From ParticipACTION to the latest in the endless parade of fad diets, a healthy lifestyle is typically framed as an individual choice. But there’s more than willpower (or lack thereof) behind the size of your waistline, the strength of your heart, and the pinkness of your lungs.
A growing body of research suggests the best indicator of health is whether the community you live in is designed to make healthy choices easy. The small, unconscious actions of our daily lives add up, and can ultimately have a bigger impact on your overall health than whether you join a gym or eat healthier.
“Where you work, where you live, where you play—that’s what keeps you healthy,” insists New Westminster community health specialist Deanna Tan. “That’s really where ‘health’ happens, at home in your community.”
Tan works for Fraser Health, which, like most public health agencies, has long focused on preventative health care through activities like providing vaccines, promoting hand-washing, ensuring restaurants comply with health regulations, and distributing condoms and clean needles. But increasingly, regional health authorities are starting to take a holistic look at the impacts of the physical design of communities on chronic disease.
According the BC Provincial Health Services Authority, people with chronic health conditions represent about 34% of the population in BC but make up about two-thirds of healthcare costs. Rather than continuing to allocate resources to acute care services, public health is starting to look more carefully at prevention and promotion strategies, says Tan, one of which is creating healthier communities.
“The time in your doctor’s office, that’s treatment. There’s a little bit of prevention, but really that’s illness and sickness, not health,” says Tan.
Health authorities are increasingly focusing on the impacts of infrastructure and community planning on health based on research that links poor air quality to increases in childhood asthma; sedentary lifestyles and diet to diabetes and heart disease; and a lack of safe, affordable housing to paramedic and policing calls related to mental illness.
The idea is that planning and investment policies, such as zoning and investment rules, create a ripple effect that ultimately affects the health of the population as a whole. For example, people are more likely to walk to school or work, and do errands on foot when city blocks are short and there’s a diverse mix of businesses close to homes—factors determined by city land use and zoning policies.
Increasing walkability of neighbourhoods sounds like a ‘nice-to-have’ feature, but when viewed through a health lens it becomes a must-have for the economic health of our nation. Physical inactivity alone costs the Canadian health care system at least $2 billion annually in direct healthcare costs. While not the only factor in chronic illness, high obesity rates are linked with higher rates of type II diabetes, heart disease, hypertension, stroke, and cancer. Public health specialists like Tan hope that by collaborating with city councils and other community partners, they can help decision-makers consider the public health impact of decisions involving housing, transportation, nutrition, access and inclusion, and the natural environment.
“The goal isn’t necessarily to do things differently,” says Tan, “but to view things differently.”
Not every community has been receptive to this ‘health lens,’ but in New Westminster, Tan and her colleagues have been invited to sit on several City committees, and to provide research, support, and expertise to staff as they draft an updated Official Community Plan (OCP).
The OCP is being revised in a process that began in 2014. Residents have been invited to attend numerous consultation opportunities and sit at the table. Recently, the City released the first draft of Land Use Map, which will be used to determine development in the city until 2041. It is based on the input of people who have attended meetings, written in, and voiced their opinions. The importance of getting this right can’t really be ignored as this document will define the city’s goals, policies, and vision for the future.
Councillor Patrick Johnstone, who has been an active participate on this process, says: “The OCP is ‘the big one’: it is the planning document that tells us the most about how our City will look in the decades ahead. Types of housing is a big part of it, but so is neighbourhood form, and how we will continue to support other work like our Master Transportation Plan and the Urban Forest Management Strategy as we experience regional growth.”
“A healthy community is one where you can walk or ride a bike safely, where services you need are nearby and accessible, where you are supported in raising your kids, and have comfortable options to age in place. However, in an urban area like New West, it also means protecting and enhancing our limed green space, assuring we have trees to moderate our local climate, people have an opportunity to plant a seed and grow some local food, and that neighbours can have meaningful social connections. We need to plan our community to facilitate these things, not limit them.”
“If you plan Cities for cars and traffic, you get cars and traffic. If you plan for people and places, you get people and places” – Fred Kent, Project for Public Spaces
Johnstone continues: “We know what makes people healthy, and what makes them unhealthy. A good OCP should build healthy choices right into the infrastructure, and should limit the resources we put into supporting unhealthy alternatives.”
For Tan, the OCP is more than just a planning document. “The OCP is a health document,” says Tan. “It is so connected. To us, it’s a no-brainer.”
How Community Planning Affects Health
(source: BC Provincial Health Services Authority)