The Toronto Star recently published an article on the health impacts of the Urban Heat Island Effect across different socio-demographic groups in different neighbourhoods across the city. The article offers a unique opportunity to interpret this issue as both an environmental concern and a “matter of social justice.”
This is a refreshing take on urban affairs. No longer are we left to draw simplistic or narrow conclusions about the changes in our physical environment without contemplating the implications for our collective social welfare and quality of life. We are being offered a perspective that digs deeper into the relationship between health and place. This constitutes a step in the right direction. It counts as an important step towards making the connections between neighbourhood design (like the spatial arrangement of buildings and the integration of green spaces in urban centres), environmental conditions (like air pollution, smog, and extreme temperatures) and health outcomes (like childhood obesity, asthma, heat stroke, and even premature death).
Earlier this year, the Wellesley Institute set out on a journey to explore the relationship between the built environment and population health. In reviewing a wide range of literature and policy, it became clear that the relationship between health and place would only grow in importance as urban populations like Toronto continue to grow in size, diversity and complexity. In May 2013, we published a primer reviewing and describing the dynamic pathways through which population health is impacted by the built environment, while also placing a great deal of emphasis on the connections between different determinants of health like income, housing and access to health care in shaping health at the neighbourhood-level.
The Toronto Star article encourages us to make connections between determinants of health like income, employment, and the built environment (neighbourhood), as it explains that low-income household clusters typically coincide with neighbourhoods more prone to the negative impacts of the urban heat island effect. Since affordability is a primary factor in choosing neighbourhoods, many residents face a harsh trade-off. Affordable housing in Scarborough or Etobicoke requires residents to acclimate to neighbourhoods with limited or no access to health-enhancing infrastructure (like convenient, safe access to a range of transit modes) and assets (like tree-lined streets). The article goes on to explain that Toronto neighbourhoods like Rosedale and Forest Hill, which benefit from a greater cooling effect due to thicker and more mature tree canopies are often out of reach for those with low or modest incomes. The built environment impacts health through access to health-enhancing amenities, like trees and green spaces which can lower the temperatures of built-up areas typically made up of large expanses of concrete surfaces (that attract and retain heat). Without access to such amenities, residents experience higher rates of exposure to health risks like sunstroke, dehydration and exhaustion. Over time, this leads to diminished quality of life and increased vulnerability to chronic illnesses and even premature death.
Other (less obvious) health determinants like age, language, and settlement status also come into play when considering how neighbourhoods impact health. Often these determinants compound the vulnerabilities or risk factors that lead to negative health outcomes. For example, an elderly person living in a high-rise apartment located in the inner suburbs of Toronto may experience mobility issues forcing them to remain within the confines of their home. With limited financial resources, it is unlikely that this person would be able to afford an air conditioning unit, thus making them more likely to develop negative health outcomes like respiratory illness. Not only are they experiencing physiological health impacts through constraints on opportunities for physical activity, but their social and mental health is also compromised by their inability to venture outside and engage with community members. Though the physical environment (or neighbourhood) is not the only factor in this scenario leading to a poor health outcome, it interacts with other risk factors, like age and place of residence, to do so.
In the face of similarly complex urban issues, it has been established that mitigation tools and coping mechanisms arise from collaborative policy development and coordinated action. In the case of managing the urban heat island effect in Toronto, departments like Toronto Public Health, Urban Forestry, and City Planning must join forces in an effort to investigate and manage health inequities in the built environment. Simple actions such as changing roof colours so that heat is reflected and increasing the number of green roofs could lower temperatures. Essentially, these mechanisms offer a means for coping with stresses like excessive energy consumption, air pollution and climate change, by building resilience into the physical landscape. These resilience-inspired changes can stimulate positive environmental conditions which in turn stimulate positive health outcomes.
With the problem fully dissected and opportunities for progress in sight, the Toronto Star article ends with a Concordia University expert stating that his measure of success in managing the urban heat island effect is the “number of peoples’ lives saved.” This gave me pause as I wonder how many of us – as engaged and passionate citizens – lose sight of what is truly at stake as we forge ahead on this journey to build “progressive,” “livable,” and “sustainable” cities. A city is more than just the sum of its parts. It is not enough just to provide shelter or parks or grocery stores. At their best, cities offer people the opportunity to discover and realize their potential. With that said, I urge urban policy-makers to account for and accommodate the diverse needs of all residents in the design of neighbourhoods and the integration of health enhancing amenities. Think of the residents who are confined to priority neighbourhoods. Will their socio-economic circumstances allow them to adapt to changes in the built environment or will they require policy or program interventions (like targeted tree plantings or vertical community gardens) to cope with these changes so as not to degrade their health and quality of life?