Ta ville te rend-elle malade?

Is your city making you sick?

by Celia Lee

The design of our communities affects how much we walk, the food we choose, how much time we spend outdoors.  But what do we know about the the built environment and health outcomes in Canada?  

New research by Dr. Gavin McCormack at the University of Calgary set out to discover what we know, where there are gaps in our knowledge, and why it might be important to fill them.  

“We know that people are more likely to walk for leisure and for transportation purposes in walkable communities - where there are nearby shops, amenities, and recreational facilities, higher population density, well connected streets and sidewalks and high quality pathways,” says Dr. McCormack.  “But are we seeing better health among those who live in these types of communities? We wanted to be able to make the direct link between the built environment and health outcomes such as chronic disease, mental health, obesity and injury.”

The results of this research indicate that the relationships between community design, obesity and diabetes in Canada are what we might predict: more walkable areas and neighbourhoods with grocery and health food stores are correlated with lower weights and better health. Population density is also linked to cardiovascular conditions - they decrease as density increases.  Studies measured walkability, walkscore, land use, access to healthy foods, access to fast food, population density, and dwelling density to evaluate the built environment.

“We wanted to examine and synthesize the Canadian evidence on built environments and health with the intention of informing local policymakers, urban and transportation planners, land developers and health professionals,” says Dr. McCormack.  “We focused on Canadian evidence because we wanted our findings to have local relevance. Our review findings are important for the general public too, suggesting that people should consider how their current and future residential neighbourhoods potentially influence their health in the short and long term.”  

“When I first introduced the connection between health and built form in 2014 at the City of Calgary, there was a lack of quantitative data in this field,” says Joyce Tang, a co-author and Program Manager at the City of Calgary’s Urban Strategy division.  “With the approval of a policy plan in 2015 that included Health Impact Assessments, there is a growing awareness on the importance of this work for all partners involved in city building. This research is an important step in the field.”

Injuries and the built environment were also found to be related, but Dr. McCormack’s work suggests there is more to learn. Injuries are more likely where there is more traffic, but increasing street connectivity can increase or decrease injuries. Presumably, this depends on the design of the street, which affects behaviour.  However, Canadian research isn’t specific enough to tell us exactly why and how design influences the likelihood of injury.

“It is important to have a clear summary of the evidence on the influence of the built environment on healthy living, including safety.  This type of research supports the planning and design efforts that practitioners aim to include in their work to create stronger, healthier and safer communities,” says Ryan Martinson, a co-author and Transportation Engineer at Stantec.  

The research identifies associations between urban form and weight status, blood pressure, metabolic syndrome, diabetes, cardiovascular outcomes, injuries and mental health.  Most Canadian studies focus on weight and injury, and speak to the preventable burden of injuries and chronic illness on Canadians and the healthcare system.

They also speak to what we’re missing. There is still a lot to learn about mental health and seniors’ health in Canada, and what city design has to do with it - in a nation where ¼ Canadians will be seniors by 2034.  

“Our findings suggest that more research is needed to better understand the causal links between the built environment and the various health outcomes.  Furthermore, many Canadian geographical locations are either not represented or are under-represented in the current evidence on build environment and health,” says Dr. McCormack.  

While studies on health and the built environment have increased since 2008 - and reflect that our leading diseases are linked to the design of our communities - we have more to learn that would help us design safe and healthy places in Canada, and develop supportive policy.  This includes a more detailed understanding of cause-and-effect, beyond correlation, of the quality of the built environment on our health.

The literature review “A scoping review on the relations between urban form and health: a focus on Canadian quantitative evidence” was published today in the journal of Health Promotion and Chronic Disease Prevention in Canada, with co-authors representing the Faculty of Environmental Design (UofC), Alberta Health Services, the Public Health Agency of Canada, the Faculty of Nursing (UofC), Stantec, the City of Calgary, Sustainable Calgary and the Department of Paediatrics (UofC).

Many thanks to the makeCalgary Network, the Public Health Agency of Canada, and the Canadian Institutes for Health Research for supporting this work.  

For further inquiries, please contact Dr. Gavin McCormack at Gavin.McCormack@ucalgary.ca.

Photo by John Campbell/ Sustainable Calgary