Thursday, January 1, 2015
The role of public health in land use planning can be traced back to the industrial revolution. At this time, newly urbanized areas needed the infrastructure to provide healthy and sanitary conditions, which resulted in public health, land use planning and civil engineers coming together. i Over time, however, there began a separation of planning and public health. This was partially due to the emerging specialization in the planning field (e.g. environmental planning, transportation engineering and urban planning) and a concentration on individual health practices and conditions in the medical field.ii
Recent research in health has returned to the thinking that health is not always decided by individual health behaviours but, rather, is largely determined by the environment in which one lives. For instance, many of today’s looming health concerns revolve around chronic disease, such as obesity, heart disease, stroke and some types of cancer. These conditions are often associated with lack of physical activity and unhealthy eating, and some with environmental exposure to air pollutants (e.g. certain types of cancer).iii
In addition to specific connections with chronic diseases, the built environment and land use planning policies have the potential to impact certain populations disproportionately at the community level, thus becoming a health equity issue. For example, studies demonstrate that individuals and families living in lower socioeconomic status (SES) neighbourhoods are more likely to live close to a highway or major industrial area, hence exposing them to higher levels of air pollution and increasing their risk of suffering associated health conditions.
Additionally, research has shown an association between food desserts – areas with limited access to fresh groceries – and lower SES neighbourhoods.iv
As age is also an important social determinant of health, designing communities that meet the “8-80 cities” concept is critical. As a non-profit community development organization based in Toronto, 8-80 Cities has four areas of focus: Parks and Public Spaces, Sustainable and healthy mobility, People friendly public realm, and OpenStreets programs.v Each of these is linked to the concept of building a healthy community or, in this case, city. A community that is built with the 8-80 concept in mind is one that promotes and enables healthy behaviours regardless of whether you are eight (8) or 80 years old. Such a community is designed to prioritize human interaction through interconnected streets and public places where people work, learn and play.vi Ultimately, “8-80 cities encourages sustainable and healthy lifestyles for people regardless of age, gender, ability and social status”.vi
The Healthy Communities movement pre-dates 8-80 Cities, however. The Ontario Healthy Communities Coalition (OHCC), which was itself established in 1992, has identified that the broader healthy communities movement has roots in the 1980’s in Ontario.vii Arguably, the term itself became popularized after the World Health Organization’s “Healthy Cities Project” was initiated in Europe in 1986.viii That same year, the First International Conference on Health Promotion was held in Ottawa. The Conference resulted in the “Ottawa Charter,” which was intended “to achieve Health for All by the year 2000 and beyond.”ix The Charter indicates that “Health is created and lived by people within the settings of their everyday life; where they learn, work, play, and love.”x Today, the importance of a given place, including its intersecting natural, built, social and cultural environments, is widely understood as being a determinant of the social, health and economic outcomes of local people.
In summary, designing and building healthy, safe and complete communities has the potential to support the health of an entire population, including that of Dufferin County. Healthy communities promote active transportation, recreation and healthy food choices; improve access to jobs, schools and health care; create strong social networks; and ensure good air and water quality.xi
1.2 Key Developments Leading to the Study
Locally, Wellington-Dufferin-Guelph Public Health’s (WDGPH) mandate is to improve the health of the population through activities that promote and protect health, and prevent disease and injury. To accomplish this mandate, it is important to work collaboratively with municipalities, school boards, health and social service agencies to create and sustain healthy communities. Municipalities can play a big role in enabling healthy decisions through their land-use design policies and practices. Nevertheless, WDGPH’s understanding and experience with land use planning policies continues to evolve.
In an attempt to inform the future direction of public health’s role in land use planning, public health staff completed a needs assessment in 2014 with municipal planners in Wellington County, Dufferin County and the City of Guelph. From the assessment, the majority of planners indicated that reviewing official plans would be a useful role for Public Health.
1.3 Purpose of WDG Official Plan Policy Review
Using funding from the Ministry of Health and Long-Term Care’s Healthy Communities Partnership, WDGPH hired a planning consultant to review municipal and county official plans, and other appropriate planning-related documents, in order to identify local strengths and areas of opportunity. This will help WDGPH make an effective contribution to the development of healthy communities throughout the region.
This report provides an assessment of the strengths and areas of opportunity contained within the Official Plans and related planning documents for municipalities within Dufferin County from a public health perspective. Subsequently, the report recommends considerations for future Official Plans and related policies that would help contribute to planning for a healthy community.
1.4 Anticipated Outcomes of the Review
There are several anticipated outcomes of this review. The review and suggested considerations could encourage local municipalities to adopt official plan amendments, or to further study the prospect thereof, whether in the short-, medium- or long-terms. It is hoped that this work will support future collaborations between WDGPH and Dufferin County; between WDGPH and local planning officials; between the County and municipalities; and, between local municipalities. As such, an anticipated outcome of this work is fuel for capacity building in the area of healthy communities. Lastly, this work is intended to provide food for thought for both public health and planning officials who serve the public interest both within and across Wellington and Dufferin counties, and the City of Guelph.
1.5 Methodology & Assessment
The built environment requirement of the Ontario Public Health Standards (2008) suggests that public health units work to address the following risk factors: healthy eating, healthy weights, tobacco, physical activity, alcohol use and UV radiation. Nonetheless, when preparing for the official plan review process, WDGPH recognized that these are health outcomes of community design, but may not be the language of how planning decisions are made. As such, the internal built environment committee at WDGPH decided to select a planning-oriented framework that would guide consistency for the official plan review process across all 16 municipalities and 2 counties.
After reviewing several documents, the committee decided to adapt the framework outlined in Healthy Built Environment Linkages: A Toolkit for Design, Planning and Health, produced by British Columbia’s Provincial Health Services Authority.xii In this document, physical features of the built environment were separated into 5 domains:
- Healthy Neighbourhood Design;
- Healthy Transportation Networks;
- Healthy Natural Environments;
- Healthy Food Systems; and
- Healthy Housing.
These domains are each described in the following sub-sections. WDGPH worked with the planning consultant to develop a planning checklist that contained several planning policy principles within each domain. These were then used to guide the official plan review for strengths and areas of opportunity. Referencing back to the checklist, successful examples from other communities and additional best practice literature were referenced and subsequent recommended considerations were developed. It should be noted that many of the suggested considerations and case examples may be relevant in a more urban community, as the literature does not always provide examples within a rural context. We have noted areas where the more rural character of local communities may require further research on approaches that would be effective in enhancing the health of the community.
1.6 Five Domains
Below we describe each of the aforementioned domains in some detail.
1.6.1 Healthy Neighbourhood Design
Safe and healthy neighbourhood design can encourage active transportation and physical activity by considering mixed land use development, density, and efficient street connectivityxiii,xiv. These considerations can indirectly impact a community’s physical and mental health via cycling, walking and accessible physical activity opportunitiesxv,xvi. Convenient access to a range of amenities, such as recreation facilitates, through mixed land use development has been shown to increase active transportation and overall physical activityxvii,xviii. High density neighbourhoods increase proximity to work, school, amenities and recreation options, having multiple positive impacts, such as improved air quality, active transportation and physical activityxix,xx. Research also suggests that compact and connected street design promotes safe use of active transportation, therefore encouraging community members to walk or cyclexxi.
Community design can also moderate climate change impacts. The links between climate change and human health are numerous and diverse. For example, extreme weather events (heat waves, flooding, droughts, tornadoes), which are expected to increase in frequency and severity, may lead to increased risks of injury and illness, as well as increased risks of damage to critical infrastructure (water and sanitation systems, power grids, etc.)xxii. Communities can increase their resiliency to climate change impacts by understanding local needs and vulnerabilities. Adaptation efforts may include increasing green spaces, decreasing impervious surface runoff, and designing infrastructure to withstand severe weather eventsxxiii.
The following Healthy Neighbourhood Design planning principles were adapted from Healthy Built Environment Linkages: A Toolkit for Design, Planning and Healthxii as the criteria used to review municipal planning documents:
1. Enhance neighbourhood walkability
2. Create mixed land use
3. Build complete and compact neighbourhoods
4. Enhance connectivity with efficient and safe networks
5. Prioritize new developments within or beside existing communities
6. Create infrastructure resilient to climate change (addition to original toolkit referenced above)
1.6.2 Healthy Transportation Networks
The design and connectivity of transportation networks can make it either easier to get around by walking or biking or simply easier to drivexxiv. Communities can build healthy transportation networks by including features that improve streetscapes, including sidewalks, crosswalks, lighting and benches, which have been shown to be associated with an increase in physical activity among older adultsxxv. Meanwhile, in rural settings, physical activity among adults is found to be associated with trails and parks with pleasant aestheticsxxvi. There are also various design features that can help improve safety and consequently potentially encourage walking and cycling, for example, traffic calming measuresxxvii,xxviii and cycling infrastructure (such as dedicated cycle routes, both on and off road)xxix,xxx,xxxi. Evidence suggests that biking or walking to school may not only be influenced by proximity, but also by supportive infrastructure, and that active transport to school may also increase habitual physical activity among childrenxxxii.
The following Healthy Transportation Networks planning principles were adapted from Healthy Built Environment Linkages: A Toolkit for Design, Planning and Health as criteria used to review municipal planning documents:
1. Enable mobility for all ages and abilities
2. Make active transportation convenient and safe
3. Prioritize safety
4. Encourage use of public transit
5. Enable attractive road, rail and waterway networks
1.6.3 Healthy Natural Environments
1.1.3 Healthy Natural Environments
Healthy natural environments serve to enhance public health through improved air quality and cooling effects, as well as by providing opportunities for community member to engage with nature. Research indicates that urban trees have the potential to clean the air of air pollutantsxxxiii, which in turn can help prevent the onset of cancerxxxiv, cardiovascular disease and respiratory difficultiesxxxv. Preliminary studies also suggest that urban trees and green spaces can have cooling effectsxxxvi,xxxvii, mitigating the impacts of extreme heat events which are linked to increased mortality, in particular for those with pre-existing cardiovascular and respiratory conditionsxxxviii. Meanwhile, studies have demonstrated that exposure to nature is not only associated with increased physical activity, but is also linked with increased general wellbeing, including improved cognitive function and reduced stress and anxiety xxxix,xl,xli.
The following Healthy Natural Environments planning principles were adapted from Healthy Built Environment Linkages: A Toolkit for Design, Planning and Health as the criteria used to review municipal planning documents:
1. Preserve and connect open space and environmentally sensitive areas
2. Maximize opportunities to access and engage with the natural environment
3. Reduce urban air pollution
4. Mitigate urban heat island effect
5. Expand natural elements across the landscape
1.6.4 Healthy Food System
The local food system impacts a community’s access to, and choice of, food optionsxlii. Land use planning can directly influence factors within the local food system, such as production, distribution and procurementxliii. A community is more probable to reap the health benefits of nutritious foods when healthy and affordable local food options are easily accessiblexliv. Individuals who do not have convenient neighbourhood access to a healthy food retail outlet, like a grocery store, may be more likely to choose costly and less nutritious options (e.g., processed food)xlv. Research also suggests that this unequal distribution of food retail outlets in residential areas occurs more in lower income neighbourhoodsxlvi. When a local food system is adequately supported to provide development initiatives like community gardens and kitchens, healthy local food options are made accessible, while bolstering community members’ food skills, social and coping skills, and overall community empowermentxlvii,xlviii.
The following Healthy Food Systems planning principles were adapted from Healthy Built Environment Linkages: A Toolkit for Design, Planning and Health as the criteria used to review municipal planning documents:
1. Enhance agricultural capacity
2. Increase access to healthy foods in all neighbourhoods
3. Improve community-scale food infrastructure
1.6.5 Healthy Housing
Housing affordability and quality impact health in numerous and diverse ways. Access to affordable housing reduces the frequency of moving and improves the chances of having disposable income available, both of which reduce stress and allow people and families to take better care of themselves and stay healthy1,xlix,l. Additionally, living in quality housing may be associated with an improved sense of safety and decreased fear of crime, which in turn reduces stress and improves social connectionsli. And high quality housing with appropriate ventilation and moisture control leads to improved indoor air quality, which can have impacts on general and respiratory health, particularly for children with asthmalii,liii. Moreover, providing energy efficient housing helps people to afford living in their homes, while reducing risks of illnesses aggravated by cold and damp conditionsliv.
The following Healthy Housing planning principles were adapted from Healthy Built Environment Linkages: A Toolkit for Design, Planning and Health as the criteria used to review municipal planning documents:
1. Increase access to affordable housing through provision of diverse housing forms and tenure types
2. Ensure adequate housing quality for all segments of society
3. Prioritize housing for the homeless, elderly, low income groups and people with disabilities
4. Site and zone housing developments to minimize exposure to environmental hazards
1.7 Layout of this Report
The next three chapters in this report provide: an overview of the roles of the public health and planning professions in supporting the development of healthy communities; description of the Provincial planning framework; and, review of relevant Provincial policy directions. The subsequent chapters correspond to the review of planning documents developed by the County and each of its local municipalities. Each report includes a discussion of strengths, areas of opportunity, considerations along with practical guidance and examples, as well as other strategies and actions. The report concludes with a discussion of common themes that emerged through our review of policies and plans in Dufferin County, and a review of next steps for this work.