THE IMPORTANCE OF INTERSECTORAL COLLABORATIONS TO PROMOTE HEALTHY PUBLIC POLICY Ghazal Fazli, MPH, Phd(c) Centre for Research Inner City Health Li Ka Shing Knowledge Institute, St. Michael’s Hospital Toronto, Ontario ACT CANADA SUMMIT DECEMBER 2014

OBJECTIVES To share findings from consultations from a stakeholder engagement event including a variety of sectors and disciplines across Southern Ontario To discuss key findings on knowledge gaps, challenges and key steps to implementing policy changes related to the built environment that would promote physical activity and reduce obesity.

DIABETES EPIDEMIC Ontario is encountering an alarming burden of illness associated with diabetes Rising prevalence of type 2 diabetes will require population based interventions Lipscombe L and Hux J. Lancet 2007;369:750-6

Neighbourhood Environments and Resources for Healthy Living: A Focus on Diabetes in Toronto

Neighbourhood Environments and Resources for Healthy Living: A Focus on Diabetes in Toronto , , , , ,000

The built environment as a potential target for intervention

FEATURES OF WALKABLE NEIGHBOURHOODS More compact/dense Grid-like street pattern (shorter blocks) Mixed land use Destinations within walking distance Sidewalks More walkable neighbourhoods more walking

Suburban design discourages walking and increases reliance on cars Large lot sizes (more sprawl) Less connected streets (longer blocks) Purely residential zoning Few walkable destinations Often no sidewalks Less walkable neighbourhoods less walking, less physical activity and more obesity

MORE TIME SPENT IN CARS HIGHER RATES OF OBESITY Frank LD et al Am J Prev Med 2004

TORONTO RESIDENTS LIVING IN MOST WALKABLE AREAS WERE APPROXIMATELY:  three times more likely to walk to work  twice as likely to take public transit  one-half as likely to drive to work  one-quarter less likely to be obese As those living in the least walkable areas Glazier et al., PLoS One 2014

4-YEAR CIHR PROPOSED RESEARCH PLAN Dr. Gillian Booth of St. Michael’s Hospital holds a 4 year CIHR Grant on the built environment and its impact on health outcomes – obesity and diabetes Multiple studies designed to: Examine 10-year trends in the incidence of diabetes in urban settings that differ on the basis of walkability, access to healthy resources, and exposure to unhealthy vs. healthy foods (Time series methodology - area level study) Evaluate the impact of area walkability, access to resources, and exposure to unhealthy vs. healthy food on the development of diabetes (propensity-matched retrospective cohort study – individual level study) Model a series of predictive algorithms using hierarchical modeling techniques to model the impact of built environment interventions - changes in neighbourhood walkability, access to healthy resources and retail food environment) on diabetes incidence (using linked CCHS data) Critical components of this research program include integrated knowledge translation events and opportunities to engage important stakeholders, knowledge users and policymakers to identify policy solutions and recommendations

RESEARCH PLAN - STUDY AREA

How do we get multiple sectors and agencies involved in translating evidence into planning and practice ? URBAN PLANNING City of Toronto planning department Parks and recreation Transit Private and public urban planning groups Canadian Urban Institute LEED-ND PUBLIC HEALTH Public Health Agency of Canada Ministry of Health Promotion Toronto Public Health Public health units Community health centers FOOD SECTOR Food policy experts City of Toronto, Food programs and strategies Nutritionists

KNOWLEDGE USERS AS DISSEMINATORS

INTEGRATED KT EVENT : A COLLABORATIVE INITIATIVE In collaboration with Public Health Ontario (PHO) a knowledge user and stakeholder engagement event was organized on October 4 th 2013 in Toronto Stakeholders were invited from planning, transportation and public health sectors, plus government, NGOs representatives from across Southern Ontario

The objectives of this meeting were: 1. Disseminate research findings to key stakeholders 2. Engage key stakeholders to explore potential applications 3.Provide a forum for sharing success stories and barriers to achieving changes in the built environment 4.Establish partnerships with researchers, planning and public health INTEGRATED KT EVENT: OBJECTIVES

Participants = 55 Public health = 20 CRICH and PHO Staff and team = 13 Transport ation = 10 Planning = 12 INTEGRATED KT EVENT: PARTICIPANTS ATTENDED

Regions/Municipalities Toronto Ottawa London Peel Hamilton Halton Durham York Non-governmental organizations Canadian Diabetes Association Canadian Partnership Against Cancer Ontario Professional Planners Institute Ontario Public Health Association Heart & Stroke Foundation Canadian Institute for Health Research Government Public Health Agency of Canada Ministry of Health and Long-Term Care Ministry of Infrastructure Ministry of Municipal Affairs and Housing Public Health Ontario INTEGRATED KT EVENT: INVOLVING MULTIPLE SECTORS

THEMATIC ANALYSIS A preliminary qualitative thematic analysis was conducted to identify: emerging themes related to gaps in knowledge and barriers that impede evidence-based decision-making and policy development related to the built environment Relevant themes and sub-themes were identified and validated through post-meeting consultations using online surveys. Survey response rate was 73% (stakeholders further validated the themes, knowledge gaps and actions identified)

Cross-cutting Themes Partnership and Collaboration System Integration THEMATIC ANALYSIS RESULTS: THEMES AND KNOWLEDGE GAPS Emerging Themes from Research on the Built Environment Targeted and Impactful Messaging Common Measures and Tools Policy informed and actionable research Intersectoral collaboratio n within/betw een Levels of Government Importance of Public and Private Sector Advocacy Solution- focused implementati on

Economic arguments/tools Awareness of Political Environment Public awareness Changing Perceptions Communicating across sectors/agencies Intersectoral Partnerships Identifying champions THEMATIC ANALYSES RESULTS: BARRIERS/ENABLERS AND ACTIONS

RESEARCH AND INFORMATION GAPS Research and Information Gaps with respect to evidence that can help promote actions and policy on the built environment

NEXT STEPS TO SUPPORT POLICY AND PLANNING Summary of recommended Next steps to support policy and planning related to the built environment

Interventions targeting the built environment that encourage physical activity may have tangible health benefits for the population if multiple sectors are engaged from earlier on Challenges in translating research findings into policy and planning initiatives aimed at promoting physical activity and curbing the rise in obesity will require addressing the barriers, enablers and gaps SUMMARY

QUESTIONS

PEEL REGION HEALTHY DEVELOPMENT EVALUATION TOOL AIM: Tool to rate development submissions To encourage future development to proceed in a form more conducive to healthy living with a focus on physical activity

INVOLVING MULTIPLE STAKEHOLDERS Peel Diabetes Atlas Healthy development tool New partnership, shared interest in obesity-prevention Toronto Diabetes Atlas Toronto Community Health Profiles Consulting re: Ontario Diabetes Strategy Mapping of services MOHLTC Toronto Public Health Peel Region Public Health Ontario

INTEGRATED KNOWLEDGE TRANSLATION APPROACH Policy and Planning Research