Healthy neighbourhoods

Healthy Neighbourhoods

Gavin McCormack, PhDAssociate ProfessorDepartment of Community Health Sciences Cumming School of Medicine, University of Calgary

January 19, 2017

Welcome

Associate Professor, Cumming School of Medicine

Associate Scientific Editor for the journal “Health Promotion and Chronic Disease Prevention in Canada”.

Co-chair of the 2017 Walk21 Calgary International Conference Steering and Scientific Program Committees.

In 2014, recognized as Avenue Magazines “Top 40 under 40”.

Graduate training in Sports Science (Exercise Physiology) and Public Health.

Canadian Institutes of Health (CIHR) New Investigator.

Reasons for choosing your current neighbourhood

Did you choose your current neighbourhood based on how well it could support your (or your family’s) physical activity behaviours?

Reasons for choosing your current neighbourhood

Do you consider your neighbourhood to be convenient for undertaking physical activity (…is it “walkable”)?

Purpose

To briefly describe how neighbourhoods influence population health and why this is an important strategy for promoting physical activity

Share our research in Calgary showing the relationships between the neighbourhoods people live in and their physical activity levels and body weight

https://www.flickr.com/photos/127568985@N04/20315160663/sizes/o/

Important definitions

Population Health - an approach to health that aims to improve the health of the entire population and to reduce health inequities among population groups (PHAC, 2013).

Physical Activity - any bodily movement produced by skeletal muscles that requires energy expenditure (WHO, 2014).

Recreational Walking – walking for the purpose of recreation, leisure, exercise, or fitness. Transportation Walking – walking for the purpose of travelling from destination to

destination. Perceived Built Environment – individual’s self-reports about their perceptions of the

environment. Objective Built Environment – “directly measured” characteristics of the actual

environment. Walkability – extent to which an environment (perceived or objective) is connected, safe,

pleasant, and suitable for walking.

Urban planning and health

Built environment changes during the 19th/early 20th century reduced infectious disease (e.g., cholera, yellow fever, tuberculosis).

• waste management; sanitization; zoning; housing/building conditions

Built environment changes also encouraged residential mobility from crowded inner cities to outer areas.

Expansion of the suburbs increased post WW2 and continue today (leading to urban sprawl)

• rise in motor vehicle popularity; over zealous zoning.

“The practice of ‘Euclidian zoning’ or the separation of uses formed, in part, a basis for what became an auto-dominated single-use landscape. This approach to land development and transportation investment evolved into a highly planned and regulated landscape and also into what we call sprawl.” (Frank and Savage, 2008 – J Public Health Management and Practice)

Urban planning and health

Urban planning and health, examples:

• Air quality: motor vehicle exhausts, excessive removal of trees and natural vegetation

• Water quality: contaminated run-off (motor vehicle oil, herbicides/pesticides, household contaminates, decreased ground water supply (lawns and gardens)

• Mental health: traffic congestion, loss of restorative spaces (nature reserves and gardens)

• Social capital: Fewer opportunities for social interaction (home garage, car, office garage, office, reverse then repeat!)

• Fatal and non-fatal Traffic-related injuries: pedestrian/cyclist-motor vehicle conflicts

• Diet: Drive-thru food services encouraging car use and purchase of unhealthy foods

• Sedentary behaviour: over reliance on motor vehicles,

• Physical activity: Fewer opportunities to be active

Health gains and physical activity

Warburton D. and Bredin S. (2016). Reflections on physical activity and health: What should we recommend. Canadian Journal of Cardiology, 35, 495-504

CVD*

Stok

e*

Hyper

tens..

.

Colon C

an...

Breas

t Can

...

Diabet

es*

Depre

ssion

**

Obesit

y***

0

0.25

0.5

0.75

1

1.25

1.5

1.75

2

Relative risks (RR) of disease among inactive versus active adults

ActiveInactive

RR

*Katzmarzyk (2000) The economic burden of physical inactivity in Canada. CMAJ; **Paffenberger (1994) Physical activity and personal characteristics associated with depression and suicide in American college men Acta Psychiatr. Scand (<1000Kcal versus 1000-2499Kcal PA/week); ***Popkin et al . Measuring the full economic costs of diet, physical activity and obesity-related chronic diseases. Obesity Reviews.

Physical activity and chronic disease risk

http://www.statcan.gc.ca/pub/82-625-x/2015001/article/14135-eng.htm

Physical activity levels among Canadians

% active and moderately active based on leisure-time physical activity (Canadians ≥12 years; 2011)

CAN NL PE NS NB QC ON MB SK AB BC YT NT NU0

10

20

30

40

50

60

70

5551 51

56 53 52 55 55 5556 60 62

51

33

Source: Statistics Canada. Health Indicator profile, age-standardized rates annual estimates, by sex, Canada, provinces and territories Statistics Canada, 2012.

%

Population-level or “upstream” approaches for improving health and wellbeing

Daniels S R et al. Circulation 2005;111:1999-2012

Engineering health back into daily life- creating opportunities for physical activity

• Creating health supportive/physical activity supportive built environments is a “population-level” intervention.

• Neighbourhoods will continue to be built to accommodate a growing population.

• The “intervention” is semi-permanent, therefore sustainable.

Environment as an enabler or barrier to physical activity

Source: Commissioned report for the French Ministry of Youth, Sports and Community Development (2008). Physical activity. Context and effects on health

Your neighbourhood’s walkability

From the list below what do you consider to be the most important feature that makes a neighbourhood walking-friendly?

• Availability of parks and recreational facilities• Availability of sidewalks and pathways• Attractive and appealing streets• Safety from crime and traffic• Mix of stores, services, and shops• Street patterns and types• Proximity to transit stops and stations

Neighbourhoods and physical activity – the evidence so far…

Land use mix and destinations Local recreational/utilitarian destinations

Connectivity Street/sidewalk patterns, layout, route options

Residential density Economic viability, surveillance, cues to be active

Appeal and aesthetics Trees, architecture, sights, monuments, open space

Pedestrian infrastructure Sidewalks, benches, signs, crossing aids

Safe places Personal safety, traffic safety, civil order

McCormack et al (2002). J Sci Med Exerc Sports; Humpel et al (2002) Am J Prev Med; Duncan et al. (2005) Int J Behav Nutri Phys Act

Source: Spielberg F. The traditional neighbourhood development: how will traffic engineers respond? ITE J. 1989;59:17

Which neighbourhood design best supports walking?

EcoEUFORIA Project

Study design Two random cross-sectional samples (1 person/household; age ≥18 yrs) Calgary, Alberta, Canada

Telephone-interviews • August-October, 2007 (n=2199; RR=33.6%).• January-April, 2008 (n=2223; RR=36.7%).

Neighbourhood-based physical activity (including walking, moderate, vigorous-intensity)• E.g., Walking undertaken within a 15-minute walk from home.• E.g.., Transportation and recreational walking in a “usual” week.

Reasons for moving to neighbourhood (self-selection) Years residing in the neighbourhood Attitude towards walking Socio-demographic characteristics

EcoEUFORIA Project

Prevalence of walking in a “usual week” by location

Walking purposeInside

neighbourhoodOutside

neighbourhood

For transportation, to get to a from places

60% 33%

For recreation, leisure, fitness

74% 36%

*Neighbourhood = everywhere within a 15-min walk of home; n=4422

Where do you walk?

Household postal code geocoded and a 1.6km walkshed based on street network estimated (i.e., the “neighbourhood”).

2008/2009 City of Calgary/GIS databases:

Variables (n=9): Walkshed area (km2) # businesses/km2

Sidewalk length meters/km2

# bus stops/km2

# different types of parks/km2 # different types of recreational facilities/km2

Population density % green space within neighbourhood Path/cycleway length meters/km2

Less walkable walkshed (1.6km from respondent home)

High walkable walkshed(1.6km from respondent home)

Calgary neighbourhood types based on their built characteristics

The most walkable neighbourhoods are located closer to the city core.

The least walkable neighbourhoods are located on the city periphery.

Map of Calgary neighbourhoods

Sandalack B, Alaniz Uribe F, Eshghzadeh A, Shiell A, McCormack G, Doyle-Baker P (2013). Neighbourhood type and walkshed size. Journal of Urbanism: International Research on Placement and Urban Sustainability.

Associations between walkability and ‘any’ neighbourhood-based walking in a usual week

Any WT in usual week Any WR in usual week0

0.5

1

1.5

Low walkableMedium walkableHigh walkable

* *

*p<.05; Propensity score analysis. Adjusted for neighbourhood self-selection, socio-demographics, walking, attitude, season, neighbourhood tenure, clustering; n=4034

OR

Minutes of WT in a usual week Minutes of WR in a usual week0

10

20

30

40


*

*

Associations between walkability and weekly minutes neighbourhood-based walking (walkers only)

*p<.05; Propensity score analysis. Adjusted for neighbourhood self-selection, socio-demographics, walking attitude, season, neighbourhood tenure, clustering; n (WR)=3022; n(WT)=2385

Min

Associations between walkability and sufficient (≥150min/wk) neighbourhood-based walking

(walkers only)

Suff. WT in usual week Suff. WR in usual week0

0.5

1

1.5


*

*p<.05; Propensity score analysis. Adjusted for neighbourhood self-selection, socio-demographics, walking attitude, season, neighbourhood tenure, clustering; n (WR)=3022; n(WT)=2385

OR

but each person subjectively observes and interprets it and

behaves accordingly.

There is a real or objective environment…

Capturing perceptions of neighbourhood walkability

Perceptions of neighbourhood walkability

• Residential density• Land use • Traffic safety • Pedestrian safety• Personal safety• Connectivity• Pedestrian infrastructure• Neighbourhood surroundings• Barriers to walking• Access to services

2http://www.ipenproject.org (International Physical Activity and Environment Network)

Perceptions of neighbourhood walkability

Any WT Sufficient WT Any WR Sufficient WR0

1

2

1 1 1 11.32*

1.54*

0.92 1.09

Low walkable neigh-bourhood

*p<.05; Adjusted for socio-demographics, attitude, neighbourhood self-selection; n=1867

Likelihood of walking in a usual week by “PERCEIVED” neighbourhood walkability

OR

Specific built characteristics in relation to different types of physical activity

Better understanding of the environmental correlates of specific behaviours is needed1,2

• Improving walkability on a grand-scale not always economically feasible or desirable (e.g., established neighbourhoods)

• Identify built characteristics that are the most amendable with the biggest impact on physical activity

• Better understanding of the winners and losers – will increasing built support for one behaviour (e.g., walking) reduce supportiveness for another behaviour (e.g., cycling).

1Humpel, N. et al. Environmental factors associated with adults’ participation in physical activity. Am. J. Prev. Med. 22:188–199, 2002.2 Giles-Corti et al. Understanding physical activity environmental correlates: increased specificity for ecological models. ESSR, 33(4), 175-181

Neighbourhood-based physical activity “participation” by built characteristics

Walking for transport

Walking for recreation

Moderate physical activity

Vigorous physical activity

Intersections +Business locations +Mix of recreation destinations +Sidewalks + + +Green space -Path and cycleways + +

p<.05 shown above only; Logistic regression adjusted for socio-demographics and reasons for residential selection

Neighbourhood-based physical activity minutes by built characteristics

Walking for

transport

Walking for

recreation

Moderate physical activity

Vigorous physical activity

Total physical activity

Business locations 19.1 25.6

Mix of recreation destinations -8.8

Sidewalks 18.1

Population density -9.3

City managed trees 6.4 7.3

*Change in minutes for 1 unit (standard deviation) change in built characteristicsp<.05 shown above only; linear regression adjusted for socio-demographics and reasons for residential selection

What do these findings mean?

Your neighbourhood can enable or restrict the amount of physical activity you undertake (even for highly motivated people)

• But some characteristics may be more important for some types of physical activity than others

Neighbourhoods that have many destinations, well connected pedestrian networks, sidewalks, access to transit stops, and pathways and cycleways could encourage higher levels of physical activity

• In general, suburban neighbourhoods appear to be less supportive of physical activity than non-suburban neighbourhoods

Study aim To investigate the pathways by which the neighbourhood built and socioeconomic

context influence weight status via physical activity and diet.

Study design Cross-sectional design (1 person/household) Data collection via internet survey, in April 2014 (Calgary, Alberta, Canada)

Sample design Stratified random sample (n=10,500 households invited from 12 neighbourhoods) Neighbourhoods stratified by street pattern (grid, warped-grid, curvilinear) and

socioeconomic status Inclusion criteria: English language; ≥20 years of age; internet access N=1023 (response rate=10.1%) recruited

The “Pathways to Health” Study

The “Pathways to Health” Study

Neighbourhood administrative boundary Line-based network walkshed (sausage-buffer), areal interpolation, and buffer

containment

Administrative boundary, aggregate census data, expert opinion of neighbourhood design

GIS boundary, network layer, dissemination area census data

Neighbourhoods and obesity

Weight characteristicsEstimate (n=851)

Weight modification attempt 51 %

Waist circumference (WC) 86 cm

Waist-to-hip ratio (W-HR) 0.88

Body mass index (BMI) 25

WC high risk [≥102 cm for men and ≥ 88 cm for women] 24 %

W-HR high risk [≥0.90 cm for men and ≥0.85 cm for women] 52 %

BMI overweight [25 to 29.9 kg/m2] 30 %

BMI obese [≥30 kg/m2] 10 %


Neighbourhood characteristicsWC

(high risk)W-HR

(high risk)BMI

(over-weight or

obese)

BMI (obese only)

Neighbourhood design (postal code)

Walk Score® - -

Socioeconomic status (walkshed)

Advantaged vs. Disadvantaged - - - -

Estimates adjusted for sociodemographic and health characteristics.*p<.05


Neighbourhood characteristicsWaist

circumferenceβ

Body mass index

βNeighbourhood design (administrative boundary)

Curvilinear 0.79 0.55

Warped-grid 0.56 0.41

Grid 0 0

Socioeconomic status (administrative boundary)

Advantaged -4.73* -2.27*

Somewhat advantaged -4.17* -1.80*

Somewhat disadvantaged -0.80 1.12

Disadvantaged 0 0

N=851 provided complete data. β is the difference in weight outcome relative to reference group. *p<.05.Positive value represent higher weight status and negative values represent lower weight status.Estimates adjusted for sociodemographic and health characteristics


Marginal means of waist circumference for combinations of neighbourhood design and socioeconomic status based on significant interaction (p<0.10). Columns with the same superscript are significantly different based on Fisher’s Least Significance test (p<0.05)

Interaction between neighbourhood design and socioeconomic status – waist circumference

Conclusions

Residing in a less walkable neighbourhood has the potential to increase your weight and waist circumference (i.e., they are “obesogenic”).

• The effect is likely exacerbated for socioeconomically disadvantaged neighbourhoods

• Purchasing a new home or looking for a house to rent - investigate the surrounding neighbourhood:

• Are their transit stops or train station within easy walking distance (5-10 minutes)?• Are shops and services within easy walking distance (5-10 minutes)?• Is the neighbourhood street network “grid-like” or does have many “cul-de-sacs and loops”?• Are there sidewalks on most streets that form a well connected network that is easy to

navigate, safe, and that link to pathways and cycleways, transit, parks, and shops and services?

• Check Walk Score® (see www.walkscore.com)

Conclusions

• Residing in a low walkable neighbourhood, then:

• Increase awareness about characteristics that are available that might support physical activity (parks, pathways; identify shortest most convenient routes to destinations and transit).

• Approach community associations and municipalities and local advocacy groups to demand (evidence-based) improvements to make the existing neighbourhood more physical activity supportive.

• Look to other opportunities to be physically active (local walking groups, community exercise classes).

• Identify physical activities that might be best supported by the existing infrastructure .

• Make “health” an important consideration when choosing your neighbourhood.

“You can't make positive choices for the rest of your life without an environment that makes those choices easy, natural, and enjoyable.”

Deepak Chropra

Take-home message

Thank you

Sign up for other UCalgary webinars,download our eBooks,

and watch videos on the outcomes of our scholars’ research at

ucalgary.ca/explore/collections

Information presented today was a summary of the scholar’s research and the opinions expressed were based on the scholar’s field of study

Other Webinar Topics

For ideas on other UCalgary webinar topics,please email us at

[email protected]

Healthy neighbourhoods

Design

Transcript of Healthy neighbourhoods