PLACES

Designing for Health in HEALTHY

WHAT THAT MEANS, WHAT IT LOOKS LIKE & HOW PUBLIC POLICY CAN MAKE IT HAPPEN

HEALTHY PLACES 1 TABLE OF CONTENTS

4 Introduction 6 About Active Neighbourhoods Canada 8 Healthy Places in the Making 10 Why Healthy Places? 18 What do Healthy Places Look Like? 30 The Policies That Make Healthy Places 34 Conclusion

A project of Sustainable Calgary’s WHAT IS A HEALTHY PLACE? Active Neighbourhoods An environment that Canada program promotes healthy behaviour like walking, cycling, socializing, playing and CREDITS

Authors: Celia R. Lee and Katie J. Lore healthy eating for those of Editor: Roxanne LeBlanc Design: Fran Motta all ages, incomes, genders Renderings: Matthew Knapik Published March 2019 and cultural backgrounds.

2 SUSTAINABLE CALGARY INTRODUCTION Changing the built environment could significantly influence people’s daily

Are we building communities for health? air quality. Transportation options help people get to physical activity. Chief Public Health Officer of Canada Dr. Theresa Tam work on time and reduce employee turnover. Healthy devoted her first publication in office to designing places increase productivity and reduce health care costs. healthy communities. It recognizes that the way we build Healthy places are attractive to tourists and prospective cities and communities contributes to disturbing health workers alike. — DR. THERESA TAM, CHIEF PUBLIC OFFICER OF HEALTH trends, and to the leading causes of death faced by It is time to scale up. Cities and communities have Canadians today. been taking action, creating policies and projects to Throughout history, we have adapted our cities to make their places healthier. For five years, we have respond to our most pressing health concerns – think engaged communities in Alberta in a participatory sanitation, public parks, emissions regulation. Health planning and co-design process towards that same goal. trends suggest we are facing a new health crisis. While We can leverage all of this work for greater impact. In our medical system has responded expertly, we haven’t this booklet, we share our research and co-design work, taken sufficient strides to reverse the root causes of and put forward policy recommendations that emerged these issues, which lie outside the scope of medicine from community conversations, subject matter experts and within the realm of the built environment and its and our own design explorations. We want to start a effect on human behaviour. conversation about healthy places in Alberta, and the Rates of diabetes and obesity are on the rise. We role of policy in making them happen. The overarching are increasingly sedentary. We spend too much time goal we propose: that all new provincial infrastructure in vehicles. Our cities reflect this car dependency, with projects demonstrate how they support healthy and most urban growth occurring in low-density suburbs. equitable built environments. A comprehensive approach We know these trends – health, urban form, vehicle use will allow Alberta to scale up, invest, and commit to – are related. They are also at odds with what we hear building a province of healthy places. about the aspirations of Albertans, who value physical activity in daily life, recreation and tourism. We want human connection. We want places where our kids Celia R. Lee, Program Director can be active and safe, and places where our seniors Katie J. Lore, Research and Community Liaison can age happily. Noel Keough, Sustainable Calgary President Adapting the built environment can improve health. Many people have been involved in research, community action, government programs and policy, and private investments to make change happen. As you’ll see in this booklet, the solutions to this health crisis look and feel great! Consider communities that are safe for children and seniors, that create places to bump into neighbours, where amenities and transportation options are accessible and available to all. Healthy places have multiple benefits across sectors, levels of government, ministries and departments. Healthy places are climate-friendly. They contribute to better

4 SUSTAINABLE CALGARY HEALTHY PLACES 5 ABOUT ACTIVE NEIGHBOURHOODS CANADA The Participatory Planning Process How can the design of communities 1. LAUNCH Establish a partnership with local stakeholders and lay out an contribute to public action plan. 2. health and health UNDERSTAND Create a portrait of the use equity? of public space. 3. EXPLORE Identify design scenarios that will meet needs and resolve issues.

4. DECIDE With the various stakeholders, validate and improve upon the developed solutions.

This question inspired the development of Active We focus on communities experiencing lower than 5. Neighbourhoods Canada (ANC), a partnership of the average incomes or those with higher proportions of new ACT Montreal Urban Ecology Centre, the Centre for Active Canadians, because these places are often underserved Participatory planning is Implement the design Transportation, and Sustainable Calgary. Funded by the when it comes to active transportation infrastructure, and an approach to designing solutions and advocate for Public Health Agency of Canada, we work with commu- as a result experience health inequities. Our approach active, liveable cities, citizen visions. nities to design walkable, bikeable and liveable places. is uniquely founded on the connection between health which makes urban We have developed a co-design approach that brings equity, community participation, and built environments planning accessible, com- citizens, design professionals and decision-makers that support active transportation. munity-driven, and fun. It is together to identify and work toward changes in their Through this program, Sustainable Calgary has grounded in the belief that 6. neighbourhoods. Our approach makes urban planning worked with over 1200 community members, collabo- blending local and expert accessible, community-driven and fun. We believe that rated with more than 20 governmental and non-profit knowledge leads to strong CELEBRATE blending local and expert knowledge leads to strong organizations, and 75+ professionals in design and outcomes. We work on the infrastructure, and outcomes. planning – and we’ve been taking notes! Now in Phase neighbourhood scale, and placemaking all inform We have used this approach in 12 communities, with 3 of our work, we are scaling up. We continue our take an integrated view residents’ experiences each organization working with four communities in their core work in communities, while also sharing what of planning. Since land of their neighbourhoods, province. In Alberta, we work with three urban and one we’ve learned to inform policy, professional practice use, urban design, we involve professionals rural community. and curriculum. architecture, transportation across these disciplines.

6 SUSTAINABLE CALGARY 7 1960s 1990s 2010s Healthy Places in the Making — Vision Zero A boom of research, dissemination and action Vision Zero is approved by the Writing on the links between active transportation, health and the built environment surges. Adapting cities for health since Swedish Parliament. Fatalities The Canadian Institute of Health Research identifies healthy cities as one of their priority decrease 30.7% 1980-2016, areas, and the Centre for Healthy Communities is founded at the . and Sweden has the lowest In Alberta, traffic safety strategies focus on the relationship between street design, 3000BC rate of fatalities at 27/million behaviour and safety. Communities experiment with tactical urbanism, cycling inhabitants. The Vision Zero infrastructure, “road diets” and new speed policies. movement spreads across the world. Air Quality 2011 - Obesity rates 3000 BC 1850s – 1910s – New and numerous air quality triple among Canadians, regulations in Canada lead 1985-2011. 2015 2017 Skara Brae, Scotland The Cycle Track is built in East Village in Calgary is to substantial air quality Earliest record of 1890s - Rates of diabetes Calgary, following the Peace designed with a commercial 1920s improvements. 2014 separate fresh and The Lungs of the City The Rise of the Personal Places for People increase by 39% in Alberta, Bridge in 2012. Cycling sees street dedicated to pedestri- waste-water systems. Frederick Law Olmsted Vehicle Jane Jacobs and Jan Gehl focus 2003-2014. a 50% increase for work trips ans and the first parking-less frames parks as the on building ‘places for people’, 2012-2018. building. Personal vehicle use - SOx emissions in “lungs of the city” and as where people can walk, enjoy each 2014 increases. Collisions increase, Canada have decreased The City of Edmonton an important opportunity others’ company, and frequent local and are met with backlash 71%, 1990-2014. adopts Vision Zero. for recreation and from concerned parents businesses. Their analysis and tools 1996 - “City Repair” group is exercise for all. and citizens. The concept of contribute to the field of Planning. born in Portland, in response “jaywalking” is born. 400s BC Places for “Superhighways” to a fatal collision with a Hippocrates: On Airs, Highway 401, the Don Valley Parkway child. They focus on what will Edmonton’s first Waters & Places and Autoroute Metropolitaine become known as tactical Hours spent driving dedicated bike A warning against 1890s - “Water Closet are built. Interestingly, Calgary urbanism. is correlated with swamp-living. Ames” (Herbert Brown shelves the proposed “Downtown lanes lead to 1998 - Healthy Cities initiative obesity, according to Ames) leads a campaign Penetrator”. Parallel proposals to (1998) launched by the WHO. University of an 81% increase against “pit privies” in pedestrianize 8th Avenue and turn Calgary joins in early 2000s. Montreal. 7th Avenue into a transit-only street Calgary research in cyclists from move forward, and exist today. published in 2014. 2017-2018.

1978 - Edmonton Light Rail 2003 - London 2009 - Edmonton Transit (LRT) is born. As of Airdrie, Alberta congestion charge passes its Active 2016, Edmonton has one of is introduced. Transportation Policy. 1885 - While not the changes speed In 1952, The the busiest LRT systems in only Canadian city to - Diabetes - Calgary’s Great Smog of North America. limit on most 2006 2009 experience outbreaks identified as “global Municipal Develop- of smallpox, Montreal London causes residential threat” by the UN. ment Plan aims to limit sees the highest 4,000 deaths roads to 30km urban sprawl. mortality rates in over five days - Active North America in per hour. 2009 Neighbourhoods the 19th century. due to smog. 1850s 1979 - ¼ Canadian 2006 - ⅓ Canadian Canada is funded children are over- children are obese. The “Sanitary Idea” by the Public Health John Snow traces a weight or obese. Agency of Canada. 2018 cholera outbreak to a Research out of the polluted well, leading to University of Calgary changes in urban waste reveals that as Walk- and water systems ScoreTM increases, across Europe and later 1920s & socio-economic status in Canada. increases, and weights 1930s 1970s decrease. Rural Conservation The World Health Suburban sprawl 1981 - The Calgary Light Campaigns to protect rural Organization’s Healthy begins in earnest. Rail Transit is born. environments take shape in Cities initiative turns 30 Britain. Green belts and urban Stop de Kindermoord 2000s (2018), with 57 publica- 1760s – growth boundaries aim to con- With over 500 child fatalities Physical activity, health and the built tions on urban health. 1850–1920 trol urban sprawl and protect in one year, Dutch citizens 1980s environment The City of Edmonton 1840s The rise of Canadian cities. agricultural land, forests, and protest. Combined with oil The World Health The U.S.Centre for Disease Control focuses on releases Winter Design The Industrial By 1921, 50% of Canadians natural, recreational spaces. shortages this shifts Dutch Organization World the relationships between built environment and Guidelines. Revolution live in cities. Public transport Similar policies are adopted in cities to design for travel on Charter physical and mental health, and funds the Healthy 2016 The growth of cities in services suburbs by horsecar, the U.S. in the 1950s, in France foot and by bike. Cycling is Access to health, including Design Initiative. In Alberta, municipal policies curb Calgary introduces new The Canadian Institute Europe leads to poor then electric streetcar. Street- in the 1960s, in South Africa in now the most commonly used a healthy environment, suburban sprawl. Federal and municipal govern- off-site levy bylaw to reduce of Planners releases their sanitation, air pollution cars appear in Edmonton and the 1970s, and in Canada and transportation mode for 36% is acknowledged as a ments invest in housing developments designed financial incentives for Healthy Communities and disease outbreaks. Calgary in 1908 and 1909. Australia in the 2000s. of the population. human right. for walkability and a vibrant local economy. low-density development. Policy.

8 SUSTAINABLE CALGARY HEALTHY PLACES 9 WHY HEALTHY PLACES? Health Equity Even those who

Not every Albertan has access to opportunities that aren’t that into improve their health, and this is impacted by their income. The more affluent In Calgary, Communities experiencing low-incomes are more are 3-5x more neighbourhoods likely to have poor infrastructure: less green space, fewer active. with lower house- sidewalks and pathways, and less connection to other walking will do it Households in Alberta with hold incomes are communities and destinations. They experience more an annual income between correlated with traffic and pedestrian collisions. As a result, they dis- $125,000 and $149,999 proportionately experience poor health. When it comes were 3.5 times more likely more pedestrian more in accessible to be physically active than collisions. to consultation and engagement on city development, households with an income lower-income communities are also often left out of of less than $20,000. See map on the pages 16-17. the conversation. In 2018, Sustainable Calgary and Active Neighbour- environments, with hoods Canada conducted research on the relationship between neighbourhood income and the frequency of collisions in Calgary. A relationship does exist: in lower income neighbourhoods, collisions are more frequent. measurable health The cause of this requires further investigation, but it suggests that low-income neighbourhoods would benefit benefits. from quality and effective infrastructure.

Age Inclusion

Not everyone can drive. Children, seniors, and people with mobility issues rely on other modes of transporta- tion. Our cities, designed for cars and drivers, isolate a Physically active Seniors provide We know Albertans love to walk and be active, and huge portion of the population. By 2031, 1 in 5 Albertans children are 1 billion volunteer that physical activity helps prevent and manage will be a senior. Research tells us that community design better students. hours nationally diabetes, obesity, cancer, and heart disease. Yet, plays a role in how socially connected these seniors will They have better academic with an estimated value too many Albertans are sedentary for more than 10 be. Poor pedestrian infrastructure or ice and snow can achievement, concentration, of $23 billion annually. hours every day, so we have to ask: why? Is our built cause less mobile seniors to become isolated. This social and classroom behaviour. Without access to their city Even their ability to manage and community, seniors environment safe and welcoming enough? Research tells isolation comes with an economic cost. stress and self-concept is simply cannot make these us that some Albertans do not have access to places Children, like seniors, are affected by neighbourhood improved. contributions. that encourage them to be active. On the other hand, design. Research has shown a connection between when there are accessible pathways and destinations, increased physical activity (such as walking or biking to people walk more. Even those who report “not being that school) and benefits in the classroom. When children into walking” will walk more in walkable environments, are physically active, they have better academic simply because it is convenient, with measurable health achievement, concentration, classroom behaviour, and benefits. In addition, people who have access to green more focused learning. Even children’s ability to manage space, recreation centres, parks, or bike paths are much stress and develop a healthy self-concept improves with more likely to get the physical activity they need. more physical activity.

10 HEALTHY PLACES 11 WHY HEALTHY PLACES? DID YOU KNOW?

Transit users are healthier Decreasing residential simply from walking to and speed limits from 45 to from transit stops 30 km/hr can increase In 2016, pedestrian survival in pedestrian collisions and fatalities collisions from 50-90% cost Calgary an estimated Cycling 20 minutes per $120 million day can reduce risk of $10 heart disease by 50%

estimated amount inactivity costs Canada annually

IN OUR PROVINCE BillionTRENDS ON ↑ Sedentary behaviour “Shifting from sedentary THE RISE ↑ Diabetes behaviour to low levels 55% 37% 39% of Albertans Albertans increase in ↑ Obesity and child obesity of activity” results in a are overweight sedentary 10+ diabetes ↑ Suburban development significant reduction of or obese hours per day 2003-2014 ↑ Hours spent driving all-cause mortality

SUSTAINABLE CALGARY HEALTHY PLACES WHY HEALTHY PLACES? WHY HEALTHY PLACES? The Environment $2.3-$3.7 The Economy

billionCongestion cost to the 9 largest Canadian municipalities in 2006 ⅔of household greenhouse gas $2lost to San Francisco businessesbillion annually emissions in Canada through employees stuck in traffic come from personal transportation $255 $700- Average money spent by Commercial districts benefit from great pedestrian and cycling tourists in Alberta, cycling infrastructure through increased property values according to the Ministry of $3000 and sales, and decreased pedestrian collisions. Trends on Tourism, Culture, and Sport U.S. dollar increase in home In 2018, the City of Calgary set aside $5.5 million for (2018). That is $84 more than values alongside a 1 point 1/10th the rise the average visitor at $171 increase in WalkScoreTM active transportation in the Manchester area, also home A commuting cyclist has ↑ Greenhouse gases to the city’s booming beer industry - the Barley Belt. This 1/10th the environmental funding will have wide ranging benefits. For example, footprint of someone who ↑ Global temperatures drives to work ↑ Car ownership there is evidence that a thriving beer culture brings eco- nomic benefits. Breweries in the state of Maine added $228 million to the state’s economy and employed more than 1,600 people. The community of Manchester, where the Barley Belt is located, is underserved when it comes to quality pedestrian infrastructure. Funding in Manches- ter to improve pedestrian and cycling infrastructure will Alberta produces the largest volume of greenhouse 14,400 3.6 make the community safer, encourage physical activity, gas in the country, more than the second leading premature deaths per and offer more transportation options. producer, . Community design can help reverse year are linked to air According to the Ministry of Culture and Tourism, pollution in Canada million these trends. In fact, creating walkable and transit-ori- motorized vehicles “Recreation, active living and sport are integral to the ented communities is the most effective way to reduce in Alberta culture of Alberta”. According to the Alberta Recreation household greenhouse gas - more effective than having Survey (2017), 96% of Alberta households participated in energy-efficient vehicles or houses. Of course, both an activity that year, with walking, gardening, bicycling, are best! aerobics, and jogging being the most popular. Approximately 3.6 million motorized vehicles travel This attraction to recreation extends beyond Alberta on Alberta roads, and the air pollution they create poses Alberta is the residents to tourists from around the world. Calgary was a major health risk to Albertans. Not only does poor air #1 producer of 274 listed on the New York Times 52 places to visit in 2019. quality affect breathing and lung conditions like asthma greenhouse gas megatonnes Why? The architecture of the new Central Library and the and Chronic Obstructive Pulmonary Disease (COPD), it Alberta’s greenhouse development in East Village. When we invest in healthy also increases the risk of stroke. Building healthier places emissions in gas emissions in 2015 places, it not only benefits Albertans, it can also have an would decrease these adverse health effects. The choice Canada impact on the tourism industry with economic benefits. to bus, walk, or bike means people pollute less: a decision In 2016, the tourism industry brought in $8.5 billion and that is good for their health and their neighbours. currently supports 127,000 jobs in Alberta.

14 15 Health Inequity — Pedestrian collisions tied to neighbourhoods experiencing low incomes

Are we designing our cities for health equity? SOURCE: KHAKH, 2019

In 2016, 1691 pedestrians and cyclists were injured in collisions in Alberta, 3 of which were fatalities. City of Calgary : Pedestrian Collisions Several North American cities have correlated pedestrian collisions with socio-economic factors Pedestrian such as income, age, gender and ethnicity, as well Collisions 2016 as with the quality of the built environment. We wanted to know if the same held true in Calgary, and commissioned new research to explore this. Preliminary results tell us there is a correlation Median After-tax between collision frequency and nearby household Household Income ($) incomes. Research is underway to explore addi- tional contributing factors. Of particular interest is analysis of collisions as a rate of total pedestrians or of local population density. Research in other cities suggests that serious pedestrian collisions are more See this interactive map likely in areas that experience both lower incomes for yourself at: and lower pedestrian flows. https://bit.ly/2ufFalX

16 SUSTAINABLE CALGARY HEALTHY PLACES 17 WHAT DO HEALTHY PLACES LOOK LIKE? “I love the Farmers’ Market, What Encourages it has changed my lifestyle. Many other seniors do too.” Active Transportation? Quotes from residents Dedicated Public transit infrastructure Density stop nearby for walking People will walk if and cycling ”The road is wide enough for cycling but cars go by at high there are destinations speeds. I still use the sidewalk when I’m with my son.” Connected Attractive to walk to and great streets spaces pathways to get them Nearby amenities there. Green ”The railway is a barrier.” spaces Feelings of safety Public art and We’ve heard from experts and non-experts that what Association of City Transportation Officials (NACTO) makes a healthy place will vary based on the context of and Complete Streets design guidelines. In Alberta, we cultural spaces the place itself. Asking who are we designing for? Urban have Alberta Health Services’ WalkABle program, which or rural? What budget do we have? engaged communities to create healthy urban and rural A door every 6 metres “If we created access to We do know that some aspects of the built environments. We can learn from Edmonton’s Winter City increases walkability – the new car dealership environment lend themselves to more physical activity Guidelines, Calgary’s StepForward Pedestrian Strategy, particularly in commercial across the nearby and liveable communities. “Generally, areas with higher Safer Calgary’s “Safe and Smooth” program – and more. districts. This can have a highway, it would create population density, a mix of residential, commercial, In the following pages, we share what healthy places positive impact on local walk-to-work educational and employment areas, connected streets, could look like based on our research and co-design business, because it opportunities for us.” good access to destinations, bike paths, good sidewalks, experiences. These designs reflect community priorities. means smaller and more good public transit, green spaces and attractiveness They respond to the needs of seniors, children and new commercial bays – which have been linked to more active transportation or Canadians; they address local economic development are more affordable for Affordable reduced driving (Tam, 2017).” Low-density development, and tourism, traffic safety, public health, transit small business. How recreational on the other hand, means less access to transit, more investments, climate-friendly design, health facilities many doors per block Gathering driving and higher rates of obesity. and schools. This work represents a community-based do you have in your facilities Tools and resources exist to help communities mandate to work towards Healthy Places in Alberta, and town centre? places develop healthy places, including the National inspires us to consider what policy change can look like.

18 SUSTAINABLE CALGARY HEALTHY PLACES 19 Urban Form — A case study of Calgary WHAT DO HEALTHY PLACES LOOK LIKE?

Sustainable Calgary’s Active Neighbourhoods Canada “Patchiness” in Calgary’s density 2 NUMBER OF INHABITANTS PER KM program has been developing design schemes based makes public services and utilities 0 1001-2000 5001 - 10,000 on community feedback for the past six years. more expensive, and doesn’t promote These aim to promote more liveable, walkable and active transportation, but the updated 1 - 250 2001 - 3000 >10,000 vibrant communities. What do healthy places look like? Municipal Government Act provides 251 - 500 3001 - 4000 Here are some of our ideas! an incentive to start filling the gaps. 501 - 1000 4001 - 5000

Calgary Berlin, Germany Madrid, Spain Osaka, Japan SOURCE: GUO, J. AND FAST, V., 2018. V., J. AND FAST, SOURCE: GUO,

DESIGN SCHEME: LANEWAY + PARKWAY, MARLBOROUGH, CALGARY

Calgary Montreal Toronto Vancouver Green walking networks, How can we design healthy places in Alberta? New These maps show that Calgary has unevenly research suggests we can begin by filling in low-density distributed density compared to other Canadian cities, parkside living and gentle areas in our cities and communities. and even more so when compared to Madrid, Berlin and Federal and municipal projects have already done this Osaka. This isn’t the most financially efficient use of land density make walking/cycling by developing decommissioned military bases or land when it comes to services and infrastructure. It also does previously considered undevelopable: East Village, Garri- not promote healthy behaviours, which improve with safe and attractive, and son Woods, the Bridges and Village at Giesbrach. Recent increased density and increased access to transportation changes to the province’s Municipal Government Act options. A population density of 1160 people/km is increase use of local parks. (MGA) make this kind of development more attractive, by correlated with less driving. providing tax breaks for “brownfield” re-development.

20 SUSTAINABLE CALGARY HEALTHY PLACES 21 DESIGN SCHEME: ACADIA POP-UP PLAZA DESIGN SCHEME: ACADIA POP ROCKS

Collaborators: Sustainable Calgary, the Acadia A prototype Community Association, O2 Planning + Design, the bench project, Kilometre Design, the City of Calgary, Arusha, n+1 design, local volunteers, and the Acadia brought the pop-up Art and Garden Society. Funded by The Alberta plaza to life. Traffic Safety Fund.

MORE AT SUSTAINABLECALGARY.ORG

Speed on residential roads has been a concern for local residents for many years. They have also said they A neighbourhood would like more local hangouts – places to run into neighbours, sit, chat, drink and eat. The pop-up plaza gathering space is turns unused parking stalls into a flexible neighbourhood plaza in the heart of Acadia. If you put chairs out, will also a traffic people come? Can a coffee truck become a sustainable business? This project offers a playful space to ask calming strategy. questions about life in Acadia’s public spaces.

22 HEALTHY PLACES 23 DESIGN SCHEME: CONFLUENCE - RETHINKING HERITAGE STATION DESIGN SCHEME: RE-IMAGINING BONAVENTURE DRIVE, ACADIA

A new plaza and commercial district at a major transit hub makes travel convenient, attractive and safe.

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Behind many commercial streets in Calgary sits another street that does the ‘dirty​ work’: loading, shipping, and dividing commercial from residential. What if it became a walkable main street?

24 HEALTHY PLACES 25 DESIGN SCHEME: MERCER TRAIL AND PEDESTRIAN BRIDGE, HIGH RIVER DESIGN SCHEME: LANDSCAPE LRT BRIDGE, BRIDGELAND-RIVERSIDE

The green bridge creates an oasis above city traffic and helps connect three popular communities that each have missing amenities.

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A north-south pedestrian link across the river connects residents to each other and to local businesses.

26 HEALTHY PLACES 27 PROJECT: FOCUS ON HEALTH CARE FACILITIES PROJECT: RE-IMAGINE CATWALKS

How can we take advantage of great existing infrastructure?

Catwalks: Pedestrian pathways that provide shortcuts to schools, parks, stores and bus stops

Marlborough residents told us that catwalks were essential to pedestrians, but that they were unsafe and not accessible for everyone. In 2018, we started to change that by working alongside the community “Healthy Places: A Precedent Review of Integrated to reimagine what the catwalks could be. Partnerships How can health Health Care Facilities” is a publication highlighting with two local schools, Marlborough Elementary and examples of innovative design in healthcare facilities: Bob Edwards Junior High, created lessons on equity facilities improve community-integrated, inviting, walkable, and mixed-use. and inclusion, introduced children to urban planning, We commissioned this work in response to a new facility and allowed youth to contribute to their communities. slated for Bridgeland-Riverside, where residents – Students used this knowledge to make temporary chang- health beyond primarily seniors in seniors’ housing – wanted amenities, es to the catwalks. They painted, gardened, and added vibrancy and walkability. We held the 2018 Healthy lighting and play materials. They also drew plans for the their walls? Places event to share this work and start a local conver- catwalks, made a snow-clearing game, created afford- sation. This brought experts and leaders to the table, able housing, and installed community food pantries. shed light on local challenges and showcased local In the weeks following the redesign, we heard and saw capacity. Conversation revealed shared enthusiasm and that the catwalks were being used - and not only to a will to create ‘healthy places’. It stressed the need to do pass from street to street. Hula hoops leaned against so collaboratively in complex health care developments, the fence, and chalk drawings scattered the pavement. leveraging different jurisdictions and stakeholder groups. One neighbour told us that she used the garden to get Participants mentioned a need to build on this work by salad greens and tomatoes. Another neighbour told us developing guidelines and best practices – in healthy the catwalks were cared for and respected. “It goes to design and in collaborative processes - and engaging in show,” she said, “that people really feel pride for their pilot projects. neighbourhood”.

28 SUSTAINABLE CALGARY HEALTHY PLACES 29 THE POLICIES THAT MAKE HEALTHY PLACES Building Learning on our From Successes Others 1 1 WalkABle Bike BC an Alberta Health Services a Province of BC initiative program that aims to make that contributes half the communities more walkable. funds for cycling projects in Working with 16 cities, towns, 2 towns and cities. The focus 2 and communities, the pro- Edmonton Vision Zero is to create transportation The Greater Golden 3 gram creates local strategies networks, reduce traffic Step Forward Horseshoe Greenbelt Plan based on international best Edmonton was the first city in congestion, and promote a pedestrian strategy in practices. Canada to adopt this policy cycling for commuting and provides a plan for Ontario’s Calgary created to make that makes infrastructure tourism. Greater Golden Horseshoe walking safer, comfortable, and traffic safety changes. area, including future growth and interesting. Six Vision Zero is based on the 3 and protection of the area’s measurable targets to be principle that no deaths are Ontario Cycling agricultural and natural 4 acceptable. Since 2015, Strategy features. It provides a wide completed by 2025 include Winter City Edmonton collisions with motorcyclists range of opportunities for more children walking to promotes cycling and a strategy that wants have decreased by 26%, rural communities, agricul- school, better winter walking cycling safety in the Edmontonians to “fall in love pedestrians by 14.6%, and ture, tourism, recreation and conditions, and 15% of trips province. This collaborative, with winter”. Developed with cyclists by 19.6% resource uses, and works made on foot. 20 year vision is guided a local spin, it is based on against climate change. by five areas: healthy best practices from winter and active communities, cities around the world. The safer streets and highways, strategy considers social, 4 cycling awareness and Quebec’s Sustainable cultural, and economic fac- 5 7 behaviour change, quality Mobility Policy tors, and focuses on planning Walkable Camrose - Canadian Institute of cycling infrastructure, and and design changes that Snow Removal responds to the challenges Planners’ (CIP) Healthy cycling tourism. make active transportation Communities Policy Campaign faced by public transport 5 and physical activity possible users, including public health, The Metro Vancouver recognizes the role of plan- recognizes that older adults, year-round. public safety, and vulnerable Translink Regional ners to create healthy built people with limited mobility, and parents with strollers persons with mobility issues Transportation Strategy environments that promote and disabilities. The policy active lifestyles and protect struggle to remove snow responds to a growing region from their sidewalks and get aims to reduce motorized the health of Canadians. This 6 trips and traveling distances that requires affordable, Grande Prairie Active around the city after a heavy policy commits to designing through better integration accessible, and sustainable streets for all users, creating Transportation Strategy snowfall. The campaign per- transportation choices. It sonalized the need for snow of land use and transporta- a human-scale and inclusive embraces its northern, winter tion; increase low-energy aims to have half of all trips public realm, and ensuring removal, showing community made by walking, cycling city status and makes active members who needed help consumption options such adequate, accessible, and public transportation as public transit and active or transit, and reduce the and affordable options for clearing their walkways and distance people drive by one the easy and first choice. asking the question: “will transportation; and improve housing, transport, and The focus of change is the vehicle efficiency. third. With 407 million transit health services. you shovel for my family, my boardings in 2017, transit built environment, transit, friend, or my mother?” and active transportation ridership grew more in Metro for school, commutes, and Vancouver than anywhere leisure. Funding changes, else in Canada and the including an increase in United States. snow removal funds, are recommended.

30 HEALTHY PLACES 31 THE POLICIES THAT MAKE HEALTHY PLACES

All new provincial infrastructure projects demonstrate how they support healthy and equitable built environ- ments, as determined by new guidelines. Guidelines Scaling Up — Our policy for healthy built environments are developed through a collaborative, inter-ministerial process that builds on best practices. Assessment tools for healthy built recommendations environments are identified and adapted. Guidelines for multi-stakeholder collaboration are developed, to help major infrastructure projects respond to the needs of the local community, and best leverage We want to start a conversation about healthy places in the roles, responsibilities and strengths of stakeholders. Alberta with a set of provincial policy recommendations Affordable that emerged from what we heard from community Housing New affordable housing Seniors’ projects funded by the prov- conversations, subject matter experts, and from our ince are sited in healthy and Housing affordable places. Projects explorations in co-design. must demonstrate how their New seniors’ housing design and site selection projects are in healthy and support healthy, affordable age-friendly places. Projects and equitable built environ- funded by the Province ments. Affordable housing Tourism demonstrate how their locations are often based on Transportation design and site selection land costs, which does not Health The Province invests in support healthy and always coincide with overall regional active transportation (a) Roads and bridge projects age-friendly built environ- suitability. The surrounding The Province supports and infrastructure that meet the demonstrate how they sup- ments. As our population built environment can play grows the role of Alberta Infrastructure needs of local communities Environment port healthy and equitable ages, we need to consider a big role in determining Health Services’ public and tourists alike. Clusters of Education built environments. Attention not just housing, but the suit- household expenses, partic- health professionals, such New healthcare facilities, communities have expressed The Province demonstrates is paid to the role of high- ability of neighbourhoods for ularly transportation. It can (a) The Province invests in as public health inspectors, schools, roads, bridges, the benefits of investing in how Land Use Frameworks ways in rural and indigenous seniors; create age-friendly also affect which economic walking school buses and health promoters and and seniors’ and affordable regional active transportation support public health using communities: how they are places that provide social opportunities and social bike-to-school programs, and medical officers of health, housing investments demon- for tourism and economic identified assessment tools, used by vulnerable users connection, transportation supports are accessible. who already work collabo- strate how they support a development, as well as and enhances support for options, safety, and access (b) incorporates healthy and how they impact local Affordable housing should ratively in local communities healthy and equitable built mobility and accessibility for brownfield re-development. to services, amenities and place-making into curriculum. mobility. Projects respond to emphasize affordable and providing expertise on environment. local residents. community needs, regional recreation. healthy neighbourhoods, healthy built environments. Curriculum helps children evaluate the built environ- tourism strategies, especially which incorporate: accessible They and public health those focused on walking transportation options, academics are engaged in ment around their schools and propose changes. We and cycling, and use a Vision amenities, schools, services, developing inter-ministerial Zero lens. food, jobs and affordable policy guidelines and tools know from experience that kids are observant, recreation options. for designing and evaluating (b) An Active Transportation perceptive, and empathetic. healthy built environments. group is created to advise They come up with the best the Ministry of Transportation ideas! and local communities on (c) The Ministries of infrastructure projects, and Education and Transpor- liaise with other ministries. tation collaborate with (c) A fund for active transpor- municipalities and towns to tation projects is created in create active transportation partnership with the Ministry infrastructure around schools, of Environment. The Alberta and contribute to healthy Traffic Safety Fund continues behaviour and successful to provide learning and learning environments. prototyping opportunities for communities.

32 SUSTAINABLE CALGARY HEALTHY PLACES 33 Gordon, D.L.A., Hindrichs, L. and Twells, L.K., Gregory, D.M., St. Lawrence, J. (2007). A demand CONCLUSION REFERENCES C. Willms. (2018) Still Suburban? Reddigan, G. and W.K. Midodzi. perspective on greenhouse gas Growth in Canadian Cities Suburbs (2014). Current and predicted emissions. EnviroStats, 1(2). Sta- 2006-2016, Working Paper #2. prevalence of obesity in Canada: a tistics Canada Catalogue number: Pages 4-5 Council for Canadian Urbanism & trend analysis. Canadian Medical 16-002-XIE. Enviro Stats. 1(2). Queens University. Association Journal, 2(1), E18-E26. Tam, T. (2017). The Chief Public Travel Alberta. (2018). Visitor Health Officer’s Report on the Howell, T. (February 29, 2016). Page 14-15 Economy [webpage]. Retrieved State of Public Health in Canada: Pedestrian injuries, fatalities in from https://industry.travelalberta. Designing Healthy Living. Ottawa: Calgary cost society $120 million Blais, P. (2011) Perverse Cities. com/visitor-market-insight/visi- Public Health Agency of Canada. each year, says city. The Calgary Vancouver: UBC Press. tor-insights/visitor-economy Herald. Pages 10-11 Cortright, J. (2009). Walking the Pages 16-17 Howell, S.T., & Klingbeil, A. (May Walk: How Walkability Raises Alberta Center for Active 10, 2018). Data reveals pedestrian Home Values in U.S. Cities. CEOs Alberta Transportation. (2016). Living (n.d.). Benefits of Active danger: One hit per day, and most for Cities. Retrieved from https://bit. Alberta Traffic Collision Statistics Humans have been designing their Transportation. Retrieved February had the right of way. The Calgary ly/2LAvhp5. 2016. Edmonton: Alberta Transpor- 7, 2018 from https://www.centre- Herald. tation Office of Traffic Safety. 4activeliving.ca/media/filer_public Health Canada. (November, 2017). cities for health for thousands of years, /07/77/077713ef-e097-4bc5-8278 Katzmarzyk, P. (October 1, 2016). Health Impacts of Air Pollution in Anderson, C. L., Vaca, F. E., & -1fb455d26630/2017-active-trans- Tallying the global economic Canada: An estimate of premature Chakravarthy, B. (2010). Socioeco- portation-factsheet.pdf burden of physical inactivity. mortalities. (Catalogue number: nomic disparities in pedestrian from the original wastewater systems Wellspring, 27(10). Retrieved from H144-51/2017E-PDF). Retrieved injuries. Injury Prevention, 16 (Suppl Alberta Culture and Tourism. (2017). https://www.centre4activeliving. from http://publications.gc.ca/ 1). A259--A259. 2017 Alberta Recreation Survey. ca/media/filer_public/a2/e2/ collections/collection_2018/sc-hc/ a2e24beb-85af-4504-b970- H144-51-2017-eng.pdf Delmelle, E. C., Thill, J.C., & Ha, in 3000 BC Scotland to dedicated bike Center for Active Living. (2019). H.H. (2012). Spatial epidemiologic 1b4ae8000454/2016-oct-econom- Alberta Survey on Physical ic-impact.pdf Ministry of Environment and analysis of relative collision risk Activity. Retrieved from https:// Natural Resources Canada. (2017). factors among urban bicyclists and lanes in 2017 Edmonton. www.centre4activeliving.ca/media/ McCormack, G.R. and J.S. Virk. Air pollution from cars, trucks, vans pedestrians. Transportation, 39(2). filer_public/0a/3c/0a3ca055-13c2- (2014). Driving towards obesity: and SUV’s. 433–448. 4ac6-930d-f3062086d118/2019-ab A systematized literature review -survey-physical-activity.pdf on the association between Ministry of Health Canada. (2019). Khakh, A. (2019). [Collision Fre- motor vehicle travel time and Health effects of air pollution. quency and Household Income by Chiu, M.; Shah, B.R.; Maclagan, distance and weight status in Retrieved from https://www.canada. Census Tract: Preliminary Analysis]. L.C.; Rezai, M.; Austin, P.C. and J. adults. Preventive Medicine 66 ca/en/health-canada/services/ Active Neighbourhoods Canada. V. Tu. 2015. Walk Score and the (September), 49-55. air-quality/health-effects-in- Unpublished raw data. Presence of Utilitarian Walking and door-air-pollution.html#hi Obesity among Ontario Adults: A McCormack, G., Blackstaffe, A., Tam, T. (2017) The Chief Public cross-sectional study. Statistics Nettel-Aguirre, A and Csizmadi, National Complete Streets Health Officer’s Report on the Canada Health Reports, 26(7). I. (2019). The Independent Association. (2012) Benefits of State of Public Health in Canada: Associations between Walk Score® Complete Streets: Complete Designing Healthy Living.Ottawa: Government of Alberta. (2011). and Neighborhood Socioeconomic Streets Stimulate the Local Public Healthy Agency of Canada. Active Alberta 2011 – 2021. Status, Waist Circumference, Waist- Economy. Smart Growth America To-Hip Ratio and Body Mass Index and National Complete Streets Toronto Public Health. (April 2012) Ministry of Employment and Social Among Urban Adults. International Association. Retrieved from: https:// Road to Health: Improving Walking Development Canada. (2014). Journal of Environmental Research www.smartgrowthamerica.org/app/ and Cycling in Toronto. Action for Seniors Report. and Public Health, 15(6), 1226. legacy/documents/cs/factsheets/ cs-economic.pdf Pages 18-19 National Seniors Council. (2016). Ontario Ministry of Education. Report on the Social Isolation of Guo, J., and Fast, V. (2019). Spatial (2015). Quick Facts for Parents: National Heart Foundation of Seniors. Retrieved from https:// Insights on Urban Density: A Case Learning about Active Transporta- Australia. (2011) Good for Busine$$: ties that are healthy, climate-friendly and economically www.canada.ca/en/national-se- Study of Calgary. Proceedings Albertans have been a part of this continuous tion, Including Cycling. Retrieved The benefits of making streets niors-council/programs/publica- of the 7th Conference on progression towards health through research, community resilient. Communities that create connections, more from http://www.edu.gov.on.ca/ more walking and cycling friendly. tions-reports/2014/social-isola- Spatial Knowledge and Information eng/curriculum/elementary/trans- Retrieved February, 2019 from: action, private investments, and government programs convenient trips, and happier people. Communities that tion-seniors/page05.html Canada, 7(3), 2. http://ceur-ws.org/ portfact.pdf https://www.heartfoundation.org. au/images/uploads/publications/ Vol-2323/ and policies. Edmonton was the first city to adopt a are built for everyone. Tuckel, P. & W. Milczarski. 2015. Rao, D.P., Kropac, E., Do, M.T., Good-for-business.pdf Walk Score ™ , Perceived Neighbor- Vision Zero strategy, dedicating itself to the vision that When we build these communities, not only do we Roberts, K.O., and G.C. Jayaraman. Pages 26-27 hood Walkability, and Walking in (2016) Childhood overweight and Statistics Canada. (2019). no loss of life is acceptable. Alberta Health Services embrace the future, we also reclaim the past. For many the US. American journal of health Morar, J. (2018) Healthy Places: obesity trends in Canada. Health Greenhouse gas emissions, by created a program committed to making communities in years, we viewed personal vehicles, highways and behavior, 39(2), 242-256. sector. (Statistics Canada Table: Precedent Review of Integrated Promot Chronic Dis Prev Can, Healthcare Facilities. Calgary: our province more walkable. The City of Grand Prairie’s overpasses as vital to our daily lives. Now, we have the 36(9), 194-198. 38-10-0111-01). Ottawa, ON. Wang, K. (2013). Causality Retrieved February, 2019 from Sustainable Calgary. between Built Environment and Active Transportation Strategy embraces its winter city awareness that transit options and complete communi- Rissel, C., Curac, N., Green- https://www150.statcan.gc.ca/t1/ Travel Behaviour. Journal of the away, M., Bauman, A. (2012). tbl1/en/tv.action?pid=3810011101 status and strives to make public transit and active ties create more liveable cities, and positively impact our Transportation Research Board. Physical activity associated with 2397 (1), 80-88. transportation the first and easy choice for residents. health, our seniors, and our children. public transport use—a review Statistics Canada.(2019). Health and modelling of potential indicators, annual estimates, We know that Albertans value health, recreation, and When we build these communities, we all have a role Pages 12-13 benefits. International Journal 2003-2014. (Statistics Canada Table: 13-10-0451-01). Retrieved the safety of their communities. We also know that our to play. That’s what we heard repeatedly in our conversa- Celis-Morales, C.A., Lyall, D.M., of Environmental Research and from https://www150.statcan.gc.ca/ Welsh, P., Anderson, J., Steell, L., Public Health, 9(7), 2454-2478. province enjoys a vast and booming tourism industry that tions with Albertans – that we need to think strategically t1/tbl1/en/tv.action?pid=1310045101 Guo, Y., Maldonado, R., Mackay, is influenced by these shared values. about the skills we bring to the table and how best to Spectator Health. (April 20, 2017). D.F., Pell, J.P., Sattar, N., & Gill, Statistics Canada. (2019). Road The evidence is clear that it is time for the next evo- work together to leverage those skills. The recommenda- J.M.R. (2017). Association between Cycling to work ‘halves your risk of heart disease and cancer’. motor vehicle registrations, by active commuting and incident type of vehicle. (Statistics Canada lution in city-building. The question is: how do we scale tions provided in this document were created from these cardiovascular disease, cancer, Spectator Health. Retrieved from https://health.spectator.co.uk/ Table: 23-10-0067-01). Ottawa, up? How do we make our infrastructure accountable to conversations and we hope they can be a starting point and mortality: prospective cohort ON. Retrieved February, 2019 from study. The British Medical Journal, cycling-to-work-halves-your-risk-of- the health of Albertans, and prioritize those projects that for collaboration between experts, decision makers, and heart-disease-and-cancer/ https://www150.statcan.gc.ca/t1/ 2017(357), j1456. tbl1/en/tv.action?pid=2310006701 promote health? It is clear that we have the knowledge citizens. This collaboration and the policies that occur as Statistics Canada. (2014). Table and tools to do so. Our design work shows what new a result will ensure that we design for health in Alberta 13-10-0096-01 Health characteris- policy can look like when it is implemented – communi- and, ultimately, make this a “healthy places” province. tics, annual estimates.

34 SUSTAINABLE CALGARY HEALTHY PLACES 35 Our mission is to encourage and support community-level actions and initiatives that make Calgary a safer, healthier, more sustainable city. Projects are based on our State of the City reports, which identify where interventions are needed. Recent work with communities focuses on municipal design and planning processes. Our expertise is producing credible research, and engaging with communities to participate in research, discussion and action. We would love to work with you!

sustainablecalgary.org Active Neighbourhoods Canada @sustainableyyc participatoryplanning.ca

What is a Healthy Place? An environment that promotes healthy behaviour like walking, cycling, socializing, playing and healthy eating for those of all ages, incomes, genders and cultural backgrounds

36 SUSTAINABLE CALGARY