Presented at CONFERENCE NAME, CITY DATE Healthy Built Environment (HBE) Linkages: A Toolkit for Design  Planning  Health PRESENTER Title Organization Presented at CONFERENCE NAME, CITY DATE

Healthy Built Environment Alliance (HBEA; the Alliance) Members from: Land use planning Design fields Provincial ministries Health authorities Community-based health organizations Local government Universities/academia Knowledge sharing network Forum for collaboration on priority activities to promote & develop built environments that encourage & support healthy living

Healthy built environments: What do they look like? e.g., Which of these neighbourhoods is more ‘walkable’? (A) (B) So while many in the HBEAlliance are experts, it doesn’t take an expert to understand what makes for a healthy built environment We know healthy vs. unhealthy built environments when we see them One example: Healthy neighbourhood design – enhancing neighbourhood walkability Photo 1 – poor urban landscape Photo 2 – active / happy / streetscape etc

…? ≠ Healthy built environments: How do we create them? How do you decide what to do? Examine the evidence..... Even if we intuitively know what healthy built environments look like, it’s often difficult to figure out how to get there. The amount of evidence is overwhelming, and individual studies often conflict with each other or are inconclusive or require larger samples to prove rigorous enough for wide application …?

Purpose Why did the Alliance develop another toolkit? How should we share health evidence that can support good planning and the HBE? What are our key messages about the HBE? (need for common language/consistent messaging) This dilemma about the unclear/overwhelming evidence is what led to the development of the Linkages toolkit.

HBE Linkages Toolkit: Approach Collected, analyzed & summarized the evidence Consultation with experts Advisory groups – planners and content experts Evidence review methodology Literature reviews of the physical features: Neighbourhood design Transportation Networks Natural environments Food systems Housing Grading system Systematic clustering of findings

HBE Linkages Toolkit: Findings Current evidence used to identify planning principles for each of the five physical features User guide created to encourage consideration of context All the content in the toolkit is organized around the planning principles The User Guide strongly encourages users to consider their context. Not all principles will make sense in all context and will certainly need to be addressed in different ways. The User Guide encourages people to consider things like: 1) location and population of community (e.g., demographics, vulnerable populations); 2) existing community health issues; 3) community preferences; 4) political priorities. *The toolkit is a starting point to ask the right questions in your local context* Note: The toolkit identifies what should be done to create HBE…it doesn’t get into the how. For answers re: “how” we direct people to other resources (see p. 8 & 9) like: CIP, PlanH, NCCEH, CLASP. These resources provide case studies and describe examples of successful HBE efforts.

HBE Linkages Toolkit: What does the evidence say? New research area New research area New research area New research area New research area Strong evidence Toolkit provides graphic representation of linkages between planning principles, impacts and health related outcomes So if we go back to our example of a healthy built environment/neighbourhood-- There is evidence to show a strong link between the “enhancing neighbourhood walkability” planning principle and increasing physical activity and a moderate link between enhancing neighbourhood walkability and increasing cycling and walking activity. For the “create mixed land use” planning principle”, the evidence shows a strong link between walkability of neighbourhoods and decreased in obesity and BMI and increases in social cohesion and mental health. We can conclude by looking at these linkages that there is evidence to support the conclusion that enhancing neighbourhood walkability will improve peoples’ physical, social and mental health. Describe the grading system and legend (i.e. dark line, medium line, thin line, dashed lines, grey boxes) Note: Evidence linking planning principles and health outcomes is often indirect Some links are supported more strongly by evidence than others Many areas require further research

HBE Linkages Toolkit: Components Planning principles for: Healthy Neighbourhood Design Healthy Transportation Networks Healthy Natural Environments Healthy Food Systems Healthy Housing We’ve already seen that there are best practices planning principles and vision statements for each of the five physical features Scope: Focused on large-scale, outdoor physical features of the built environment (policy, small-scale elements and indoor elements were out of scope) www.phsa.ca/populationhealth

HBE Linkages Toolkit: Scope of Evidence Review/Toolkit Systematic reviews English; North America, Europe and Australia No specified time frame Context: urban and rural Focused on large-scale, outdoor physical features & environments) No specified time frame but worked backwards from the most recent and did as extensive a search as time and resources would allow Although we recognized the following elements as important considerations, we did not include policy, social environments, small-scale elements or indoor features (i.e. we focused on large-scale, outdoor physical features & environments)

HBE Linkages Toolkit: Limitations See User Guide! Indirect nature of evidence linking principles to health outcomes Toolkit identifies what should be done to create HBEs – it doesn’t get into the how Significantly more research is available for some physical features (e.g., neighbourhood design) vs. others (e.g., food systems) See User Guide! Indirect nature of evidence linking principles to health outcomes – We sought out systematic reviews linking planning principles to health outcomes therefore certain bodies of research focusing on one segment of the relationship may have been missed (e.g., link between increasing cycling and decreased obesity). It identifies what should be done to create HBEs – it doesn’t get into the how (but does direct users on pages 8 & 9 to additional resources that provide that information) Significantly more research is available for some physical features (e.g., neighbourhood design) vs. others (e.g., food systems)

HBE Linkages Toolkit: Components Linkages Summary Briefly describes the links shown in the literature between: Planning principles Intermediate impacts Health-related outcomes X all 5 physical features www.phsa.ca/populationhealth

HBE Linkages Toolkit: Components Fact Sheet Describes the evidence behind each planning principle, and how these link to intermediate impacts & health-related outcomes X all 5 physical features www.phsa.ca/populationhealth

HBE Linkages Toolkit: Components Health Evidence Diagram Visually show the strength of evidence or expert opinion linking planning principles to impacts & health-related outcomes Shows areas where more research needed X all 5 physical features www.phsa.ca/populationhealth

HBE Linkages Toolkit: Summary It’s a “conversation-starter” Provides an organizing framework for presenting information and facilitating discussions between & within sectors Helps users apply health evidence Provides consistent & clear messages to inform the development of other documents & support decision-making around health & the built environment Identifies where more research needed Toolkit provides a roadmap for emerging and innovative evidence Potential Uses: The Toolkit could be used... By anyone to guide a presentation or breakout session at a workshop or conference By planners to: inform the development of funding proposals, briefing documents to obtain support for HBE work By health professionals to: engage and support partners that are important to the community but fall outside the direct role of health (e.g., new school programs) By local government representatives to: provide and organize background reports for reports on certain policy and program issues (e.g., new subsidized housing developments)

HBE Linkages Toolkit: Next Steps Sustainability plan Monitor the evidence base & periodically update the toolkit Develop a user guide to support evidence collection/capture Evaluation plan Track toolkit use Seek feedback from users for toolkit improvement & suggestions for other resources needed www.phsa.ca/populationhealth

Questions? Download the HBE Linkages Toolkit www.phsa.ca/populationhealth Contact us! pph@phsa.ca

Discussion Questions Will the HBE Linkages Toolkit be useful for your work? If yes, please share some examples of how it will be useful. Who will you share the HBE Linkages Toolkit with? How do you think HBE Linkages Toolkit could be improved? What additional HBE tools or resources would help support you in your work?