Built Environment Health Research: The Time Is Now for a Canadian Network of Excellence

Article excerpt

Every generation since World War II has faced its own great public health challenges. In the post-war period, the challenge was the integration back into society of young men and women who had fought a war that took a terrible toll on life and spirit; in the 1960-70s, efforts to control or eradicate smallpox, polio and malaria dominated; in the 1980-90s, tobacco control, heart disease, stroke and HIV/AIDS commanded attention; and in contemporary times, SARS, the H1N1 flu epidemic, mental health and a host of natural and human-made catastrophes have been added to the mix. But of all the great public health challenges, the global epidemic of obesity has emerged as the nemesis of our generation. The numbers paint a grim picture. Obesity is a disorder in its own right, but more pervasively it is also the gateway to many other chronic conditions. The public health and medical care costs attributable to obesity are staggeringly large, and the personal and social costs are not far behind. It is against this backdrop that we offer this special supplement on the built environment and health from a Canadian perspective.

Why this supplement, and why now? While it is clear there is an urgent need to take action to address obesity, particularly in children, it is also very apparent that the empirical body of evidence regarding the determinants of obesity - especially those most upstream, such as the built environment, time use and technology change - is only now taking shape. The sense of urgency to halt the childhood obesity epidemic has helped catalyze political processes in some local jurisdictions aimed at making environmental changes by altering public policy. We need new research, especially as it relates to Canadian cities, to indicate which policydriven built environmental factors are the most important contributors to obesity, and to understand the mechanisms through which they work. Such evidence is critically needed to deepen the policy debate, leading to action with greater promise of decreasing childhood and adult overweight and obesity in Canada.

The articles in this supplement present current Canadian evidence supporting the impact of the built environment on health,1-11 particularly with regard to child health and obesity. Collectively, these works represent the contributions of multidisciplinary teams of researchers from all five regions of Canada and offer evidence linking various aspects of built and food environments (defined around neighbourhoods and schools) and community design, and their impact on active transportation, physical activity, diet and obesity.

Reports from studies in three Canadian cities - Toronto, Kingston and Saskatoon - investigate types of urban form (for example, as one study identified: grid-pattern, mixed grid- and curvilinearpattern, or curvilinear-pattern neighbourhoods) in order to understand their impact on physical activity or BMI.1-3 These papers push the threshold of current built environment research by going back to the basics - looking at the design of our urban centres and neighbourhoods, and how that constrains or facilitates people's choices, activities and even residential selection. It is necessary to start with the basic form (structure) of urban and rural neighbourhoods as that is the blueprint that directs what gets built, as we delve into the specifics of built characteristics.

Seven of the ten papers in this supplement report on children between the ages of 8 and 14 years.1-7 Are there any theoretical or developmental reasons that make children of this age group particularly advantageous to study? Where in neighbourhoods, or when and how do they accumulate their physical activity? In practical terms, 10-14 year-olds may be an ideal group to study given that they are old enough to make choices regarding travel and mobility but not so old as to be completely travel independent (i.e., driving a vehicle). There may be neurodevelopmental reasons as well. Between the ages of 11-15, youth undergo a second phase of brain development specifically related to spatial configuration and analysis. …