COVID-19 has brought health front of mind. It has infected over 500 million people worldwide and created major supply chain disruptions, resulting in a healthcare system and economic crisis. Such events will become more frequent – but in the meantime, rates of chronic illness will continue rising.
These forecasts aren’t foregone conclusions; there are things that we, as shapers of the built environment, can do to reverse these trends.
These factors influence four of the most important determinants of health:
- physical activity (responsible for 20-30% of leading chronic diseases including cancer, diabetes and heart disease);
- food choices (responsible for 25% of deaths);
- air and water quality (responsible for 25% of all deaths and 30% of cardiovascular disease); and
- the feeling of inclusion and safety.
Green spaces, for example, entice exercise and strengthen our immune systems. The presence of fewer fast-food outlets is correlated to 50% lower incidence of diabetes. And reduced travel from fossil fuel-powered vehicles is associated with lower incidence of respiratory disease.
However, it is not enough to add a few more parks, remove fast-food restaurants or introduce e-bikes. Many people might not benefit from these improvements due to personal vulnerability factors. There are also global megatrends that will further increase people’s vulnerability in the built environment.
Financial insecurity, ability-related barriers, and oppression reduce likelihood that the built environment supports physical and mental health. For example:
- Low-Income. In the U.S., the richest 1% live 12 years longer than the poorest 1% – partly because lower-income households have lower quality housing with poor air and water quality, and find employment and healthcare less accessible.
- Children. Poor housing increases children’s risk of illness and disability by 25%.
- BIPOC (Black, Indigenous, and People of Colour). BIPOC are less likely to have access to healthcare services. Many racialized communities have been underfunded for decades, offering weak physical foundations for health.
- First Nations. Only 35% of First Nations reserves have adequate internet access, compared to 87% of the Canadian population overall - resulting in poorer access to education, employment and health services.
- Disabilities. In Canada, over 1 in 5 working-age adults have a disability that hinders participation in work and social settings.
Globally, a greater proportion of the population is projected to become a “vulnerable population”, due to a changing climate and macroeconomic trends:
Climate change is the greatest threat facing humanity. Approximately 3.5 billion people are highly vulnerable to climate change. By 2050, 2.5 billion will have been affected by climate change. Heat, flooding and volatile weather patterns will increasingly:
- damage infrastructure, injure people, and disrupt lives and economies;
- cause mental distress; and
- disrupt supply chains and food and materials production, decreasing access to commodities required for health.
The real value of most people’s wages has stagnated or decreased in the past few decades in North America. Over half of Canadians say they are falling behind, decreasing their ability to:
- afford healthy homes close to amenities and active transport corridors;
- access employment and education; and
- afford healthy food.
Making Good Health Easy
To reverse rates of chronic disease, requires focus on the people who are most at risk. Here are six solutions to make a difference:
Set health objectives
Use health equality as an indicator for community wellbeing. Communities that improve residents’ overall well-being, such as through walkable neighbourhoods and access to greenspaces, also perform better in other metrics, such as climate neutrality and air quality.
Map health risks
Map walking distance, facility accessibility, demographics, air quality, housing condition, and climate risks across your community, to understand baselines and needs. Overlay anticipated projects and investments to see which locations need more attention.
Human-centred design: barriers and pain points
Identify individuals whose health and wellbeing are lowest. Work with them to map barriers and pain points on their daily journeys. Engage people who are difficult to reach, as their health and wellbeing may benefit the most.
Use successful design to influence policy
Test new approaches to improving health and wellbeing through individual projects. Where successful, convert these improved standards and approaches into policy.
Data, modelling and simulation to understand decision impacts
Bring together datasets on socio-economic and health status; infrastructure investments; and social programs, and monitor trends over time. This requires agreements for the sharing of government, non-government, and private data to gain real insight about how wellbeing improves overall.
The impact of technological changes is highly uncertain. For example, will smart, clean transit options be affordable and accessible for vulnerable populations? Or expensive, mostly benefiting already well-off sections of the population? A good technology strategy can help ensure technology promotes equity.