health-201-presentation (How the environment affect our health).ppt
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Health 201: Five Things
That Planners and Design Professionals
need to know about
Health and the Built Environment
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Guide for using this presentation
• This presentation is part of PHSA’s Healthy Built Environment
Initiative. Find references and other resources at
http://www.phsa.ca/HealthProfessionals/Population-Public-Health/Healthy-Built-
Environment/default.htm.
• Speaker’s Notes can be found in the small brown box in top
left of each slide.
• Users may freely use and adapt this presentation. Please
credit PHSA. You can also insert local data at Slide 14.
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Key message: Good planning and
design can help build healthy places
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT
• The planning sector and local government already
play an important role in creating healthy built
environments.
• Chronic illness and injury are a risk to both public
health and our universal health care system.
• Promoting healthy lifestyles alone is not enough.
Effects of the built environment must also be
addressed.
• Professionals working in health, planning and design
share a responsibility to promote active living and to
modify the built environment.
• Good planning and design can help people avoid or
change unhealthy physical environments.
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Five Things about
Health and the Built Environment
1. The impact of chronic illness and injury is immense;
much is preventable.
2. Why are some people healthy while others are not?
It’s not just genetics and lifestyle.
3. Many sectors of society influence population health.
4. The Built Environment affects health.
5. Collaborative action works.
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT
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1. The impact of chronic illness and
injury is immense
• Preventable chronic illness and injury cost BC’s
health care system billions of dollars every year
• Money spent on hospital care affects what we can
spend on things that keep people healthy, like parks,
active transportation and disease prevention
• This presentation will explain how planners and
design professionals play an important role in
preventing illness and injury
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT
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Why should planners care about
runaway health care costs?
Resources spent on health care take away from other
public benefits:
• Early childhood development
• Affordable housing
• Education at all levels
• Regional economic development
• Clean air and water
• Support for research and innovation
• Transportation and recreation infrastructure
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT
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Obesity increases the risk for many
chronic diseases
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT
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Many injuries could be prevented by
good design
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT
• Pedestrian fatalities higher than driving
• Seniors and kids are the most vulnerable
• Road design – wide arterials in suburban areas
most dangerous
• Traffic calming – reducing vehicle speed
reduces risk of pedestrian injury
• Public transit – decreases the number of
automobile miles traveled
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2. Why are some people healthy while
others are not?
• People’s choices to adopt a healthy lifestyle are limited by their
income, social status, education, occupation, neighbourhood
environment, social environment, etc
• These factors are called the social determinants of health
• These factors are often inversely related to health
• Good planning and design can help reduce the inequities in people’s
choices
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT
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3. Many sectors of society influence
population health
‘Population health’ is an approach that aims to improve the health
of the entire population and to reduce health inequities among
population groups… It looks at and acts upon the broad range of
[influencing] factors: social, economic and environmental health
determinants”
Source: Public Health Agency of Canada
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT
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Individual action can reduce the impact of health hazards.
But socio-economic factors make the job harder.
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT
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What does population health look like
in our community?
Placeholder for local data e.g. birth rate, proportion of seniors, health
and illness indicators etc. (see the geography of wellness and well
being across British Columbia)
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT
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4. The Built Environment has an impact
on health
Community design can impact:
• Traffic safety and injury prevention
• Neighbourhood walkability
• Access to public transit
• Mental health affects of noise
• Air and water quality
• Access to healthy foods
• Social inclusion
• Disability access
• Access to affordable and safe housing
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT
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HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT
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HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT
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5. Collaboration is necessary to create
Healthy Built Environments
• Complex problems require solutions from many
sectors…
• … and leadership by community groups, planners,
the development industry, engineers, design
professionals, health professionals and elected
officials.
• Tobacco control is a successful example of cross
sector collaboration
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT
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Tobacco Control – an example of
successful cross-sectoral collaboration
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT
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Tobacco Control – an example of
successful cross-sectoral collaboration
Health
Municipal and
Regional Licensing
Tax Policy
School Programs
Media Policy
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT
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The health sector and planners have
many opportunities for collaboration
• Environmental factors air and water quality, noise, heat
• Housing quality, affordability
• Access and inclusion mental health and disability, arts
and culture
• Injury prevention
• Physical activity transportation, recreation, connectivity
• Nutrition and food security
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT
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Summing Up
• The planning sector and local government already
play an important role in creating healthy built
environments.
• Chronic illness and injury are a risk to both public
health and our universal health care system.
• Promoting healthy lifestyles alone is not enough.
Effects of the built environment must also be
addressed.
• Professionals working in health, planning and design
share a responsibility to promote active living and to
modify the built environment.
• Good planning and design can help people avoid or
change unhealthy physical environments.
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT
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Image sources
Page 1: www.wikipedia.com; www.eps-newswire.com
Page 2: Dan Burden (www.pedbikeimages.org)
Page 8: www.allianz.com
Page 14: City of Peterborough; LEES + Associates
Page 17: LEES + Associates
Page 20: Co-operative Housing Federation of BC; Lower Trinity
South Regional Development Association
Page 21: LEES + Associates
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT
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We need your feedback in order to ensure this presentation is relevant and
informative to participants. Please take a few minutes to answer these questions:
1. The presentation is clear
1 2 3 4 5
2. The presentation is relevant to my work
1 2 3 4 5
3. My knowledge increased as a result of this guide
1 2 3 4 5
4. What do you find most useful about this presentation?
5. What would you suggest to improve this presentation?
NOTE: Responses can be sent to the Provincial Health Services Authority (PHSA), Attention Jane McCarney, jmccarney@phsa.ca,
604-875-7354, fax 604-875-7368. Evaluations can be anonymous but your organization and department name would be helpful
for our reference.
Evaluation
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT
Editor's Notes
This presentation aims to engage elected officials and leaders among planning and design professionals.
It could be delivered by any planning team member because in-depth presentation materials on the same topic already exist and a reference list is available. It is also suitable for web-based viewing.
The goal is to convince the audience that local government should care about the health effects of the built environment. It also explains that solutions can be developed from collaboration between planning and design professionals and Health.
Intended presentation time is less than 30 minutes, including questions.
Definition: “Built environments are the urban and rural human-made surroundings that provide the settings for human activity. Built environments encompass buildings and spaces (e.g. homes, schools, workplaces, neighbourhoods, parks/recreation areas, industrial/commercial areas and other settings) the products they contain, and the infrastructure (e.g. transportation, energy and agricultural systems) that link and support them.” BC Ministry of Healthy Living and Sport.
Definition: “The built environment encompasses all of the buildings, spaces and products created… by people. It includes our homes, schools and workplaces, parks, business areas and roads. It extends overhead in the form of electric transmission lines, underground in the form of waste disposal sites and subway trains and across the country in the form of highways.”
Health Canada (1997) Health and Environment
Local government already plays a very important role in HBE work for example in providing safe drinking water, tobacco control and air-quality measures such as anti-idling by-laws. The next step is to pick off some of the “low-hanging fruit” for further improvements.
Planners and design professions share with the health professions the ethical duty to improve the health and wellbeing of ALL those who use their services.
It is important to note that HBE work is related to other initiatives including reducing green house gases, reducing air pollution, managing traffic congestion, increasing street safety and vibrancy, etc.
Healthy built environments should concern everyone, not just health care providers.
If we do not address the causes of chronic illness and injury, we will be faced with social problems that have been compared in impact with climate change.
This presentation provides a high-level overview of the key topics.
It introduces the important concepts so that participants can see the “big picture” and why they need to take action.
Chronic Diseases and Injuries in Canada
Chronic diseases such as diabetes, kidney disease, heart disease and respiratory conditions account for 89% of deaths in Canada. Chronic diseases are expected to cause the deaths of two million Canadians over the next decade. Cardiovascular disease (CVD) is the leading cause of death in Canada and accounts for a loss of 4.5 years of life. In 2003, injuries were the second leading cause of death before age 70 in Canada.
“As long as we keep spending money on hospitals, we will not have resources for early child development and care of seniors and other vulnerable people.”
This slide illustrates how much government expenditure in BC is already going to health care. Much of this is preventable.
Costs of chronic illness in British Columbia are a major factor in these steadily increasing costs. CVD, cancer and diabetes account for 10.3% of the health care budget—or about $1.28 billion. The total direct cost of injuries reaches $852 million annually. Other chronic illnesses include arthritis, asthma and lung disease, kidney disease and vascular disease. Many are related to inactivity and environmental factors.
There are also significant social costs of preventable injury and chronic illness such as personal care, insurance costs, loss of income and taxes.
The message for local politicians is that there is an opportunity for potential economic gain in avoiding these costs. Communities that develop an age-friendly built environment may also be more successful in attracting new residents and businesses.
Obesity is a special concern because of the health impacts as shown in this slide, but also because it is so much more visible than other effects of the built environment (such as social inclusion or respiratory disease).
Obesity and overweight have been dubbed a ‘global epidemic’ by the World Health Organization (WHO). Obesity is a condition in which weight gain has reached the point where it poses significant risks to health. Obesity may be considered as a disease in itself and as a risk factor for other diseases.
Recently US researchers noted that obesity now equals smoking as a threat to health. “Obesity is the new tobacco.” Although this is not the only consequence of unhealthy lifestyles, the effect of obesity on other diseases makes it one of the most serious concerns.
In adults, obesity is associated with an increased risk of diseases that are a major cause of morbidity and mortality, notably type 2 diabetes, coronary heart disease (CHD), hypertension, various cancers and osteoarthritis.
In children the persistence of obesity into adulthood is the most important concern; the risk of persistence increases with increasing age of the child and the severity of obesity, but obesity also causes significant morbidity in childhood.
In general Type 2 diabetes follows the onset of obesity by about twenty years. Thus we fear a “conveyor belt” for today’s overweight children and adolescents to future chronic illness.
It is important to point out to officials, that local government has a record of success in encouraging active transport with collaborative projects involving BCRPA as a good example.
But – activity may be a risky behaviour if the built environment is not supportive. E.g. uneven or slippery pavement surfaces.
“In relation to the built environment, the poor live downwind, downstream, downhill (but uphill if the slopes are dangerous), on floodplains and other marginal lands, near landfills, industrial plants and hazardous sites, in damp, unsafe, unhealthy housing, in dangerous neighbourhoods, and they work in unsafe, unhealthy workplaces. So place matters when it comes to their health.” (Trevor Hancock)
This is the most important message in the presentation: Good planning and design can help people avoid or change unhealthy physical environments.
Look at the places on this map that are shaded in darker colours (Downtown Eastside, North Vancouver Island, rural and remote locations). Is there any surprise that these people live shorter lives due to natural causes of ill health?
“Potential years of life lost” [PYLL] is the number of years of life "lost" when a person dies "prematurely“. This is An indicator of premature mortality (death before age 75), which gives greater weight to causes of death occurring at a younger age than to those at later ages. This measure is calculated by subtracting the actual age of death from 75, dividing the total potential years of life lost by the total population under age 75, and then presented as "years lost per thousand people". By emphasizing the loss of life at an early age, PYLL focuses attention on the need to deal with the major causes of such early deaths - cancer, accidents and cardiovascular disease - in order to improve health status. For example, the death of a 50-year old contributes "1 death" to premature mortality, but "25 years" to PYLL; whereas the death of a 70-year old also contributes "1 death" to premature mortality, but only "5 years" to PYLL. PYLL has been found to vary with characteristics such as sex, socio-economic status and place of residence.
Improving population health usually requires multidisciplinary approaches (educational, environmental, behavioral and legal) and involvement of communities to address root or underlying causes of disease.
Many early gains in improving the health of populations came not from advances in medical science but from engineering, such as the provision of clean water, disposal of wastes, refrigeration, safer roads.
Health inequities are systematic disparities in health (or in the major social determinants of health) between groups with different social advantage or disadvantage (e.g. wealth, power, prestige).
As each socio-economic factor makes the health gradient steeper, the individual has to work harder to avoid health hazards
“In [BC], as in other jurisdictions in the developed world, health tends to be unevenly distributed
among social groups within the population on a gradient corresponding to socioeconomic status. The
data in this report show that, in general, people from more advantaged socioeconomic groups enjoy
longer life expectancy and better health than people from less advantaged groups.
Inequities are reflected by consistent differences in the prevalence of chronic diseases (e.g., heart disease, kidney disease and
diabetes) among people from the highest and lowest income and education groups across the province; the
lower a person is on the socioeconomic hierarchy, the greater their risk of developing these diseases.” (Health Officers’ Council of BC 2008)
“The built environment is part of the overall ecosystem of our earth. It encompasses all of the buildings, spaces and products that are created, or at least significantly modified, by people. It includes our homes, schools and workplaces, parks, business areas and roads. It extends overhead in the form of electric transmission lines, underground in the form of waste disposal sites and subway trains and across the country in the form of highways.”
Health Canada (1997) Health and Environment
The BE has impacts on both the physical environment - Building design and location, Streets, Noise, Air and water quality, Traffic safety and injury prevention as well as social environment including social inclusion, disability access and housing and food security
How would you interpret the relationship between population health and the built environment in these pictures?
Prompts clockwise from upper left
Idling car –asthma (anti-idling by-laws)
Urban sprawl - loss of farmland, inactivity, air pollution, traffic injuries
Unsafe sidewalk – discourage activity, falls, traffic injuries
Homelessness – poor health, social exclusion, loss of productivity, discourage activity by others
Subdivision design – reliance on cars, inactivity, asthma
How we design and create our built environments - at every level from the design of products to the design of city-regions - has significant implications for health and other aspects of human development.
Planning and investment policies also include plans and zoning and development rules, development pressures, provincial transportation initiatives, among others… City building is more complex than just zoning bylaws.
“Smart growth” doesn’t mean “no growth,” but it does mean planned growth.
The health impacts of land-use decisions need as much consideration as economic impacts.
Design communities around people rather than around automobiles
Public health professionals and those in architecture, engineering, design and planning have much in common.
The challenge now is for each profession
to learn from the others
to determine what answers each has that the other needs,
to create a common language, and
to initiate the opportunities to use it.
Smoking rates have dropped dramatically in regions where comprehensive policies have been implemented. Health services alone cannot achieve this.
The design professions share with the health professions the ethical duty to improve the health and wellbeing of ALL those who use their services.