Reimagining urban centres as healthier places to live is essential to reducing the billions of dollars spent every year treating chronic illnesses, according to a panel on the future of cities.
A group of experts who gathered virtually this week for a “Future Cities, Future Care” event agreed that creating healthy cities requires collaboration between urban designers, builders, civic leaders and health care providers. The event was presented by The Globe and Mail and moderated by Globe reporters Andrea Woo, André Picard and Adrian Lee.
With eight out of 10 Canadians living in urban areas, according to a 2019 Statista survey, leaders and policy makers need to come together to listen to their communities, the panelists all agreed.
That starts with understanding barriers that people face, says Dr. Jane Thornton, assistant professor and Canada research chair in injury prevention and physical activity for health at the University of Western Ontario in London.
Good health depends on more than just an individual’s medical situation, she explains. “For example, having access to green space and looking at different ways people can get around in the city are important factors.”
We have to think in a more circular, inclusive way about cities and health.— Dr. Angela Mashford-Pringle, Indigenous health lead, Dalla Lana School of Public Health
Understanding that some people feel ignored or discriminated against is also essential to encouraging healthier lifestyles for people living in cities, says Dr. Angela Mashford-Pringle, assistant professor and Indigenous health lead at the University of Toronto’s Dalla Lana School of Public Health.
“When I think about cities right now, I don’t see myself,” she continues. Even products at grocery stores where Indigenous people shop are not familiar to their culture or customary to their diets, Dr. Mashford-Pringle explains.
“There isn’t even a word for ‘banana’ in Cree – it’s called the ‘yellow curvy thing.’ Even the BMI [body mass index] doesn’t take Indigenous peoples’ bodies into account. We have to think in a more circular, inclusive way about cities and health.”
Dr. Sean Wharton, head of the Wharton Medical Clinic and adjunct professor at McMaster and York universities agrees, saying marginalized and racialized people need their voices heard as part of a continuing conversation among decision makers about making cities healthy.
“Some of the ways are simple – sitting less and walking more, for example. But you also need to involve lower-income people in how policies are made,” he says.
Gil Penalosa, founder and chair of 8 80 Cities, a not-for-profit group that advocates for easier mobility and public space, says the political system needs an overhaul. “Ranked balloting in elections would bring new people into the system, with better decisions,” he says.
The current system of first-past-the-post tends to elect the same people with stale ideas; a more proportional system would bring about new voices and better ideas, he explains.
For example, we should not be spending $6-billion to turn green space into highways, as Ontario Premier Doug Ford has proposed, he says.
Mississauga mayor Bonnie Crombie raised the issue of how environment and infrastructure factor into the health of a city.
“Mississauga grew into a community that was dependent on the car,” she says, “[But] we are becoming healthier; we’re building new waterfront communities and a completely urban downtown.”
The experts agree that cutting down on the use of cars – which results in cleaner air – and making services such as shopping, doctors’ offices and gyms easier to walk to, are immediate ways to contribute to the robust health of intensified areas.
New facilities, such as the recently announced $40-million Novo Nordisk Network for Healthy Populations at U of T Mississauga, are taking a leading role in public-health research in the global fight against diabetes and other chronic diseases, the mayor added.
Dr. Lorraine Lipscombe, associate professor of medicine at the University of Toronto and staff physician in endocrinology at Women’s College Hospital, says architects and designers are incorporating accommodation into their work more as they realize the value of collaboration.
“Better health trickles down to the way cities are designed,” she says, adding that fixing cities to be healthier requires extensive retrofitting.
Layla Guse Salah, co-ordinator of public and patient engagement for the Canadian Medical Association, and a person with a disability, says even a small measure of forethought can improve the quality of life for marginalized communities.
“The building I live in is quite new, but the unit I live in was not designed for accessibility. I can manage fine, but given that it was built so recently, there’s no reason that the design couldn’t [have been] more accessible.
“We can all do better at building healthier cities if we work together.”