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Students in Grades 6 to 10 are more likely to participate in team sports than individual sports. Footnote It appears that a greater proportion of Canadian students in Grades 6 to 10 are spending more of their leisure time playing video games and on the computer than in the past. The presence of parks and green spaces may play an important role in increasing physical activity in children in urban areas, although some evidence shows that neighbourhoods with destinations, such as recreation facilities, parks, playgrounds and features linked to walking are associated with lower levels of physical activity in children.

Footnote , Footnote A key factor for physical activity may be the availability of undeveloped areas that allow for unstructured play. This type of play encourages children to evaluate their environment and its challenges before taking action. It has also been linked to helping children learn about assessing and managing risks, to be more independent and to develop better learning and judgment skills. Footnote Footnote Living in suburbs or small towns was linked to the highest levels of physical activity in children while living in urban areas was linked to the lowest.

Children living in rural areas were more likely to spend time outdoors and in unstructured play than children living in urban areas. Footnote This may be linked to how safe rural neighbourhoods, in terms of both traffic and crime, are perceived to be. Footnote Like other age groups, children who walk or cycle are more likely to get injured than children who travel in a motor vehicle.

Footnote Measures to increase safety such as traffic calming and having recreation areas nearby were linked to more physical activity and fewer injuries among children. Features such as higher road density, having schools and other services nearby and crosswalks were linked to more walking, but not increased safety. Footnote Crime is also an issue. Children living in neighbourhoods with less crime are more likely to be physically active.

Footnote It appears that using active transportation in Canada is decreasing. Among students in Grades 6 to 10, rates appear to be decreasing, particularly in lower grades see Table 1. Distance and safety are two key factors - children are more likely to use active transportation if their school is nearby and the route to get there is safe. Footnote They are also more likely to use active transportation in areas experiencing urban sprawl. Footnote Parents are important role models for their children in terms of physical activity. Footnote Children whose parents use active transportation are also more likely to do so.

Healthy diets: Research in this area is still evolving, but generally, access to healthy or unhealthy food has the same effect on children and teenagers as it does on adults. Footnote One aspect that differs is the fact that children and teenagers can also be influenced by food access near schools or on route to school.


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Recent findings suggest that children and teenagers who live or go to school in neighbourhoods with many places that sell unhealthy food are more likely to have an unhealthy diet and be overweight, be obese, have higher insulin resistance and have poor bone density. Footnote In Canada, children who spend more time outdoors are more likely to be physically active, have fewer problems with their friends and have better psychosocial health.

However, they may benefit from a neighbourhood that encourages physical activity and healthy eating. Evidence suggests that healthy diets and physical activity are important for appropriate weight gain during pregnancy, although they may have no effect on issues such as preeclampsia, gestational diabetes and induction of labour. Research is mixed, but some evidence suggests that exercise and healthy diets in the postpartum period are linked to weight loss and improvement in postpartum depression symptoms.

Footnote Many women have trouble losing weight during the postpartum period, suggesting a need for specific interventions for this group. Communities are not always built to support aging. Most older adults want to stay in their homes and neighbourhoods as they get older. As they age, older adults are also more likely to spend more time in their neighbourhoods and to be more sensitive to changes in their environment. Footnote 11 Ensuring that the built environment supports healthy aging is becoming increasingly important. Falls are also the leading cause of hospitalization among older Canadians.

Older adults who felt that they were part of their community and that people would help them were less likely to experience falls. Neighbourhoods that were thought to be cleaner and safer were linked to fewer falls. Outdoor hazards increase the risk or the perceived risk for falls among older adults.

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Examples include uneven surfaces, curbs, lack of street, sidewalk and path maintenance, poor lighting, potholes, cluttered areas, unsafe traffic, unclear signs and crossings that are perceived to be unsafe. Physical activity: Even older adults who are already in poor health can benefit from being active. Footnote , Footnote Many neighbourhood features e. Footnote Some research suggests that walkable neighbourhoods are linked to more walking even among older adults with mobility issues.

Some of the biggest barriers to being active for older adults include how accessible and safe their neighbourhood is e. Footnote , Footnote , Footnote , Footnote Living in the suburbs is linked to many of these factors and can create a challenging situation for older adults , particularly for those who no longer drive. Concerns about safety include worries about crowds, crime, violence and traffic. For older adults who have health and mobility issues, having benches in neighbourhoods is important.

They function as rest stops during longer trips and can be good places for older adults to better enjoy green spaces and areas near water. Social isolation: Neighbourhoods may not be set up to address the risk for social isolation associated with aging. Risk factors for being lonely at an older age include not being married, being in poor health, having a declining income and having a low education. Footnote Limited research has addressed how the built environment can support social interactions and reduce social isolation for older adults.

Footnote Walkable neighbourhoods and physical activity itself are linked to increased activity and being more social in older adults. Building a healthy community addresses the needs and improves the health of all of its residents, including those who are marginalized. Footnote 1 Access to food, clean water and housing are basic needs. It makes sense that some approaches to improve healthy living, such as building more recreational areas or cycling infrastructure, may not have a positive impact on community health before these basic needs are met.

Accessibility for people living with a disability: The needs of people living with a disability are not always considered when designing and building communities. Footnote In , 3. Evidence suggests that neighbourhoods with good accessibility, high quality and safe streets, lower traffic density as well as uncrowded and open spaces increase the likelihood that people with a disability can be mobile, productive and social.

Footnote , Footnote , Footnote , Footnote Winter can further reduce accessibility for people living with a physical disability, leading to increased risks to health and for being isolated. Certain features can worsen health inequity, particularly in disadvantaged neighbourhoods. Examples of these features include Footnote , Footnote Affordability is an important factor that influences where people decide to live.

For those living with a low income, access to affordable housing is linked to better health and more income being available to support health and well-being. Gentrification: Gentrification is the transformation of areas into middle class or affluent neighbourhoods.

Limited research is available on the role of the built environment for Indigenous populations, people living in poverty, the homeless and people with a disability, and no evident research is available on people who identify as lesbian, gay, bisexual, transgendered, queer, questioning, intersex and two-spirited LGBTQQI2S. Footnote Whether Indigenous Peoples live in an urban, rural or remote area varies by Indigenous population:. For First Nations and Inuit populations, particularly those living in remote and isolated communities, there are challenges and opportunities for harnessing the built environment to support healthy living.

Challenges can include lack of infrastructure and jurisdictional barriers. From a built environment perspective, some of the more pressing health concerns for remote Indigenous communities are related to safe drinking water, food availability, security and safety, access to health care and housing quality, affordability, accessibility and crowding. Like Canada as a whole, Indigenous populations are also dealing with a shift to sedentary lifestyles, physical inactivity, unhealthy diets and resulting impacts on health. Footnote , Footnote This is linked to a shift from traditional built environments.

Traditionally, Indigenous communities and camps were designed and located with purpose and to address community needs, well-being and geographic realities. In some cases, communities were temporary and moved in response to changes in season and food availability. With colonization and assimilation, communities were displaced and relocated, often away from traditional lands and practices.

For healthy living, there is limited research on the impact of the built environment on Indigenous communities. Footnote 83 Examples of barriers to physical activity that have been identified include isolation, an environment that does not make being physical active easy e. Footnote 83 , Footnote There are also opportunities to learn from Indigenous populations. Ties to the land, water, family, community and identity are important components of Indigenous culture that also emphasizes wholeness, connectedness and balance. Footnote , Footnote For Indigenous communities, place is an important source of health and is seen as part of a holistic, interconnected view of health and well-being.

This section provides a brief overview of some of the approaches that are used to design communities in Canada to improve healthy living. Communities that effectively support, promote and inspire healthy living take a collaborative, multidisciplinary effort that includes expertise not traditionally linked to health, such as economics and transportation.

They involve all levels of government and engage at the community level. Multi-sectoral collaboration: Currently, public health professionals are working closely with urban planners, traffic engineers, architects and policy makers at all levels across Canada to varying degrees. Building these relationships is seen as a particularly important step for moving initiatives forward. Health in All Policies is an important approach that encourages decision makers across all sectors to consider the health implications of public policies.


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Footnote This has been noted as an important approach for planning, development and equity. It involves finding a balance to. Much of what drives this work happens at the local level; however, provincial, territorial and federal laws, regulations and policies can have an impact. Examples include investments in various sectors such as public transportation and the establishment of policies for municipal planning.

Tackling urban sprawl: While some cities are working to proactively address or prevent urban sprawl, the response to urban sprawl is often reactive happening once its effects are already being felt. Urban sprawl is often characterized as living in the suburbs. Although suburbs are linked to unhealthy behaviours Footnote , they often provide attractive options at affordable prices for some Canadians. Many Canadians want to live in the suburbs and enjoy doing so. Footnote 65 , Footnote 66 This suggests that there is a need for innovative thinking to tackle the unhealthy aspects of suburban living.

Examples of proactive approaches can be found in Ontario and Metro Vancouver where growth plans have been developed to address urban sprawl. In southern Ontario, this included establishing density targets for development and protection of green spaces. The goals of the Metro Vancouver plan include. Examples of Canadian guidelines and other resources: There are many guidelines on promising practices for building healthy communities. Below are some examples. All cities in Canada have plans, policies and laws in place to guide the design and building of their communities.

Active transportation is now the most addressed issue by planners, followed by access to public spaces, social networks and meeting areas. Lack of government or political support is the most often cited barrier for making sure planning considers health implications. The built environment is something that can be tangibly changed. It is important for understanding population-level physical barriers and incentives for making healthy choices.

It can also maximize the effectiveness of the built environment through policies and programs focused on designing healthy living. Improving health should be a goal of all community planning. Since , the city has put in place many approaches. Mortality rates decreased from almost 9, per million people per year in to almost 8, per million people per year in Vancouver, Toronto and Montreal are used below as examples of multi-sectoral planning at a large scale for large populations.

It should be noted that multi-sectoral community planning is happening in many areas, including planning that covers the suburbs and smaller communities. What works in larger cities may not work for the suburbs, smaller cities and communities or rural or remote communities. The shift to a focus on the impact of the built environment on healthy living has taken time. Making widespread changes is difficult and often starts as smaller changes at the community level.

Evidence is important, but so is context. This makes local knowledge and community engagement important. Seeing the effects of change also takes time, particularly on the health of a population. Together, these challenges show that harnessing the built environment to improve health is no easy task. Vancouver Population in 2. For many years, the City of Vancouver has focused on developing a sustainable city and on improving the health and well-being of its residents through policies, planning and related initiatives.

In , the Vancouver Coastal Health Authority implemented a collaborative focus on the built environment. The Health Authority has worked closely with communities on their Official Community Plans to ensure that the built environment is considered in their development. Information on planning, zoning, development, community building and public health can be found at:.

Active living and getting outside. Goal: All residents are engaged in active living and have incomparable access to nature. Getting around. Environment to thrive in. Goal: Residents have the right to a healthy environment and equitable access to a livable environment in which they can thrive.

Feeding ourselves well. Vancouver Food Strategy. Citizen engagement and involvement: In Vancouver, citizens can be involved in many aspects of city government and municipal affairs. The City promotes engagement through Talk Vancouver, an on-line forum and public consultations. They also hold open City Council meetings and provide opportunities for members of the public to speak at City Council meetings, for citizens to serve on boards and committees and for citizens to volunteer. They also use various means, including social media, to reach out to citizens. More information on how to become involved can be found here: Citizen involvement.

Toronto Population in 5. Toronto was one of the first cities to adopt the concept of Healthy Cities. Footnote , Footnote Toronto Public Health has been heavily involved in the development of various plans and strategies and in working with other municipal sectors on the built environment. Below are examples of innovative approaches, best practices, activities and projects taking place in Toronto to improve healthy living by focusing on the built environment. Complete Streets Guidelines. Toronto Food Strategy. Examples of projects :.

Parks, Forestry and Recreation Initiatives. Transportation Initiatives. The City of Toronto holds Council and committee meetings that are open to the public, undertakes various public consultations and provides many engagement opportunities to its citizens. A recent pilot project asked citizens to propose and vote on projects to improve their neighbourhoods through the Participatory Budgeting Pilot Project.

Toronto also engages citizens through social media. Montreal Population in 4. Montreal has many initiatives and projects in place that address the built environment. For many years, the City has involved neighbourhoods and non-governmental organizations in addressing issues related to the built environment. Since the early s, it has focused on transportation and health. Structuring efficient transportation networks to fully integrate into the urban fabric in French only.

An enhanced architectural, archaeological and natural heritage in French only. A healthy environment in French only. Other: Strategic plan for sustainable development Water management policy Municipal waste management plan Implementation of traffic calming measures Noise mitigation policy. Citizen engagement and involvement: In Montreal, citizens can be involved in many aspects of city government and municipal affairs. The City undertakes consultations on various issues and holds open City Council meetings.

More information on how to become involved can be found here: Democratic participation. Community planning and Indigenous populations: Planning has always been a part of Indigenous communities and included many traditional and historical practices. Over time, these practices have been ignored, particularly in urban centres. However, there are examples that this is changing. Based on a survey of planners from Canadian provinces in , strong provincial leadership through policies, legislation and regulations that recognizes the role of the built environment in health can greatly benefit municipalities and communities in planning, designing and building healthy communities.

Currently, approaches, policies, regulations and legislation that consider health in the design and building of communities vary considerably across Canada. Although different sectors do work together to develop healthy communities, the need for better collaboration has been noted at both the provincial and municipal level. Leaders from the health sector, academics and non-governmental organizations are seen as important supporters of healthy communities.

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British Columbia, Ontario, Quebec and New Brunswick are provinces where strong healthy community networks exist. The principles that guide these networks include community engagement, political commitment, multi-sectoral collaborations, asset-based community development and healthy public policy.

Important factors for this approach include recognizing the social determinants of health, diversity, social justice and equity, empowerment and community ownership, research and evaluation, and creativity and innovation. Footnote , Footnote More details on these networks, including their governance and organizational profiles, can be found here and here. It also supports many initiatives that help develop healthy communities, including Community Wellness Initiatives and On the Land Healing programs. The Public Health Agency of Canada PHAC supports work on the link between the built environment and healthy living through surveillance, research, knowledge mobilization, collaborations and funded interventions:.

Its aim was to move evidence into action and build collaborations that harness the built environment to improve health. Footnote 62 , Footnote , Footnote Many countries are looking to the built environment to improve health. Covering all the examples that exist is outside the scope of this report. Outlined below are two examples of World Health Organization initiatives. Healthy Cities: The concept of building a healthy city has a long history. As an international movement, it grew in part from an initial health city workshop held in Toronto in and aligns with the Ottawa Charter for Health Promotion.

In , the World Health Organization Healthy Cities project began with the involvement of representatives from 21 cities and seven countries in Europe. Footnote 60 , Footnote 61 This project focuses on clean and safe environments, community connections, interaction and engagement, stable and sustainable ecosystems, meeting basic needs of all citizens, diverse, vital and innovative local economies and good health.

Footnote 60 , Footnote 61 , Footnote Today, there are approximately 30 national Healthy Cities networks with more than cities involved. Footnote 61 , Footnote In Canada, the healthy communities movement has developed on a different path with a broader approach that looks beyond urban areas and involves several separate networks rather than a pan-Canadian approach. Initiatives tend to be more local and built on existing community capacity. Across Canada, this has led to a wide variety of strategies that reflect individual community needs and have led to a broad range of results.

Since that time, its Global Network for Age-friendly Cities and Communities has grown to include communities in 33 countries with Canada being a key partner. This project focuses on eight areas for making communities age-friendly: outdoor spaces and buildings; transportation; housing; social participation; respect and social inclusion; civic participation and employment; communication and information; and community support and health services.

In Canada, communities in all provinces are implementing age-friendly initiatives. PHAC recently developed a set of indicators to help communities evaluate the implementation of these initiatives, as did the World Health Organization. Most work on age-friendly communities focuses on aging in urban areas, but there is a need to consider what age-friendly communities look like in rural settings. Footnote In , a report called Age-Friendly Rural and Remote Communities: A Guide was developed in Canada and endorsed by federal, provincial and territorial Ministers responsible for seniors.

Its purpose was to raise awareness of the needs of older adults and to present a practical guide for rural and remote communities in Canada. Taking research that links a design feature to a health outcome, such as walkable communities and diabetes, and translating it into community action is challenging. Policies and programs need to be developed and implemented using the most relevant and up-to-date evidence, but they also need to be evaluated to determine their effectiveness.

Many projects and initiatives related to the built environment have taken place or are underway in Canada, but many are not evaluated or if they are, evaluation findings may not be accessible. In addition, cities and communities already collect data on various built environment initiatives, but data are not collected in a standardized way, limiting their use for researchers and planners in other communities.

Systematically sharing data, knowledge and lessons learned about the effectiveness of initiatives is important to improve the health of Canadians in all communities. Doing research that is policy and program relevant and engages stakeholders is a good step towards ensuring that community and neighbourhood planning is evidence-based. Footnote This type of research can help create traction with decision-makers and help generate public awareness and community support.

We can do more to help Canadians take charge of their own health. We have an exciting opportunity to consciously design our communities to support healthy living and help Canadians unconsciously improve their own health and the health of generations to come. Changing behaviour is complicated. Why people do what they do is based on a wide variety of connected factors. These include age, physical and mental health, socioeconomic status, culture, and genetics as well as how we react to our physical and social environments. The built environment is only one piece of this much larger puzzle.

Designing the built environment for healthy living is about supporting social connection and seamlessly providing access to features that promote physical activity, healthy eating and mental wellness. It can include simple things like connected streets, access to healthy food and places to gather with family and friends. We know that communities are not all designed the same way and that they evolve over time. In addition, most of us spend our lives in many different neighbourhoods at any given time and across our lifespan. This makes it challenging to quantify how the built environment impacts health.

While many cities in Canada are already considering health in their community planning, there is much that remains to be explored. Research in this area is relatively young and moving findings into action is still a challenge. This means that we can be proactive and now is the time for public health to work closely with other sectors to take advantage of this growing domain. Public health can influence the way forward and ensure that community planning and infrastructure initiatives, as well as sustainable, economic and technological development are based on integrated evidence and consider good health as a key outcome.

Unravelling the complexity of the impact of the built environment on population health lies in precision public health , which uses data to guide interventions to benefit populations more effectively. Going forward, I call on domestic and international partners, all levels of government including municipal, provincial, and federal leaders, political decision makers, community planners and entrepreneurs to take action in the following six ways:.

All of these actions could improve the lives of millions of Canadians. Corburn, J. Urban place and health equity: critical issues and practices. Return to footnote 1 referrer. Greaves, L. Health in All Policies — All talk and little action? Canadian Journal of Public Health, 6 , Return to footnote 2 referrer.

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Genome-wide association and meta-analysis in populations from Starr County, Texas, and Mexico City identify type 2 diabetes susceptibility loci and enrichment for expression quantitative trait loci in top signals.

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Is sleep per se a zeitgeber in humans?

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Beneficial impact of sleep extension on fasting insulin sensitivity in adults with habitual sleep restriction. Mantua J, Spencer RM. The interactive effects of nocturnal sleep and daytime naps in relation to serum C-reactive protein. Napping reverses the salivary interleukin-6 and urinary norepinephrine changes induced by sleep restriction.

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A novel mechanism controlling resetting speed of the circadian clock to environmental stimuli. A neuropeptide speeds circadian entrainment by reducing intercellular synchrony. This will be a client facing role, where you will be involved in full life cycle implementations from discovery to go live. To apply please send your CV to r. Company Registration No. Dynamics AX Jobs. Dynamics NAV Jobs.

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