You are where you live

The health of a city and the health of its residents are inextricably linked. As Canada continues to urbanize — with nearly two-thirds of us living in cities — there is dramatic association between urban sprawl and chronic diseases such as obesity. As the Ontario College of Family Physicians says: “Sprawl impacts negatively on well-being by eroding social capital, robbing people of all ages of the opportunity to have a balanced, healthy lifestyle, degrading the natural environment, and increasing the stress of commuting, which not only impacts on mental health but also physical health.”

The suburban ‘white picket fence’ lifestyle promoted after World War II brought with it a host of changes affecting personal health. Separation of residential areas from other land uses, increasing reliance on automobiles and extended commuter time and distance travelled made it more difficult for people living in neighbourhoods to get sufficient daily physical activity. This link between fitness and health is well established. It’s time we started treating these lifestyle disorders with lifestyle solutions starting with one of the biggest factors: Where we live.

Currently, one in four Canadian youths is overweight or obese. Young Canadians now suffer from Type-2 diabetes and high blood pressure, previously seen almost exclusively among adults. Chronic diseases cost Canadians at least $190 billion annually. With an estimated 75% of the health of the population determined by factors outside the healthcare system, local and provincial governments must understand the need for programs and services. Actuarial and economic analyses suggest that Canada’s current health care system is not sustainable beyond a 25-years window without a fundamental shift towards chronic disease prevention.

We cannot afford to ignore this new health care reality.  The prescription for this growing chronic health care epidemic lies in creating more complete communities and writing a more preventative health prescription. Healthcare policy and funding allocations must better recognize the value of preventative measures. The Public Health Agency of Canada has identified that there is a major gap between existing policy tools and health promotion through community design.

Municipalities are well situated to influence key determinants of health and inequalities. Bylaws impeding healthy living can be changed. Land-use design and zoning changes can promote active living and healthy lifestyles in neighbourhoods. An emphasis on fewer single-family houses and more multi-unit residential homes is fundamental. Encouraging higher density of neighborhoods with proximity to services may be achieved in part by pricing utilities to reflect the higher infrastructural and maintenance cost of delivering services to suburban development in comparison to more compact development.

The design of our neighbourhoods including walkability, affordability, transportation, the availability of parks, safety, access to healthy food markets and shops, should be part of the chronic disease prevention conversation.  Imagine a health care discussion including the improving of the walkability of all urban neighbourhoods, of reducing intersection density, community safety and the implementation of transportation policies that promote physical activity through safe, well-lit bicycle and pedestrian routes. Expanding public transit lines and bicycle paths could help to reduce the essential role a car plays in suburban communities and lifestyle changes.

It won’t be easy to transcend the lines of budget allocation or the jurisdictional orders of government.  While health care is generally considered a provincial issue it makes economic sense to consider preventative healthcare opportunities in the design and function of the neighbourhoods and communities that form our nation’s cities.

As Winston Churchill said we “shape our buildings, thereafter, they shape us”. Building preventative health policy thinking into built form municipal policy requires collaboration across departments and jurisdictions to enhance capacity for building health promoting, sustainable communities that are livable for all members of society. The future of our cities and our health care system depends on it.