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Healthy neighbourhoods

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What does it take to get people out of their houses and feeling comfortable walking around in their neighbourhoods? Can our communities influence our physical activity, health and overall wellbeing?

Gavin McCormack’s extensive research on these topics provides key insights into how built environments can impact our health and wellbeing in different ways. Read on to gain insight into what characteristics in your neighbourhood can help make you healthier.

Watch the webinar recording at: http://www.ucalgary.ca/explore/healthy-neighbourhoods

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Healthy neighbourhoods

  1. 1. Healthy Neighbourhoods Gavin McCormack, PhD Associate Professor Department of Community Health Sciences Cumming School of Medicine, University of Calgary January 19, 2017
  2. 2. Welcome  Associate Professor, Cumming School of Medicine  Associate Scientific Editor for the journal “Health Promotion and Chronic Disease Prevention in Canada”.  Co-chair of the 2017 Walk21 Calgary International Conference Steering and Scientific Program Committees.  In 2014, recognized as Avenue Magazines “Top 40 under 40”.  Graduate training in Sports Science (Exercise Physiology) and Public Health.  Canadian Institutes of Health (CIHR) New Investigator.
  3. 3. Reasons for choosing your current neighbourhood Did you choose your current neighbourhood based on how well it could support your (or your family’s) physical activity behaviours?
  4. 4. Reasons for choosing your current neighbourhood Do you consider your neighbourhood to be convenient for undertaking physical activity (…is it “walkable”)?
  5. 5. Purpose  To briefly describe how neighbourhoods influence population health and why this is an important strategy for promoting physical activity  Share our research in Calgary showing the relationships between the neighbourhoods people live in and their physical activity levels and body weight https://www.flickr.com/photos/1275689 85@N04/20315160663/sizes/o/
  6. 6. Important definitions  Population Health - an approach to health that aims to improve the health of the entire population and to reduce health inequities among population groups (PHAC, 2013).  Physical Activity - any bodily movement produced by skeletal muscles that requires energy expenditure (WHO, 2014).  Recreational Walking – walking for the purpose of recreation, leisure, exercise, or fitness.  Transportation Walking – walking for the purpose of travelling from destination to destination.  Perceived Built Environment – individual’s self-reports about their perceptions of the environment.  Objective Built Environment – “directly measured” characteristics of the actual environment.  Walkability – extent to which an environment (perceived or objective) is connected, safe, pleasant, and suitable for walking.
  7. 7. Urban planning and health  Built environment changes during the 19th/early 20th century reduced infectious disease (e.g., cholera, yellow fever, tuberculosis). • waste management; sanitization; zoning; housing/building conditions  Built environment changes also encouraged residential mobility from crowded inner cities to outer areas.  Expansion of the suburbs increased post WW2 and continue today (leading to urban sprawl) • rise in motor vehicle popularity; over zealous zoning.
  8. 8. “The practice of ‘Euclidian zoning’ or the separation of uses formed, in part, a basis for what became an auto-dominated single-use landscape. This approach to land development and transportation investment evolved into a highly planned and regulated landscape and also into what we call sprawl.” (Frank and Savage, 2008 – J Public Health Management and Practice) Urban planning and health
  9. 9. Urban planning and health, examples:
  10. 10. Health gains and physical activity Warburton D. and Bredin S. (2016). Reflections on physical activity and health: What should we recommend. Canadian Journal of Cardiology, 35, 495-504
  11. 11. 0 0.25 0.5 0.75 1 1.25 1.5 1.75 2 RR Relative risks (RR) of disease among inactive versus active adults Active Inactive *Katzmarzyk (2000) The economic burden of physical inactivity in Canada. CMAJ; **Paffenberger (1994) Physical activity and personal characteristics associated with depression and suicide in American college men Acta Psychiatr. Scand (<1000Kcal versus 1000-2499Kcal PA/week); ***Popkin et al . Measuring the full economic costs of diet, physical activity and obesity-related chronic diseases. Obesity Reviews. Physical activity and chronic disease risk
  12. 12. http://www.statcan.gc.ca/pub/82-625-x/2015001/article/14135-eng.htm Physical activity levels among Canadians
  13. 13. % active and moderately active based on leisure- time physical activity (Canadians ≥12 years; 2011) 55 51 51 56 53 52 55 55 55 56 60 62 51 33 0 10 20 30 40 50 60 70 CAN NL PE NS NB QC ON MB SK AB BC YT NT NU Source: Statistics Canada. Health Indicator profile, age-standardized rates annual estimates, by sex, Canada, provinces and territories Statistics Canada, 2012. %
  14. 14. Population-level or “upstream” approaches for improving health and wellbeing Daniels S R et al. Circulation 2005;111:1999-2012
  15. 15. Engineering health back into daily life - creating opportunities for physical activity • Creating health supportive/physical activity supportive built environments is a “population-level” intervention. • Neighbourhoods will continue to be built to accommodate a growing population. • The “intervention” is semi-permanent, therefore sustainable.
  16. 16. Environment as an enabler or barrier to physical activity Source: Commissioned report for the French Ministry of Youth, Sports and Community Development (2008). Physical activity. Context and effects on health
  17. 17. Your neighbourhood’s walkability  From the list below what do you consider to be the most important feature that makes a neighbourhood walking- friendly? • Availability of parks and recreational facilities • Availability of sidewalks and pathways • Attractive and appealing streets • Safety from crime and traffic • Mix of stores, services, and shops • Street patterns and types • Proximity to transit stops and stations
  18. 18. Neighbourhoods and physical activity – the evidence so far… Land use mix and destinations  Local recreational/utilitarian destinations Connectivity  Street/sidewalk patterns, layout, route options Residential density  Economic viability, surveillance, cues to be active Appeal and aesthetics  Trees, architecture, sights, monuments, open space Pedestrian infrastructure  Sidewalks, benches, signs, crossing aids Safe places  Personal safety, traffic safety, civil order McCormack et al (2002). J Sci Med Exerc Sports; Humpel et al (2002) Am J Prev Med; Duncan et al. (2005) Int J Behav Nutri Phys Act
  19. 19. Source: Spielberg F. The traditional neighbourhood development: how will traffic engineers respond? ITE J. 1989;59:17 Which neighbourhood design best supports walking?
  20. 20. EcoEUFORIA Project
  21. 21. Study design  Two random cross-sectional samples (1 person/household; age ≥18 yrs)  Calgary, Alberta, Canada  Telephone-interviews • August-October, 2007 (n=2199; RR=33.6%). • January-April, 2008 (n=2223; RR=36.7%).  Neighbourhood-based physical activity (including walking, moderate, vigorous-intensity) • E.g., Walking undertaken within a 15-minute walk from home. • E.g.., Transportation and recreational walking in a “usual” week.  Reasons for moving to neighbourhood (self-selection)  Years residing in the neighbourhood  Attitude towards walking  Socio-demographic characteristics EcoEUFORIA Project
  22. 22. Prevalence of walking in a “usual week” by location Walking purpose Inside neighbourhood Outside neighbourhood For transportation, to get to a from places 60% 33% For recreation, leisure, fitness 74% 36% *Neighbourhood = everywhere within a 15-min walk of home; n=4422 Where do you walk?
  23. 23.  Household postal code geocoded and a 1.6km walkshed based on street network estimated (i.e., the “neighbourhood”).  2008/2009 City of Calgary/GIS databases: Variables (n=9):  Walkshed area (km2)  # businesses/km2  Sidewalk length meters/km2  # bus stops/km2  # different types of parks/km2  # different types of recreational facilities/km2  Population density  % green space within neighbourhood  Path/cycleway length meters/km2
  24. 24. Less walkable walkshed (1.6km from respondent home) High walkable walkshed (1.6km from respondent home)
  25. 25. Calgary neighbourhood types based on their built characteristics
  26. 26.  The most walkable neighbourhoods are located closer to the city core.  The least walkable neighbourhoods are located on the city periphery. Map of Calgary neighbourhoods Sandalack B, Alaniz Uribe F, Eshghzadeh A, Shiell A, McCormack G, Doyle-Baker P (2013). Neighbourhood type and walkshed size. Journal of Urbanism: International Research on Placement and Urban Sustainability.
  27. 27. Associations between walkability and ‘any’ neighbourhood-based walking in a usual week 0 0.5 1 1.5 Any WT in usual week Any WR in usual week Low walkable Medium walkable High walkable * * *p<.05; Propensity score analysis. Adjusted for neighbourhood self-selection, socio-demographics, walking, attitude, season, neighbourhood tenure, clustering; n=4034 OR
  28. 28. 0 10 20 30 40 Minutes of WT in a usual week Minutes of WR in a usual week Low walkable Medium walkable High walkable * * Associations between walkability and weekly minutes neighbourhood-based walking (walkers only) *p<.05; Propensity score analysis. Adjusted for neighbourhood self-selection, socio-demographics, walking attitude, season, neighbourhood tenure, clustering; n (WR)=3022; n(WT)=2385 Min
  29. 29. Associations between walkability and sufficient (≥150min/wk) neighbourhood-based walking (walkers only) 0 0.5 1 1.5 Suff. WT in usual week Suff. WR in usual week Low walkable Medium walkable High walkable * *p<.05; Propensity score analysis. Adjusted for neighbourhood self-selection, socio-demographics, walking attitude, season, neighbourhood tenure, clustering; n (WR)=3022; n(WT)=2385 OR
  30. 30. but each person subjectively observes and interprets it and behaves accordingly. There is a real or objective environment…
  31. 31. Capturing perceptions of neighbourhood walkability
  32. 32.  Perceptions of neighbourhood walkability • Residential density • Land use • Traffic safety • Pedestrian safety • Personal safety • Connectivity • Pedestrian infrastructure • Neighbourhood surroundings • Barriers to walking • Access to services 2http://www.ipenproject.org (International Physical Activity and Environment Network) Perceptions of neighbourhood walkability
  33. 33. 1 1 1 1 1.32* 1.54* 0.92 1.09 0 1 2 Any WT Sufficient WT Any WR Sufficient WR Low walkable neighbourhood High walkable neighbourhood *p<.05; Adjusted for socio-demographics, attitude, neighbourhood self-selection; n=1867 Likelihood of walking in a usual week by “PERCEIVED” neighbourhood walkability OR
  34. 34. Specific built characteristics in relation to different types of physical activity  Better understanding of the environmental correlates of specific behaviours is needed1,2 • Improving walkability on a grand-scale not always economically feasible or desirable (e.g., established neighbourhoods) • Identify built characteristics that are the most amendable with the biggest impact on physical activity • Better understanding of the winners and losers – will increasing built support for one behaviour (e.g., walking) reduce supportiveness for another behaviour (e.g., cycling). 1Humpel, N. et al. Environmental factors associated with adults’ participation in physical activity. Am. J. Prev. Med. 22:188–199, 2002.2 Giles-Corti et al. Understanding physical activity environmental correlates: increased specificity for ecological models. ESSR, 33(4), 175-181
  35. 35. Neighbourhood-based physical activity “participation” by built characteristics Walking for transport Walking for recreation Moderate physical activity Vigorous physical activity Intersections + Business locations + Mix of recreation destinations + Sidewalks + + + Green space - Path and cycleways + + p<.05 shown above only; Logistic regression adjusted for socio-demographics and reasons for residential selection
  36. 36. Neighbourhood-based physical activity minutes by built characteristics Walking for transport Walking for recreation Moderate physical activity Vigorous physical activity Total physical activity Business locations 19.1 25.6 Mix of recreation destinations -8.8 Sidewalks 18.1 Population density -9.3 City managed trees 6.4 7.3 *Change in minutes for 1 unit (standard deviation) change in built characteristics p<.05 shown above only; linear regression adjusted for socio-demographics and reasons for residential selection
  37. 37. What do these findings mean?  Your neighbourhood can enable or restrict the amount of physical activity you undertake (even for highly motivated people) • But some characteristics may be more important for some types of physical activity than others  Neighbourhoods that have many destinations, well connected pedestrian networks, sidewalks, access to transit stops, and pathways and cycleways could encourage higher levels of physical activity • In general, suburban neighbourhoods appear to be less supportive of physical activity than non-suburban neighbourhoods
  38. 38. Study aim  To investigate the pathways by which the neighbourhood built and socioeconomic context influence weight status via physical activity and diet. Study design  Cross-sectional design (1 person/household)  Data collection via internet survey, in April 2014 (Calgary, Alberta, Canada) Sample design  Stratified random sample (n=10,500 households invited from 12 neighbourhoods)  Neighbourhoods stratified by street pattern (grid, warped-grid, curvilinear) and socioeconomic status  Inclusion criteria: English language; ≥20 years of age; internet access  N=1023 (response rate=10.1%) recruited The “Pathways to Health” Study
  39. 39. The “Pathways to Health” Study Neighbourhood administrative boundary Line-based network walkshed (sausage- buffer), areal interpolation, and buffer containment Administrative boundary, aggregate census data, expert opinion of neighbourhood design GIS boundary, network layer, dissemination area census data
  40. 40. Neighbourhoods and obesity Weight characteristics Estimate (n=851) Weight modification attempt 51 % Waist circumference (WC) 86 cm Waist-to-hip ratio (W-HR) 0.88 Body mass index (BMI) 25 WC high risk [≥102 cm for men and ≥ 88 cm for women] 24 % W-HR high risk [≥0.90 cm for men and ≥0.85 cm for women] 52 % BMI overweight [25 to 29.9 kg/m2] 30 % BMI obese [≥30 kg/m2] 10 %
  41. 41. Neighbourhoods and obesity Neighbourhood characteristics WC (high risk) W-HR (high risk) BMI (over- weight or obese) BMI (obese only) Neighbourhood design (postal code) Walk Score® - - Socioeconomic status (walkshed) Advantaged vs. Disadvantaged - - - - Estimates adjusted for sociodemographic and health characteristics.*p<.05
  42. 42. Neighbourhoods and obesity Neighbourhood characteristics Waist circumference β Body mass index β Neighbourhood design (administrative boundary) Curvilinear 0.79 0.55 Warped-grid 0.56 0.41 Grid 0 0 Socioeconomic status (administrative boundary) Advantaged -4.73* -2.27* Somewhat advantaged -4.17* -1.80* Somewhat disadvantaged -0.80 1.12 Disadvantaged 0 0 N=851 provided complete data. β is the difference in weight outcome relative to reference group. *p<.05. Positive value represent higher weight status and negative values represent lower weight status. Estimates adjusted for sociodemographic and health characteristics
  43. 43. Neighbourhoods and obesity Marginal means of waist circumference for combinations of neighbourhood design and socioeconomic status based on significant interaction (p<0.10). Columns with the same superscript are significantly different based on Fisher’s Least Significance test (p<0.05) Interaction between neighbourhood design and socioeconomic status – waist circumference
  44. 44. Neighbourhoods and obesity Marginal means of waist circumference for combinations of neighbourhood design and socioeconomic status based on significant interaction (p<0.10). Columns with the same superscript are significantly different based on Fisher’s Least Significance test (p<0.05) Interaction between neighbourhood design and socioeconomic status – waist circumference
  45. 45. Conclusions  Residing in a less walkable neighbourhood has the potential to increase your weight and waist circumference (i.e., they are “obesogenic”). • The effect is likely exacerbated for socioeconomically disadvantaged neighbourhoods • Purchasing a new home or looking for a house to rent - investigate the surrounding neighbourhood: • Are their transit stops or train station within easy walking distance (5-10 minutes)? • Are shops and services within easy walking distance (5-10 minutes)? • Is the neighbourhood street network “grid-like” or does have many “cul-de-sacs and loops”? • Are there sidewalks on most streets that form a well connected network that is easy to navigate, safe, and that link to pathways and cycleways, transit, parks, and shops and services? • Check Walk Score® (see www.walkscore.com)
  46. 46. Conclusions • Residing in a low walkable neighbourhood, then: • Increase awareness about characteristics that are available that might support physical activity (parks, pathways; identify shortest most convenient routes to destinations and transit). • Approach community associations and municipalities and local advocacy groups to demand (evidence-based) improvements to make the existing neighbourhood more physical activity supportive. • Look to other opportunities to be physically active (local walking groups, community exercise classes). • Identify physical activities that might be best supported by the existing infrastructure . • Make “health” an important consideration when choosing your neighbourhood.
  47. 47. “You can't make positive choices for the rest of your life without an environment that makes those choices easy, natural, and enjoyable.” Deepak Chropra Take-home message
  48. 48. Thank you Sign up for other UCalgary webinars, download our eBooks, and watch videos on the outcomes of our scholars’ research at ucalgary.ca/explore/collections Information presented today was a summary of the scholar’s research and the opinions expressed were based on the scholar’s field of study
  49. 49. Other Webinar Topics For ideas on other UCalgary webinar topics, please email us at exploreucalgary@ucalgary.ca

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