There has been heated discussion about the future of the stretch of the Gardiner Expressway east of Jarvis Street. The debate has focused on commute times, urban development, economic impacts and environmental concerns – all of which are important to consider. But missing from the discussion is health and health equity.
How a highway overpass could affect your health is a difficult connection for some to make. However, these kinds of connections are important to consider in the debate about the future of the Gardiner Expressway. The decision that’s about to be made is an important opportunity to enhance health in Toronto.
Extensive research shows why we should consider health in transportation and urban planning. The connections between vehicle emissions and poor health are well established. Vehicle exhausts expel particulates that contribute to poor air quality and have serious health impacts, including the development of asthma. A 2014 Toronto Public Health report found that air pollution accounted for 1,300 premature deaths and 3,550 hospitalizations in Toronto each year. Vehicle emissions accounted for 280 premature deaths and 1,090 hospitalizations.
There are other ways that the way we move around cities impacts our health that are critical to consider, but are perhaps less obvious than the air pollution caused by traffic congestion. Green spaces provide places for recreation and socializing and help cool urban environments. They have been shown to contribute to greater overall health. Toronto desperately needs more green spaces to help cool the city – Toronto Public Health estimates that extreme heat contributes to an average of 120 premature deaths each year in Toronto.
Active transportation options such as sidewalks, paths and bike lanes encourage residents to walk and cycle, reducing the risk of a number of chronic diseases including cardiovascular disease, obesity, type II diabetes, and certain types of cancer. Active transportation also has a positive effect on mental health, as physical activity can reduce the symptoms of depression, anxiety, and panic disorders.
While walking, cycling, social interaction in public parks, urban cooling, and less air pollution affect everyone, not all Torontonians are equally impacted. Poor air quality and urban heat have larger impacts for homeless people, frail, elderly, and isolated people and people with low income, all of whom are at greater risk of heat-related illness and deaths than other Torontonians. People with low income are also less likely to live in neighbourhoods that have good access to green spaces that can contribute to good health. There are also inequities in the populations that are most likely to have low income and, consequently, poorer health. In Toronto members of racialized groups have lower income levels than non-racialized group members and people who report experiencing racial discrimination are more likely to report fair or poor self-rated health than people who do not experience racial discrimination.
So when we talk about what we are going to do about the east portion of the Gardiner Expressway, we are talking about much more than a few minutes of extra commute time.
There are two options for the future of the Gardiner: the “hybrid” option that would maintain an elevated connection to the Don Valley Parkway or the “remove” option that would replace the elevated highway with a boulevard. City councillors will be deciding which option to proceed with at their meeting on June 10th.
Part of that decision will rest on the findings of an environmental assessment (EA) of the two options. The environmental assessment considered many issues, from travel time to the need to use private property during construction to the road network’s flexibility. The EA included two health indicators: air quality and noise. For these indicators, removal of the Gardiner with construction of a boulevard was the preferred option.
While it’s good that the health impacts of air quality and noise were considered, we need a more complete picture of how the options could affect health. Many of the issues considered by the environmental assessment have health impacts, but these were not considered. For example, the EA considered the potential of each option to accommodate sidewalks for “use by the local community,” but did not consider the health benefits of facilitating active transportation or the negative health impacts of not accommodating sidewalks. Similarly, the EA addressed the streetscape that each option would create but did not address the health impacts that improving the quality of place along Lake Shore Boulevard could provide.
Critically, the EA did not address how each option could affect specific populations, including differential health impacts. To make the healthiest choice, councillors need to know how their decisions could affect vulnerable populations. Which option would help to reduce urban heat? Which option creates the most green space? Which option opens up land for the development of affordable housing?
With the EA identifying only two health indicators among a far greater number of economic indicators it will be very difficult for Council to factor health into their decision. The heavy weighting of the EA toward economic indicators creates a bias toward this frame of analysis. Good health and economic development can go hand in hand, but we need high quality analyses that ensure that we can consider both.
The clock is now ticking and councillors will decide which option to proceed with on June 10th. Whichever option is chosen, city staff should complete a Health Impact and Health Equity Impact Assessment. Health Impact Assessments identify possible health effects of a policy or program decision, while Health Equity Impact Assessments analyze potential to influence health inequities and/or the health of disadvantaged populations.
Undertaking a health impact assessment and a health equity impact assessment is the only way that city councillors can be confident that their decisions won’t worsen health inequities in Toronto.
But more than that, we are faced with a once in a lifetime opportunity to think about how we can redesign a key piece of Toronto’s waterfront in a way that supports good health and health equity. We owe it to ourselves to make a smart – and healthy – decision.