Can where you live impact your health? The answer is yes.
“We tend to blame ourselves a lot. If only I had more willpower! But did you realize that a regular adult-size soda in the 1950s was smaller than today’s child size? I find people are relieved when we talk about these factors because they realize that it’s not just them; it’s not just about willpower.”
Karen Lee, MD, MHSc, FRCPC, an associate professor of Public Health & Preventive Medicine in the Department of Medicine at the University of Alberta, is the author of Fit Cities: My quest to improve the world’s health and wellness — including yours. Her book — newly released this month — documents her experiences and successes improving health through environmental and policy changes while working for the U.S. Centers for Disease Control and Prevention, and the City of New York, among other roles.
“We now know from the available evidence — and it’s a growing evidence base — that the physical environments we occupy either provide supports or can create barriers for our individual motivations and our individual attempts at healthy lifestyle changes, whether that’s physical activity, healthy eating or even our ability to be socially connected.”
Make it easy to make healthy choices
One of the biggest impediments to health is how easy it is to make unhealthy choices and the difficulty that comes with making healthy ones. Our environments tend to pose barriers rather than supports for healthy decisions. Dr. Lee gives the example of a walkable community. Such a community provides various means for people to integrate physical activity into their daily routines, especially when paired with transit. This wellbeing is further enhanced when healthy food is readily available. In contrast, driver-centric communities and unhealthy food exposure are linked with lower physical activity, higher weights and less healthy diets.
“Our schools, our daycares feed our children; they determine how much activity is possible during the school day or daycare day when parents aren’t even there, so how do we make the default options healthier ones? Do we have the required and needed spaces for physical education and recess? There’s the programming side but there’s also the space side.”
Dr. Lee’s book highlights in particular how physical environments relate to individual health. She gives the example of how buildings are now designed for escalator and elevator use, as opposed to favoring the use of stairs for able-bodied individuals. This leads to inefficiencies like elevators stopping at every floor and removes an opportunity for daily active living.
“For example, there is a Harvard Alumni Study, a cohort study of over 10,000 men whom they followed over a 13 year period. They found that the men who climbed an average of 20-34 floors of stairs per week — divide that by seven and that’s only three to five floors a day — had a 29 per cent reduction in their risk of stroke, regardless of whether or not they exercised in leisure time,” says Dr. Lee.
“So these things that are incorporated into our daily lives are actually really important pieces of whether people can achieve the healthy behaviour changes that we know they’re trying to make.”
Physicians can advocate for healthier spaces
If there’s one takeaway that Dr. Lee would like people to get from her book it’s that everyone can play a role in advocating for and working towards healthier spaces. For example, hospitals are often rife with unhealthy food retail. Physicians might lead the call for healthier food options. Hospitals can also serve as spaces for healthy amenities if such facilities are missing from a neighbourhood. For example, Dr. Lee says they can incorporate into their designs walking spaces and paths, and farmers markets, placed in and around the hospital site, if activity spaces and healthy foods are needed in the community.
“I hope the book will stimulate discussions among health care providers, many of whom are part of the leadership teams in their health care settings,” says Dr. Lee.
“We should think about what we can do within those environments to improve the health of our staff, but also our patients and their families.”