Well designed cities improve citizens' health

“You know there is something wrong when you need to consume a litre of gas just to purchase a litre of milk.”

This was one of the many thought-provoking statements I heard at a recent Canadian Institute of Planners conference in New Brunswick. One of the topics was “Public Health and the Built Environment,” and it focused on the different ways community and neighbourhood design can contribute to better health.

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Given the original purpose of zoning was to improve health, it is a sad irony that in subsequent years it appears to have contributed to many of the new illnesses we face today.

Development and building codes were first written to combat contagious diseases such as tuberculosis, cholera and yellow fever. By separating noxious industrial and residential uses, and ensuring buildings had access to clean water, daylight and fresh air, city planners assisted medical professionals in curing these ailments.

Today we are seeing a rising incidence in chronic diseases such as diabetes, hypertension, heart disease, osteoarthritis, depression and cancer. Their causes are numerous and complex.

However, research is increasingly showing connections between how neighbourhoods and buildings are designed, and the incidence of these diseases.

In the Greater Toronto area, some doctors claim they can often assess someone’s health from their postal code.

It is not just a question of whether they live in a poor or affluent neighbourhood. It’s also a question of whether it’s “walkable” and well served by transit, or a suburban, car-dependent community.

Research carried out by the Heart and Stroke Foundation and other organizations is revealing that money spent on public transit and active community design will ultimately pay dividends in the form of reduced healthcare costs, all other things being equal.

Some conference speakers presented alarming maps and statistics illustrating the increase in adult and child obesity across the country over recent decades using Body Mass Index (BMI) as a measure.

Doctors will tell you there is a correlation between BMI and chronic diseases, especially diabetes in adults and children.

While British Columbia has the lowest obesity rate of any province, it still increased from approximately 15 per cent of the population to 20 percent from 2000 to 2011.

Moreover, health professionals question these statistics since women often under-report weight while men over-report height.

In New York City, former mayor Michael Bloomberg made it a priority to address community health. While his efforts to restrict the size of sugar-laden drinks are well known, what is less known is how he has promoted active living through design.

One of his initiatives was to retain Dr. Karen Lee, a Canadian, to work with architects and planners in the preparation of now internationally-recognized Active Design Guidelines. He also converted roads to bike lanes, public spaces and pedestrian areas. Today New Yorkers are amongst the healthiest Americans.

There is no doubt the layout of a neighourhood determines whether you walk, bike or drive a car. While some contributing factors are obvious, such as whether there are shops or community facilities within walking distance, others are more subtle.

Slightly wider sidewalks separated by a landscape boulevard encourage walking, as do routes that include high degrees of pedestrian interest.

One planner suggested we should think of a sidewalk as a room, with design attention given to walls, floor and ceiling. Ideally the ceiling is rain protection or a canopy of trees.

As I listened to the presentations I was struck by two sad ironies.

For decades architects and planners have worked hard to make buildings more accessible for those in wheelchairs. While admirable and necessary, this has had the unintended consequence of making it easier for the rest of us to use elevators instead of stairs.

If we try to use the stairs, often the doors to each floor are locked for security reasons.

Security concerns also discourage parents from allowing their children to walk or ride their bikes to school.

We need to design safer routes to school and more attractive, well lit stairwells.  

Furthermore, just as we now undertake environmental impact assessments of new plans and projects, we should also carry out health impact assessments.

They could help us all live longer.


twitter/ @michaelgeller

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