Does HRM* Provide a Does HRM* Provide a Healthy Environment for Healthy Environment for

its Citizens?its Citizens?

Michael GoodyearMichael Goodyear

Department of Medicine,Department of Medicine,Queen Elizabeth II Health Sciences Centre, Queen Elizabeth II Health Sciences Centre,

Dalhousie University, Halifax,Dalhousie University, Halifax,Nova Scotia, CanadaNova Scotia, Canada

Ecology Action Centre May 19 2010Ecology Action Centre May 19 2010Conversations IIIConversations III

*Halifax Regional Municipality

It All Depends…It All Depends…

1.1. What do we mean by What do we mean by HealthHealth??

2.2. What do we mean by What do we mean by EnvironmentEnvironment??

3.3. How does Environment impact How does Environment impact Health?Health?

4.4. Can you measure health? Can you measure health?

5.5. How healthy should we be?How healthy should we be?

6.6. Whose responsibility is it anyway? Whose responsibility is it anyway?

1. Health1. Health

A Multidimensional ConstructA Multidimensional Construct

““State of complete State of complete physical, mental physical, mental and socialand social well-being and well-being and

not not merely the absence of disease or merely the absence of disease or infirmity.”infirmity.”

World Health OrganizationWorld Health Organization

Preamble to Constitution of WHO 1946Preamble to Constitution of WHO 1946

HealthHealth““An individual or group must be able to An individual or group must be able to identify and to identify and to

realize aspirations, to satisfy needs and to realize aspirations, to satisfy needs and to change or cope with the environment.change or cope with the environment.

Health is a positive concept emphasizing social and Health is a positive concept emphasizing social and personal resources, as well as physical capacities. personal resources, as well as physical capacities.

Therefore, health promotion is Therefore, health promotion is not just thenot just the responsibility ofresponsibility of

the health sectorthe health sector, , but goes beyond healthy lifestyles to well being.”but goes beyond healthy lifestyles to well being.”

WHO: Ottawa Charter for Health Promotion 1986WHO: Ottawa Charter for Health Promotion 1986

Healthy CommunitiesHealthy Communities• Social, environmental and economic factors are Social, environmental and economic factors are

important important determinantsdeterminants of human health and of human health and are inter-related.are inter-related.

• People People cannot achieve their fullest potentialcannot achieve their fullest potential unless they are able to unless they are able to take controltake control of those of those things which determine their well-beingthings which determine their well-being..

• All sectors of the community are inter-related and All sectors of the community are inter-related and share their knowledge, expertise and share their knowledge, expertise and perspectives, perspectives, working togetherworking together to create a to create a healthy communityhealthy community

Ottawa Charter 1986Ottawa Charter 1986

HealthHealth

From: Health Care to HealthFrom: Health Care to Health

From: Measuring Illness and DiseaseFrom: Measuring Illness and Disease

to –to –

Determinants of HealthDeterminants of Health

Asclepius to Hygiea

Sir Michael MarmotSir Michael MarmotChair, WHO Commission on Social Determinants of Chair, WHO Commission on Social Determinants of HealthHealth

““What good does it do to treat What good does it do to treat people’speople’s

illnesses, and then send them back toillnesses, and then send them back to

The conditions that made them sick?”The conditions that made them sick?”

Determinants of HealthDeterminants of Health

• PeacePeace• ShelterShelter• EducationEducation• FoodFood• IncomeIncome• Stable Eco-systemStable Eco-system• Sustainable ResourcesSustainable Resources• Social Justice, and EquitySocial Justice, and EquityOttawa CharterOttawa Charter

Canadian Institute Canadian Institute for for Advanced Research Advanced Research

Attributing HealthAttributing Health

25%25% Health Care System Health Care System

15%15% Biology and Genetics Biology and Genetics

10%10% Physical Environment Physical Environment

50%50% Social and Economic Environments Social and Economic Environments

2. Dimensions of Health2. Dimensions of HealthRole of environmentRole of environment

• Individual characteristicsIndividual characteristics

• Social and Economic EnvironmentSocial and Economic Environment– Living environmentLiving environment– Social networkSocial network– Society norms, values and ideologiesSociety norms, values and ideologies

• Local Physical EnvironmentLocal Physical Environment

3. Health and Physical 3. Health and Physical EnvironmentEnvironment

NaturalNatural– AirAir– WaterWater– Food (availability, price, quality)Food (availability, price, quality)– ClimateClimate

Urban Form Urban Form – Built EnvironmentBuilt Environment– Open SpacesOpen Spaces

Health Promotion Int. 1993

Healthy Cities and Healthy Cities and VillagesVillages

WHO 1986

Healthy CommunitiesHealthy Communities

?

ChallengesChallenges

• Teasing out effects of separate Teasing out effects of separate factorsfactors– Local, larger territory*Local, larger territory*

• Determining extent of contributionDetermining extent of contribution

• Determining mechanismsDetermining mechanisms

• Evaluating outcomesEvaluating outcomes

* Very different associations in Scottish v Canadian cities. K Wilson Health Place 2010

Urban FormUrban Form

• Urban Design as tool to optimise Urban Urban Design as tool to optimise Urban FormForm

Urban Form and Urban Urban Form and Urban DesignDesign

• Built Environment and Open SpacesBuilt Environment and Open Spaces

• Previous Emphasis on Built Previous Emphasis on Built EnvironmentEnvironment

• Incorporates Healthy PlanningIncorporates Healthy Planning

Healthy Communities, Sustainable Communities

Land use planning decisions shape us in ways that we are only just beginning to appreciate …where we work, live, and play is vitally important to the quality of our lives. Our built environments are not addressing emerging public health issues well and are resulting in a less than optimum human environment. These issues are not minor and for the first time in many decades, our children's life expectancy may not exceed our own. We need to reconsider our built environment expectations to better address emerging public health issues.

4. Measuring the Health of 4. Measuring the Health of a Communitya Community

Developing IndicesDeveloping Indices• IncomeIncome• Social NetworksSocial Networks• EducationEducation• EmploymentEmployment• EnvironmentEnvironment• DiseaseDisease

etc.etc.

5. How Healthy is 5. How Healthy is Healthy?Healthy?

““Partnership with the Partnership with the communitycommunity implies that the community has a implies that the community has a voice in problem definition, data voice in problem definition, data collection and the interpretation of collection and the interpretation of results, and the application of the results, and the application of the results to address community results to address community concerns.”concerns.”Institute of Medicine. Promoting Health, 2004Institute of Medicine. Promoting Health, 2004

Genuine Progress Index Genuine Progress Index AtlanticAtlantic

Ron Colman, Nova Scotia 2001-2004 (King’s County, Glace Bay)Ron Colman, Nova Scotia 2001-2004 (King’s County, Glace Bay)

•Jobs and Income securityJobs and Income security•Safety from CrimeSafety from Crime•Air and Water Quality*Air and Water Quality*•Population Health & EducationPopulation Health & Education

•Balance between work and familyBalance between work and family•Community valuesCommunity values•Activities for youth*Activities for youth*•Aesthetic quality of urban space*Aesthetic quality of urban space*

*least agreement as to how to measure *least agreement as to how to measure

Problems with Measuring Problems with Measuring and Standardsand Standards

• Existing data insufficient to measure Existing data insufficient to measure or create standardsor create standards

• Unclear whether has to be Unclear whether has to be community specificcommunity specific

• Subjective (e.g. Not just Crime Subjective (e.g. Not just Crime Statistics, but Statistics, but feelingfeeling safe) safe)

6. Whose Responsibility?6. Whose Responsibility?

• Clearly not HRM – aloneClearly not HRM – alone– Yet has input at many levelsYet has input at many levels

• Requires multi-level coordinationRequires multi-level coordination

• Community input and participationCommunity input and participation

• Need for Health Impact Analysis in Need for Health Impact Analysis in policypolicy

Research

Practice Policy

After Dr Carolyn Bennett

Research

Practice Policy

KT*

*Knowledge Translation

Research

Practice Policy

KT

Political Will

Research

Practice Policy

KT

Political Will

AppliedResearch

Research

Practice Policy

ENGAGED CITIZENS

KT

Political Will

AppliedResearch

Healthy CommunitiesHealthy Communities

• Incorporate health into all public policyIncorporate health into all public policy

• Committment to creation and preservation Committment to creation and preservation of physical and social environments that of physical and social environments that support and promote better healthsupport and promote better health

• Intersectoral collaborationIntersectoral collaboration

• Community participation Community participation

• Action planAction plan

• EvaluationEvaluation

Healthy CityHealthy City

WHO 1988

mgoodyear@dal.ca