Social Determinants: Have we designed physical activity out of our cities?

CHEO's Dr. Mark Tremblay talks about child obesity during the Conference Board of Canada Summit on Health Care Sustainability.

CHEO’s Dr. Mark Tremblay talks about child obesity during the Conference Board of Canada Summit on Health Care Sustainability.

OPSEU’s head office is located about a brisk 15 minute walk from the Leslie subway station in Toronto. The building is located in a business park in which thousands of workers arrive each morning. Given the proximity to the subway station, you’d expect long lines of pedestrians to be making their way past the North York General Hospital and into the business park each day. The thing is, they don’t. It’s rare to see anybody on the sidewalk at all.

Half an hour a day of brisk walking would add tremendous health benefits to the people in the business park. Dr. Mike Evans has a wonderful animated talk in which he speaks about half an hour of exercise reducing dementia and Alzheimer’s, the risk of hip fractures, diabetes, depression and anxiety. If it were a drug we’d be all asking our doctor for it.

If you’ve ever done that walk from the subway, chances are you wouldn’t want to repeat the experience. Leslie is very wide at that point and thousands of cars go roaring by in the morning. There is nothing in human scale to relate to. The noisy underpass below the 401 is particularly inhospitable. Worst still, there is no crosswalk to give pedestrians the right of way against traffic zipping along into an Eastbound on-ramp to the 401. The walk is full of anxiety. When you get to the business park, the sidewalk ends on one side of the street, meaning you have to cross the road and back again to get to OPSEU.

Suzanne Nienaber says we are designing physical activity out of our lives by designing our cities this way. The Partnership Director of New York’s Center for Active Design, told this week’s Conference Board of Canada Summit on Health Care Sustainability that if you make enticing public realms, people will actually use them.

Nienaber is actively working to design physical activity back into people’s lives through good urban planning.

In a vertical city like New York – not unlike Toronto – it makes sense to encourage people to use the stairs. Two minutes of stair climbing has tremendous health value. So why aren’t we making stairs attractive places and urging people to use them with encouraging signs Nienaber calls a “stair prompt?” If you visit many of our buildings – such as the Ontario Federation of Labour tower, the stairwell is not easy to find, and you might have a problem accessing the floor you are looking for from the stairwell.

Unlike Toronto’s Mayor, in New York the municipal government is mandating active design in public buildings. In Toronto we are more worried that bike lanes might be construed as a war on the car.

If we aren’t making Toronto friendlier to pedestrians, we should at least do it for our kids.

Dr. Mark Tremblay of the Children’s Hospital of Eastern Ontario told the Summit that the typical 12-year old kid in 2013 is taller, heavier, fatter, rounder, less flexible and less aerobically fit than their counterpart from 1981.

Only five per cent of kids today meet Canada’s physical activity guidelines. That’s 60 minutes of physical activity. That used to be called play.

Kelly Murumets, CEO of ParticipACTION said we have an inactivity crisis in this country. “Sedentary behavior is the new smoking,” she said.

ParticipACTION has launched a nation-wide campaign to “bring back play” although the plan includes a second phase to persuade parents its safe to let their kids go outside and play.

Sadly, Murumets says kids today engage in three hours or less of play per week.

This year’s Summit on Health Care Sustainability is focused on solutions, the “sky is falling” hyperbole about out of control health spending mostly absent from the podium.

When Conference Board Senior VP Glen Hodgson made the claim that 6 per cent cost increases didn’t work when the economy was growing by 2 per cent, he sounded like a man out of time.

This year the provinces are limiting new investment in health care to an average of just 2 per cent and health care spending has been dropping as both a share of the overall economy and of provincial program spending.

That doesn’t mean that provinces are necessarily making good investments.

Judith Shamian, the former CEO of VON Canada told the group that only 25 per cent of population health was determined by the health system.

“This is my elevator speech,” she said. “We spend a lot of money and get little results.”

In her new role as President of the International Council of Nurses, Shamian argues we should be paying greater attention to the social determinants of health. She admits that as a CEO this was not always easy to achieve.

Nobody knows that better than the 32 part-time personal support workers employed by the VON in Grey Bruce. The workers need a vehicle to do their home care work, yet are paid less than $14 an hour – or below what advocates are insisting should be the present minimum wage. After giving the union a strike vote, OPSEU staff recently reminded the media that these VON workers have to rely upon food banks and other United Way agencies to make ends meet. This is hardly a shining model of community care.

Shamian said that nurses are often sicker than the patients they look after. The challenge is to “walk the talk.”

Danielle Martin, speaking as VP of Medical Affairs and Health System Solutions at Women’s College Hospital, made a pitch for universal Pharmacare, arguing that the most common problem in the ER is patients who don’t take their medication. That’s because one in ten cannot afford to fill their prescription.

Both Martin and Amy Porteus of Bruyere Continuing Care demonstrated that hospitals could play new and innovative roles in the health care system. Martin said Women’s College Hospital has eliminated all in-patient beds and now plays an ambulatory role that serves as the “glue” between primary and tertiary care. Porteus spoke about Bruyere’s “Village” concept in serving up new long term care models and is instrumental in expanding the role of the hospital into community-based care.

Barbara E. Collins and Dr. Rueben Devlin spoke at length about how they were reinventing Humber River Regional Hospital. They claim the new builiding will be the first fully digital hospital in North America. Much of the focus on the planning has been on using the new building to reduce longer term operating costs. That includes reducing energy costs by 40 per cent and replacing transport staff with robots to ferry materials to the units.

While there was consensus on the need for change, the solutions are varied and not always the responsibility of governments. Many of the presentations were about projects that had yet to be evaluated.

During a reception at the end of the day, Globe and Mail columnist Andre Picard spoke about how Canada’s rich legacy of health care reports were consistent, but we somehow failed to implement their findings.

The Summit illustrates that innovation is none-the-less taking place and despite the scrutiny that makes many fearful of making a misstep, the evidence would suggest the system is undergoing a level of experimentation.

If we do find a way to “fix” the system Canadians both love and complain about, the solutions are likely to be both many and big and small.

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