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

1. Healthy Neighbourhoods
Gavin McCormack, PhD
Associate Professor
Department of Community Health Sciences
Cumming School of Medicine, University of Calgary
January 19, 2017

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. 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. Reasons for choosing your
current neighbourhood
Do you consider your neighbourhood to be
convenient for undertaking physical activity
(…is it “walkable”)?

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. 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. 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. “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. Urban planning and health, examples:

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. 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. http://www.statcan.gc.ca/pub/82-625-x/2015001/article/14135-eng.htm
Physical activity levels among Canadians

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. Population-level or “upstream” approaches for
improving health and wellbeing
Daniels S R et al. Circulation 2005;111:1999-2012

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. 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. 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. 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. Source: Spielberg F. The traditional neighbourhood development: how will traffic engineers respond? ITE J. 1989;59:17
Which neighbourhood design best supports
walking?

20. EcoEUFORIA Project

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. 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.  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. Less walkable walkshed
(1.6km from respondent home)
High walkable walkshed
(1.6km from respondent home)

25. Calgary neighbourhood types based on their
built characteristics

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. 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. 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. 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. but each person subjectively
observes and interprets it and
behaves accordingly.
There is a real or objective
environment…

31. Capturing perceptions of
neighbourhood walkability

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. “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. Thank you
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Information presented today was a summary of the scholar’s research and the opinions expressed were based
on the scholar’s field of study

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