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Graceful lines of grass and concrete complete a sweeping view of a plaza as a man walks through it on his way to work in downtown Vancouver.

John Lehmann/The Globe and Mail

Trevor Hancock has always been ahead of the curve.

A doctor and long-time public health expert, he was also the first leader of the Green Party of Canada in 1984, when he ran federally (finishing fourth) in Toronto's Beaches neighbourhood.

But his day job, in public health, turned out to have far more impact than his brief political career. Beginning as one of a small international cadre that promoted ideas about urban planning's key role in human health, he is now watching his work over the past quarter-century start to explode into the mainstream.

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It's a paradigm shift in the way urban planners and municipal leaders see the world: how we build and manage our cities directly affects the health of the populace. And with mounting research showing that cities where people walk more and drive less are healthier cities, the automobile is losing out to the pedestrian as the main focus of city-building.

In Vancouver, already ranked as Canada's healthiest city, they are nonetheless acting.

"These kind of seismic changes in our understanding take a long time to work into the system," said Dr. Hancock, who serves as a professor and senior scholar at the new School of Public Health and Social Policy at the University of Victoria, while working as a public health and planning consultant. "It takes a generation for the old guard to die or retire, and a new way of thinking to take its place."

Urban planning, in its modern sense, started in the mid-19th century.

Imagine animal carcasses and vegetables rotting in the streets, cramped housing and rampant spread of disease, belching smokestacks blackening the midday sky. These urban conditions in England moved civic planners to consider the health of the populace in the design of cities.

Smarter design equalled healthier citizens. But the connection between health and planning unravelled not long after. The idea of separating neighbourhoods from industrial and commercial activities took hold and, with the rise of the automobile, urban planners divided cities up into zones for living and zones for working, with roads between them.

The result is modern cities that make people sick. New research has found that cities designed for cars also foster obesity and diabetes. In studies from Atlanta to Vancouver, evidence shows that people who live in neighbourhoods that require cars to get around are fatter and less healthy than people who live near shops and grocers.

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A quarter of Canadians are obese, which imposes added burdens on the nation's health-care system. Yet the solution to problems in health care is always more money for health care – even though research indicates that three-quarters of the factors that influence human health happen outside the health-care system.

Wilbert Keon, the renowned heart surgeon and retired senator, estimates that the "obesity epidemic," particularly among children, could cost billions in added medical expenses. "Diabetes, hypertension, organ failure, heart disease, you name it. It's abhorrent," said Dr. Keon. "It's one big chunk of money that could be pulled right out of health care if we could just build healthy communities."

Dr. Keon believes momentum is building in favour of healthier cities, even though a report on a "healthy, productive Canada" he led in 2009 failed to garner much notice, or action.

The challenges include co-ordinated action among different levels of government. Municipalities decide on zoning, allowing developers to build cul-de-sac suburbs kilometres from the nearest grocery store. Higher levels of government administer health-care dollars but have little say on what cities do with their road-building budgets.

Because of such disconnects, efforts have been piecemeal. Atlanta created a program to vet and fund projects that make the city healthier. Bogota built one of the world's best bike path networks. In Canada, Vancouver has taken the lead.

Vancouver has seen old left-right political divisions over urban planning break down, with a consensus emerging on what constitutes a desirable city.

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On the right, Suzanne Anton was a Crown prosecutor and a soccer mom when she pushed a decade ago for more playing fields, work that led her to politics and a seat on Vancouver's parks board. Ms. Anton this month lost her bid for mayor to Gregor Robertson, a greener incumbent. But as a city councillor, she was an important force behind the city's adoption of "EcoDensity" – the promotion of greater housing density among the many single-family homes in the city, to combat sprawl.

"Dense urban environments are good for human health, because people walk," said Ms. Anton.

In Vancouver's ambitious goal to become the "world's greenest city" by 2020, "improved health" is one of the top results expected from a more intelligently designed urban landscape.

Ms. Anton describes herself as a "land-use geek," arguing that zoning is the crucial lever to create a healthy city. One practical application is how to make neighbourhoods better suited to older residents as the number of seniors is set to double by 2025.

Health care, Ms. Anton said, starts at home. Using her own south Vancouver neighbourhood, Kerrisdale, a typical single-family-home community, she points to the importance of "seniors housing" that is functional and within walking distance of real street life.

"An 80-year-old lady, she goes down the elevator, walks to buy bread, buy milk, sees her friends, walks home," said Ms. Anton. "That creates health for her."

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Canada’s healthiest cities

  1. Vancouver
  2. Victoria
  3. Calgary
  4. Edmonton
  5. Ottawa

By the numbers

  • 25 per cent of Canadian adults are obese
  • This costs Canada $12-billion annually, to treat chronic diseases connected with obesity
  • It costs the health care system $1,500 more, each year, to treat obese Americans compared with people of normal weight
  • 75 per cent of factors that influence health occur outside the health care system
  • Each grocery store within 1-kilometre of a person’s home reduces the likelihood of being overweight by 11 per cent
  • Transit users are 3 times more likely to meet daily minimum of recommended physical activity
  • A walkable neighbourhood with shops and grocers near homes slashes the probability of obesity by 35 per cent
  • Improving a neighbourhood’s “walkability” by just 5 per cent gets people 32.1 per cent more active in their travel
  • A typical white male who lives near shops weighs 10 pounds less than the same man in a suburb of cul-de-sacs
  • Young teenagers are 2.5 times more likely to walk if there is a recreation destination within 1-kilometre of their home
  • Women are about 20 per cent less likely to be obese, or suffer from diabetes, if they live in a nice neighbourhood with services compared with a poor neighbourhood

Compiled by David Ebner; Sources: Lawrence Frank/University of British Columbia; SMARTRAQ; Government of Canada, U.S. Department of Housing; Trust for Public Land; Best Health Magazine

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