7. Tackling obesity in Canada through urban design



To stem Canada’s rising obesity levels, the Urban Public Health Network built a coalition of organisations, including planners, engineers, health charities and local government, to develop and share ways of embedding health in urban and transport policy and planning.





Canada’s Urban Public Health Network (UPHN) establishes a Healthy Built Environment working group for its members.


UPHN establishes a loose, cross-disciplinary coalition of organisations interested in healthy built environments.


Coalition members successfully bid for Coalitions Linking Action and Science for Prevention (CLASP) funding to formalise the coalition, and the Healthy Canada by Design coalition is formalised.


Delivery of Healthy Canada by Design phase one projects.


Process and outcome evaluations of Healthy Canada by Design phase one projects.


A second phase of Healthy Canada by Design projects is funded.


In 2008, in response to rising obesity in Canada, the Urban Public Health Network (UPHN) established a Healthy Built Environment working group to find ways to make health a central consideration in urban and transport planning, including to promote walking and cycling.

The working group believed it would need to convince the planning and engineering community of the benefits of a healthier built environment, and was concerned that public health professionals lacked the knowledge to accomplish this. However, Canada’s planning and engineering community was already keen to address urban sprawl, reduce congestion and promote cleaner air. In addition, improving the urban realm was becoming a public and political priority across the country, as people started to realise congestion in towns and cities was damaging economic growth, and younger voters began shunning the car and demanding safer streets and better walking and cycling routes.

This groundswell of diverse interests with a shared goal created a fertile environment in which to act.

The intervention

In 2008, the UPHN brought together a cross-disciplinary coalition of interested parties to explore how their efforts could be better supported and coordinated. The coalition comprised:

  • six provincial health authorities that were UPHN members: Peel Region, Toronto, Montreal and three health regions of southern British Columbia
  • four national partners: the Heart and Stroke Foundation, the National Collaborating Centre for Healthy Public Policy, the Canadian Institute of Planners, and the Canadian Institute of Transportation Engineers.

For the Canadian Institute of Planners and the Canadian Institute of Transportation Engineers, the value of joining the UPHN coalition was to be able to harness health arguments and the influence of public health professionals to help drive forward changes. A key purpose of the coalition became to upskill public health professionals so they could bring their influence to bear on planning decisions.

The Healthy Canada by Design coalition

In summer 2009, the UPHN coalition secured a Can$2m grant from the Coalitions Linking Action and Science for Prevention (CLASP) programme, and Healthy Canada by Design formally came into being.

The Healthy Canada by Design coalition aimed to develop and disseminate ways of embedding health in urban and transport policy and planning to improve the population’s health. It would do this by:

  • improving understanding across sectors of the relationship between the built environment and health, including how policy, programmes and public engagement can be used to develop healthier environments that contribute to preventing illness
  • making new, state-of-the-art decision-making tools available to policymakers and practitioners across sectors
  • developing a new community of practice that would include the public health community, planning professionals and NGOs, to translate the literature linking the built environment and health into usable, practical tools.

The coalition funded projects in six provinces. For example, in British Columbia three health authorities used the funding to build staff capacity for developing evidence-based healthy planning policies, including:

  • teaching staff about how the built environment and health are linked
  • supporting staff to use evidence for local policymaking and practice
  • creating networking opportunities for public health staff and urban planners.

The partners with national reach took on an overarching knowledge transfer and exchange role, which involved disseminating learning through webinars, reports, conference presentations and workshops, and meetings with key strategic stakeholders.


Each of the six projects and the overall Healthy Canada by Design project were evaluated through process and outcome evaluations. The evaluations gathered data from public health specialists and professionals from other sectors using a variety of methods, including surveys, focus groups and interviews. The findings included:

  • The CLASP grant made urban planning a more strategic priority for coalition members. The funding led to in-kind resources being allocated by each of the national partners and each of the six sites, amounting to Can$1.4m additional investment.
  • Health authorities built new relationships with other health authorities and other sectors, particularly local planning departments. This facilitated information sharing and created opportunities to influence decisions about the built environment.
  • Public health staff became more skilled at working with partners outside of public health to improve the built environment. In 2010, 62% of public health survey respondents felt they had increased their skills. In 2011, this rose to 80%. In turn, urban planners became more aware of the health impacts of the built environment and said they would consider health more in local policies and plans.
  • In British Columbia, health was increasingly included in urban planning policies and strategies. For example, the 2011 Metro Vancouver regional growth strategy committed to develop healthy communities with access to services and amenities. In the city of North Vancouver, health authority staff were embedded in the planning team to develop the district’s official community plan and other strategic planning documents.

Lessons learned

What worked well

  • Professionals working in public health, planning and transport embraced the opportunity to work together and learn from each other because they shared similar goals.
  • Bringing experienced planners into public health departments upskilled public health staff and increased their capacity to work with planning colleagues and influence the planning process.
  • Framing health conditions such as obesity as a planning issue, rather than a health issue, and developing medical professionals’ abilities to advocate in planning terms, contributed to healthier planning decisions.
  • External funding helped catalyse the partnerships and supported continuing partnership working, which influenced partner organisations to prioritise and invest in health.

What worked less well

  • Healthy Canada by Design was delivered and evaluated over a three-year period. Given the length of the planning process (typically, 5–10 years), and since the health impacts of urban realm improvements can take many years to become evident, this timescale may have been too short to deliver and measure meaningful change.
  • Similarly, participants in the evaluation suggested public health departments would need more than three years to fully integrate urban planning into their work programmes. Partners could have invested more in continuity planning to ensure teams were prepared to sustain the integrated approach after funding ceased.
  • While commercial developers broadly accepted Healthy Canada by Design at national level, companies objected to some specific proposals in which they felt profit and public health objectives were at odds. Some developers did not engage in the project at all, or used their power to block plans, due to concerns that it would increase costs and reduce profit margins. Stronger political commitment and leadership may have helped planners overcome these challenges in order to create healthy communities.
  • Aside from public health specialists, a further challenge was engaging the wider medical community on the importance of prevention and the role the built environment plays in population health. One health authority reported that its executive directors did not support public health projects and instead prioritised acute care initiatives.

Implications for the UK

The creation of metro mayors in some of the UK’s largest cities presents an opportunity to establish cross-disciplinary teams to focus on the urban realm and develop health-promoting environments. This is already starting to happen in some areas.

Air quality is a priority across the UK and represents a policy area under which broader ambitions to create health-promoting environments could be championed. Since the health harms of pollution are widely acknowledged, this presents an opportunity to engage health care professionals in promoting action on urban planning and transport.

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