These past few weeks, I have been working with and reading about the interaction between urban design/planning and population health. It’s an interesting field and a really interesting (albeit complex) concept. It seems fairly straightforward to begin with – where you live impacts on your health in both direct and indirect ways. Someone who lives in Bangladesh is going to have vastly different life experiences and influences than someone who lives in Chicago or Toronto. The political, economic and social circumstances at national, international and local levels all have an impact on why such a disparity exists.
But what about differences within cities? Or within countries? Consider Vancouver’s Downtown East Side in comparison to North Vancouver or Kitsilano… Or Edmonton to Saint John, New Brunswick. Are these cities and neighbourhoods markedly different in how they affect the health of the people who live there? What’s more, are these differences actually significant?
The answer seems to increasingly be yes. People and places exist in mutually reinforcing relationships – that is, you help to shape the places where you live and places influence you and your behaviour. It’s something of a classic divide between structure and agency, we are able to make independent choices as agents only to the extent that we are not opposed by structural influences and the options available to us.
Consider this tension from the perspective of a healthy lifestyle – this requires you to select and consume foods that are healthy and nutritious, get regular exercise, reduce stress, sleep properly, and so on. The health promotion folks use these strategies and messages all the time, but such an approach presumes that these choices are actually available to you to choose from. There is increasing evidence that in many neighbourhoods, healthy foods aren’t readily accessible, even in countries like Canada, USA and the UK. These are called “food deserts” and refer to populated areas (neighbourhoods, for example) that are typically urban, low-income areas that have limited access to full-service supermarkets (ie: fresh fruits and vegetables). Check out an article on food deserts in Edmonton here.
Similarly, getting exercise can involve something as simple as choosing to walk somewhere instead of driving. Seems simple, right? Increasingly, urban spaces are being designed to be less amenable to walking and, thus, more in favour of driving. This is referred to as neighbourhood walkability, and is influenced by things like the availability of sidewalks, connectivity of roads, traffic safety, protection from the elements (rain, wind, etc.) and so on. Whereas previously, neighbourhoods were designed with a mostly grid pattern (North-South and East-West roads), new neighbourhoods often lack this pattern and use something more in favour of a random assortment of streets, cul-de-sacs and crescents. The effect is that this makes it notoriously difficult to walk anywhere because to travel a distance that is quite short in the absolute sense, it is relatively far because of the circuitous route a person must take. Furthermore, most new neighbourhoods are built lacking a critical feature: sidewalks. These two factors ultimately impact on how we, as pedestrians, use the streets. The obvious impact is that we walk less and drive more… The implications of which are, again, both direct and indirect. The direct effect is that we get less physical exercise and produce more emissions. The indirect effects are the ways in which we interact with each other, our neighbours and our environment. The less involved we are in using public spaces, the less appealing they become. Again, this mutually reinforcing relationship between people and places comes back.
The Canadian Mortgage and Housing Corporation (CMHC) has an interesting alternative to the grid and the loop/curl designs of neighbourhoods, that combines the good in both of them. It’s interesting and is available here. Radiolab (a fantastic podcast) had a really interesting show about cities last week, as well. One of the segments talked about something that relates very closely to this – walking, and more specifically, walking speed. Apparently, each city studied has a different pace at which they walk and this can ultimately serve as a predictor or all kinds of different social phenomena… In essence, walking sets the pace of the city – from innovation to creativity. Check it out here.
In essence, the relationship between the health of populations and individuals is invariably tied to the places in which we live. This is affected by all sorts of things from the density of fast food restaurants in a neighbourhood (and yes, lower-income neighbourhoods have a higher density) to the availability of health services. These observations have created not only (what I think is) a really cool area of study and research, but also some extremely important considerations for those of us working in population health and health services. We can’t ignore the built environment, and we certainly need to figure out how to work with it.