and well-being impacts, the Toolkit states, by preserving and connecting the surrounding natural environment; ensuring the “accessibility and affordability of healthy foods”, which – interestingly – “can be supported through land use planning and design”, and developing quality, affordable housing options for everyone, especially including marginalised people.

Interestingly, many of these are also features of sustainable community design, reinforcing the general principle that if we design for people and the planet, we are likely to build better communities – more pleasant, atttractive and livable as well as healthier and more sustainable.

Next week, I will delve in more detail into some of the key characteristics of healthy community design.

© Trevor Hancock, 2018


Public health and urban planning are natural partners

Public health and urban planning are natural partners

Dr. Trevor Hancock

10 July 2018

697 words

In North America we are 80 percent urbanised and on average spend 90 percent of our time indoors. The fact that we spend about 21-22 hours a day indoors may come as a bit of a surprise. But if you stop and think about it – or if you keep a time diary for a week, which is what I have my students do – you will see how much time is spent indoors.

To begin with, we sleep and eat there, which is about half a day, and we work, go to school, shop and often play indoors – even in health and nature-conscious Victoria. On top of that, on average North Americans spend about half their ‘outside’ time in vehicles, so in the end we only spend about five percent of our time – a bit over one hour a day – truly outdoors. And since we are 80 percent urbanised, we spend most of that time outdoors in a built environment.

So although ultimately our health depends upon the natural environment that provides the most basic determinants of our health such as air, water, food, fuel, materials and other ecosystem goods and services, the built environment is by far our most important immediate environment. Yet in recent decades we have paid suprisingly little attention to how the built environment influences and shapes how we lead our lives and the implications of that for our health.

It was not always so. In the mid-19th century, the appalling conditions of the slums and factories of the industrialising cities of Britain led not only to the birth of modern public health but also of modern town planning as new approaches to improve health. And of course, building codes were established largely to ensure the health and safety of those who lived and worked in those buildings.

By 1875 Sir Benjamin Ward Richardson, a leading Victorian public health practitioner, could describe a city of health that he called Hygeia, and that had many elements we would recognise today – and some we still aspire to. His writing influenced Ebenezer Howard, founder of the Garden City movement that continues to influence urban planning.

In Canada, the connections between public health and urban planning were even more apparent. In 1909 the federal government established a Commission on Conservation; today we would call it a Commission on Sustainable Development – there really is nothing new under the sun! However, their notion of conservation was not limited to the conservation of natural or physical resources but included the conservation of ‘vital resources’ – meaning the health and longevity of the population.

Thus the Commission established a Public Health Committee, which became concerned about health in Canada’s burgeoning towns and cities. So in 1914 they invited Thomas Adams – a leading British town planner and Secretary of one of the first Garden Cities, Letchworth – to become the Commission’s Town Planning Advisor. In the five years he spent in that role, Adams had a hand in preparing town planning bills in most of the provinces. He also helped to organize the Civic Improvement League and the Town Planning Institute of Canada.

But over time, the links between urban planning and public health weakened and become lost. In part I think this is because both public health and urban planning came to see their work together as having been successful, and moved on to other concerns. Public health became more medicalised, while planning became more focused on the automobile and the grander symbols and techniques of high rise towers and urban redevelopment.

But in the past three decades, there has been a slow re-awakening of the links between the design of the built environment – from individual rooms to entire cities – and the health of the people who live there. To a large extent this has arisen from the ‘Healthy Cities’ movement, and the urban planning interest in sustainable communities.

In BC this led to the creation of the Healthy Built Environment Alliance a decade ago, bringing together architects, urban planners, public health staff and others to learn from each other. One of the fruits of that collaboration has been the Healthy Built Environments Toolkit, which will be the topic of next week’s column.

© Trevor Hancock, 2018


Population growth only part of our ecological problem

Population growth only part of our ecological problem

Dr. Trevor Hancock

2 July 2018

701 words

My recent columns about the ecological crisis we face and the need to reduce our ecological footprint, generated e-mails from several people saying I should address the issue of population growth. They have a good point, but the issue is complex, and the solution not just a matter of family planning.

There is a famous ‘equation’ proposed by Paul Erlich and John Holdren in 1972: I (human impact on the Earth) = P (population) x A (level of affluence, usually measured by GDP per person) x T (technology). While affluence is not quite the same as material consumption, land damage and pollution production (all key indicators of impact on the Earth), it is not a bad proxy; as we get wealthier, we consume more stuff and produce more waste.

The point is simple; it’s not just how big the population is, but how much each person consumes – and our technology can either make things worse, because we become more powerful and more damaging, or make things better if we become more efficient.

The latest World Bank data tracking changes since 1960 shows that between 1960 and 2017 global population grew from 3.03 to 7.53 billion, or almost 2.5 times. In that same period, GDP per person grew from $3,694 to $10,634, measured in constant 2010 US dollars (which adjusts for inflation), or almost 3 times. Put these two together and humanity’s impact has grown more than seven-fold in these 67 years.

It is illuminating to compare Canada on those same metrics. Between 1960 and 2017 Canada’s population increased just over two times and the GDP per person increased just over three times, so our impact on the Earth increased more than six times over those 67 years, measured this way. But on top of that, our per person impact is much higher than the global average – and greater than the Earth can sustain – so further increases in our already excessive footprint will be far more damaging than increases in the GDP and ecological footprint of low and middle-income countries.

The Global Footprint Network has just released its latest data. Overall, the global footprint for humanity in 2014 was equivalent to 1.7 Earth’s worth of biocapacity. If everyone in the world lived the way we do in Canada, we would need 4.8 Earths. So we live at almost three times the global average, meaning a child born in Canada will have roughly three times the impact on the Earth of an average child – and six times the impact of a child born in a lower middle-income country .

Thus we need to both reduce population and reduce consumption per person. But from a global impact perspective, reducing both these factors in high-income countries such as Canada will have a far greater beneficial effect than doing so in low-income countries. So attempts by some high-income countries to increase population size – and a 2017 article in The Independent newspaper in the UK identifies ten countries that are doing so – are very misguided.

Moroeover, we have good evidence dating back decades that one of the most important ways to reduce population size is through education – particularly for women. In a 2015 interview with the World Economic Forum, Wolfgang Lutz – founding director of the Wittgenstein Centre for Demography and Global Human Capital and lead author of World Population and Human Capital in the 21st Century – noted “Education leads to lower birth rates and slows population growth”. He also linked education to poverty eradication, economic growth and environmental consciousness.

But universal education is expensive, and requires sufficient economic development to create enough wealth to achieve it. (It also requires enlightened leaders and policies that prioritise universal education, especially for girls and young women.)

So in summary, from the point of view of global impact on the planet, the key priority is to reduce the size of both the population and the ecological footprint per person of high-income countries. But for low-income countries, we need to support their economic development (while helping to ensure it follows a 21st century sustainable development path, not a 19th/20th century industrial development path) and support the creation of universal education, especially for young women, contributing to their emancipation.

© Trevor Hancock, 2018


Finding hope for the future

Finding hope for the future

Dr. Trevor Hancock

26 June 2018

697 words

In an article about Canada’s health care system a few years ago, two of my colleagues came up with what is my favourite definition of hope: Finding positivity in the face of adversity. But finding hope can be challenging these days, what with the global ecological crisis, high levels of poverty and inequality, nasty xenophobic and nationalistic politics and the general failure of governments and societies to respond effectively to these and other challenges of the 21st century.

Which is why it was such a pleasure to attend several meetings in the past month where people of good will who care about others and the planet came together to find common cause and work for a healthier, more just and sustainable future. They are working on the basis of a long-standing maxim: Think globally, act locally.

The first meeting was hosted by the Victoria Foundation and the BC Council for International Development, and was the topic of my column two weeks ago. The meeting focused on the UN’s Sustainable Development Goals (SDGs) and included participants not only from the social justice and environmental groups that one would expect to find there, but also from local government, the Chamber of Commerce and others from the business sector, faith communities, the academic community and others.

Among the priority issues for Victoria that emerged in the discussions were addressing poverty, climate change and the sustainability of our lands. The Foundation’s commitment to addressing SDG 11, the creation of sustainable cities and communities, is exactly about bringing all the SDGs down to the local level. The fact that the SDGs are to be treated as a single unit, with all being addressed together, ensures an holistic approach to the challenges we face.

The second meeting was a public gathering of Greater Victoria Acting Together. GVAT is a group of 19 organisations (and growing) that includes many from the faith communities and the labour movement, but with others from the environmental, educational and social justice sectors. They are motivated by concern for future generations and the need to find and pursue the common good because, as one speaker put it, “the next generation deserves a better world than this”.

GVAT’s approach involves in-depth listening and discussion over a long period of time to arrive at a clear and shared understanding of what the common concerns are and what common action can be taken. The process includes training in community organising and empowerment. The intention is to “hold market and governmental decision makers to account by speaking with one voice”.

Then there was a recent Conversation for a One Planet Region, with leaders from several faith communities exploring the role of faith communities in creating a One Planet Region. Since this issue will be the topic of a future column, I will not get into it in any detail. Suffice it to say that within many if not all faiths there is both a concern for ‘the poor’ and a reverence for nature, the latter often in the context of nature as an expression of ‘the Creator’. As noted in the two examples above, faith communities are important players in this work.

Finally, there was the first meeting and training session for the One Planet Saanich team of ‘Community Integrators’. These are 15 – 20 people of varying ages who have volunteered to work with a Stakeholder (businesses, community groups, and schools who want to join the initiative) to develop a One Planet Action Plan. The group, which came from a variety of backgounds, from architecture to psychology, business to education, farming to energy systems, was enthused and engaged. Their plans, large and small, will help move Saanich towards the goal of being a One Planet community.

These are just a few examples of which I am aware of people and organisations from a wide cross-section in our communities who are brought together by shared concerns about the social and ecological challenges we and future generations face. But while concerned, they are not paralysed; they are determined to find ways to address these challenges and create a healthier, more just and sustainable community. They are finding positivity in adversity, and they give me hope.

© Trevor Hancock, 2018