1. Context Collaboration among many partners Multiple level advisory committees Public Health involvement since the beginning Regional Growth Management Strategy (RGMS)

2. Action Plan for Housing Eastside Development Countryside Line Cultural Heritage Landscapes Rapid Transit and TDM Reurbanization Corridor Greenlands Plan Human Services Plan Health & the Built Environment Multiple Components

3. HEALTH ECONOMY COMMUNITYENVIRONMENT Built Environment These areas relate primarily to “hard” Infrastructure & services Human Services Planning These areas relate primarily to “soft” Infrastructure & services

4. ECONOMY COMMUNITYENVIRONMENT Built Environment “hard” Infrastructure & services Human Services Planning “soft” Infrastructure & services Healthy Food System Urban Agriculture Urban Form & Physical Activity Family Health Plan EMS Plan Clinical Services Plan Population Health Projections Rural Health Study Health of Immigrants in WR Health in Urban Neighbourhoods HEALTH

5. Public Health ↑ Chronic Disease ↑Demands & Access Issues ↑Disparities Rural Limited income Immigrants ↓Air Quality Impacts of Growth

6. Public Health Immigrants, Growth & Health

7. Immigrants Living on Low Income by Year of Immigration Waterloo Region, 2001

8. Public Health Urban Neighbourhoods & Health Outcomes

9. Public Health Health disparities exist and they are strongly and consistently associated with a specific subset of social-economic indicators. 10 socio-economic characteristics were associated with all adverse health outcomes. 9 of these were associated with low EDI scores

10. Urban Form, Physical Activity and Health Public Health

11. Neighbourhoods in the Study

12. Inner-city Walk more days/week More purposive walking Likely walk or cycle to work Drive 42 min/day Destinations matter – (especially food retail) Walk with someone Own more vehicles Likely drive to work Drive 74 min/day Suburban

13. Public Health Rural Health and Rural Access to Services

14. Protecting farm land from development = Farm Viability

15. Loss of Rural Culture & Stress Rural residents have a strong sense of connection to the land and history, and a sense of community Smaller farms are disappearing, and those left are finding it increasingly difficult to compete Farmers are facing a great deal of stress and financial concerns, resulting in many pursuing off-farm incomes "Young people end up leaving -- they see no future in farming

16. Public Health Towards a Healthy Community Food System

17. Reliable Access to Healthy Food Improved Dietary Habits Reduced Chronic Disease

18. 71% of urban population does not live within reasonable walking distance of a supermarket 46% does not live within walking distance of either a supermarket or a convenience store. How will increasing densities and re-urbanization affect food access?

19. even during the peak season, produce grown in Waterloo Region is not readily available to residents audits of supermarkets and convenience stores found number of food items grown or raised in Region to be low Missed opportunity Rural and Urban Problems are Linked

20. Public Health Air Quality and Growth Already much focus on “walkable” communities to improve air quality Focus further on purposive walking by encouraging neighbourhood retail Encourage food retail for additional impact.

21. Greater reliance on local food is another untapped mechanism to improve air quality Imports of 31 commonly-eaten foods travel an average of over 4,500 km to Waterloo Region, and generate an average of 1.8 kg of greenhouse gases for every kg of food imported Imports of studied foods generate over 50,000 tonnes of GHG emissions annually, equal to 16,000 cars on roads

22. Evolving Goals Slow escalation of chronic disease Increase healthy food options in re-urbanized areas Increase purposive walking in urban areas Improve air quality Reduce ozone precursors associated with food transport Increase purposive walking in urban areas Reduce health disparities Strengthen rural communities – improve farm viability Increase employment opportunities for new immigrants Support action to reduce poverty

23. Influence land use policy Join up advocacy efforts Walk the Talk Increase Citizen Action Surveillance & Monitoring

25. Public Health www.region.waterloo.on.ca/ph Resources Health Status & Research

27. Public Health