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photo of Queen St., TorontoIn this 90-minute online discussion, held on February 12, 2019, researchers, epidemiologists, data analysts, urban designers and health promoters discussed their work on developing and applying indicators of healthy built environments.   

Slides | Recording

Over 125 individuals registered for the discussion, from every region of Ontario as well as a few from Nova Scotia, Saskatchewan and British Columbia. Participants came primarily from the public health sector, but also from municipalities, environment and community organizations, federal government, transportation, and the private sector.

To guide the discussion three general questions were sent to the presenters and participants ahead of time:

  1. What indicators or screening tools are you working with?
  2. What indicators do you need that you haven’t been able to measure?
  3. What are some promising practices that you can share?

Participants were encouraged to use the chat box on the online platform to respond to these questions, ask other questions, provide information and share their experiences.

The discussion was moderated by Paul Young, Urban Designer, Public Space Workshop. He noted that the impetus for this discussion was a question posed in the Built Environment Listserv of the Ontario Public Health Association’s Built Environment Work Group, regarding health-related indicators of healthy built environments. It also built on a previous OHCC/HC Link Built Environment and Health webinar that was focused on how public health staff can engage in reviewing and commenting on planning policy. This webinar continued that discussion in greater detail by looking at measures of how a built environment is or isn’t supporting health. Much of the work in this area is still in progress, so it was by no means the last word on the topic.

The presentations were divided into three main themes, followed by a Q&A session.

Theme 1: Community-Based Indicators

Ghazal Fazli, Post-Doctoral Fellow, Public Health Ontario
ghazal.fazli@oahpp.ca

Justin Thielman, Lead Epidemiologist, Public Health Ontario
Justin.Thielman@oahpp.ca

Ghazal and Justin discussed two tools for measuring walkability. An Urban Walkability Index for Toronto, Canada has been validated at different geographic levels, showing that residents of areas that were more walkable not only reported higher levels of active transportation and physical activity, but also showed an inverse association with levels of overweight, obesity and diabetes, even after adjusting for known confounders such as age, sex, income and education.

The work of Nicholas Howell on the interactions of walkability and air quality were also reviewed, underscoring the need to recognize the interaction of walkability with other health indicators. For example, Howell found that smoking rates were higher in high walkability areas. Also, where there is higher traffic pollution there are few benefits of walkability, whereas lower traffic pollution has greater benefits of walkability. Justin related positive experiences in working with Walk Score, a validated metric that is available for cities across Canada. Nine amenity categories are measured, and the more amenities that are close to your location, the higher the walkability score. The closer they are, the higher their contribution is to the overall score. Numerous references were provided at the end of their presentation.

Theme 2: Geo-spatial / GIS Indicators

Ahalya Mahendra, Epidemiologist, Public Health Agency of Canada
ahalya.mahendra@canada.ca

Ahalya spoke about the built environment subgroup that is part of the Association of Public Health Epidemiologists in Ontario (APHEO) Work Group. Their goal is to create standardized definitions and calculation methods for over 120 public health indicators, so that community health status reporting across public health units in Ontario will be more accurate and standardized. They have selected and operationalized several indicators that measure aspects of the built environment that influence physical activity. Recently they have started to work on indicators related to the food environment. Their research indicated that they should focus on the community nutrition environment as it is well studied and suited to objective measures.

Tina McBrien, Public Health Nutritionist Region of Peel Public Health
tina.mcbrien@peelregion.ca

Tina is also a member of the APHEO indicators workgroup and is working on the Food Environment Built Environment Strategy for the Region of Peel. The ultimate goal of this work is to engage stakeholders to build relationships for collaborative problem solving. Ultimately, they want to develop a health in all policies approach that encourages healthier food environments in Peel. She shared some of her learning and challenges. For example, creating an interactive mapping tool that provides a snapshot of community level access and availability is an important first step to identify patterns that could be modifiable through policy and land-use planning. It is critical to access clean data to serve as a foundation for the indicator. They began with food inspection data, which provided a comprehensive list of food outlets. One approach was to rate each of the food outlets as either more healthy or less healthy, but they decided to take an approach similar to that of the National Food and Environment Assessment Tool (UK), which categorizes stores and outlets based on the types of food, beverages and services they offer.  For example, instead of looking at restaurants labelled less healthy, the work could look at the density of fast food restaurants in a geographical area. Tina noted that it will also be important to explore urban/suburban/rural geographic implications, and, to be fully informed, local knowledge, context and other sources of data.

Jackie Edwards, Data Analyst, Public Health Sudbury & Districts
edwardsj@phsd.ca

Jackie explained how their team worked with food outlet data at the level of dissemination blocks (the smallest geographic units for which the census provides socioeconomic and demographic data) to classify them as more or less healthy. She worked with the nutrition team to validate the ratings. The map can be updated as food premises open or close, or other information is gathered. They are also in the final stages of developing and testing an indicator that would evaluate the food environment around schools

Patrice Martineau, Statistics Canada
patrice.martineau2@canada.ca | 613 219-5899

Patrice gave a brief overview of the City Data Project. He is working with data providers to increase access to data and improve the quality of statistics available at the city level. He is working on disaggregating existing datasets at the city level and developing new indicators that are relevant for cities. He plans to establish an interactive, user friendly hub which would be a repository of city level data.

Dany Doiron, Data Linkage Specialist, Canadian Urban Environmental Health Research Consortium (CANUE)
dany.doiron@canue.ca | www.canue.ca

CANUE is funded by the Canadian Health Research Institute (CIHR). Its purpose is to characterize the place where people live by generating data on outdoor environmental exposure, urban form and social and economic data sets to better understand the environmental determinants of health. Their goal is to provide well-documented and reproduceable metrics and tools to link them to existing health databases. They are also developing procedures for providing the data free of charge to Canadian cohorts, health data administrators and environmental researcher. CANUE currently has teams working on exposure data in 6 broad domains: transportation, neighbourhood factors, greenness, air quality noise pollution, climate and weather. All are indexed to postal codes and provided in an analysis-ready .csv format. Dany reviewed some of the data sets that are currently available; e.g. Material and Social Deprivation Index, Canadian Active Living Environments Index Air Quality and Nighttime Light.

Theme 3: Public Health Practitioners’ Perspective

Jackie Gervais, Health Promote, Niagara Region Public Health
Jackie.gervais@niagararegion.ca

Jackie explained the role of Niagara Region Public Health in active transportation performance indicators. Data collection is a challenge within Niagara Region as there are 12 local municipalities within Niagara, each of which collect some data, but not in a consistent manner. In an effort to improve the quality and quantity of available data, they brought together representatives from public works, planning, organizational performance and accountability, and public health. Using a Results-Based Accountability (RBA) process, they explored how they could better share data and coordinate data collection. They initiated an active transportation indicator project and, with the help of a consultant, developed a system to measure and evaluate infrastructure investment in Niagara. Jackie provided a detailed list of potential data sources, discussed some of the challenges and successes of the project and offered recommendations to others embarking on a similar course.

Kendra Willard, Health Promoter, Halton Region Health Department; Co-Chair - OPHA Built Environment Work Group  
Kendra.Willard@halton.ca | 905-825-6000 x2988

Kendra Willard, supplied information about the Built Environment Work Group (BEWG) of the Ontario Public Health Association, Their goal is to work collaboratively to improve the health of the public as it is impacted by the natural and built environment.

In the final fifteen minutes of the session the presenters answered questions about the tools and methods that they are working on. Some resources were shared in the chat box; such as:

Wrapping up the discussion was a comment that the momentum towards creating more spaces that support physical activities is continuing to build. However, to push for greater investment in creating healthier places we need better studies to show the benefit to municipalities. We need to measure, evaluate and report changes to the built environment and health to guide public health, planning, transportation and other departments as they work together to create healthier places.