Healthy Communities and the Built Environment A collaborative project to build awareness of the impacts of the built environment on human health. Funded by the Public Health Agency of Canada

Partners Ontario Healthy Communities Coalition Ontario Inclusion Learning Network Ontario Public Health Association Ontario Professional Planners Institute Ontario Smart Growth Network Region of Waterloo Public Health Simcoe Muskoka District Health Unit Waterloo Region Healthy Communities Coalition

Background air pollution and related respiratory illnesses such as asthma; traffic injuries and fatalities; and lack of physical activity due to living in low- density towns and cities, and consequently, increased prevalence of obesity, diabetes and cardiovascular disease. This project is a response to growing concerns about the impact of land use planning and the built environment on human health, including:

Rationale To improve the health of Ontarians, there is a need to encourage: more compact development; mixed land uses; alternate modes of transportation; more walkable communities; and greater access to green space.

Identified Needs OHCC staff, members and clients identified a need for greater understanding within the general public of the links between health, land-use planning/design and the environment. Few examples of relevant and local research were readily available. There is little integration between the work of public health professionals, land-use planners, environment groups and community and business associations.

Project Goal To improve the health of Ontarians and reduce health care costs through health promotion and chronic disease prevention strategies linking health and the built environment.

Project Components 1.Environmental Scan 2.Literature Review 3.Indicators and Case Studies of Best Practices 4.Community Workshops 5.Regional Forums 6.Focus Groups 7.Publication 8.Conference Presentations 9.Evaluation 10.Support for multi-sector collaborations to develop Healthy Community plans, policies and projects

Environmental Scan Project Prepared by: R.A. Malatest & Associates Ltd. Prepared for: Simcoe Muskoka District Health Unit November 2007

Environmental Scan and Objectives Objectives: To gain an understanding of the scope and involvement of public health agencies, environmental groups and community agencies; and To gather resources, tools, examples, documents or reports that have been developed that can be shared with other disciplines and sectors to enhance the work being done across Ontario. Purpose: to gather information on strategies, programs and practices currently being used across Ontario to promote healthy communities.

Methodology Representatives of all Ontario Health Units (36) were invited to participate in key informant interviews. A sample of community / environmental organizations (83) was developed, in consultation with OHCC and the Ontario Smart Growth Network. Participation rate was higher from Health Unit representatives, with 28 Health Units (of 36) participating and 50 (of 83) community / environmental organizations participating.

Methodology Awareness and any communication strategies related to the issue of land use planning and the built environment; Current/future relevant research, including consultation and information gathering; Current/future policies, programs and initiatives; and Current/future partnerships and knowledge sharing. Information was collected through interviews about the activities and roles of respondent organizations, specifically:

Methodology Key Informant Interviews Conducted with representatives from Ontario Health units and community / environmental organizations Undertaken by telephone Interview guide was ed in advance Given the option of allowing one or two co- workers to be interviewed at the same time Interviews lasted between 45 minutes and two hours Conducted from July 17 to September 21, 2007

Health Units Key Informants Health program supervisors, coordinators or managers, Chief Executive Officers, health specialists and promoters and health policy planners. Employed in a variety of fields, including in the areas of obesity, environmental health, family health, disease prevention and substance abuse. The length of employment varied greatly from 2 to 35 years, at an average of 10 years. Equal number of rural, urban and rural / urban mixed communities represented

Community / Environmental Groups Key Informants Senior staff such as Executive Directors, Managers or Coordinators responsible for: Program / project start-up, management and delivery; Research activities; Office / staff management; Strategic planning; Public / media relations; Liaison to Board of Directors; and Fundraising. Most had an environmental mission in place or were focused on sustainable development strategies

Cautions and Limitations Findings of the study reflect the views and knowledge of those representatives interviewed and do not necessarily represent the views of their entire organizations. Key informants were not always aware of all activities (such as research) being conducted within their organization.

Summary of Findings: Awareness and Communication

Satisfaction with the attention given to land use issues by governments, local media and community groups varied Approximately half of the Health Unit informants were satisfied with the attention given to land use issues by the municipal government and by local community organizations Community / environmental organizations were less satisfied than Health units with the attention given to land use issues by the municipal government and provincial government *Only asked by Health Unit representatives

Reasons for dissatisfaction with the attention given by governments, local media and community groups: Health unit representatives noted there is a lack of understanding about the role of public health in land use issues. Community/environmental organizations noted a lack of knowledge about land use issues as well as a focus on short-term gains rather than on the sustainability of long-term goals.

Perceived level of awareness among respondents’ staff of the issue Most (92%) of community / environmental organizations’ staff are aware of the impact of land use issues on building healthy communities Approximately two thirds of Health Unit representatives (67%) are aware.

Agreement that impact is understood by Stakeholders

Summary of Findings: Communication Strategies and Research

Communication Strategies to promote action and increase attention to how land use and the built environment affect health 86% of Health Units utilize a related communication strategy. Examples include: Community-based workshops, active involvement in advisory committees & promotional activities 80% of community / environmental organizations utilize a communication strategy including: Workshops, newsletters, reports and / or information booklets and / or media campaigns.

Communication Strategies Communication strategies covered a wide series of topics, including promoting biking, shopping local, information on promoting clean air, strategies to promote physical activity, community gardens, pesticide education, climate change. The built environment/land use planning and the impact on health is often indirectly addressed through communication strategies.

Research, Consultations and/or Data Collection Completed The most common areas of research within Health Units are : accessible parks, paths and trails; alternate transportation; water quality; and air quality. The most frequently cited areas of research within community / environmental organizations are on issues relating to air quality; alternative transportation; and preservation of green space / agricultural land.

Adequate Research Completed More community / environmental representatives (52%) than Health Units (29%) agreed or strongly agreed that the amount of research their organizations had done was adequate. “There is a lot of work to be done. We have no information on good solid ways to operationalize solutions.” ~ Health Unit Informant

Research on Developing Healthy Communities – Future Plans About half (54%) of the Health Units plan to do future research on building healthy communities, while 38% of community / environmental organizations plan to do so. Future research planned includes literature reviews, impact assessments, cost/benefit and policy analyses

Research on Developing Healthy Communities – Barriers Health Unit and community / environmental organization informants identified a number of barriers to conducting research including: Lack of funding Lack of human resources, including sufficient staff and volunteers to do research Lack of capacity to do the research internally Lack of partnerships, community support

Summary of Findings: Policies, Programs, Initiatives and Partnerships

Current Policies, Programs and Initiatives * Only asked of Health Unit representatives

More Health Units led initiatives then community / environmental representatives / organizations About two-thirds of Health Units (67%) and community / environmental agencies (62%) plan to implement new relevant programs, strategies or initiatives in the near future Almost half (48%) of Health Unit representatives thought their Health Units’ involvement in developing policies, programs or initiatives was inadequate. Policies, Programs and Initiatives

Informants describe the success of policies, programs and initiatives being attributed to: Community support and awareness Public buy-in and media coverage Strong partnerships Commitment of membership Other policies, programs and initiatives are less successful as a result of inadequate or a lack of: Leadership Skilled resources Budget Follow-up programs Professional planning resources and government support

Partnerships

For More Information Please see the final report: Building Healthy Communities – Environmental Scan Project, which includes additional resources provided by respondents.