We have a big problem. We have engineered physical activity out of peoples’ lives by building communities that require the use of cars. This physical inactivity costs $1.4 billion dollars in healthcare expenses each year in the Greater Toronto and Hamilton Area (GTHA). What's worse, over the next 17 years these costs and congestion will increase as we add 2.2 million people and their cars to the GTHA. This timely presentation by Gayle Bursey discusses how the design of communities can significantly impact your health. There is no single solution to this challenge; however, Gayle will describe how city planners, engineers and health professionals are working together in New York City and in the GTHA to create communities that are well-designed, transit friendly and socially connected.

1. PEDTalk
Gayle Bursey
Director
Growth Management Strategy
Region of Peel

2. Acknowledgements
Improving Health By Design –
Media Launch
• Union Station (May 14, 2014)
• Resulted in 40 media spots
• Follow-up meetings with
provincial decision-makers
Left to right: Dr. Ninh Tran (Hamilton), Dr. David McKeown (Toronto),
Dr. David Mowat (Peel) and Dr. Charles Gardner (Simcoe Muskoka)
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6. This will have a huge impact on…
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7. This will have a huge impact on…
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8. …And our health
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$
49%
Health
$
51%
Everything
Else
The Provincial Pie

9. But What’s This Got to Do
with Health?
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Community Design
Elements
Street Connectivity
Impact
Bus Transit
Health Outcomes
Diabetes

10. The more things change ….
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*Lowell, Mass 1903; **Chicago 1910

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…the more they remain the same

12. What’s Changed is the Nature of the
Leading Causes of Death
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21st
Century Epidemic
Chronic Diseases
(e.g., diabetes, cardiovascular
diseases, some cancers)
19th
Century Epidemic
Infectious Diseases
(e.g., cholera, typhoid, typhus,
tuberculosis)

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14. Obesity & Physical Inactivity Cost
$4 Billion a Year in the GTHA
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Coronary
Artery
Disease
DiabetesStroke
Breast &
Colon
Cancer
How Big is the Health Problem?

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0
5
10
15
20
25
30
Prevalence of Measured Obesity, 18+, Canada
Overweight + Obesity = 62.1% of adult population (measured, 2008)
Source: CIHI, PHAC. Obesity in Canada. 2011.

16. Prevalence & Excess Medical Costs of
Diabetes in the GTHA
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0
2
4
6
8
10
12
14
16
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2002 2004 2006 2008 2010 2012 2014 2016 2018 2020 2022 2024 2026
%
Year
663,842
$2.6 billion
995,067
1,178,574
Projected
$4.5 billion
(today’s $)
Physical inactivity
contributes 12,500 new
cases of diabetes each year

17. So what has changed?
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18. The Loss of Physical Activity from Daily Life
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20. The Preventive Power of Physical Activity
(if this were a pill…)
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21. Sitting in a Car…
• Not just about inactivity
• Motor vehicles are a major source of air pollution 21

22. Walk?
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23. Bike to Work?
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24. Bike to School?
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25. Existing Plans
• Metrolinx’s multi-year plan to
develop and implement an
integrated transportation system
for the GTHA.
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• Provincial plan to address growth
challenges in GTHA by building
compact, vibrant and complete
communities.

26. Many Societal Benefits Already Identified…
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27. How do you assess potential health
benefits?
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Existing Projections
Scientific Literature Available Tools
Baseline Transit & AT

28. Feasible Health Estimates
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29. While Recognizing That Only Addressing a
Portion of the Health Impact
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30. Conservative Estimates
Item Absolute % Change # of People
↑ Public Transit Use 9.8% 337,531
↑ AT to Work &
School (adults)
5% 168,845
↑ AT Instead of
Short Car trips
5% 66,753
↓ Traffic Emissions
(PM2.5)
33% ALL
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31. Projected Health Benefits*
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*Under-estimate health impacts
Prevent 184 deaths/year
($1.2 billion)
Prevent 1,061 cases of
diabetes/year
($250 million over 10 years –
lifetime costs)
Prevent 154 deaths/year
($1 billion)
Prevent 90
hospitalizations/year

32. A Public Health Perspective to
Community Design
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33. Advocacy
Influence provincial legislation,
municipal decision-makers, media and
the public
Recommendations:
1) Fund public transit
2) Normalize public transit planning
3) Strengthen provincial policy
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34. Examples of Policy Changes
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35. HEALTHY DEVELOPMENT INDEX
A framework to provide consistent, quantifiable standards to inform planning decisions
HDI consists of seven “elements” –
categories of built environment characteristics that are known to be associated with health:
Density  Proximity to Services and Transit  Land Use Mix  Street Connectivity
Road Network & Sidewalk Characteristics  Parking  Aesthetics & Human Scale35

36. • Elements are further broken down into measures, many of which are quantitative
• Based on strength of evidence, measures are either Prerequisites or Credits
Example of HDI
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37. • City of Brampton Official Plan Amendment 43
4.10.4.7 (xiv) Development will be subject to consideration of how the design and
use of the physical development positively contributes to human
health.
5.31.3 The City may require health impact studies as part of a complete
development application.
5.32.2 Impact studies shall consider public health impacts.
• Applying the Healthy Development Index - Ongoing
Brampton’s Commitment to Health Built Environments
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38. City of Brampton Council Resolution
• City of Brampton to reference Peel Public
Health’s Health Development Index (HDI) and
consult Public Health staff in future
transportation studies, urban design guideline
studies, community improvement plans, block
plans, future community planning studies.
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39. City of Brampton Council Resolution
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At a municipal level, applied
the HDI to:
• City of Brampton
Sustainable Development
Guidelines
• Local Environmental
Assessments
• Municipal Secondary and
Block Plans

40. Using the Health Index Locally
Policy Changes using the Health Index:
• Strengthening policy through the Regional
Official Plan Review
• Sustainability Development Guidelines
• Continuing comments on:
– Development applications, secondary plans
– Environmental Assessments
• Community Improvement Plans
• Active Networks Parks and Playgrounds Pilots
• Actively Designed Buildings Pilots
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41. Hamilton LRT
• B-line – McMaster University to the Queenston Traffic Circle
• A-line spur – James Street North
• Procurement for the LRT will start in 2017, with construction starting in 2019

42. New Road Characterization Categories
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How do we use access control to plan for growth in an evolving
Region?
Land Use Transect (Source: Duany Plater-Zyberk & Company)
As Urbanization Occurs…

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RCS Section II: Illustrative Cross Sections
• Developed design guidelines and cross sections that support the road classifications
• Cross-sections show desired roadway components
• Guidelines were determined for the dimensions of each component
Some of the design elements discussed
include:
• Parking Lanes
• Bicycle Facilities
• Drainage
• Medians
• Sidewalks
• Geometrics

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Access Control Benefits: Economic & Health
• Highly connected networks benefit
property owners by creating
commercially valuable municipal street
frontage
• Increased access to the local street
network reduces the amount of parking
required from property owners
• Creates more than one route to a
destination for both cars and
pedestrians
Strip lots and inadequate street network:
…Need more collector and local streets

46. Actively Designed Buildings
Council resolution:
“Create a supportive environment to reduce sedentariness
and increase activity by phasing in bike parking, mobile
meetings, treadmill desks, stair use signage, and other
relevant programs.”
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47. Affordable Housing Active Design –
Guidelines and Standards
Regional sites:
• Mavis – Dundas
• Copper Road
• Wolfdale
• Peel Manor
• Twin Pines – Affordable Housing
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53. Urban Design Awards
Featuring for the first time a focus on healthy
built environments
• Brampton
• Mississauga
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54. 16
Creditvale Mills – Mississauga
• 6000 sq ft. amenity space to promote active living activities
• Bicycle room to promote cycling
• Creating neighbourhoods, streets, and outdoor spaces that
encourage walking, bicycling, and active transportation
Affordable Housing
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55. Design Guidelines for Bike Lanes
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NYC Small Space – Actively Designed Parks

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60. Shifting from…
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61. To…
JHS 135, the BronxProperty of The Trust for Public Land
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62. Active Parks and Playgrounds
• Lake Wabukayne Park in
Meadowvale – Mississauga
(Completed October 2014)
• Heritage / Active Signs
– City of Mississauga and
Town of Caledon
(Completed in 2015)
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63. Active Parks and Playgrounds
• School Design Days (stakeholder consultation)
– Gordon Graydon Public School
– St. Alfred Public School
• School playground enhancements at Madoc Public School (Completed June 2014)
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64. Active Design Schools and Workplaces
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65. Retrofits
Painted walking loops
at regional building
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66. Retrofits
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67. Next Steps
• Moving from pilot projects to mandatory implementation:
– Evaluate the health benefits and costs
• NYC 2000 – 2010 289% increase in commuter cycling
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68. Results
In New York City
5.5 percent decline in
the number of obese
schoolchildren from
2007 to 2011
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69. In summary, we have engineered physical
activity out of our lives
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70. More of the
same is not
going to work…
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71. Key Messages
1. We are making progress
2. Good design changes behaviour
3. A Planning decision is a health decision
4. Take heart! If Edwin Chadwick could bring
sanitation to London in the 1800’s then…
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