Creating Partnerships for Healthy Communities

David L. Mowat, MBChB, MPH, FRCPC, FFPHMedical Officer of Health, Peel Region, Ontario

Communities Putting Prevention to WorkBuilt Environment Mentoring Project

New York, New YorkNovember 4, 2011

Assumptions

• The science shows reasonably consistent relationships between built environment of outcomes of interest

• Outcomes include major chronic diseases, air quality, social connectedness, injuries

• North American built environment is sprawling, car dependent, not health-supporting

• The issue falls within the mandate of Public health

Scope• “built environment” encompasses a range

of issues, including:Land use planningActive transportationTransportation demand managementSchool travel planningParks, trails and recreational facilitiesBuilding designNeighbourhood developmentStreetscape

The Region of Peel

Lake Ontario

2011 2021 2031Population 1,261,000 1,425,0

001,571,0

00

Peel’s Population Growth is One of the Highest in the GTHA

Popu

lati

on

(Mill

ions

)

-

0.5

1.0

1.5

2.0

1971 1981 1991 2001 2011 2021 2031

PEELYork

DurhamHaltonHamilton

1

22.0

1.0

0.5

1.2 million 1.6 million

+ + 13%13%

+ + 10%10%

Figure DM0: Diabetes Mellitus Prevalence Rate† by Year, Region of Peel and Ontario, 1995/1996 to 2004/2005

0

1

2

3

4

5

6

7

8

9

10

Fiscal Year

Num

ber o

f cas

es‡ per

100

pop

ulat

ion

aged

20

year

s an

d ol

der

Peel 5.9 6.3 6.6 6.8 7.2 7.5 8.0 8.4 8.8 9.2

Ontario 5.4 5.7 6.0 6.3 6.6 6.9 7.3 7.6 8.0 8.4

1995/96 1996/97 1997/98 1998/99 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05

† Age-adjusted prevalence rate‡ Number of cases of DM include new and existing - identified using the Ontario Diabetes Database in a specified population for a given year.Fiscal year: extends from April 1st of one calendar year to March 31st of the next calendar year.Source: Institute for Clinical Evaluative Sciences. inTool. instant interactive information. http://www.ices.on.ca/intool

The Region of PeelPEEL

The Region of PeelEarly Healthy Built Environment Initiatives

1. Literature Review

2. Conceptual Models on relationship between health and planning

3. Peel Health position statement

4. Active Transportation Master Plan Steering Committee

5. Healthy policy development for Regional and Municipal Official Plan policies

6. Comments on Municipal Block and Secondary plans

Who we areHeart and Stroke Foundation of Canada

Canadian Institute of Planners

Urban Public Health Network

National Collaborating Centres for Healthy Public Policy

Six public health units:Montreal

Peel Surrey

TorontoVancouver

Victoria

Our goals

Together, we are:1. Piloting and evaluating different approaches to translating the latest

research into the needed tools, policies and processes to support policy-makers and practitioners in creating healthier built environments.

2. Exchanging knowledge and lessons learned, and seeking out opportunities to adapt practices from one city or region to another.

3. Cultivating the building of a cross-sectoral community of practice.

National projects

Development of a software tool that would assess the health impacts of land use planning decisions

Administration of a residential preferences survey that would determine the demand for walkable communities, and the

degree of discrepancy between current and preferred neighbourhoods, for residents of the Greater Toronto and Greater Vancouver areas

Site-specific projects

Inventorying, mapping and evaluating community-based interventions to promote greener, more walkable neighbourhoods in Montreal

Developing a framework for health background studies in Peel and Toronto

Developing processes for applying a Healthy Development Index to proposed and existing developments in Peel

Exploring relationships between socio-economic status, health outcomes, and the urban built environment in Toronto

Working with local governmentsto integrate a health lens into planning policy and practice inSurrey, Vancouver and Victoria

Peel Healthy Development Index

Purpose:To evaluate development applications in a consistent manner and provide health-based rationale to inform planning decisions

Process:1. Review of academic and grey literature2. Strength of evidence analysis3. Extensive stakeholder consultation4. Policy gap analysis5. Geographic Information Systems (GIS)-based validation analyses

The Region of Peel

Peel Healthy Development Index

Output:Index consisting of seven built environment elements:

– Density– Proximity to services and transit– Land use mix– Street connectivity– Road network and sidewalk characteristics– Parking– Aesthetics and human scale

Elements are further broken down into measures, many of which are quantitative

The Region of Peel

Peel Healthy Development Index – Examples

The elements and measures were pulled from relationshipsdocumented in the literature, after strength of evidence analysis

The Region of Peel

Peel Healthy Development Index Refinement

• Pilot Test the targets and ranges in the Healthy Development Index– 3 “new-urbanism-type” secondary plan sites– 2 “traditional suburb” sites in Peel.

• Refine/calibrate the Index to reflect each municipal context

• Develop an implementation plan unique to each municipal context to integrate the targets and ranges in the Healthy Development Index into existing development approval process.

Now, Pilot Testing and Refinement

The Region of Peel

Health Background Study FrameworkDeveloping the content and criteria for a health background study to

be implemented at the municipal and/or regional levels:

Purpose: •To develop a framework for municipally- mandated Health Background Studies

• To design the framework to be applicable across a range of different contexts and allow developers to identify and pre-emptively mitigate any potential health hazards associated with their development proposals.

•Joint project between Region of Peel and City of Toronto

The Region of Peel

Health Background Study FrameworkRationale Description of the Core Element and why it is important from a community health perspective.

ObjectiveStatement of desired development objective.

StandardsMinimum development standards to be achieved by the proposed development.

Key QuestionsList of key questions that should be considered in the planning and preparation of the development.

Reporting/Content RequirementsDescription of the minimum reporting.

The Region of Peel

Creating supportive policies at each level of the planning policy hierarchy

Regional

Official P

lan

Loca

l Officia

l Plan

Seco

ndary Plan

Block Plan

Plan of S

ubdivisio

n

Site P

lan

Planning A

ctPro

vincia

l Polic

y Stat

ement

Provin

cial P

lans (

e.g. P

2G)

Zoning bylaw

Regional

Official P

lan

Loca

l Officia

l Plan

Seco

ndary Plan

Block Plan

Plan of S

ubdivisio

n

Site P

lan

Planning A

ctPro

vincia

l Polic

y Stat

ement

Provin

cial P

lans (

e.g. P

2G)

Zoning bylaw

Regional

Official P

lan

Loca

l Officia

l Plan

Seco

ndary Plan

Block Plan

Plan of S

ubdivisio

n

Site P

lan

Planning A

ctPro

vincia

l Polic

y Stat

ement

Provin

cial P

lans (

e.g. P

2G)

Zoning bylaw

Regional

Official P

lan

Loca

l Officia

l Plan

Seco

ndary Plan

Block Plan

Plan of S

ubdivisio

n

Site P

lan

Planning A

ctPro

vincia

l Polic

y Stat

ement

Provin

cial P

lans (

e.g. P

2G)

Zoning bylaw

M A C R O M I C R O

Health Promoting Policy

Official Plan PolicyDocument Policy # Intent

Peel Regional Official Plan Amendment 24

7.9.2.9 The Region will prepare an assessment tool to evaluate the public health impacts of development, jointly with the area municipalities

7.9.2.10 The Region will work jointly with the area municipalities to raise public awareness of the health impacts related to planning through public and private partnerships

Peel Regional Official Plan Amendment 25

7.3.6.2.2 The Region may require health impact studies as part of a complete development application to amend the Regional Official Plan

7.9.2.3 The Region may develop public health indicators to analyze the effectiveness of Official Plan policies and serve as a basis for policy adjustments

Caledon Official Plan Amendment 226

4.1.10.3.2 The Town will participate jointly with the Region of Peel and area municipalities in the preparation of an assessment tool for evaluating the public health impacts of development proposals

4.1.10.3.3 The Town will work jointly with the Region of Peel and area municipalities to raise awareness of public health issues related to planning

Mississauga draft Official Plan

19.3.5 The City may require health impact studies as part of a complete development application

19.3.7 The City requires all development applications to have regard for public health

1. Regional Council• Supportive at every step (but there have been no challenges)

2. Local Planning Staff• Timid support• Seeking other jurisdictions doing similar work (fear of pioneering)• Seeking Recognized Authorities to evaluate Health Assessments

3. Planning Consultants• Open-minded• Eager to contribute to new concepts• Raised many questions and concerns on how assessment index

might work (demonstrating index)• Proposed no opposition

Reactions so far…

Reactions so far…4. Developers

• Progressive developers showed interest (do not wish stigma that their products are unhealthy)

• Indicate compliance w/ rules as long as they apply equally to all• Transition considerations during initial start-up• Noted that many of the ‘design attributes’ were outside of their

ability to control

5. Engineers• Resistant to modification of any engineering standard• Safety considerations outweigh unproven health considerations

Provincial Advocacy

PROVINCIAL BODY TOPICS FOR ADVOCACYMinistry of Municipal Affairs and Housing • Review Municipal Act

• Require stronger adoption of urban design guidelines by municipalities

Ministry of Energy and Infrastructure • Participate in the review of the Growth Plan as it is implemented

Ministry of Transportation • Create a provincial Active Transportation Strategy

Ministry of Environment • Work with Ministry of Transportation on Active Transportation Strategy and Climate Change

Ministry of Education • Regulate site design for schools to improve access by pedestrians and cyclists

A range of provincial sectors involved

• Public, politicians• Planners• Public health• Transportation engineers• Architects• Parks and recreation• School boards• Retailers• Landscape Architects

• Conservation• Utilities• Developers• Industry• Finance• Homebuyers• Commuters• Public

Multiple Stakeholders

Changes to technical norms at PeelAn example

Recently, transportation engineers approved a decrease in road and median width on all Regional roads. In addition, they approved the placement of off-road bicycle lanes to improve active transportation opportunities in Peel.

Peel’s Transportation Trends At A Glance

• Average time spent commuting will increase from 82 minutes to 109 minutes

• Travel time by car from Hamilton to Downtown Toronto will take approximately 3 hours

• Annual cost of congestion to the GTHA economy will increase from $2.7 billion to $7.2 billion

If Current Trends Continue………

The Region of Peel

THE DIABETES ATLAS FOR THE REGION OF PEEL: PREVIEW

The Number of Walkable Destinations and Diabetes

Challenges

• Complexity• Long term vs. short term• Concentrated and diffuse interests• Large amounts at stake

Working Together

• Parallel interests, common goals• Lending credibility• Funding• Recognition• Support in approaching decision-makers• Persistence