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Urban Health

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Michael O'Neill

on 25 November 2013

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Transcript of Urban Health

A Brief History of Urban Health
- Evidence that ancient Greek cities were located and designed with nature and aesthetics in mind
- The "ideal town environment would offer the benefits of the city and countryside within its walls", with an environment conducive to activities that are still considered beneficial to health (incl. physical activities, singing, other artistic and spiritual activities)
- Roman cities often lauded for their health promoting qualities
- Incorporated baths, aqueducts, lavatories, etc.
- (Author) argues that Rome didn't really perform better than other preindustrial cities of its size.
- Supernatural link
The "Physical Environment"

(Built Environment)
Affects physical and mental health as well as behaviours, crime and violence (Galea, 345)
Physical and emotion well-being are related (Veenstra, 2815)

...Therefore, Social and Physical environments are interconnected
Infrastructure (345)
Density (352)
Water and Sanitation (345)
Ageing Infrastructure (Private and public) (352)
Industrial Progression (346)
Noise (347)
Green Space (346)
Greater physical activity from walkable green space (346)
Urban Climate (346)
Highways/streets runoff (346)
Heat Island affect (346)
Disasters (Manmade or natural) (346)
Physical Stresses?
Proximity to Industry
Ageing Infrastructure
Urban Design
What Main Categories (Regarding the Physical Environment) Would you Justify having as Key Areas of study in Urban Health?
Focus on: Deinstitutionalization and "Landscapes of Despair"
Discussion on the Study of Urban Health
- "Urban health... concerns itself with the determinants of health and diseases in urban areas and with the urban context itself as the exposure of interest."
- suggested division of analysis into the physical environment, social environment, and access to health and social services

- hypothesize that neighbourhood might affect health in two ways:
1:short term influences on behaviours, attitudes, and health care utilization, which in turn affect health conditions that can be quickly changed
2: long-term process of "weathering, whereby the accumulated stress, lower environmental quality, and limited resources of poorer communities... erodes the health of residents in ways that makes them more vulnerable to mortality from any given disease."
Issues and how to solve them:

- Controlling for individual or family characteristics
- Measurement of neighbourhood conditions
- Linearity
- Temporal
- Spatial
- Cities are often home to a wide variety of health and social services, including higher level medical services not available in rural areas. (a good thing right? probably contributes to the higher level of health cities typically enjoy)
- however, the relationship between the provision of such services and urban life is complicated and varies widely within and between cities
- This relationship is often associated with the socioeconomic status of a neighbourhood, which can be seen to contribute to inequalities

- Community Based Care/ Social Enterprise to reduce inequality
what do you know about Edmonton
What do you know about the environment of Edmonton ?
What is urban?
Social disorganization/strain
The urban social environment
Garbage & Recycling
The built environment
density of development
mixed land uses
scale of streets
aesthetic qualities of place
connectivity of street networks
The built environment
Developing alternate sources of power
- mining landfills for methane to produce electricity
- turning organic waste into bio-fuel for city vehicles
- developing concept homes that will generate much power as consume
Urban Climate – urban heat sink
Pest Management
Light pollution

Graffiti Management
Drainage and flood prevention
Urban infrastructure, water and sanitation
Industrial zone
The built environment
Commercial zone
The built environment
The built environment
Urban infrastructure, water, and sanitation
Access to green space
Urban climate
The urban physical environment
Many cities worldwide are highly segregated with multiple historical, logistical, and practical barriers to mixing social groups.
Spatial segregation
Edmonton Natural areas
Access to green space
Hodgson Wetland, located in Hodgson Neighbourhood, has been protected since 2002
Access to green space
Safe needle disposal
Urban infrastructure, water and sanitation
Urban infrastructure, water and sanitation
Residential zone
The built environment
Persons who are in positions of authority or influence in specific areas can affect norms and behavior of others in direct and indirect ways.
Social contagion
Community – friends, family
Social resources
What is urban
Cities can be small and compact
Cities can be unique, cosmopolitan places
Cities frequently include both sophisticated and wealthy areas, featuring commercial and entertainment interests that are among the best in their country, as well as areas of extreme poverty and deprivation.
Within Edmonton
Vancouver has one of the largest film production centers in North America
Has hosted numerous international conferences and events
Comparison between Edmonton & Vancouver
What is urban?
The physical environment - Jan Gehl
Physical environment – Jan Gehl’s livable city
Physical Environment – Jan Gehl’s eco-city concept
How to improve urban health status?
- Continued recognition that the environment could affect health:
Value of nature
- Plague!
A pressing issue for hundreds of years
Efforts were taken to improve health by altering the urban environment
- Religion and urban health
Bishops often established as all-purpose public authorities with a key role in responding to infectious outbreaks
Response to issues of health often mediated by religion: although there was a general knowledge disease was "spread" and could be prevented, it was ultimately from God.
Symbolic appropriation of urban space
Arguably positive contribution to improved spiritual health and social capital
Comes back to the question of: what does it mean to be healthy?
Physical Examples:
Low Walkability leading to Obesity
Low Bikability (Copenhagen)
Accidents or expensive cost of maintenance
Social Examples
Pollution and Environmental Justice issues
Increased stress

Urbanized (2010)
Office Space (1999)
Falling Down(1992)

Adrulis, D.P (2000) Community, Service, and Policy Strategies to Improve Health Care Access in Changing Urban Environment
Canadian Institute for Health Information, Improving the Health of Canadians: Mental Health and Homelessness. Ottawa: CIHI, 2007.
City of New York(2010) Active Design Guidelines: Promoting Physical Activity and Health in Design. Retrieved on February 1, 2013 from http://centerforactivedesign.org/dl/guidelines.pdf
Corburn, J. (2009). Towards the healthy city: People, places, and the politics of urban planning. Cambridge, MA: MIT.
Davis, M. C. (1998). The English Medieval Urban Environment Before the Black Death: Learned Views and Popular Practice. Medieval Perspectives, 1369-83.
DeVerteuil, G. & Evans, J. (2010). Landscapes of despair. In T. Brown, S. McLafferty, & G. Moon, (Eds.) (2010). Companion to Health and Medical Geography (pp. 278-300). Wiley-Blackwell: Oxford.
Sheard, S., & Power, H (Eds.). (2000). Body and city: Histories of urban public health. Aldershot, UK: Ashgate.
Ward Thompson, C. (2011). Linking landscape and health: The recurring theme. Landscape and Urban Planning, 99, 187-195.
- A steep decline in the quality of the urban environment and urban health followed by some of the most significant improvements to this day
Montreal Tunnel Collapse 2011
The Montreal Gazette, 2011
28% of Canadian municipal infrastructure is at least 80 years old (LeBlanc, 2012)
Suburban Monoculture
Galea outlines several areas....
What are they?
Office Space (1999)
Copenhagen Cycling
Urbanized, 2010
The Urban Social Environment
Broad definition includes
"...occupational structure, labour markets, social and economic processes, wealth, social, human, and health services, power relations, government, race relations, social inequality, cultural practices, the arts, religious institutions and practices, and beliefs and place and community."
-Barnett E, Casper M. in Galea S. and Vlahov D. p.347
Five features of the urban social environment as health determinants
Social Disorganization/Strain
Social Resources
Social Contagion
Spatial Segregation
Social Disorganization/Strain Theory
Social order and stability are conducive to conformity while crime and poor integration into social structures are conducive to disorder
People of all social classes aspire to achieve unattainable goals and, as a result, may partake in illegal activity to do so.
Living in such conditions can have adverse health affects, particularly mental stress.
Social Resources
Cities can be looked at vast social networks between individuals
Informal/formal social ties support social cohesion and social support
In cities: connection between proximity of these networks and health
Social Contagion
Infectious diseases within the context of urban settings
Social norms and group practices seen as heavily influential on the transmission of STI's/HIV
Spatial Segregation
What are the impacts of segregated communites on health?
Ecologic evidence shows that countries with higher distribution rates of wealth have lower mortality rates
What other effects does inequality have on society?
Health and Social Services
Varies between cities and countries
Rich countries, and even the poor communities within them, enjoy many different kinds of social agencies.
These agencies have been associated with many health successes over the last two decades.
However, disparities in quality of care exist. How does this affect disadvantaged neighborhoods?
http://www.victorianweb.org/art/illustration/phiz/bleakhouse/29.html- From Bleak House
Changing Attitudes
The "Great Stink"
Sanitary Reform
How has the city responded?
So, are our cities killing us? Let's look at the stats.
Obesity and type 2 diabetes are now epidemic in New York City.
NYC's Active Design Guidelines
Urban Design Strategies-
creating neighborhoods, streets and outdoor spaces that encourage walking, bicycling, active transportation and recreation.
Building Design Strategies-
for promoting active living where we live and work and play
Promoting physical activity and health in design
"History has shown that environmental design can play a crucial role in public health."
Improve access to full-service grocery stores and fresh produce
Which becomes a determinant of health first, the social aspect or the physical aspect? Or, which impacts the other more?
Effectively manage the Branch by evaluating business processes to maximize the efficient and effective use of existing resources
Improve service delivery and enhance program sustainability through the utilization of technological advancements
Collaborate with internal and external partners to provide effective response to citizens
Corporate outcome:
The City of Edmonton delivers valued, quality, cost-effective services to its citizens
Diverse, engaged and innovative employees involved in service delivery contribute to achieving the City’s vision, goals and outcomes.
The City of Edmonton embraces its relationships with people and partners to deliver services to citizens

Citizens integrate past, present and futures necessary and appreciate the balance of how we work together to ensure Edmonton is a sustainable City
Partnerships are strong and positive

Develop and integrate
social sustainability into the neighbourhood
Support the implementation of the targeted
outreach initiatives to under-represented communities
Create a corporate-wide
volunteer recreation
Improve the
funding management
systems for grants
Goal 6 – Edmonton is a sustainable city
Initiatives (cont’d):
Work in partnership to support and expand a
city-wide financial literacy program
Support programs for new immigrants
Update the City of Edmonton’s Urban Aboriginal strategy
in collaboration with urban Aboriginal communities and stakeholders
Build community
economic development
capacity into neighbourhood revitalizations and community development
Develop a corporate
volunteer engagement
Implement the inclusion Edmonton: Measuring Up Tool Kit
Lead a review of the Family and Community Support Services Program (FCSS)
Implement the learnings from the
Aging-in-Place demonstration project
Goal 3 – Edmonton is a caring, inclusive and affordable community
Citizens have diverse opportunities to enhance their personal wellness and awareness

Support the development of an
access strategy to sports and recreation
for multicultural and Aboriginal groups
Support the expansion of
alternative community-based recreation programs
Support the updating of the
community recreation services delivery and funding models
Goal 2 – Edmonton celebrates life
Improve the social environment
Facilities, neighbourhoods and public spaces are developed and sustained to meet community needs.

The Community and Social Development Branch supports numerous initiatives in the City that work towards making Edmonton a more attractive city.
Goal 5 – Edmonton is an attractive city
Citizens and their property are safe

Initiatives: support the research and development of a
service delivery model
Support the building of a new model for engaing citizens from Edmonton’s multicultural and Aboriginal communities in
crime prevention

Refine the domestic
violence response
and service delivery model
Revise the
Emergency Social Service Plan
Goal 4 – Edmonton is a safe city
Services are accessible and affordable

Develop a
social development strategy
Implement the
Racism Free
Edmonton Action Plan
services for at risk populations
Work towards the development of a
provincial poverty strategy
Reduce panhandling through enhanced
employment initiatives
Goal 3 – Edmonton is a caring, inclusive and affordable community
Citizens are socially connected and active in their communities

Develop and implement an
Immigration and Settlement Strategy
Support the development of and engagement in
volunteer opportunities
Support the
multicultural and Aboriginal communities
in accessing or developing
physical spaces
to meet and recreate
Expand internal capacity for social mapping
Goal 1 – Edmonton is a vibrant connected, engaged and welcoming city
Roadway System
Pedestrian Circulation
Well designed
built and urban forms
street framework
Additional Connected
Parks and Open space
Historic Preservation
Improve the built environment – well-designed
Commercial, retail and educational places

Improve the physical environment - vibrant
Improve the physical environment
natural environment
energy and emissions
and improved
air quality
Stewardship of
natural and material resources
A sense of
Improve the physical environment - sustainable
How to improve urban health status ?
John Graunt and the "Natural and Political Observations Made upon the Bills of Mortality" (1662)
Urbanized (2011)
What could these physical stresses could lead to?

... Discuss in groups of 2-3
Urbanized (2011)
Sanitation and Mumbai
Source: Wikipedia
Source: Wikipedia
Aging Population
Food Deserts
"Food deserts are areas that lack access to affordable fruits, vegetables, whole grains, lowfat milk, and other foods that make up the full range of a healthy diet."
A great example of how the built environment has effects on the physical well-being.
May have links to negative health impacts such as the walkability of the neighborhoods, access to unhealthy foods instead etc.
Whereas, Canadian cities define it alone the lines of grocery stores within a specific distance.
Improve the physical environment - Accessible
Community and Social Development - Business Plan 2012-2014
The built environment
The Urban service zone
What aspects of concentrated urban populations make them particularly vulnerable to adverse health effects?

Key Recommendations include:

Develop and maintain mixed land use in city neighborhoods
Improve access to transit and transit facilities
Improve access to plazas, parks, open spaces, and recreational facilities, and design these spaces to maximize their active use when appropriate
Improve access to full-service grocery stores and fresh produce
Design acceptable, pedestrian-friendly streets with high connectivity, traffic calming features, landscaping, lighting, benches, and water fountains
Facilitate bicycling for recreation and transportation by developing continuous bicycle networks and incorporating infrastructure like safe indoor and outdoor bicycle parking
Creating an active city
Creating opportunities for Daily Physical Activity Through Building Design
Key Recommendations Include:

Increase stair use by providing conveniently located stairs for everyday use, designing visible and appealing stairs, and posting motivational signage for stair use.
Provide appealing and supportive walking routes within buildings
Provide facilities that support exercise: visible physical activity spaces, showers, locker rooms, bicycle storage, and drinking fountains
Design building exteriors to contribute to pedestrian-friendly urban environments such as maximum variety and transparency, multiple entries, stoops, and canopies.
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