THE PROJECT
The Saskatoon Area of the Saskatchewan Health Authority (SHA) has been working with the City of Saskatoon for several years to incorporate population health and health equity into the land use and transportation planning processes. A team within the SHA developed a Health Equity in Healthy Built Environment Framework that could be used to assess planning proposals for their impact on both population health and health equity, and to help guide their work in the area overall.
Saskatchewan is a prairie province in central Canada with a population approaching 1.2 million. In 2016, its two largest cities, Saskatoon and Regina, registered approximately 245,000 and 214,000 residents, respectively
Until 2016, Saskatchewan had 13 regional health authorities that were responsible for public health in the province. In 2017, the province began the process of merging those agencies into one health authority – the Saskatchewan Health Authority – for the entire province. The SHA is an arms-length and autonomous agency of the provincial Ministry of Health. The Saskatoon Area of SHA has a long history of population health promotion efforts and has prioritized healthy built environments that include working with municipalities and collaborating with the Medical Health Officers (MHO).
THE PROCESS
The Saskatoon Area of SHA established a team of staff with representatives from different disciplines to develop a Health Equity in Healthy Built Environment Framework to guide their work. The goal was to create built environments that mitigate harm, improve population health, reduce health inequities, and encourage health-promoting choices.
“We really wanted to focus our resources on creating environments that are supportive of health and foster health-promoting choices,” explained Cora Janzen, Population Health Promotion Practitioner with the SHA. “We also wanted to ensure that health equity was embedded in all elements of our built environment work.”
“Our framework identifies health equity goals for planning decisions affecting transportation, housing, neighbourhood design, and food systems in the city,” offered Janzen. “Unfortunately, to date, we have only had the resources to deeply implement the transportation and neighbourhood design elements of our framework.”
While a multi-disciplinary team worked to develop the framework, the implementation has been carried out largely by one staff person to date.
The health authority applied the framework to the Growth Plan proposed for the City of Saskatoon in 2016. This growth plan was creating a vision and the policies that would shape the city’s development for 30 to 40 years into the future. Staff from the Saskatoon Area of SHA worked in collaboration with the non-profit organization Think Upstream to conduct a Health Equity Impact Assessment (HEIA) on the proposal.
The project team used the HEIA developed by Ontario’s Ministry of Health and Long-Term Care and included some adaptations developed by the Wellesley Institute. A multi-disciplinary team that included an Epidemiologist, a Population Health Practitioner, an Environmental Health Officer, an MHO, and two staff from Think Upstream was established to conduct the assessment. A brief report that includes 17 recommendations was submitted to the city. Among the recommendations were the following:
Corridor Growth
Ensure that infill due to corridor growth contains a mix of housing types, with a deliberate emphasis on affordable owner-occupied and rental units.
Reduce policy barriers to developing affordable infill housing, and incentivize developers into providing safe, affordable, and quality housing in corridor growth areas.
Increase neighbourhood green cover as corridor growth occurs in order to mitigate the urban heat island effect and improve mental health and air quality.
Public Transit
Focus the shift to an intensity model of service on neighbourhoods with lower socio-economic status, thus improving their access to transportation.
Encourage development along bus rapid transit routes that improves the availability of services like grocery stores, community gathering places, and employment centres.
Active Transportation
Direct early investments in new and rebuilt active transportation infrastructure to lower income neighbourhoods and remove physical barriers to active transportation in these areas.
Ensure active transportation infrastructure is well integrated with public transit and facilitates connectivity between neighbourhoods, employment areas, and services such as grocery stores.
“The relationship fostered between health and the municipality has increased the opportunities to be involved in developing plans and providing public health’s perspective, including a health equity lens,” offered Janzen. “We were invited to participate directly in the development of the city’s Active Transportation Plan. Our MHO was offered a seat at the Steering Committee, which included Directors from several departments in the city, while I was offered a seat at the Advisory Committee where details of the plan were discussed.”
“This two-tier involvement worked well for us,” said Janzen. “The MHO and I would meet before hand to discuss our recommendations, then the MHO would articulate our high-level recommendations and principles at the Steering Committee, particularly with respect to health equity, while I would provide detailed comments on the plan at the Advisory Committee.”
Since that time, the Health Authority has provided comments, at meetings or in writing, on a number of proposed plans including Neighbourhood Sector Plans and the Bus Rapid Transit Plan to name a few.
“Once a policy or plan has been developed, we will check with our colleagues at the city to see if there are ways that we can support its approval,” explained Janzen. “Sometimes a letter of support to a Council Committee and/or Council is warranted; other times a deputation. If health data, such as transportation-related injury hospitalizations or deaths, can support the decision, we will work collaboratively to include that information in the body of information that is used to support decisions.”
“While Cora is the content expert on this file for Saskatoon and area, I will go to Committee or Council meetings to articulate our support for a policy or a plan recognizing that the office of the MHO carries weight with City Councillors and members of the public,” offered Dr. Jasmine Hasselback, MHO for Saskatoon and surrounding communities with the SHA. “We will often ask our colleagues in planning and transportation departments to identify the specific policies that need our support because they understand the concerns of their decision-makers and the public on these issues better than we do.”
OUTCOMES ACHIEVED
The SHA has developed relationships with colleagues in Planning and Transportation Services at the City of Saskatoon. Staff at the SHA are now informed about land use and transportation plans and invited to participate as external reviewers or committee members.
Recommendations offered by the SHA, particularly those related to health equity, have been adopted in a few of the plans developed. For example, the City’s Active Transportation Plan identifies health equity as a criterion that was used in the identification of routes.
The Mayor and a few City Councillors have publicly acknowledged the role that SHA has played in the incorporation of health equity into the City’s plans.
“While our healthy built environment work is directed at improving population health and reducing health inequities, we do believe that our overall goals – the creation of green, walkable, bikeable, and transit-supportive communities – can reduce greenhouse gases and increase the resiliency of our communities,” noted Janzen.
LESSONS LEARNED
It is important for those in population and public health to develop relationships with the municipal staff responsible for the plans and policies that guide development within the community.
It is important for public health staff to have established knowledge about the associations between that the built and natural environments have with population health and health equity so they can bring evidence and leading practices to the municipal tables to support their goals.
Health authorities must be willing to commit staff resources to the municipal planning processes they want to influence.
Prepared by Kim Perrotta, MHSc, Executive Director, CHASE
This is one in a series of case studies that explore strategies, policies and programs that public health agencies can employ to advance climate action, population health and health equity in their communities. These case studies are produced through a collaboration of the Canadian Public Health Association, the Canadian Health Association for Sustainability and Equity, and the Ontario Public Health Association with funding from the McConnell Foundation.
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