Direction de santé publique

Urban environment and health

Perspectives in Montreal: Examples in transportation, physical activity and food security

Lise Bertrand, Anne Pelletier and François Thérien

McGill Institute of Health and social policy, April 14, 2010

Mandate of the Montréal Public Health Department

• Inform the population on such issues as their state of health, priority health problems, vulnerable groups, risk factors and efficient interventions

• Follow the evolution of the public’s health and conduct appropriate research

• Ensure that the required preventive measures are adopted by the appropriate authorities

Objective of the presentation

• To illustrate how the Montréal Public Health Department is working to improve the health of the Montréal population by acting on the built environment

The built environment: a definition

1. Land use (spatial distribution of functions and uses)

2. Design of buildings and public places

3. The transportation system: infrastructures, equipment, rolling stock, policies and service provision

Source: Handy, Boarnet, Ewing and Killingsworth, 2002

Vision of the urban environment and health sector

• Montréal is a city where Indoor and outdoor air are of good quality Housing is accessible, affordable, adapted,

healthy and safe and takes into account the needs of the vulnerable population

Urban planning promotes safe active transportation and promotes mixity of functions and accessibility to local services

Public transit allows for less dependence on the automobile and is accessible for all

Green spaces are available for all Healthy food is accessible within walking distance

of homes

Food environment, food security

Why are we interested in food system ?

• Inequalities in the food environment inequalities in health

• Food access in neighborhood : proximity and types of stores, diversity and quality of foods available, cost…

• « Food Deserts » ! ! ! ? ? ?

• Environmental issues – use of car for food shopping, proximity of services, proximity of production sites

Are there inequalities in access to healthy foods in Montreal?

Source: Bertrand and coll., 2007

CSSS St-Léonard et Saint-Michel (Source: Bertrand and coll., 2007)

Fruit and vegetable selling areas within a walking distance of 500 m ( DSP 2006)

En pieds carrés

Actions sur la sécurité alimentaire et l’approche de développement durable à l’échelle des quartiersVitalité économique•Diversifier les commerces de proximité;

•Revitaliser le secteur économiquedes quartiers;

•Soutenir les producteurs locaux;

•Faciliter l’achat d’aliments à coût raisonnable

Équité• Favoriser l’accès pour tous

à des aliments santé de coût raisonnable;

• Assurer l’accès aux ressources conférant des connaissances et des habiletés (jardins collectifs, cuisines collectives…);

• Développer la solidarité sociale.

• Influencer les politiques

Convivialité• Aménager des espaces publics,

des marchés publics;

• Mettre en place des mécanismes de participation citoyenne;

• Organiser des événements de promotion des aliments du quartier.

Qualité de vie• Réduire la circulation motorisée;

• Promouvoir la préservation de la qualité des sols;

• Promouvoir l’utilisation responsable de l’eau;

• Aménager des espaces verts, des jardins collectis;

• Promouvoir l’achat d’aliments transportés sur de courtes distances;

• Promouvoir la consommation d’aliments non transformés;

• Implanter des stratégies de réduction des emballages.

Milieu de vie• Aménager des pistes cyclables,

des voies piétonnières;

• Aménager des espaces verts, des jardins collectifs;

• Embellir des rues commerciales.

Économie Environnement

D

U R

A B

L E

Social

Septembre 2007 - Direction de santé publique – Agence de la santé et des services sociaux de Montréal

Our actionsCommunity mobilisation

17 local projects financed by Montréal Public Health involving multiple partners (NGOs, local health and social services centers, local municipalities, food producers…) aimed at making healthy food accessible within 500 m of walking distance from the home

Research: access to healthy foods; food consumption; practices and concerns among poor families

Support Nourrir Montréal, a regional assembly

Jardin Guybourg, Mercier-Ouest

Urban transportation: a question of health

Trends in trips: a 20-year evolution on the territory of AMT (1987 boundaries, am peak)

1987 2008 Δ

By car 865 000 1 203 000 39%

By public transit

395 000 427 000 8%

Population 2 910 000 3 464 000 19% (0.8% p.a.)

Nb of cars 1 204 700 1 789 900 49% (1.9% p.a.)

Source : Enquête O-D 2008, Faits saillants

Health impacts

Diseases related to air pollution Injuries and death caused by road

accidents Diseases related to physical

inactivity

All these impacts essentially related to traffic volume (VKT)

The presence of air pollutants varies

according to traffic volume

Source: Smargiassi and coll., 2005

Hospitalization for respiratory problems in people aged 60 years and older

Traffic category

Number of cases (%)

Number of controls

(%)

RR(IC95%)

RR adjusted for SES (IC95%)

<3160 vehicles

5 322 (91,7%)

36 725 (93,5%)

1.00 1.00

3160-7700 vehicles

345 (5,9%)

1 922 (4,9%)

1.24(1.10-1.39)p<0.001

1.07(0.95-1.20)

p=0.28

>7700 vehicles

138 (2,4%)

613 (1,6%)

1.55(1.29-1.87)p<0.001

1.30(1.07-1.57)p=0.007

Source: Smargiassi and coll., 2006

The number of road injuries varies directly with traffic volume

Source : P Morency, MS Cloutier, Urgences-santé 1999-2003; C. Morency. Enquête O-D 1998.

Localisation de l'ensemble des piétons blessés* (1999-2003)

0 4 1502 075

Mètres

* Victimes d'une collision routière ayant entraînéeune intervention d'Urgences-santé.

Projection: NAD83, MTM zone 8Sources: Ville de Montréal; Urgences-santé

Prod. cartographique: MS Cloutier, 2004© Direction de santé publique de Montréal

Sites où un ou plusieurs piétons ont été blessés

Réseau routier

Pedestrians are injured at thousands of different sites!

1999-2003 : 5 082 ambulance calls

Source: Morency and Cloutier, 2005

Strategies advocated towards sustainable transportation

• Reduce the number of vehicle-kilometers travelled

• Increase the number of trips by public and active transportation

• Reduce the speed of vehicles• Design walkable neighbourhoods• Improve mobility for all

Recent examples of advocacy

Participation in public hearings and debates• Transportation projects

Notre-Dame hybrid boulevard/expressway Turcot A-25 Montréal transportation plan Road safety code

• Urban planning CHUM, U de M campus in Outremont Griffintown development project

Active transportation

Walking in Montréal

• 35% of trips shorter than 2 km are made walking

• Almost all (96%) walking trips are shorter than 2 km

• 40% to 50% of peak hour travel are walking trips in Montréal central area. It goes down to 20% in peripheral areasEnquête Origine Destination 2003

Walking’s decrease

• Between1998 and 2003, proportion of 6 to 12 year old students walking to go to school went from 45% to 34% in Montréal(Enquête OD, 1998 et 2003)

• During the same period, car trips to school increased from 17% to 32%

(Enquête OD, 1998 et 2003)

Biking

• 32,5% of the 12 to 17 year old use bike as a transportation mode at least 1h a week (Kino-Québec 2005)

• Use of bike decreases to 6,9% among people 18 years and over(Kino-Québec 2005)

• During peak hour, cycling can be more effective than a car trip for distance up to 8 km (Demers 2006)

Public health involvement to increase active transportation

• Support community projects: Aménager des quartiers durable Quartier 21

• Research: Walkability audit

• Promotion and education: Allego Kino-Quebec campaign’s and program

Support local communities

• Aménagez des quartiers durables: Financial support for eight RUI of

Montreal Information and educational

background Example of Mercier Est

• Quartier 21 Financial support joint with city of

Montreal Information and education

background Tools Example of Peter McGill

Walkbility audit method

• Objective grid use to characterize the urban planning and the structure of a neighbourhood (based on the evaluator’s

judgement)

• Originally conceived for research purpose and advocacy groups

• Allow to collect qualitative as well as quantitative data

Research

• Goal: Create a tool simple enough to be used by communities and complete enough to have a comprehensive picture of the field studied.

• Exploratory phase during summer and fall 2008 in three RUI of Montréal

• Second research phase upcoming this summer integrated to a Canada-wide evaluation project

Thank you!