To improve health, governments have to move beyond changing people’s behaviour to fixing the urban environment – including requiring health assessments for new development proposals. That’s the message the director of public health for Peel Region delivered to the recent Hamilton conference on air quality and the environment.
Dr David Mowat contends we have to redesign our transportation systems and other urban infrastructure to make healthy living the logical choice, rather than just trying to convince people to adopt healthier personal behaviours. He pointed to the historical example of Sir Edwin Chadwick, the driving force behind the introduction of sewers into England in the 1840s – a 60-year battle against fierce opposition that argued “my customers don’t want sewers, it’s cheaper without sewers” etc.
“But he persisted and now we take this stuff for granted, we don't think about it,” noted Mowat. “What he didn't do is say let's have a campaign to get people to wash their hands. Think about it, right, that's what he didn't do. What he did was to transform into the kind of society we have now where you don't have to worry about that kind of infectious disease because we collectively have changed the way we live in order to make that an easy and healthy choice.”
Mowat, who’s also been the medical officer of health for all of Ontario, argues similar transformational methods are required today to overcome diabetes and other health problems that are reaching epidemic proportions. He reminded the attendees at the city’s biennialUpwind Downwind Conference that public health has long been a central focus of city planning by trying to separate residential areas from industrial pollutants.
“We've moved from the early days of a lot of disease being either to toxins or especially, communicable diseases, to our situation today where what is killing us is chronic diseases, cardiovascular diseases, diabetes, lung disease, and so on,” stated Mowat. “In the next 15 years we will reach a status where 1 in 6 adults in Peel Region will have diabetes; for those over 65 it will be 1 in 3 and diabetes is a very significant serious disease.”
He showed oft-cited statistics linking obesity to diabetes and to heart disease, but suggested that simply encouraging people to “take out the gym membership, ride your bike, walk more” isn’t very effective because “we do the things that are the easiest and if there are barriers to doing healthy things then we don't do the healthy things.” And he reminded conference delegates that while the body strongly resists losing weight, there are marked health improvements just with increased physical activity, even if there isn’t an accompanying weight loss.
So Mowat advocates making active transportation opportunities (cycling, walking, and transit) easy choices for urban residents and says this has to be a key focus of public health departments. That includes “changes in the way we lay out our roads” and making cities walkable.
“We cannot address our obesity overweight problem without addressing the fact that we spend nearly all of our time on the couch and in the car,” he declared. “That is what we have to address and the only way we can address that is by changing the way we build our cities.”
That includes adopting “age-friendly” design, including simple steps such as making it possible for an 85-year-old to walk across major roadways. And cutting car dependence also slashes the air pollution that is harming health, especially those with lower incomes.
“There's a lot of evidence showing that it's those of low socio economic status who bear a disproportionate burden when it comes to poor air quality,” Mowat noted. “So we know, for example, that people who self-report exposure to pollution, those who live within 200 metres of a major highway and those living near point source emissions are all much more likely to do poorly.”
In Peel, public health officials convinced the municipal government to modify the official plan to require “health impact studies” for some developments that require official plan amendments. They’ve also made formal submissions praising the anti-sprawl legislation of the provincial government.