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Planning for Health
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Planning for Health

IV. Influence and mobilize

With the groundwork laid through relationship and capacity building, public health units can move to more successfully engaging in shaping the built environment. Strategies reported by health units centred around creating and sharing high quality public health evidence, providing expert review from a public health lens, and mobilizing communities and stakeholders through education and outreach. Not surprisingly, given the importance of evidence to their work, public health units reported an ongoing need for high quality, synthesized and compelling evidence on healthy built environment topics.

Public health units act as knowledge brokers in healthy built environment work by developing relationships with municipal partners and providing them with information they can use to advance their work. Access to high quality evidence is part of the ‘value add’ that health units can offer to planners and transportation experts. The requirements placed on this evidence, however, are demanding: it must be rigorous, but it also must be synthesized, locally relevant, timely, and communicated compellingly in lay terms. Public health units are using a variety of strategies to respond to this demand: 

Making use of existing resources

A growing number of resources on healthy built environments exists. A compilation of those that emerged as being the most useful through the literature review and the focus groups with health units are available on the resources for practitioners page.

Synthesizing research on topics of interest

Public health units release statements, discussion papers, and reports synthesizing the evidence on topics of interest to their municipalities. These reports inform decision-making, advocate for outcomes that support health and set the initial stages of collaboration. By reviewing municipal council meeting agendas and minutes, sitting on committees, and building relationships with senior municipal staff, public health units are able to keep abreast of key issues and work proactively to gather and report on the relevant evidence. 

Conducting new research on topics of interest

Beyond reviews of current evidence, public health units conduct their own research to answer questions of local concern. For example, they conduct population health research to produce current and locally relevant data, and use this data to create modelling tools on topics such as heat, physical activity and chronic disease. Health units also collaborate with each other to conduct research on issues of broader concern.

Public health units are increasingly providing expert review on built environment policies and projects, by invitation and by their own initiative. Review is happening at three distinct levels:


Public health units reported providing input at multiple points in the municipal policy hierarchy, including official plans, transportation plans, cycling and active transportation plans, community design (secondary) plans, zoning amendments, development guidelines, urban forestry plans, climate action plans and more. To learn of upcoming opportunities, public health units monitored municipal council agendas, sat on committees, and cultivated relationships with municipal staff from a variety of different departments.

Municipal official plans are governed by the Provincial Policy Statement and provincial growth plans, and while the public health units did not mention these documents, key informant interviews with provincial planning staff indicated that greater health input would be valuable when these documents come up for review. 


Public health units are reviewing individual planning projects through development applications and individual transportation projects through environmental assessments. In many municipalities, processes to seek review from different municipal departments are already in place, and adding public health as a stakeholder is relatively straightforward. Many public health units reported using Peel Public Health’s Healthy Development Assessment Tool, which centres on the complete community elements of density, service proximity, land use mix, street connectivity, streetscape characteristics and efficient parking. Public health units also reported providing input on accessibility, equity, active transportation, air quality, noise pollution, and soil contamination.

These reviews can be resource-intensive because of the volume of development applications and environmental assessments being undertaken in some municipalities. They also require public health staff to be familiar with the vocabulary and standards (set-backs, level of service, gross floor area, etc.) used by transportation and land-use planners at the project level.

Another challenge with project level feedback is the tight timelines, particularly for development applications. Once an application has been submitted, the municipality has a very short time-frame in which to respond. One solution to this issue is to work with the development community and educate them on what healthy communities look like, in advance of them submitting an application. Engaging at a higher level on policy and guideline documents intended for developers also helps ensure health is considered as part of individual projects. 


Reviewing internal municipal processes involves providing input to transportation engineering and planning departments on how their assessment and application processes could better evaluate for —and ultimately secure—healthy built environment outcomes. These municipal departments have internal manuals and guidelines stating the studies and evaluations required, depending on the type of environmental assessment being undertaken or the development application being submitted. Health units may advocate for requiring additional reports or studies on health-focused topics from project proponents under certain scenarios. For example, as part of an environmental assessment for a corridor in an urban area, performing a community walking audit or multi-modal level of service analysis could be required. As part of a plan of subdivision, developers could be required to submit a walkability audit of proposed school locations. Changes of this nature can be difficult to make because they require municipal planning and transportation departments to alter their own internal manuals and guidelines and add to their evaluation processes. A strong, committed partnership between the public health unit and the municipality is needed to make these changes happen. 

In addition to formal avenues for review and input through the planning process, public health units are using a variety of strategies to dialogue with stakeholders outside of municipal planning and transportation departments, such as municipal councillors, the development industry, and the public. Decisions impacting the built environment are often political in nature, and a broad base of support is necessary to advance a health agenda.


Public health units described themselves as taking on the role of educator for the development industry, municipal council and the public about the need for, and benefits of, healthy community design. Public outreach often consists of campaigns around a specific topic (such as active school travel or safe cycling), but some public health units are developing materials around healthy built environments in general. With the development industry, public health units said that they focused on the economic benefits of healthy community design and reported a need for more cost-benefit analysis of specific interventions. On the political side, cultivating a direct relationship with municipal councillors is important. Municipal elections offer an opportunity to strategically advocate for healthy built environment outcomes, and a number of public health units reported holding events and creating materials targeted specifically to municipal candidates.


Public health units are also building support for healthy community design by participating in community events. These interactions also provide the health units with opportunities to hear from the community and discover what issues are resonating with them. 


A few health units have found ways to involve the public in healthy community design. Active school travel programs often involve an assessment of the design of the surrounding streets, undertaken with the school community. Similar evaluations can be part of an environmental assessment, with walking audits undertaken by the community. One health unit has made small grants available to community organizations to undertake projects that will enhance the health of the community through design.

Create High Quality Evidence

• A recent Locally Driven Collaborative Project focused on healthy built environments in rural communities. In collaboration with the University of Guelph, they created the Healthy Rural Communities Toolkit: A Guide for Rural Municipalities, based on a literature reviews, surveys, focus groups and key informant interviews.

• As part of their Healthy Communities Series, Peel Public Health released Active Parks Design Guide, with a focus on maximizing the potential of parks and greenspace to promote physical activity in the community. The guide synthesized findings from grey literature, literature reviews and observational studies.

• Ottawa Public Health conducted research on the impact of implementing the walking, cycling and transit targets in Ottawa’s 2013 Transportation Master Plan. The research estimated that as many as 1,620 cases of diabetes could be prevented over 10 years, through less sedentary travel. The research was published in the Canadian Journal of Public Health. It was cited, along with many other Ottawa Public Health reports, by the City’s Planning, Infrastructure and Economic Development division in a discussion paper titled The Building Blocks for a Healthy Ottawa, released in preparation for Ottawa’s new official plan process.

• Toronto Public Health released a series called Healthy Toronto By Design, which includes reports on topics such as apartment neighbourhoods, active transportation and transit use, principles for an active city, and a health impact assessment tool. 

 Provide expert review

• Toronto Public Health worked with City planning staff to amend the zoning by-laws for apartment towers. Previously, the zoning for these neighbourhoods allowed very little commercial space, leaving residents with little access to services and retail, including grocery stores, and creating ‘food deserts’. The revised zoning increases the commercial allowances, and there are now 400 towers eligible for new or additional retail space. As part of this process, Toronto Public Health released a report titled, Toward Healthier ApartmentNeighbourhoods.

• Peel Public Health is working with the Region’s Transportation division to integrate multimodal level of service (MMLOS) analysis into transportation planning, through avenues such as environmental assessments, Transportation Impact Studies, and policy documents (Official Plan and the Region’s Road Characterization Study). For environmental assessments, Peel Public Health has developed a matrix to guide when MMLOS analysis should be undertaken, as an addition to the Transportation division’s manual for environmental assessments. Integrating MMLOS into Transportation Impact Studies will likewise require changes to the guidelines that govern these assessments. Read more in the Region of Peel’s Sustainable Transportation Strategy.

• Middlesex-London Health Unit has created an Active Community Toolkit for Reviewing Development Plans that includes a series of checklists and specific targets for land use, density, service, employment and educational proximity, housing diversity, street design, pedestrian and cycling orientation, public transit, streetscape design, parking, parks and open space, safety, and social connection. The Windsor Essex District Health Unit uses an adapted version of this toolkit to review development applications.

• Peel Public Health has created the Healthy Development Assessment (HDA) as a tool to guide practitioners working in the planning, design and approval of development. The assessment covers six core elements of healthy community design: density, service proximity, land use mix, street connectivity, streetscape characteristics and efficient parking. The HDA is part of a larger Healthy Development Framework, which includes a suite of tools adapted to the specific contexts found in each local municipality.

• The Simcoe Muskoka District Health Unit collaborated with planning staff to create a resource of health-related suggestions for Official Plan policies and implementation activities. The document, Healthy Community Design: Policy Statements for Official Plans, provides municipalities with policy language and concepts that are in line with provincial policies and that they can adapt to suit their own context.

Mobilize communities and stakeholders

• Ottawa Public Health collaborated with the City’s Planning Division to release two videos to raise awareness of the link between health and the built environment, and highlight how residents can get involved to make changes in their communities.

• Peel Public Health runs the Healthy Living Supports Program, which promotes health supportive environments by providing small grants to community organizations to make infrastructure change that will encourage physical activity and healthy eating among residents. • One public health unit reported collaborating with the municipal planning division on joint education initiatives, where they conduct public outreach at community events on the topic of the built environment and how planning affects people’s lives.  

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