The Healthy City Approach The Role of Local Governments 11/13/2018

Evolution of Public Health The Health City movement 1970s Recognition that the shift from communicable to chronic disease needed new approach. Health for all and Alma Ata addressing social targets for health 11/13/2018

Canadian Philosophical Shift Lalonde Report .1974 Health Fields Environment Human Biology Lifestyle Health Services 11/13/2018

Public Health In 1980s Toronto’s Blueprint for change Addressed Chronic disease Reorganized The Health Department Attracted Public health Leaders Strong Political commitment Recognition that municipalities have strong role in addressing the health of the population Beyond health Care Conference Healthy Public policy Healthy City conceived 11/13/2018

Rethinking Policy Development and Health Key Assumptions The health of the population has less to do with health care spending than other factors Policy development in all sectors can have major health impacts See speech notes 11/13/2018

Ottawa Charter for Health Promotion 1986 Cornerstone for change. 11/13/2018

Health Promotion Process of enabling people Increase control Determinants of health Improved health In ther 1980s The First WHO Charter on HP was developed. This was the Ottawa Charter. Most development of HP has evolved from this thinking. Global input and conceptualisation. 11/13/2018

Ottawa Charter Conditions or Determinants for health Peace Shelter Education Access to food and clean water Income A stable ecosystem Sustainable resources Social justice Equity The Ottawa Charter clearly outline the conditions in ones life that were necessary to live healthy lives. These are sometimes called the Determinants of HEALTH. 11/13/2018

Approaches to Health Treatment Behavioural Socio-environmental Page 10 model 1. Socio-environmental 11/13/2018

Socio-environmental approach to health Health Status Physiological risk factors Behavioural risk conditions Psychosocial risk conditions Psychosocial risk factors 11/13/2018

Socio-environmental approach Risk Factors Isolation Lack social support/networks Self esteem Self blame Perceived power Risk Conditions Poverty Education/occupation Dangerous stressful work Discrimination Power Gaps in income Unaffordable housing Access to nutrition 11/13/2018

POLICY FRAMEWORK APPROACHES GOALS STRATEGIES Treatment Quality hospitals and people Build hospitals High Tech. Behavior Change behavior Knowledge and skills Education Lifestyle Socio Environmental Access to healthy conditions Healthy public policy. 3 slides. General; Diabetes or cvd and road traffic accidents. 11/13/2018

Policy Framework example Heart disease 11/13/2018

Road Traffic Accidents Approach Goals Strategies Treatment Increase paramedic response and treatment Development of Regional Trauma Unit Behavioural Increase use of seat belts Decrease driving speeds Decrease drunk driving Education campaigns in seat belt use/drunk driving Police spot checks Socio/ environmental All roads and cars have safety standards and construction Alternate modes of safe transportation ensured Gmt Policy and incentives for safe design,maintenance Comprehensive funded transportation policy and program. 11/13/2018

Healthy Cities Development WHO Euro. Leadership Formal project 1985 WHO partnered with local government Health for All at municipal level Intersectoral and multisectoral Health profiles and plans People involved in process Political commitment funding 11/13/2018

WHO. Parameters of Healthy City Safe high quality Clean environment Stable sustainable ecosystem Strong supportive non-exploitive community High degree of public participation Provision of basic needs. Access to wide variety of experiences,resources, interaction Diverse vital economy Connections to cultural and biological heritage City form compatible with and enhances parameters and behaviours Optimum level of appropriate health services High health status 11/13/2018

Strong Board of Health and Political Leadership 1989-Toronto Strong Board of Health and Political Leadership Strong leadership in Public Health Department Clearly laid out priorities Formally instituted Healthy Cities Office outside Health Department. 11/13/2018

Toronto Healthy City Approach New decision making process Work on issues that affect health and cross municipal departments Work in partnership with other levels of government and community and private sector Strategically placed within the organization 11/13/2018

Decision making frameworks / Equity/Community Environment Economy Original speeches. 11/13/2018

Changes in Decision Making Rigid Bureaucratic Hierarchical Chimney Pipe Top down Innovative Flexible Inter sectoral Decentralized decision making 11/13/2018

Settings Approach to Health Healthy cities Healthy communities Healthy schools Healthy workplaces Healthy islands Healthy marketplaces etc 11/13/2018

Big Smog 1989 Toronto suffered major smog problem Assigned to Health City Toronto-first task from city council Chaired Interdepartmental working committee on smog reduction 11/13/2018

Major progress Clean Air strategy Task Force on Automobile Air shares Building retrofit Toronto Atmospheric fund Task Force on Automobile Green Tourism Strategy 11/13/2018

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Healthy City Toronto Model Political commitment Part of city structure Funding Staffing Intersectoral steering committee Developed to address the key determinants Innovation valued Integrated Partnerships approach Also Focus on community/ neighbourhoods. 11/13/2018

Healthy City Strategies. Moving the Vision 11/13/2018

State of The City reporting Organizing facts for citizen and political use Economy Environment Community Health Education Housing Transportation Safety 11/13/2018

Partnerships Coalition and partnership development Citizens committees and Mayors task forces Community capacity building Strengthening community input 11/13/2018

Innovation 11/13/2018

Equity 11/13/2018

Healthy Public Policy Policy implemented or changed in any sector that would work towards improving the health of the population. 11/13/2018

Applying the model to the built environment. Issues Link between built environment and human and social behaviour Address Urban sprawl Low density development Heavy car use Poor building design Lack of green space High levels of noise Poor air quality 11/13/2018

New approach to community planning Create a balance between developing built environment and conserving natural ones. Require all official plans to include human service planning and integrated healthy community concepts Ideal community. Transportation. recreational space etc. Establish a role for Public Health Units in fostering Healthy Communities Coordinate planning across jurisdictions and develop mechanisms to integrate decision making at local level. 11/13/2018

Points for success Establish a formal Intersectoral approach Visionary and visible Leadership Cross sectoral, Partnership and cooperation Community participation Political commitment Strategies developed by people Adequate Resources mobilizes together People own the action and outcome Healthy public policy 11/13/2018

Eating an elephant. 11/13/2018