1. Peel Health Initiatives Health and Urban Form Region of Peel Public Health alPHa Conference June 9, 2008 Gayle Bursey Director, Chronic Disease and Injury Prevention

2. Declaration No part of the information and materials I am presenting today has been funded by any or the conference sponsors and I do not have an employment or funding relationship with any of the conference sponsors.

3. Outline Built Environment Background Initiatives Assessment Tool Food Environment Influencing Factors Obesity Prevention Strategy

4. Region of Peel: Caledon, Brampton and Mississauga Rapid Growth – 1.5 million by 2031 Highest settlement in Brampton, Mississauga. Unique Challenges: development of intensification in Mississauga; greenfield in Brampton; rural community in Caledon (Peel Planning/05) Rapid growth is fueling more vehicle trips (Peel Planning/05) Single occupant vehicle trips increasing Physical Activity levels are decreasing Obesity and related chronic diseases like diabetes, cardiovascular disease are increasing (Health Status Report/05)

5. Health and Urban Form: Background Council discussion 2002 narrow focus – individual control Council Report - “State of the Region’s Health: Focus on Overweight, Obesity and Related Health Consequences in Adults” (2005) Recommendations –Marketing –School food activity environment –Policy-active/public transportation –Policy-built environment

6. Health and Urban Form: Background Council Resolution: advocate for provincial legislation to limit advertising of unhealthy foods during children's TV programming Private Members Bill to limit children’s food ads in Ontario work with school boards to implement programs and policies that support children to eat healthy and be active Education Act Amendment: Bill 8 (Healthy Food for Healthy Schools Act)

7. Health and Urban Form: Background Council Resolution: study and make recommendations for planning policies and processes that provide greater opportunities for active living advocate for policies which strengthen public and active transportation option Active Transportation Initiative (Phase 1 = Social Marketing Campaign; Phase 2 = Plan) Health staff to comment on any development applications that come to the Region for comment Urban Form Health Assessment Tool

8. Complex Set of Factors Affect Urban Form URBAN FORM INFRASTRUCTURE Roads Transit Water Sewer ENVIRONMENT Protection Enhancement Clean Air PEOPLE Health Customs Values Behaviour Law FORM Land Use Design Buildings Public Spaces ECONOMY Taxation Incentives Development - Eco Revenue Generation

9. What have we done, what is yet to come? 1.Conceptual Model Development - PHAC 2.Literature Review – systematic, realist view 3.Feedback on Municipal Block Plans 4.Mississauga Urban Form Committee 5.Peel Health Position Statement in Official Plan 6.Active Transportation Committee 7.Good Governance Project 8.Urban Form Health Assessment Tool

10. Urban Form Health Assessment Tool: WHAT PURPOSE Develop an evidence-based prototype Health Assessment Tool that would systematically identify the public health impact of built environments in Peel Goals: 1.Promote the development of healthier built environments in Peel 2.Using the tool’s statistical relationships, develop health and urban form policy

11. Urban Form Health Assessment Tool: WHY 1. Seattle Study: Lawrence Frank: A 5% increase in Walkability is associated with: 1)A 32% increase in minutes walking and biking 2)A ¼ pt reduction in BMI (about ½ kilogram) 3)A 6.5% reduction in per capita vehicle kilometers travelled 4)A 5.5% reduction in ozone precursors 2. Atlanta Study: Lawrence Frank: 1)Additional 30 minutes driving/day  3% increase obesity likelihood 2)Additional KM walked  4.8% reduction in obesity likelihood 3)AJPM/08 study No behaviour difference in more walkable community Crime reduced walking in walkable community RESULTS

12. Urban Form Health Assessment Tool: HOW WALKABILITY SURFACE LAND USE VARIABLES TRAVEL PATTERNS HEALTH OUTCOMES People Buildings Streets Reality

13. Urban Form Health Assessment Tool: HOW DATA PLANNING VARIABLES: Parks and Trails Transit routes/schedules/stops Greenspace Sidewalk Attribution Census information (demographic, income, HH size) Postal code polygons Building Square Footage Property Assessment Parcels Street Networks (signalized intersections) Traffic Zone Data HUMAN DATA: Physical Activity Sedentary Activity Leisure Activity Obesity Chronic Conditions Stress Mode of travel to work Public Transit Use

14. Urban Form Health Assessment Tool: HOW Tool Requirements: 1.Ability to evaluate land development alternatives 2.Ability to evaluate at a relatively small scale (neighbourhood) 3. Flexibility to incorporate outcomes and land use measures based on reasearch 4.Ability to incorporate health and air quality outcomes

15. Urban Form Health Assessment Tool: THE MODEL Potential model PLACE3S 1.Web-based 2.GIS-based – Visual Output 3.Flexible 4.Public engagement and collaborative decision making 5.Meets our model requirements for Tool 6.Used in other government settings (California, Seattle)

16. Obesity prevention strategy reframe obesity epidemic to comprehensive health promotion interventions: –Built environment policy –Food environment policy then –Behaviour change interventions, i.e. skill building (Popkin 2005) Obesity Prevention Strategy

17. European Model FOOD ENVIRONMENT small portions culture and food slow food movement buy fresh, buy local the norm BUILT ENVIRONMENT proximity pleasant streetscape active/public transportation transportation hubs and smart card

18. Food Environment and Built Environment in Europe

19. Food Environment – Influencing Factors (Causal Web of influence on the prevalence of obesity – Harris, University of North Carolina) Macro physical, cultural, economic and social environment Dietary intakes Energy expenditures Obesity Household/individual/social/ demographic/economic Psychological/behavioural Clinical Biological (genetic, neurochemical, etc) Childhood Emerging adulthood Young adulthood Older adulthood Adolescence

20. Food Environment - Influencing Factors: The Case for Healthy Public Policy Biological Factors Biological drive to eat to survive Evolutionary perspective, obesity rates predictable Increase access to calorically-dense food Decreased activity (clerical 300 less calories) Eating patterns reflect caloric needs of ancestors Other Factors Psychological factors, satiety Sociological, cultural, familial factors (Bursey, Health Status Report/08)

21. A Case for Healthy Public Policy Beyond Individual control because of Changes in Food Supply and Globalization of Food Industry Widespread availability of cheap food Increase portion sizes, caloric density Increase in food marketing Lack of regulation of food marketing or content of food supply in relation to prevention of chronic disease Lack of policy, i.e. government, workplace standards for small portions, flavourful, nutritious food on site

22. OBESITY PREVENTION STRATEGY POLICY Built Environment Food Environment Behaviour Goals –Not  weight loss, current population   Activity, to  Chronic Disease Risk (Cuban Study)   European Food Experience

23. Towards walkable communities…. step-by-step peelregion.ca/health/urban/

24. For More Information…. www.peelregion.ca/health/urban/