Does HRM* Provide a Healthy Environment for its Citizens?

1. Does HRM* Provide a Healthy Environment for its Citizens? Michael Goodyear Department of Medicine, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada Ecology Action Centre May 19 2010 Conversations III *Halifax Regional Municipality

2. It All Depends… What do we mean by Health? What do we mean by Environment? How does Environment impact Health? Can you measure health? How healthy should we be? Whose responsibility is it anyway?

3. 1. Health A Multidimensional Construct “State of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” World Health Organization Preamble to Constitution of WHO 1946

4. Health “An individual or group must be able to identify and to realize aspirations, to satisfy needs and to change or cope with the environment. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just theresponsibility of the health sector, but goes beyond healthy lifestyles to well being.” WHO: Ottawa Charter for Health Promotion 1986

5. Healthy Communities Social, environmental and economic factors are important determinantsof human health and are inter-related. People cannot achieve their fullest potentialunless they are able to take controlof those things which determine their well-being. All sectors of the community are inter-related and share their knowledge, expertise and perspectives, working together to create a healthy community Ottawa Charter 1986

6. Health From: Health Care to Health From: Measuring Illness and Disease to – Determinants of Health Asclepius to Hygiea

7. Sir Michael MarmotChair, WHO Commission on Social Determinants of Health “What good does it do to treat people’s illnesses, and then send them back to The conditions that made them sick?”

8. Determinants of Health Peace Shelter Education Food Income Stable Eco-system Sustainable Resources Social Justice, and Equity Ottawa Charter

9. Canadian Institute for Advanced Research Attributing Health 25% Health Care System 15% Biology and Genetics 10% Physical Environment 50% Social and Economic Environments

10. 2. Dimensions of HealthRole of environment Individual characteristics Social and Economic Environment Living environment Social network Society norms, values and ideologies Local Physical Environment

11. 3. Health and Physical Environment Natural Air Water Food (availability, price, quality) Climate Urban Form Built Environment Open Spaces

12. Health Promotion Int. 1993

13. Healthy Cities and Villages WHO 1986

14. Healthy Communities

15. ?

16. Challenges Teasing out effects of separate factors Local, larger territory* Determining extent of contribution Determining mechanisms Evaluating outcomes * Very different associations in Scottish v Canadian cities. K Wilson Health Place 2010

19. Urban Form Urban Design as tool to optimise Urban Form

20. Urban Form and Urban Design • Built Environment and Open Spaces • Previous Emphasis on Built Environment • Incorporates Healthy Planning

21. 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.

22. 4. Measuring the Health of a Community Developing Indices Income Social Networks Education Employment Environment Disease etc.

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

24. Genuine Progress Index Atlantic Ron Colman, Nova Scotia 2001-2004 (King’s County, Glace Bay) Jobs and Income security Safety from Crime Air and Water Quality* Population Health & Education Balance between work and family Community values Activities for youth* Aesthetic quality of urban space* *least agreement as to how to measure

25. Problems with Measuring and Standards Existing data insufficient to measure or create standards Unclear whether has to be community specific Subjective (e.g. Not just Crime Statistics, but feeling safe)

26. 6. Whose Responsibility? Clearly not HRM – alone Yet has input at many levels Requires multi-level coordination Community input and participation Need for Health Impact Analysis in policy

27. Research Practice Policy After Dr Carolyn Bennett

28. Research KT* Practice Policy *Knowledge Translation

29. Research KT Practice Policy Political Will

30. Research Applied Research KT Practice Policy PoliticalWill

31. ENGAGED CITIZENS Research Applied Research KT Practice Policy PoliticalWill

32. Healthy Communities Incorporate health into all public policy Committment to creation and preservation of physical and social environments that support and promote better health Intersectoral collaboration Community participation Action plan Evaluation

33. Healthy City WHO 1988

34. mgoodyear@dal.ca