Vancouver has banned doorknobs.
The change to the municipal building code has made the city the butt of many a quip, from the ubiquitous knock-knock jokes through to the snarky comments about bureaucracy run amok.
But the reality is that Vancouver is, once again, at the cutting edge.
The small change – come March, 2014, all new single-family dwellings and townhouses will have to be equipped with door levers rather than doorknobs – is a welcome reminder that we don't pay near enough attention to our physical surroundings and the impact they can have on our health and well-being.
Housing is one of the key socio-economic determinants of health; so too is physical environment. But making a house a home entails more than having a roof over one's head; a home needs to be usable and user-friendly if it is going to be a healthy place to live.
In 21st century Canada, accessible housing should be the norm, not the exception, and that begins with the front door, both symbolically and practically.
Roughly 3.8 million Canadians have a disability – about 11 per cent of the population. There are also five million Canadians over the age of 65, a record-high 14.3 per cent of the population.
There is some overlap between those two demographic groups there and, of course, not all disabilities are physical and not all seniors are frail and handicapped.
Still, one of the messages we should take from those numbers is that a significant percentage of the population – one in five maybe – has mobility challenges and that number is going to grow in the years to come.
In many if not most families, there is someone who has trouble turning a doorknob, climbing steps, walking upstairs, squeezing down narrow hallways, reaching the sink, not to mention walking/rolling easily on the sidewalk, getting on a bus and navigating the aisles of the local grocery store.
So why do we continue to build homes – and public buildings and workplaces – that are impractical, unwelcoming and sometimes hostile living spaces?
How homes are built is an important public health issue.
Over time, building codes have been altered to address countless health issues: We got rid of lead pipes to make drinking water safer, mandated fire retardant materials to lessen the impact of fires, got rid of asbestos to lower cancer risks, changed insulation standards to make homes warmer. Over time, stairs have been standardized, window size and placement regulated, and structures reinforced, again to make homes safer, particularly for children.
Those approaches need to continue to address the needs of other demographic groups, such as frail seniors and others with physical and mental disabilities.
As the population ages and we see an increase in chronic conditions – many of which result in physical impairments, major and minor – we don't want to find ourselves in a situation where more and more people are institutionalized. That would be expensive, not to mention inhumane.
Rather, we want to keep people in the community, ideally in their homes.
For that to happen, we need home-care programs. And that care needs to be delivered safely.
Homes have to change and building codes should be modified to spur that change.
Doorknobs are as good a place as any to begin.
Ultimately the goal should be to make all new homes accessible or at the very least adaptable. (The difference being that accessible homes have all the accoutrements – the ramps, the grab bars, the no-slip floors – in place while adaptable homes have things like reinforced walls around the toilet and bath, and space to replace stairs with ramps to make modifications easier in the future.)
In addition to rules for building new codes, you also want to provide incentives to retrofit older homes, as well as education to encourage people to do so.
Structural changes are not the only way to make homes more accessible and user-friendly. Just as parents baby-proof their homes when they have young children, they can granny-proof them when they have older parents with mobility issues.
That means removing fall hazards such as throw rugs, low-level furniture and wires for electronic equipment, and ensuring there are clear paths through each room.
Because falls are one of the principal causes of hospitalization in the frail elderly, many home-care organizations now do home inspections. There are also guides on fall prevention in the home published by organizations such as the U.S. Centers for Disease Control and Prevention.
The great thing about all these measures – structural and practical – is they benefit everyone. No one is really inconvenienced when doorknobs give way to door handles, or when steps are replaced with ramps, or when doors on rooms are made a little wider, or when grab bars are strategically located.
In fact, measures that assist those who use wheelchairs, for example, have a collateral benefit for many others, such as parents pushing strollers, people using walkers and those rolling suitcases.
The International Day for Persons With Disabilities was celebrated just a few days ago, on Dec. 3. The theme this year was "Break Barriers, Open Doors."
Vancouver has helped break barriers and open doors with its doorknob ban. Others would do well to latch on not only to that specific idea, but embrace the philosophy of making homes more inclusive and healthier for all.
Follow me on Twitter: @picardonhealth
André Picard