CONCEPTUAL MODELS: THE RELATIONSHIP BETWEEN BUILT ENVIRONMENT AND HEALTH

CONCEPTUAL MODELS: THE RELATIONSHIP BETWEEN BUILT ENVIRONMENT AND HEALTH

TABLE OF CONTENTS Acknowledgements 3 Description of Process 4 Overview Model: From Built Environment to Public Health 8 Aggregate Models: Neighbourhood Design 10 Air Pollution 11 Pedestrian Safety 12 Mental Health 13 Subcomponent Models: Neighbourhood Design 17 Air Pollution 23 Pedestrian Safety 30 Mental Health 36 Region of Peel 2008 2

ACKNOWLEDGEMENTS Conceptual Models: Source: From Built Environment To Health: An Evidence and Best Practices Based Review Lawrence Frank and Company, December 2007 Created by: Paul Conway Office of Public Health Practice Public Health Agency of Canada January 2008 Project Team: Paul Conway, Systems Analyst, Public Health Agency of Canada Dr. David Mowat, Medical Officer of Health, Peel Public Health Gayle Bursey, Director, Chronic Disease & Injury Prevention, Peel Public Health Bhavna Sivanand, Project Specialist, Chronic Disease and Injury Prevention, Peel Public Health Aarti Soni, Project Specialist, Chronic Disease and Injury Prevention, Peel Public Health Steering Committee Members: Louise Aubin, Manager, Environmental Health, Peel Public Health Kiran Ghai, Research and Policy Analyst, Environmental Health, Peel Public Health Teresa Pisani, Planner, Environment, Transportation and Planning Services Dawn Machado, Supervisor, Family Health, Peel Public Health Region of Peel 2008 3

DESCRIPTION OF PROCESS Systems thinking is an approach for viewing and understanding the real world, and its associated issues and problems through the construction, analysis, and communication of models. Models are excellent illustration techniques for identifying component parts of a system. Component parts are best understood within the context of their relationships with other system parts, rather than in isolation. Consistent with systems philosophy, systems thinking concerns an understanding of a system by examining the linkages and interactions between the variables that compose the entirety of the overall system. Systems thinking attempts to illustrate that events are separated by distance and time and that small catalytic events can cause large effects in complex systems. Acknowledging that an improvement in one area of a system can adversely affect another area of the system, it promotes organizational communication at all levels in order to avoid the silo effect. Systems thinking techniques may be used to study any kind of system natural, scientific, engineered, human, or conceptual. Peel Region has been applying systems thinking to better understand the effects of urban form on the health of populations. The report entitled First Draft of Evidence and Best Practices Review, by Lawrence Frank and Company was used as the basis for the systemsbased modelling activities. The modelling activities applied a topdown/ bottomup approach in which the following tasks were conducted: document analysis, identification of components and component parts, illustration of components and component parts, illustration of component part relationships, and illustration of component relationships. Document analysis consisted of gaining contextual knowledge of the document s contents. Components were determined by the subject headings, or chapters, of the Lawrence Frank and Company report. The component parts were determined by the section or paragraph heading of each component and referenced on the models by page number (appearing within brackets). Component parts relationships were determined through the understanding of variable relationships, either positive (reinforcing) or negative (balancing), as identified by studies referenced within the report. Finally, component relationships were aggregated based on the estimation of requirements by the modelling authority without direction from Peel Region. A final highlevel aggregate (Contextual Model) was then synthesized, without Peel Region direction, from the four component models thereby completing the topdown/ bottomup approach. The components consist of Built Environment Neighbourhood Design, Air Pollution, Pedestrian Safety, and Mental Health. Region of Peel 2008 4

The component parts of Built Environment Neighbourhood Design are: Neighbourhood Design, Other Influential Factors, Building and Site Design, Street Design and Pedestrian/ Cyclist Facilities, Floor Area Ration, Health Impacts of Obesity, Physical Activity, Diet and Body Weight, Overall Neighbourhood Walkability, Street Connectivity, Density and Land Use Mix, Transit Service and Street Design/ Pedestrian Facilities. The component parts of Air Pollution are: Exposure to Air Pollution, Per Kilometer Pollution Emission Rates, Regional Air Pollution, Localized Air Pollutants, Factories, Power Plants and Rail Corridors, MicroEnvironmental Conditions, Regional Air Pollution (2), Global Air Pollution, Health Impacts of Air Pollution, Deviation from Weather Norms, Neighbourhood Walkability Index, Vehicle Miles Travelled, Access to Public Transit, Employee Transit/ Ridesharing, Employment Centers, Vehicle Miles Travelled (2), Walkability Index (2), Residential Density, Key Outcome Indicators, Key Outcome Indicators (2), Health Benefit Conflict, and Employment Density. The component parts Pedestrian Safety are: Severity of Collisions, Pedestrian Safety, Health Impacts of Traffic Crashes, Safety of Walking Environment, Pedestrian Exposure to Traffic, Traffic, Speed, Volume and Street Design, MidBlock Crosswalks, Pedestrian Crash Risk, Driver Awareness of Walkers/ Cyclists, Holistic Application of Interventions, and Intersection Safety. The component parts of Mental Health are: Community Social Support, Proximity to Nature, Time Spent Driving, Physical Activity, and Time Spent Driving (2). Paul Conway, Office of Public Health Practice Public Health Agency of Canada Region of Peel 2008 5

THE MODELS Region of Peel 2008 6

Overview Model: From Built Environment to Public Health (Layer 1) Region of Peel 2008 7

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Aggregate Models: Physical Activity / Neighbourhood Design Air Pollution Pedestrian Safety Mental Health (Layer 2) Region of Peel 2008 9

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Subcomponent Models The aggregate models have been repeated in this section for ease of comprehension (Layer 3) Region of Peel 2008 14

Physical Activity / Neighbourhood Design Region of Peel 2008 15

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Air Pollution Region of Peel 2008 21

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Contextual Model Layer Air Pollution Local, Micro Conditions (21) Localized Air Pollutants (21) Per Capita Emission Production Exposure Rates Development Density Carbon Monoxide Lead Particulate Matter Localized Air Pollutants Factories, Power Plants and Rail Corridors (21) Concentration Near Source Health Risk Proximity to Population Systemic flow flows in the same flows in the opposite Airborne Toxins Amount of Pollution Speed Vehicle Mix MicroEnvironmental Conditions (21) Rain Wind Speed Wind Direction Regional Air Pollution (21) Congestion Traffic Conditions Emission Levels Climatic Conditions Wind Upwind Pollution Source Regional Air Pollutants Area/ Local Pollution Levels Local Variation Land Use Characteristics Proximity To Source Building Distance Exposure Potential Time Spent Walking/ Cycling Area Geography Concentrations Area Weather/ Climate Conditions Source: First Draft of Evidence and Best Practices Based Review Lawrence Frank and Company, December 21, 2007 Conceptual Model Adaptation: Paul Conway Public Health Agency of Canada, January 29, 2008 Region of Peel 2008 23

Contextual Model Layer Air Pollution Global, Health Impacts (21, 22) Global Air Pollution (CO2) Displaced Population Climate Change Food Security Predictability Health Impacts Natural Disaster Risk Global Air Pollution (21, 22) Disease Rates Severity Deviation From Weather Norms (23, 24) CO2 Emissions Greenhouse Gas Emissions Deviation From Weather Norms Potential Negative Impacts on Habitats/ Food Production Severity/ Extremes of Weather Events Health Impacts of Air Pollution (23) Congestion Airborne Fine Particulate Matter Time Spent in Traffic Pollution Level Ozone Level Inhalation of Pollutants Elderly Lung Function Effectiveness Population Vulnerability Heart Disease Youth Incidence Of Respiratory Disease Systemic flow Breathing Levels Outdoor Exercise Health Care Costs Hospital Admissions Premature Deaths flows in the same flows in the opposite Source: First Draft of Evidence and Best Practices Based Review Lawrence Frank and Company, December 21, 2007 Conceptual Model Adaptation: Paul Conway Public Health Agency of Canada, January 29, 2008 Region of Peel 2008 24

Contextual Model Layer Air Pollution Exposure, Emission Rates, Regional Levels (21) Effectiveness Emission Control Devices Per Capita Vehicle Miles Traveled Vehicle Exhaust Output Number of Vehicle Trips Vehicle Use Particle Size Pollutant Substance Composition Source Exposure to Air Pollution (21) Physical Separation Between People and Vehicles Systemic flow flows in the same flows in the opposite Air Pollution Generation Distribution Exposure Risk Health Impacts Land Use Patterns Pattern of Distribution Levels Population Density Per Kilometre Pollution Emission Rates (21) Weather Engine Temperature Travel Time Per Kilometre Pollution Emission Rates Travel Distance Source: First Draft of Evidence and Best Practices Based Review Lawrence Frank and Company, December 21, 2007 Walking/ Cycling Conceptual Model Adaptation: Paul Conway Public Health Agency of Canada, January 29, 2008 Traffic Congestion Wind Speed Great Lakes Basin Climate Conditions Area Weather/ Climate Conditions Upwind Pollution Source Wind Direction Regional Air Pollutants Concentrations Regional Air Pollution (21) Area/ Local Pollution Levels Area Geography Region of Peel 2008 25

Contextual Model Layer Air Pollution Neighbourhood Walkability, VMT, Employment Centres (25) Land Use Mix Walkability Index (25) Travel Behaviour Land Use Mix Residential Density Street Connectivity Neighbourhood Walkability Index (25) Census Block Density Retail Floor Areas Ratio Household Density Neighbourhood Walkability Index Demographics Street Connectivity Vehicle Miles Travelled Home Location Employment Density NOx Emissions Vehicle Miles Travelled (25) Vehicle Miles Travelled NOx Emissions Work Tract Employment Density Distance to Work Residential Density Street Connectivity Vehicle Miles Travelled (25) Auto Oriented Neighbourhood Walkable Employment Centre Emissions Walkability Index Vehicle Miles Travelled Air Quality Walkable Neighbourhood Employment Centres (25) Travel Mode to Work Neighbourhood Walkability Access to Public Transit (25) Source: First Draft of Evidence and Best Practices Based Review Lawrence Frank and Company, December 21, 2007 Access to Public Transit Conceptual Model Adaptation: Paul Conway Public Health Agency of Canada, January 29, 2008 Transit Availability Land Mix At Employment Centres Employee Transit/ Ridesharing (25) Share of Employees Utilizing Transit/ Ridesharing Auto Trips to Work Systemic flow flows in the same flows in the opposite Region of Peel 2008 26

Contextual Model Layer Air Pollution Density, Key Outcome Indicators (26, 27, 33) Household Distance from Public Transit Residential Density (26) Ride Sharing Residential Density Public Transit Use Household Total Emissions Per Capita Hours/ Miles of Auto Travel Air Pollution Age Income Vehicle Ownership Household Size Distance Driven Vehicle Hours of Travel Key Outcome Indicators (33) Body Weight Congestion Sedentary Activity Employees Per Acre Employment Density (27) Employment Density Employees Driving to Work Household Level Emissions Active Transport Key Outcome Indicators (33) Proximity Health Benefit Conflict (31) Transit Use Number of Auto Trips Vehicle Miles Traveled Cold Starts Emissions Auto Speed Active Transportation Health Benefits Exposure to Pollution Pollution Generation Traffic Volume Use of Alternative Fuels Clean Engine Technologies Distance Systemic flow Source: First Draft of Evidence and Best Practices Based Review Lawrence Frank and Company, December 21, 2007 Conceptual Model Adaptation: Paul Conway Public Health Agency of Canada, January 29, 2008 flows in the same flows in the opposite Region of Peel 2008 27

Pedestrian Safety Region of Peel 2008 28

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Contextual Model Layer Pedestrian Safety Traffic, Safety, Health Impacts (34) Auto Use Traffic Volume Severity of Collisions (34) Congestion Speed of Travel Road Capacity Severity of Collisions Pedestrian Safety (34) Speed of Traffic Pedestrian Safety Appropriateness of Active Transportation Infrastructure Pedestrian Exposure to Traffic (34) Pedestrian Exposure To Traffic Cars on Road Per Capita Vehicle Travel Travel Options Per Capita Traffic Fatality Rates Distance Likelihood of Being in An Accident Likelihood of Being Killed Health Impacts of Traffic Crashes (34) Age Potential Years of Lost Life Male Deaths Traffic Safety Safety of Walking Environment (34) Safety of Walking Environment Physical Activity Personal Sensitivity Assistive Walking Device Use Speed Of Movement Age Compact Mixed Use Community Per Capita Travel Miles Community Sprawl Frailty Source: First Draft of Evidence and Best Practices Based Review Lawrence Frank and Company, December 21, 2007 Conceptual Model Adaptation: Paul Conway Public Health Agency of Canada, January 29, 2008 Children/ Young Adult Deaths Systemic flow flows in the same flows in the opposite Region of Peel 2008 30

Contextual Model Layer Pedestrian Safety Streetscape Design, Traffic, Crosswalk Safety (35, 36) Traffic Claming Street Trees Parallel Parking Presence of Other Feature Activities Design Speed of Road Enforcement Of Speed Limits Maximum Speed That Feels Safe to Motorists Speed of Travel Congestion Traffic Speed, Volume and Street Design (35) Severity of Collisions Number of Collisions Probability of Vehicle Related Death MidBlock Crosswalks (36) Overhead Flashing Lights Signage MidBlock Crosswalk Safety Car Visibility of Pedestrians Vehicles Per Day Peripheral Sightlines Traffic Volume Vehicles Per Hour Number of Lanes Congestion Road Capacity Speed Limit Sidewalks Pedestrian Exposure to Traffic Pedestrian Sightline of Cars Vehicle Pedestrian Collisions Perceived Safety PedestrianVehicle Collisions Presence of Painted Stop Bars for Cars Distance From Crosswalk Systemic flow Source: First Draft of Evidence and Best Practices Based Review Lawrence Frank and Company, December 21, 2007 Conceptual Model Adaptation: Paul Conway Public Health Agency of Canada, January 29, 2008 flows in the same flows in the opposite Region of Peel 2008 31

Contextual Model Layer Pedestrian Safety Intersection Safety (36) Traffic Calming Effectiveness Street Design Intersection Safety (36) Intersection Turning Radius Speed at Intersection Speed of Travel Congestion Traffic Volume Speed Limit Road Width Ability to Stop Road Capacity Disabled Youth Intersectional Vehicle/ Pedestrian Collisions Elderly Vulnerability Of Population Pedestrian Ability To Cross The Intersection Cross Walk Signal Refuge Medians Pedestrian Volume Pedestrian Safety Width Systemic flow Length Of Time Source: First Draft of Evidence and Best Practices Based Review Lawrence Frank and Company, December 21, 2007 Conceptual Model Adaptation: Paul Conway Public Health Agency of Canada, January 29, 2008 Intersection Design flows in the same flows in the opposite Region of Peel 2008 32

Contextual Model Layer Pedestrian Safety Crash Risk, Driver Awareness, Intervention (37, 38) Holistic Application of Interventions (38) Severity Traffic Volume Likelihood of A Pedestrian/ Vehicle Accident Pedestrian Crash Risk (37) Pedestrian Crash Risk Requirement for Pedestrian Safety Improvement Spot Application Interventions Specific Area Pedestrian Improvement Intervention Effectiveness Pedestrian Volume Effectiveness of Driver Intervention Driver Knowledge of Area Walkers/ Cyclists Driver Awareness of Walkers/ Cyclists (37) Visibility of Walkers/ Cyclists Safe Street Crossing Points Holistic Area Wide Intervention Overall Pedestrian Safety Improvement Intervention Effectiveness Area Prevalence of Walking/ Cycling Driver Awareness of Walkers/ Cyclists Driver Attentiveness Toward Area Walkers/ Cyclists Seeing Others Walk/ Cycle Desire to Walk/ Cycle Source: First Draft of Evidence and Best Practices Based Review Lawrence Frank and Company, December 21, 2007 Pedestrian Crash Risk Conceptual Model Adaptation: Paul Conway Public Health Agency of Canada, January 29, 2008 Systemic flow flows in the same flows in the opposite Region of Peel 2008 33

Mental Health Region of Peel 2008 34

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Contextual Model Layer Mental Health Physical Activity, Driving, Proximity to Nature (40, 41) Proximity to Nature (41) Risk of Mental Health Issues Time Spent Driving (40) Office Frustration Job Performance Time off Work Size of Yard Ability to Cope with Stress Access to Nature Other Driver Habits Frustration Blood Pressure Incidence of Illness Demand For Health Services Residences With Back Yards Availability Time Pressures Distance From Urban Core Predictability of Traffic Conditions Sense Of Control Congestion Time Spent Commuting in Car Systemic flow flows in the same flows in the opposite Source: First Draft of Evidence and Best Practices Based Review Lawrence Frank and Company, December 21, 2007 Conceptual Model Adaptation: Paul Conway Public Health Agency of Canada, January 29, 2008 Regular Physical Activity Physical Activity (40) Time Spent Driving (40) Stress, Anxiety, Depression Involvement In the Community Time Spent Driving Desire to Drive Attractiveness of Other Transportation Options Anxiety/ Stress Incidents Of Road Rage Region of Peel 2008 36

Contextual Model Layer Mental Health Community Social Support (41) Community Social Support (41) Access to Green Space/ Open Space Desire to Walk/ Cycle Personal Feeling Of Security Participation in Social Activities DaytoDay Stress Risk of Depression Reliance On The Auto Home Ownership Years Lived In Neighbourhood Neighbourhood Variability Knowing Your Neighbours Community Cohesiveness Social Isolation Drug/ Alcohol Use, Crime Control Over Life Dependence Upon Others Access to Needed Services Viable Transportation Options Ability to Afford a Car Personal Perception Income Urban Sprawl Land Use Patterns Source: First Draft of Evidence and Best Practices Based Review Lawrence Frank and Company, December 21, 2007 Conceptual Model Adaptation: Paul Conway Public Health Agency of Canada, January 29, 2008 Residential Density Systemic flow flows in the same flows in the opposite Region of Peel 2008 37

For more information, please contact: Bhavna Sivanand, Project Specialist Chronic Disease and Injury Prevention, Region of Peel Public Health 9445 Airport Road, 3 rd Floor W. Tower Brampton, ON, L6S 4J3 9057917800 Ext. 2168 Bhavna.Sivanand@peelregion.ca Conceptual Models Source: From Built Environment To Health: An Evidence and Best Practices Based Review Lawrence Frank and Company, December 2007 Created by: Paul Conway Office of Public Health Practice Public Health Agency of Canada January 2008 This document is the intellectual property of the Region of Peel. Region of Peel 2008 38