Notes from a talk I gave at the 2014 Health Summit on Aging, Chronic Disease and Wellness, organized by the Conference Board of Canada.
By Ryan McGreal
Published October 24, 2014
These are my notes from a talk I gave at yesterday's Health Summit on Aging, Chronic Disease and Wellness, organized by the Conference Board of Canada. I was asked to speak about the opportunities and challenges for citizens to organize themselves to create change in their communities.
Of course, no one is opposed to making our neighbourhoods more healthy and age-friendly. They just oppose all the specific actions we need to take to do it.
Let me start by arguing that municipal government exists first and foremost to protect and promote public health.
The great municipal innovations of the past 150 years - distributing fresh water, treating wastewater, collecting garbage, regulating traffic, and so on - can be understood as innovations in public health that reduce disease and injury and improve quality of life.
Another kind of innovation is zoning, which is the legal concept that a municipality should control what kind of use is allowable on a given property. Zoning was originally imposed in part as a public health measure to keep noxious, polluting industrial uses away from where people lived.
It soon took on a life of its own, imposing increasingly fine gradations on land use. In addition to separating industrial uses, we also started separating commercial uses from residential uses. No more shops with apartments upstairs or corner stores - everything must be kept separate.
Eventually we came to the point where a $500,000 house couldn't be on the same street as a $600,000 house.
Our cities have come to resemble a fussy toddler's partitioned food bowl: nothing is allowed to touch anything else.
Over the same period, the car has come to dominate our thinking about how we get around, literally crowding every other way of getting around to the margins of our public streets.
Street designs are subject to traffic engineering rules and regulations that are based on the assumption that everyone will use a car for every trip. The standard way to design a street today is with multiple wide lanes, dedicated turning lanes, timed traffic signals, dangerously high speeds and no obstructions that might slow traffic.
At the same time, our zoning rules have expanded to include universal mandatory off-street parking requirements, based on the same assumption that everyone will drive to every destination.
Cars take up a lot of space whether they're going somewhere or just sitting there. We've had to set aside enormous amounts of land to move and store them.
Donald Shoup, an UCLA economist who specializes in the economics of parking, observes: "the cost of all parking spaces in the US exceeds the value of all cars and may even exceed the value of all roads."
Between the separation of uses, road widening to accommodate car traffic and parking requirements for everyone at every destination, our cities are increasingly spread out.
Everything is far from everything else, street designs are not conducive to walking or cycling, transit service is slow and unreliable, and the only feasible way to get from one place to another is in a car.
This is just one of the many tragic ironies of our transportation system: our efforts to make it as easy as possible to drive have had the effect of making it effectively impossible to do anything other than drive.
For the most part, the only places that are dense, mixed and walkable are those places that are old enough to have been built that way before the advent of zoning and traffic engineering (and survived the mass demolitions and "renewal" of the 1960s, '70s and '80s).
Our policies around land use and transportation have serious implications for health. Public health professionals increasingly recognize that the obesity epidemic isreally a land use epidemic. The way we have been designing our cities is literally making us sick and reducing our life expectancy.
We know that people who live in less walkable places have significantly higher rates of obesity, diabetes and so on, even after controlling for other factors like income and immigrant status.
We also know that people who live in more walkable places walk more. (I should note here that I'm using "walkability" as a short hand for active transportation in a broader sense: walking, cycling and so on.)
In the same way that cities have a history of building mechanisms and policies to promote public health through infrastructure, we also need mechanisms and policies to promote public health through walkability.
The problem is that our Public Health departments understand this issue but have very little influence over how our Planning and especially our Public Works departments understand their jobs.
Here's a fun case study:
Where I live, local residents asked the City for a crosswalk at a busy intersection between a fast, four-lane arterial and a residential side street that connects to a school, playground, sports field and tennis court. The city responded by putting up a sign ordering pedestrians to walk 400 metres out of their way to cross at the nearest signalized intersection.
'Pedestrians Please Cross at Locke or Queen' (RTH file photo)
Our councillor asked the Traffic Department to reconsider. They visited the site and counted just 40 people crossing in a day, concluding that it didn't justify a crosswalk. And never mind the sign telling people not to cross there.
We drafted a petition and went door to door, getting hundreds of signatures. Our councillor brought a motion to the Public Works committee and we made a delegation in which we presented the petition.
Council approved it and the Traffic Department reluctantly installed a pedestrian-activated signalized crosswalk.
We immediately noticed that it didn't work very well. You would push the button to cross and it would take between 40 seconds and almost two minutes for the signals to change.
It took several more months of prodding but our councillor managed to arrange a meeting with the Traffic manager to visit the site with us and see it firsthand. The manager acknowledged that the crosswalk had been programmed to provide "minimum service level to pedestrians".
He agreed to change it, and within a couple of weeks it was reprogrammed to be responsive.
A few months later I asked the City for its data on pedestrian calls at the intersection. I was pleased (but not surprised) to learn that pedestrian crossings more than tripled since before the crosswalk was installed.
When you make it easier, safer and more pleasant to walk, people walk more. When people walk more, their health improves. Even small amounts of walking make a dramatic difference.
So a city that is interested in healthy residents - and what city isn't? - has to start considering land use and transportation in the context of public health.
Designing for universal driving has always been a fool's errand. There have always been people who can't or won't drive - due to age (children and seniors), income or disability - and the proportion of people who can't drive is only going to increase as our population continues to age.
Three quarters of Greater Toronto and Hamilton Area (GTHA) residents age 65 and up still drive, but that drops to just half of people age 80 and up. Right now there are around 255,000 seniors age 80 and up in the GTHA, but that's expected to increase to 650,000 by 2036.
Seniors who live in car-dependent neighbourhoods and can't drive are socially isolated. They see fewer friends and participate in fewer activities. They even go to fewer doctor's visits. They suffer more loneliness and depression. They are more likely to feel like a burden rather than a participating member of their community.
We desperately need to transform this entire region to make its neighbourhods more age-friendly. The World Health Organization has identified the characteristics of an age-friendly city [PDF], and by this point they shouldn't come as any surprise:
Outdoor environment - Pleasant and clean, with well-maintained parks, abundant rest and seating areas, walkways and protected bicycle paths with smooth, level, non-slip surfacing, safe pedestrian street crossings an a general feeling of safety and security.
Public transit - Available, affordable, frequent, reliable, smooth, comfortable, connects to useful destinations, accessible for people with mobility challenges, and has courteous operators and priority seating.
Housing - Affordable, accessible, close to amenities, services and social activities. A variety of housing options in a neighbourhood allows people to "age in place" when it comes time to downsize.
Cities that are designed this way not only do a better job of accommodating people experiencing disability, but also help to preserve good health longer and delay or prevent the onset of disability.
So it's hard to imagine anyone opposing any of these sensible measures to make our cities healthier. The problems appear when it comes time to implement the changes we need to make to our existing neighbourhood designs.
I've already identified two challenges: the rules our planners follow to control land use, and the rules our traffic engineers follow to design streets.
Here's a third problem: try to insert a midrise, senior-friendly, mixed-use apartment building with affordable housing in a neighbourhood composed of single family residential houses and NIMBYs will rush in to protest it.
NIMBYism is fear of change made manifest through negative citizen engagement:
Of course, this fear of incompatible uses is at the heart of the zoning rules we use to partition our cities, so the two tend to reinforce each other.
NIMBYism has many sources, including negative past experience. It can be hard to trust the intentions of developers when residents still recall block-busting demolitions to drop in 22-storey slab apartment buildings that make no architectural effort to fit into their surroundings.
Another, more general problem is the persistent bias that favours the status quo. You rarely have to justify doing something the way it's already being done.
In Hamilton, our City Council spent more than four hours boiling the ocean over an $800,000 plan to build a protected cycle track on a four-lane arterial street that was only carrying 10-15 thousand cars a day.
The plan was proposed by a citizens group that had thousands of supporters across the community, and its spokesperson was articulate and extremely well-informed in his delegations to Councillors.
Council eventually approved it, but not without enormous amounts of hand-wringing and posturing and lots of sustained public pressure.
The cycle track opened just a few weeks ago and almost immediately attracted 400 rides a day, up from almost zero.
Protected cycle track on Cannon Street (RTH file photo)
But while Council agonizes over what amount to rounding errors in the city budget for active transportation, the decision to spend $18 million - 22 times as much money as the cycle track - on a new arterial road in the suburbs was approved and flowed silently into the city's capital plan without a whisper of debate.
Citizen engagement is generally a force for positive change, especially when it is based on a hopeful vision of transformation rather than based on fear and mistrust.
In Hamilton, we have urban neighbourhood associations that have spent literally decades advocating for changes to make city streets safer, more walkable and more accessible.
For a sense of what they're up against, consider a recent attempt to implement some modest changes to residential urban streets that Council approved more than a decade ago but never funded.
It was rebuffed by suburban residents, who suddenly noticed with horror that some of their streets don't have sidewalks. When those suburban developments were built, the home builders weren't required to include sidewalks and the new residents didn't want their taxes to go up to pay for them.
Unfortunately, there is no magic bullet to redesign our cities for healthy living, but we have to start by understanding the complex causes behind the current state of affairs.
We can't change the physical layout of our cities until we change the processes and plans city staff follow to define our land use and design our streets.
At the same time that we change our plans, we need to change the culture of our Planning and Public Works departments so that they really buy into an understanding that the public health implications of what they do must be a major factor and not an afterthought.
To do that, we need to change the political context in which policies are developed and staff are directed. City Councillors are generally risk-averse. They won't spend political capital on something unless they know it has lots of support.
So citizens need to get organized, form advocacy groups and engage with the community to inform, assuage fears and build support for change. It's slow, tedious, at times exasperating, but it's the only thing that works.
Start small - organize and advocate for a single crosswalk on an intersection that needs it. Learn how the system works, rack up some small victories and build toward larger objectives.
Share your stories - part of organizing is sharing information and knowledge so various groups don't need to keep reinventing the wheel. At the same time, groups can collaborate and speak with a larger united voice on shared concerns.
Be creative - one citizen group achieved traffic calming on a fast, dangerous intersection next to a school by literally going out in the middle of the night and screwing pylons into the street to make "guerilla bumpouts". The Public Works General Manager was livid but the issue blew up into an embarrassment for the city. It didn't take long for the City to replace the citizen-placed bumpouts with a more official solution.
Residents shouldn't need to go to these lengths just to have a safe way to cross the street, but that's the situation today. However, things are starting to change. Small victories grow into bigger victories and culture change can happen quickly once we reach a critical mass of awareness and support.
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