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Tackling unhealthy environments: locally and globally

A Melbourne GP, Dr Margaret Beavis, writes below of the need for healthy urban planning that makes it easy for people to be physically active.

At the bottom of the post is a stack of links to resources and articles about initiatives from around the world aimed at tackling unhealthy environments, particularly in disadvantaged areas.

They may be of interest for those with an interest in public health, environmental health, planning, equity, and social policy (and possibly also those involved with the new Medicare Locals).

***

How to provide access to a life-saving health breakthrough?

Margaret Beavis writes:

There’s this pill. It reduces heart attacks and strokes by about 50%. It can prevent obesity and overweight – by up to 90%. It prevents and treats diabetes, improves blood pressure and cholesterol. It prevents kidney disease and several cancers, improves job satisfaction and reduces absenteeism.  Extensive research finds it works just as well as standard antidepressant medication.

But wait – there’s more! It also reduces greenhouse gas emissions.

Many of you will have figured out this is exercise – dose: 30 minutes, 5 times a week.

If we could sell it as a pill the entire population would be on it.

But instead we mostly just feel guilty.

On average Australians gain roughly half a kilo a year from the age of 18. Doesn’t sound like much, but over 20 years 10 kg is not good. Last year a West Australian Government report found overweight and obesity is now the biggest cause of death and disability.

Prevention takes decades to show benefits. Australia has led the world in tobacco control. Since 1971 for every $1 spent on tobacco control we have saved over $50.  These savings are real, and will continue to increase, but they have taken time to appear.

Making incidental exercise easy is a no brainer from a health and a financial perspective. Australians currently spend over  $1.1 billion a year on cholesterol lowering drugs alone.

So how do we make choosing to exercise easier? A 2010 report describing 42,800 Victorians found car drivers averaged 8 minutes exercise daily, while those using public transport averaged 41 minutes. This easily exceeds recommendations for good health.

Currently we are building suburbs remote from transport infrastructure. These average roughly 15 dwellings per hectare. At this density they will never support viable public transport – that needs at least 30 per hectare.  So we are creating car dependent communities. Too bad if you are under 18, elderly or have a disability.

Liveability is “density done well”.  State governments continually expand the urban growth boundaries to provide “cheap housing”. Yet low densities add the cost of running more cars per household, which when added to infrastructure and health costs make this very false economy.

We need to encourage affordable infill development, in “brown field” and activity centres (eg shopping strips) where most of the services and transport already exists. We need to make public transport a viable choice.  Good planning is no longer just a cost issue- it is liveability issue and increasingly an urgent health priority.

This does not mean open season on the inner suburbs. Local residential streets need protection from inappropriate development that destroys neighbourhoods. And to avoid the fate of Melbourne 2030, government must provide appropriate state legislation that supports local urban planners.  Sensitive medium rise design supports local shops and communities. London has not expanded its growth boundaries in decades.

It is not enough to endlessly expand Melbourne’s growth boundaries – we are already too big. Long term planning is essential. We need real affordability, convenient mobility and in the long term a healthy community.

•  Margaret Beavis is a Melbourne GP currently doing a masters of public health on the health impacts of urban planning. She stood for the Greens for the state seat of Brighton in 2010.

***

Linking into global resources

• A new guide from England (PDF alert) that draws together the growing evidence base for integrating health into spatial planning and illustrates it with a range of practice examples from around England. Its purpose is to help practitioners ensure that the planning functions they deliver provide the most beneficial outcomes for the health and wellbeing of the community. 

• What does a livable, loveable city look like? An illustration from the Phillips Center for Health and Wellbeing

• Details of a randomised control trial in New York City investigating the impacts of affordable housing on health and wellbeing

• A Time magazine story analysing the County Health rankings in the US, which show, not surprisingly, that poorer urban and rural counties landed at the bottom of each state’s health rankings and the richer suburban counties reigned.

• An LA Times story on how one disadvantaged neighbourhood gained from a refocus on prevention

A great idea for an investigation, whether by researchers or journalists – spend time in a disadvantaged area (Philadelphia in this case) and ask people what matters for their health?

[youtube]http://www.youtube.com/watch?v=xjhr2HS_tG4[/youtube]

• A Canadian project, involving the McMaster School of Nursing, that works with communities to tackle the social determinants of health. Community members are well aware that health involves much more than access to health services.

• Another Canadian look at how urban environment influences health, while the same author also reports on Chicago moves to tackle a local food desert. Meanwhile, this is a natty US Government website that identifies food deserts.

• An Australian Institute of Family Studies report looking at what is meant by community disadvantage. Its key messages, according to this summary:

  • Community disadvantage comes about as a result of the complex interplay between the characteristics of residents living in a community (e.g., unemployment, low income) and the effects of the social and environmental context within the community (e.g., weak social networks, relative lack of opportunities).
  • The idea that economic factors alone are the foundation for advantage and disadvantage undermines the complexity and scope of disadvantage. This view also erroneously implies that economic solutions alone are an adequate response to disadvantage.
  • A number of new perspectives have recently emerged that highlight the multifaceted nature of disadvantage and demand a more sophisticated response to it.
  • In addition to theoretical advances, there have also been advances in the measurement of community advantage and disadvantage.
  • Advances in theoretical understandings and means to measure community disadvantage increase the potential for policy-makers to develop effective public policy. For practitioners, these advances have the potential to enable more in-depth understandings of clients’ needs and experiences.

• The Australian Social Inclusion board has developed advice on governance models that work best for locational approaches to address disadvantage. This paper argues that governments and public services are not typically geared to solving such complex problem and that the Australian Public Service should adopt more decentralised, flexible and more engaged ways of working with citizens.

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Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences