Dufferin County: Planning Review Through a Public Health Lens

1.0 INTRODUCTION

1.1 Background

The role of public health in land use planning can be traced back to the industrial revolution. At this time, newly urbanized areas needed the infrastructure to provide healthy and sanitary conditions, which resulted in public health, land use planning and civil engineers coming together. i Over time, however, there began a separation of planning and public health. This was partially due to the emerging specialization in the planning field (e.g. environmental planning, transportation engineering and urban planning) and a concentration on individual health practices and conditions in the medical field.ii
 
Recent research in health has returned to the thinking that health is not always decided by individual health behaviours but, rather, is largely determined by the environment in which one lives. For instance, many of today’s looming health concerns revolve around chronic disease, such as obesity, heart disease, stroke and some types of cancer. These conditions are often associated with lack of physical activity and unhealthy eating, and some with environmental exposure to air pollutants (e.g. certain types of cancer).iii
 
In addition to specific connections with chronic diseases, the built environment and land use planning policies have the potential to impact certain populations disproportionately at the community level, thus becoming a health equity issue. For example, studies demonstrate that individuals and families living in lower socioeconomic status (SES) neighbourhoods are more likely to live close to a highway or major industrial area, hence exposing them to higher levels of air pollution and increasing their risk of suffering associated health conditions.
Additionally, research has shown an association between food desserts – areas with limited access to fresh groceries – and lower SES neighbourhoods.iv
 
As age is also an important social determinant of health, designing communities that meet the “8-80 cities” concept is critical. As a non-profit community development organization based in Toronto, 8-80 Cities has four areas of focus: Parks and Public Spaces, Sustainable and healthy mobility, People friendly public realm, and OpenStreets programs.v Each of these is linked to the concept of building a healthy community or, in this case, city. A community that is built with the 8-80 concept in mind is one that promotes and enables healthy behaviours regardless of whether you are eight (8) or 80 years old. Such a community is designed to prioritize human interaction through interconnected streets and public places where people work, learn and play.vi Ultimately, “8-80 cities encourages sustainable and healthy lifestyles for people regardless of age, gender, ability and social status”.vi
 
The Healthy Communities movement pre-dates 8-80 Cities, however. The Ontario Healthy Communities Coalition (OHCC), which was itself established in 1992, has identified that the broader healthy communities movement has roots in the 1980’s in Ontario.vii Arguably, the term itself became popularized after the World Health Organization’s “Healthy Cities Project” was initiated in Europe in 1986.viii That same year, the First International Conference on Health Promotion was held in Ottawa. The Conference resulted in the “Ottawa Charter,” which was intended “to achieve Health for All by the year 2000 and beyond.”ix The Charter indicates that "Health is created and lived by people within the settings of their everyday life; where they learn, work, play, and love."x Today, the importance of a given place, including its intersecting natural, built, social and cultural environments, is widely understood as being a determinant of the social, health and economic outcomes of local people.
 
In summary, designing and building healthy, safe and complete communities has the potential to support the health of an entire population, including that of Dufferin County. Healthy communities promote active transportation, recreation and healthy food choices; improve access to jobs, schools and health care; create strong social networks; and ensure good air and water quality.xi

1.2 Key Developments Leading to the Study

Locally, Wellington-Dufferin-Guelph Public Health’s (WDGPH) mandate is to improve the health of the population through activities that promote and protect health, and prevent disease and injury. To accomplish this mandate, it is important to work collaboratively with municipalities, school boards, health and social service agencies to create and sustain healthy communities. Municipalities can play a big role in enabling healthy decisions through their land-use design policies and practices. Nevertheless, WDGPH’s understanding and experience with land use planning policies continues to evolve.
 
In an attempt to inform the future direction of public health’s role in land use planning, public health staff completed a needs assessment in 2014 with municipal planners in Wellington County, Dufferin County and the City of Guelph. From the assessment, the majority of planners indicated that reviewing official plans would be a useful role for Public Health.

1.3 Purpose of WDG Official Plan Policy Review

Using funding from the Ministry of Health and Long-Term Care’s Healthy Communities Partnership, WDGPH hired a planning consultant to review municipal and county official plans, and other appropriate planning-related documents, in order to identify local strengths and areas of opportunity. This will help WDGPH make an effective contribution to the development of healthy communities throughout the region.
 
This report provides an assessment of the strengths and areas of opportunity contained within the Official Plans and related planning documents for municipalities within Dufferin County from a public health perspective. Subsequently, the report recommends considerations for future Official Plans and related policies that would help contribute to planning for a healthy community.

1.4 Anticipated Outcomes of the Review

There are several anticipated outcomes of this review. The review and suggested considerations could encourage local municipalities to adopt official plan amendments, or to further study the prospect thereof, whether in the short-, medium- or long-terms. It is hoped that this work will support future collaborations between WDGPH and Dufferin County; between WDGPH and local planning officials; between the County and municipalities; and, between local municipalities. As such, an anticipated outcome of this work is fuel for capacity building in the area of healthy communities. Lastly, this work is intended to provide food for thought for both public health and planning officials who serve the public interest both within and across Wellington and Dufferin counties, and the City of Guelph.

1.5 Methodology & Assessment

The built environment requirement of the Ontario Public Health Standards (2008) suggests that public health units work to address the following risk factors: healthy eating, healthy weights, tobacco, physical activity, alcohol use and UV radiation. Nonetheless, when preparing for the official plan review process, WDGPH recognized that these are health outcomes of community design, but may not be the language of how planning decisions are made. As such, the internal built environment committee at WDGPH decided to select a planning-oriented framework that would guide consistency for the official plan review process across all 16 municipalities and 2 counties.
 
After reviewing several documents, the committee decided to adapt the framework outlined in Healthy Built Environment Linkages: A Toolkit for Design, Planning and Health, produced by British Columbia’s Provincial Health Services Authority.xii In this document, physical features of the built environment were separated into 5 domains:
  • Healthy Neighbourhood Design;
  • Healthy Transportation Networks;
  • Healthy Natural Environments;
  • Healthy Food Systems; and
  • Healthy Housing.
These domains are each described in the following sub-sections. WDGPH worked with the planning consultant to develop a planning checklist that contained several planning policy principles within each domain. These were then used to guide the official plan review for strengths and areas of opportunity. Referencing back to the checklist, successful examples from other communities and additional best practice literature were referenced and subsequent recommended considerations were developed. It should be noted that many of the suggested considerations and case examples may be relevant in a more urban community, as the literature does not always provide examples within a rural context. We have noted areas where the more rural character of local communities may require further research on approaches that would be effective in enhancing the health of the community.

1.6 Five Domains

Below we describe each of the aforementioned domains in some detail.
1.6.1 Healthy Neighbourhood Design
Safe and healthy neighbourhood design can encourage active transportation and physical activity by considering mixed land use development, density, and efficient street connectivityxiii,xiv. These considerations can indirectly impact a community’s physical and mental health via cycling, walking and accessible physical activity opportunitiesxv,xvi. Convenient access to a range of amenities, such as recreation facilitates, through mixed land use development has been shown to increase active transportation and overall physical activityxvii,xviii. High density neighbourhoods increase proximity to work, school, amenities and recreation options, having multiple positive impacts, such as improved air quality, active transportation and physical activityxix,xx. Research also suggests that compact and connected street design promotes safe use of active transportation, therefore encouraging community members to walk or cyclexxi.
 
Community design can also moderate climate change impacts. The links between climate change and human health are numerous and diverse. For example, extreme weather events (heat waves, flooding, droughts, tornadoes), which are expected to increase in frequency and severity, may lead to increased risks of injury and illness, as well as increased risks of damage to critical infrastructure (water and sanitation systems, power grids, etc.)xxii. Communities can increase their resiliency to climate change impacts by understanding local needs and vulnerabilities. Adaptation efforts may include increasing green spaces, decreasing impervious surface runoff, and designing infrastructure to withstand severe weather eventsxxiii.
 
The following Healthy Neighbourhood Design planning principles were adapted from Healthy Built Environment Linkages: A Toolkit for Design, Planning and Healthxii as the criteria used to review municipal planning documents:
 
1. Enhance neighbourhood walkability
2. Create mixed land use
3. Build complete and compact neighbourhoods
4. Enhance connectivity with efficient and safe networks
5. Prioritize new developments within or beside existing communities
6. Create infrastructure resilient to climate change (addition to original toolkit referenced above)
1.6.2 Healthy Transportation Networks
The design and connectivity of transportation networks can make it either easier to get around by walking or biking or simply easier to drivexxiv. Communities can build healthy transportation networks by including features that improve streetscapes, including sidewalks, crosswalks, lighting and benches, which have been shown to be associated with an increase in physical activity among older adultsxxv. Meanwhile, in rural settings, physical activity among adults is found to be associated with trails and parks with pleasant aestheticsxxvi. There are also various design features that can help improve safety and consequently potentially encourage walking and cycling, for example, traffic calming measuresxxvii,xxviii and cycling infrastructure (such as dedicated cycle routes, both on and off road)xxix,xxx,xxxi. Evidence suggests that biking or walking to school may not only be influenced by proximity, but also by supportive infrastructure, and that active transport to school may also increase habitual physical activity among childrenxxxii.
 
The following Healthy Transportation Networks planning principles were adapted from Healthy Built Environment Linkages: A Toolkit for Design, Planning and Health as criteria used to review municipal planning documents:
 
1. Enable mobility for all ages and abilities
2. Make active transportation convenient and safe
3. Prioritize safety
4. Encourage use of public transit
5. Enable attractive road, rail and waterway networks
1.6.3 Healthy Natural Environments
1.1.3 Healthy Natural Environments
Healthy natural environments serve to enhance public health through improved air quality and cooling effects, as well as by providing opportunities for community member to engage with nature. Research indicates that urban trees have the potential to clean the air of air pollutantsxxxiii, which in turn can help prevent the onset of cancerxxxiv, cardiovascular disease and respiratory difficultiesxxxv. Preliminary studies also suggest that urban trees and green spaces can have cooling effectsxxxvi,xxxvii, mitigating the impacts of extreme heat events which are linked to increased mortality, in particular for those with pre-existing cardiovascular and respiratory conditionsxxxviii. Meanwhile, studies have demonstrated that exposure to nature is not only associated with increased physical activity, but is also linked with increased general wellbeing, including improved cognitive function and reduced stress and anxiety xxxix,xl,xli.
 
The following Healthy Natural Environments planning principles were adapted from Healthy Built Environment Linkages: A Toolkit for Design, Planning and Health as the criteria used to review municipal planning documents:
 
1. Preserve and connect open space and environmentally sensitive areas
2. Maximize opportunities to access and engage with the natural environment
3. Reduce urban air pollution
4. Mitigate urban heat island effect
5. Expand natural elements across the landscape
1.6.4 Healthy Food System
The local food system impacts a community’s access to, and choice of, food optionsxlii. Land use planning can directly influence factors within the local food system, such as production, distribution and procurementxliii. A community is more probable to reap the health benefits of nutritious foods when healthy and affordable local food options are easily accessiblexliv. Individuals who do not have convenient neighbourhood access to a healthy food retail outlet, like a grocery store, may be more likely to choose costly and less nutritious options (e.g., processed food)xlv. Research also suggests that this unequal distribution of food retail outlets in residential areas occurs more in lower income neighbourhoodsxlvi. When a local food system is adequately supported to provide development initiatives like community gardens and kitchens, healthy local food options are made accessible, while bolstering community members’ food skills, social and coping skills, and overall community empowermentxlvii,xlviii.
 
The following Healthy Food Systems planning principles were adapted from Healthy Built Environment Linkages: A Toolkit for Design, Planning and Health as the criteria used to review municipal planning documents:
 
1. Enhance agricultural capacity
2. Increase access to healthy foods in all neighbourhoods
3. Improve community-scale food infrastructure
1.6.5 Healthy Housing
Housing affordability and quality impact health in numerous and diverse ways. Access to affordable housing reduces the frequency of moving and improves the chances of having disposable income available, both of which reduce stress and allow people and families to take better care of themselves and stay healthy1,xlix,l. Additionally, living in quality housing may be associated with an improved sense of safety and decreased fear of crime, which in turn reduces stress and improves social connectionsli. And high quality housing with appropriate ventilation and moisture control leads to improved indoor air quality, which can have impacts on general and respiratory health, particularly for children with asthmalii,liii. Moreover, providing energy efficient housing helps people to afford living in their homes, while reducing risks of illnesses aggravated by cold and damp conditionsliv.
 
The following Healthy Housing planning principles were adapted from Healthy Built Environment Linkages: A Toolkit for Design, Planning and Health as the criteria used to review municipal planning documents:
 
1. Increase access to affordable housing through provision of diverse housing forms and tenure types
2. Ensure adequate housing quality for all segments of society
3. Prioritize housing for the homeless, elderly, low income groups and people with disabilities
4. Site and zone housing developments to minimize exposure to environmental hazards

1.7 Layout of this Report

The next three chapters in this report provide: an overview of the roles of the public health and planning professions in supporting the development of healthy communities; description of the Provincial planning framework; and, review of relevant Provincial policy directions. The subsequent chapters correspond to the review of planning documents developed by the County and each of its local municipalities. Each report includes a discussion of strengths, areas of opportunity, considerations along with practical guidance and examples, as well as other strategies and actions. The report concludes with a discussion of common themes that emerged through our review of policies and plans in Dufferin County, and a review of next steps for this work.
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City of Guelph: Planning Review Through a Public Health Lens

1.0 INTRODUCTION

1.1 Background

The role of public health in land use planning can be traced back to the industrial revolution. At this time, newly urbanized areas needed the infrastructure to provide healthy and sanitary conditions, which resulted in public health, land use planning and civil engineers coming together. i Over time, however, there began a separation of planning and public health. This was partially due to the emerging specialization in the planning field (e.g. environmental planning, transportation engineering and urban planning) and a concentration on individual health practices and conditions in the medical field.ii
 
Recent research in health has returned to the thinking that health is not always decided by individual health behaviours but, rather, is largely determined by the environment in which one lives. For instance, many of today’s looming health concerns revolve around chronic disease, such as obesity, heart disease, stroke and some types of cancer. These conditions are often associated with lack of physical activity and unhealthy eating, and some with environmental exposure to air pollutants (e.g. certain types of cancer).iii
 
In addition to specific connections with chronic diseases, the built environment and land use planning policies have the potential to impact certain populations disproportionately at the community level, thus becoming a health equity issue. For example, studies demonstrate that individuals and families living in lower socioeconomic status (SES) neighbourhoods are more likely to live close to a highway or major industrial area, hence exposing them to higher levels of air pollution and increasing their risk of suffering associated health conditions. Additionally, research has shown an association between food desserts – areas with limited access to fresh groceries – and lower SES neighbourhoods.iv
 
As age is also an important social determinant of health, designing communities that meet the “8-80 cities” concept is critical. As a non-profit community development organization based in Toronto, 8-80 Cities has four areas of focus: Parks and Public Spaces, Sustainable and healthy mobility, People friendly public realm, and Open Streets programs.v Each of these is linked to the concept of building a healthy community or, in this case, city. A community that is built with the 8-80 concept in mind is one that promotes and enables healthy behaviours regardless of whether you are eight (8) or 80 years old. Such a community is designed to prioritize human interaction through interconnected streets and public places where people work, learn and play.vi Ultimately, “8-80 cities encourages sustainable and healthy lifestyles for people regardless of age, gender, ability and social status”.vi
 
The Healthy Communities movement pre-dates 8-80 Cities, however. The Ontario Healthy Communities Coalition (OHCC), which was itself established in 1992, has identified that the broader healthy communities movement has roots in the 1980’s in Ontario.vii Arguably, the term itself became popularized after the World Health Organization’s “Healthy Cities Project” was initiated in Europe in 1986.viii That same year, the First International Conference on Health Promotion was held in Ottawa. The Conference resulted in the “Ottawa Charter,” which was intended “to achieve Health for All by the year 2000 and beyond.”ix The Charter indicates that "Health is created and lived by people within the settings of their everyday life; where they learn, work, play, and love."x Today, the importance of a given place, including its intersecting natural, built, social and cultural environments, is widely understood as being a determinant of the social, health and economic outcomes of local people.
 
In summary, designing and building healthy, safe and complete communities has the potential to support the health of an entire population, including that of the City of Guelph. Healthy communities promote active transportation, recreation and healthy food choices; improve access to jobs, schools and health care; create strong social networks; and ensure good air and water quality.xi

1.2 Key Developments Leading to the Study

Locally, Wellington-Dufferin-Guelph Public Health’s (WDGPH) mandate is to improve the health of the population through activities that promote and protect health, and prevent disease and injury. To accomplish this mandate, it is important to work collaboratively with municipalities, school boards, health and social service agencies to create and sustain healthy communities. Municipalities can play a big role in enabling healthy decisions through their land-use design policies and practices. Nevertheless, WDGPH’s understanding and experience with land use planning policies continues to evolve.

In an attempt to inform the future direction of public health’s role in land use planning, public health staff completed a needs assessment in 2014 with municipal planners in Wellington County, Dufferin County and the City of Guelph. From the assessment, the majority of planners indicated that reviewing Official Plans would be a useful role for Public Health.

1.3 Purpose of WDG Official Plan Policy Review

Using funding from the Ministry of Health and Long-Term Care’s Healthy Communities Partnership, WDGPH hired a planning consultant to review municipal and county Official Plans, and other appropriate planning-related documents, in order to identify local strengths and areas of opportunity. This will help WDGPH make an effective contribution to the development of healthy communities throughout the region.
 
This report provides an assessment of the strengths and areas of opportunity contained within the City of Guelph’s Official Plan and related planning documents from a public health perspective. Subsequently, the report recommends considerations for future Official Plans and related policies that would help contribute to planning for a healthy community.

1.4 Anticipated Outcomes of the Review

The review and suggested considerations could encourage local municipalities to adopt Official Plan amendments, or to further study the prospect thereof, whether in the short-, medium- or long-terms. It is hoped that this work will support future collaborations in designing and supporting healthy communities in the City of Guelph. Implicit in this report is an invitation for municipal officials to collaborate with WDGPH on matters relating to land use planning and the built environment, in order to advance public health objectives locally. This report will support future collaboration between WDGPH and the city of Guelph; between WDGPH and local planning officials; and between local municipalities. As such, an anticipated outcome of this work is fuel for capacity building in the area of healthy communities. Lastly, this work is intended to provide food for thought for both public health and planning officials who serve the public interest both within and across Wellington and Dufferin counties, and the City of Guelph.

1.5 Methodology & Assessment

The built environment requirement of the Ontario Public Health Standards (2008) suggests that public health units work to address the following risk factors: healthy eating, healthy weights, tobacco, physical activity, alcohol use and UV radiation. Nonetheless, when preparing for the Official Plan review process, WDGPH recognized that these are health outcomes of community design, but may not be the language of how planning decisions are made. As such, the internal built environment committee at WDGPH decided to select a planning-oriented framework that would guide consistency for the Official Plan review process across all 16 municipalities and 2 counties.
 
After reviewing several documents, the committee decided to adapt the framework outlined in Healthy Built Environment Linkages: A Toolkit for Design, Planning and Health, produced by British Columbia’s Provincial Health Services Authority.xii In this document, physical features of the built environment were separated into 5 domains:
  • Healthy Neighbourhood Design;
  • Healthy Transportation Networks;
  • Healthy Natural Environments;
  • Healthy Food Systems; and
  • Healthy Housing.
These domains are each described in the following sub-sections. WDGPH worked with the planning consultant to develop a planning checklist that contained several planning policy principles within each domain. These were then used to guide the Official Plan review for strengths and areas of opportunity. Referencing back to the checklist, successful examples from other communities and additional best practice literature were referenced and subsequent recommended considerations were developed. It should be noted that many of the suggested considerations and case examples may be relevant in a more urban community, as the literature does not always provide examples within a rural context. We have noted areas where the more rural character of local communities may require further research on approaches that would be effective in enhancing the health of the community.

1.6 Five Domains

Below we describe each of the aforementioned domains in some detail.
1.6.1 Healthy Neighbourhood Design
Safe and healthy neighbourhood design can encourage active transportation and physical activity by considering mixed land use development, density, and efficient street connectivityxiii,xiv. These considerations can indirectly impact a community’s physical and mental health via cycling, walking and accessible physical activity opportunitiesxv,xvi. Convenient access to a range of amenities, such as recreation facilitates, through mixed land use development has been shown to increase active transportation and overall physical activityxvii,xviii. High density neighbourhoods increase proximity to work, school, amenities and recreation options, having multiple positive impacts, such as improved air quality, active transportation and physical activityxix,xx. Research also suggests that compact and connected street design promotes safe use of active transportation, therefore encouraging community members to walk or cyclexxi.
 
Community design can also moderate climate change impacts. The links between climate change and human health are numerous and diverse. For example, extreme weather events (heat waves, flooding, droughts, tornadoes), which are expected to increase in frequency and severity, may lead to increased risks of injury and illness, as well as increased risks of damage to critical infrastructure (water and sanitation systems, power grids, etc.)xxii. Communities can increase their resiliency to climate change impacts by understanding local needs and vulnerabilities. Adaptation efforts may include increasing green spaces, decreasing impervious surface runoff, and designing infrastructure to withstand severe weather eventsxxiii.
 
The following Healthy Neighbourhood Design planning principles were adapted from Healthy Built Environment Linkages: A Toolkit for Design, Planning and Healthxxiv as the criteria used to review municipal planning documents:
 
1. Enhance neighbourhood walkability
2. Create mixed land use
3. Build complete and compact neighbourhoods
4. Enhance connectivity with efficient and safe networks
5. Prioritize new developments within or beside existing communities
6. Create infrastructure resilient to climate change (addition to original toolkit referenced above)
1.6.2 Healthy Transportation Networks
The design and connectivity of transportation networks can make it either easier to get around by walking or biking or simply easier to drivexxv. Communities can build healthy transportation networks by including features that improve streetscapes, including sidewalks, crosswalks, lighting and benches, which have been shown to be associated with an increase in physical activity among older adultsxxvi. Meanwhile, in rural settings, physical activity among adults is found to be associated with trails and parks with pleasant aestheticsxxvii. There are also various design features that can help improve safety and consequently potentially encourage walking and cycling, for example, traffic calming measuresxxviii,xxix and cycling infrastructure (such as dedicated cycle routes, both on and off road)xxx,xxxi,xxxii. Evidence suggests that biking or walking to school may not only be influenced by proximity, but also by supportive infrastructure, and that active transport to school may also increase habitual physical activity among childrenxxxiii.
 
The following Healthy Transportation Networks planning principles were adapted from Healthy Built Environment Linkages: A Toolkit for Design, Planning and Healthxxxiv as criteria used to review municipal planning documents:
 
1. Enable mobility for all ages and abilities
2. Make active transportation convenient and safe
3. Prioritize safety
4. Encourage use of public transit
5. Enable attractive road, rail and waterway networks
1.6.3 Healthy Natural Environments
Healthy natural environments serve to enhance public health through improved air quality and cooling effects, as well as by providing opportunities for community member to engage with nature. Research indicates that urban trees have the potential to clean the air of air pollutantsxxxv, which in turn can help prevent the onset of cancerxxxvi, cardiovascular disease and respiratory difficultiesxxxvii. Preliminary studies also suggest that urban trees and green spaces can have cooling effectsxxxviii,xxxix, mitigating the impacts of extreme heat events which are linked to increased mortality, in particular for those with pre-existing cardiovascular and respiratory conditionsxl. Meanwhile, studies have demonstrated that exposure to nature is not only associated with increased physical activity, but is also linked with increased general wellbeing, including improved cognitive function and reduced stress and anxiety xli,xlii,xliii.
 
The following Healthy Natural Environments planning principles were adapted from Healthy Built Environment Linkages: A Toolkit for Design, Planning and Healthxliv as the criteria used to review municipal planning documents:
 
1. Preserve and connect open space and environmentally sensitive areas
2. Maximize opportunities to access and engage with the natural environment
3. Reduce urban air pollution
4. Mitigate urban heat island effect
5. Expand natural elements across the landscape
1.6.4 Healthy Food System
The local food system impacts a community’s access to, and choice of, food optionsxlv. Land use planning can directly influence factors within the local food system, such as production, distribution and procurementxlvi. A community is more probable to reap the health benefits of nutritious foods when healthy and affordable local food options are easily accessiblexlvii. Individuals who do not have convenient neighbourhood access to a healthy food retail outlet, like a grocery store, may be more likely to choose costly and less nutritious options (e.g., processed food)xlviii. Research also suggests that this unequal distribution of food retail outlets in residential areas occurs more in lower income neighbourhoodsxlix. When a local food system is adequately supported to provide development initiatives like community gardens and kitchens, healthy local food options are made accessible, while bolstering community members’ food skills, social and coping skills, and overall community empowermentl,li.
 
The following Healthy Food Systems planning principles were adapted from Healthy Built Environment Linkages: A Toolkit for Design, Planning and Healthlii as the criteria used to review municipal planning documents:
1. Enhance agricultural capacity
2. Increase access to healthy foods in all neighbourhoods
3. Improve community-scale food infrastructure
1.6.5 Healthy Housing
Housing affordability and quality impact health in numerous and diverse ways. Access to affordable housing reduces the frequency of moving and improves the chances of having disposable income available, both of which reduce stress and allow people and families to take better care of themselves and stay healthy1,liii,liv. Additionally, living in quality housing may be associated with an improved sense of safety and decreased fear of crime, which in turn reduces stress and improves social connectionslv. And high quality housing with appropriate ventilation and moisture control leads to improved indoor air quality, which can have impacts on general and respiratory health, particularly for children with asthmalvi,lvii. Moreover, providing energy efficient housing helps people to afford living in their homes, while reducing risks of illnesses aggravated by cold and damp conditionslviii.
 
The following Healthy Housing planning principles were adapted from Healthy Built Environment Linkages: A Toolkit for Design, Planning and Healthlix as the criteria used to review municipal planning documents:
 
1. Increase access to affordable housing through provision of diverse housing forms and tenure types
2. Ensure adequate housing quality for all segments of society
3. Prioritize housing for the homeless, elderly, low income groups and people with disabilities
4. Site and zone housing developments to minimize exposure to environmental hazards

1.7 Layout of this Report

The next three chapters in this report provide: an overview of the roles of the public health and planning professions in supporting the development of healthy communities; description of the Provincial planning framework; and, review of relevant Provincial policy directions. The subsequent chapters include a discussion of strengths, areas of opportunity, considerations along with practical guidance and examples, and other strategies and actions for the City of Guelph. These chapters will be discussed with planners from each municipality, in order to fine-tune the considerations and guidance provided. The report concludes with a discussion of key themes that emerged through our review of policies and plans in City of Guelph, and a review of next steps for this work.
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2015 Oral Health Status Report

Executive Summary

Oral health is essential to overall health and quality of life (World Health Organization [WHO], 2012). However, in Canada over half of children and the majority of adults have experienced oral diseases (Health Canada, 2010). Practicing good oral health behaviours consists of routine oral hygiene, a nutritious diet and receiving professional dental care. Oral health diseases are largely preventable through these practices, yet the rate of tooth decay remains high. Having dental insurance is a valuable asset to overcome the financial barriers of costly professional dental services, yet 32% of Canadians do not have access to dental insurance (Health Canada, 2010). Those who have the most difficulty accessing and affording dental insurance are also those who experience the highest level of oral health problems (Canadian Academy of Health Sciences [CAHS], 2014). These vulnerable populations include: children, low-income adults and families, seniors, and people living in rural and remote areas (Canadian Dental Association [CDA], 2010).
Key Findings
Poor oral health status and access to dental care are important issues in Wellington-Dufferin-Guelph (WDG). This report explores the current oral health status and barriers to good oral health faced by WDG residents.
• By Grade 2, almost half of WDG children will have experienced tooth decay.
• Approximately one fifth of WDG residents do not brush their teeth twice per day as recommended.
• Approximately one third of WDG residents experience teeth sensitivity and one tenth experience bleeding gums.
• Income is a barrier to receiving oral care: 70% of low-income Guelph residents reported that dental treatment was recommended to them which they cannot afford.
• Having dental insurance helps to overcome the cost of dental care. However, approximately two thirds of WDG residents and less than one third of seniors have dental insurance.
• Only 70% of WDG residents have seen a dentist in the last 3 years.
• Poor oral health is associated with heart disease, diabetes, premature delivery, low birth weights and negative social impacts. In a survey of low-income Guelph residents, half reported their poor oral health affect how they feel about themselves, and over a quarter report their oral health needs affect their social relationships and mental health status.
Recommendations
WDG Public Health delivers oral health education and preventive services to address these concerns among those most at risk. Although local public health initiatives make a difference in the lives of residents more work is required to improve the oral health status of children, low-income adults and seniors in WDG. Evidence presented in this report provides support for the following recommendations to improve oral health status and access to dental care among residents in WDG and Ontario. WDG Public Health will engage with our partners, where applicable, to pursue these recommendations.
  1. Support advocacy strategies to improve access to oral health care for those facing barriers including seniors, low-income individuals and families, and those from priority populations.
  2. Support education initiatives that encourage evidence-based behaviours that prevent oral disease.
  3. Support the expansion of oral health outreach programs to make oral care and education more accessible to vulnerable families. Rural portable oral health clinics are one example of an outreach initiative that provides oral care to children with limited access to oral health programs.
  4. Continue to provide preventive services through public health clinics to children for whom access to oral health care is difficult, including those from low-income families and other priority populations.
  5. Expand the provision of the Fluoride Varnish Initiative in schools, based upon identified need.
  6. Advocate for improved provincial and national data regarding the oral health status of the population to support evidence-based planning and programming at local levels.
  7. Investigate opportunities to include adult pregnant women who do not have dental benefits into a publicly-funded model in order to promote optimal prenatal oral health and improved oral health for newborns and young children.
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Quitting Smoking in Wellington-Dufferin-Guelph

Executive Summary

Purpose

The purpose of the Gaps Analysis was to determine the availability, reach and accessibility of smoking cessation programs and services in Wellington-Dufferin-Guelph. The report sought to answer the question: who is falling through the cracks and what can we do about it? During the gaps analysis process such questions as what services are smokers aware of, what have they used and how satisfied were they with the product or service, and what would they like to see available were addressed.

By identifying gaps in cessation services, Wellington-Dufferin-Guelph can make better use of limited resources and focus efforts on the most effective way to help residents of Wellington-Dufferin-Guelph quit smoking.

Overview of Methods

The methods used in the gaps analysis included an Environmental Scan and Community Feedback Surveys. The Environmental Scan consisted of a thorough search of smoking cessation programs and resources at both a provincial and local level, as well as interviews with Key Informants to determine the strengths and weaknesses of local resources and services. Community feedback surveys were conducted with tobacco users in Wellington-Dufferin-Guelph both by telephone and online.

Key Findings

The survey of tobacco users showed that close to half of all smokers across WDG did not make a single quit attempt in the past twelve months. There is strong supporting evidence that shows increasing quit attempts is an effective way to have an impact on the smoking rate at a population health level. Thus, there is a need in Wellington-Dufferin-Guelph to increase quit attempts among tobacco users.

Young adults in WDG, when compared to older age categories, had a higher proportion of occasional smokers yet they make more quit attempts. Nevertheless younger adults intend to quit in the longer term. Given the addictive nature of nicotine, there is a need to understand and focus on young adults to ensure that cessation services are catered to their needs.

Tobacco users across WDG showed a low level of awareness of quit smoking services in the community, with the City of Guelph having the lowest rate of awareness. Key informants identified awareness as low as well. Awareness of services needs to be increased across WDG by supporting provincial campaigns and/or developing local campaigns.

Cessation services across WDG are generally accessible. Smokers Helpline is a free provincial telephone hotline but is an underutilized resource across all of WDG. Participants indicated that the cost of quit aides is a barrier to quitting and some residents of WDG cannot access low cost nicotine replacement therapy.

Best practice guidelines support the use of nicotine replacement therapy and/or medications to quit smoking. The use of NRT and medication to quit is low in WDG with NRT use being lowest in Guelph and use of medication lowest in Dufferin. There may be opportunities to better collaborate with community partners to increase access to available community resources.

Recommendations

  • Quit attempts need to increase in WDG to have an impact on smoking rates. WDGPH should support regional and provincial efforts to increase quit attempts, including a provincial media campaign. WDGPH should consider local strategies to increase quit attempts.
  • WDGPH should support a provincial or regional cessation strategy for young adults.
  • WDGPH should develop a comprehensive plan to increase awareness of local services among tobacco users and health care professionals. The plan should include promoting Smokers Helpline.
  • WDGPH should continue efforts to build strength within the existing system, especially by improving access to free NRT. WDGPH should find innovative ways to reach those people not covered by the current system. This could include offering STOP on the Road and/or partnering with the FHTs to find ways to have non-rostered patients access to STOP with FHT.
  • WDGPH should work towards improving the use best practice quit aides such as NRT and medications among tobacco users making a quit attempt.
  • WDGPH should raise awareness of electronic cigarettes not being a proven cessation aide.
  • WDGPH should continue efforts to increase the number of health care providers who systematize tobacco interventions in their practice. The focus should be on pharmacy professionals.
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2014-2015 Influenza Report

Executive Summary

Influenza (commonly known as the flu) is a viral infection of the respiratory tract that spreads easily from person to person, most commonly in the late fall and winter months. Onset of symptoms is typically sudden and includes fever, chills, cough, sore throat, nasal congestion, and muscle pain. Those most at risk for developing health complications include children less than 5 years of age, adults more than 65 years of age, and individuals with chronic diseases, such as diabetes and cancer. Combined with regular hand washing, the influenza vaccine is the best way to protect oneself and others from the flu.
 
To reduce rates of influenza, the annual Universal Influenza Immunization Program (UIIP), funded by the Ontario Ministry of Health and Long-Term Care (MOHLTC), offers influenza immunizations at no cost to individuals aged 6 months and older in Ontario.
 
In support of the UIIP, each year Wellington-Dufferin-Guelph Public Health (WDG Public Health) conducts an Influenza Program to encourage individuals, particularly those considered high-risk and those who are in close contact with high-risk persons (e.g. healthcare workers), to receive the influenza vaccine. WDG Public Health offers the influenza vaccine at scheduled community clinics, through Public Health appointments, and by distributing vaccines to community partners (e.g. physicians, pharmacies). Public Health evaluates its Influenza Program each year to monitor reported cases of the flu, to identify immunization trends, and to encourage immunization rates by improving its own influenza clinics.
Key Findings
Below is an overview of the key findings highlighted in this report on the 2014-2015 influenza season.
• WDG Public Health administered a total of 5,494 influenza doses through: 11 community clinics (2,376 doses), Public Health appointments (800 doses, 104 FluMist doses), and through two sponsored clinics (2,214).
• Vaccine distribution to pharmacies continues to increase with each influenza season (26,330 distributed in 2014-2015 season, a 35% increase since the 2013-2014 season).
• WDG Public Health community clinic attendance rates continue to decrease, likely due to increasing vaccine availability at pharmacies since 2012.
• Among clients who completed the WDG Public Health clinic survey, 97% were satisfied with their clinic experience.
• The most popular clinic promotional tools were newspaper advertisements, the WDG Public Health website and word of mouth.
• Immunization rates for healthcare workers in long-term care and retirement homes increased since last season. However, they remain relatively low among hospitals (52.5%).
Recommendations
Based on the evidence presented in this report, the following is a summary of the key recommendations to strengthen WDG Public Health’s Influenza Program for the 2015-2016 influenza season.
Advertising
  1. Continue to promote the FluMist vaccine as a vaccine alternative.
• Consider promoting FluMist in local newspaper advertisements and through WDG Public Health’s website and social media accounts;
• Provide FluMist factsheets at community clinics and Public Health offices during future influenza seasons to increase public awareness.
  1. Continue using clinic advertisements in local newspapers, provide the complete WDG community clinic schedule on Public Health’s website, and promote clinics through its social media accounts.
  2. Increase clinic signage outside locations and inside establishments well in advance of clinic dates.
Promotional Activities
  1. Continue to distribute copies of the Healthcare Worker Fact Sheet to hospitals, LTCHs, and RHs to encourage HCW immunization among this segment of the population.
  2. Continue to target first responder service workers more directly to encourage increased influenza immunization rates (e.g. provide influenza immunizations at their facility rather than hosting a clinic at Public Health offices).
Community Clinics
  1. Continue to host future community clinics at the same 7 external sites from the 2014-2015 season, as these clinics experienced high attendance rates.
  2. Consider hosting a 2015-2016 clinic at the Salvation Army, in Guelph. During the 2013-2014 season attendance at this location was very high.
  3. Ensure signage is clear at all the clinics, particularly at locations where there are multiple entrances.
  4. Consider extending community clinic hours to accommodate more individuals.
Disclaimer: Data presented in this report may not be the same as data in subsequent reports, as the 2014-2015 influenza season is ongoing at time of data extraction, and information is constantly being updated in iPHIS.
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Nutrition Screening of Kindergarten Students in Wellington-Dufferin-Guelph: Results of NutriSTEP

Executive Summary

There is currently a lack of information regarding the eating and activity habits of preschool children in Wellington-Dufferin-Guelph. In February and March 2014, through a partnership with the Upper Grand District School Board and Wellington Catholic District School Board, Wellington-Dufferin-Guelph Public Health embarked on a surveillance study of kindergarten students across the region using NutriSTEP® (Nutrition Screening Tool for Every Preschooler). This tool is a valid and reliable, parent-administered nutrition screening tool. The goal of the surveillance was to determine kindergarten student risk for nutrition-related problems as well as to inform future Public Health programming and interventions.
 
Packages including a NutriSTEP® screening tool, How to Build a Healthy Preschooler educational brochure and a pre-paid, addressed envelope were distributed to kindergarten students with the help of both school boards and kindergarten teachers. Parents filled out NutriSTEP® at home and mailed the completed tool to Public Health where it was securely stored and analyzed.
 
A total of 5432 surveys were distributed with a sample rate of 22.85%. Overall risk for nutrition-related problems was relatively low; 4.7% of students scored high risk for nutrition-related problems, 11.1% were moderate risk and 84.2% were low risk. Primary areas of concern were consumption of grains, fruit and vegetables, use of supplements, exposure to TV while eating and parental control during meals. Notably, about 1 in 8 respondents indicated that they have difficulty buying food to feed their child at least sometimes. The level of food insecurity noted in this study (13.2%) is troubling as children who experience food insecurity are more likely to experience poorer overall health.
 
Few differences were found between priority and non-priority neighbourhoods. However, significant differences did exist between counties on a number of NutriSTEP® questions including intake of grains, fruit and fast food, recreational screen time, TV watching while eating and risk level. These results have led to the following recommendations.
Recommendations
1. Promote vegetable and fruit consumption and family meals, including awareness raising, education and skill building. Partner with other community groups for greater impact.
2. Create supportive environments for vegetable and fruit consumption where children live, learn and play, including child care centres, schools and recreation programs.
3. Continue to support collaborative partnerships with community groups who advocate for income security, and play a role in addressing food insecurity in Wellington-Dufferin-Guelph.
4. Champion public policies supportive of vegetables and fruit access and consumption.
5. Continue to promote and make NutriSTEP® (or Nutri-eSTEP) available throughout the community.
6. Further explore parents’ attitudes, beliefs, barriers and facilitators to getting their children to eat grains, vegetables and fruit.
7. Conduct a similar survey of kindergarten students in 3-4 years time
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Reproductive Health in Wellington-Dufferin-Guelph

Executive Summary

Reproductive Health is an important Public Health issue and an upstream investment (Ministry of Health Promotion, 2010). Health before and during pregnancy contribute to healthy birth outcomes. Healthy birth outcomes and preparation for parenthood contribute to healthy children and families (Ministry of Health Promotion, 2010).
 
This report provides data on many reproductive health indicators. While it is not exhaustive, its intention is to aid Wellington-Dufferin-Guelph Public Health and community partners in their work with expectant mothers and babies. Some data highlights in the Wellington-Dufferin-Guelph area include:
Average age at birth
In Wellington-Dufferin-Guelph, the average age of mothers giving birth to their first child was 28.2 years while the average age of all mothers giving birth was 29.9 years.
Fertility rate, age-specific fertility rate, and total fertility rate
In 2009, for every 1000 women aged 15-49 living in WDG, there were 44 live births. This was comparable with Ontario rates. In the same year, women in WDG were expected to have an average of 1.7 children over the course of their childbearing years. The fertility rate among the 30-34 year old population in WDG increased slightly over time. In 2005, the fertility rate for this group was 109 live births per 100 women in this age group. The rate in 2009 for the same population was 118 live births.
Pregnancy rate, age-specific pregnancy rate, and induced abortions
From 2005-2009, the pregnancy rate in Wellington-Dufferin-Guelph was below the provincial rate. The pregnancy rate takes into account live births, still births, and induced abortions. One trend that was observed was a rise in the teen pregnancy rate in Dufferin County over time. In 2005, the Dufferin teen pregnancy rate of 10.2 pregnancies per 1000 women 10-19 was below the provincial rate of 14.2 pregnancies per 1000 women 10-19 years old. However, in 2009, the Dufferin teen pregnancy rate was 15.4 pregnancies per 1000 women aged 10-19 which was above the provincial rate of 14.8 pregnancies per 1000 teens. At the same time the teen pregnancy rate in Dufferin County was rising, the teen induced adjusted abortion rate was also rising. This increase in the teen induced adjusted abortion rate in Dufferin County was determined to be statistically significant.
Preterm birth rate
The preterm birth rate in WDG was below the provincial rate from 2005-2008 but rose in 2009 due to an increase in the preterm birth rate in Wellington County, in 2009.
Birth weight
The low birth weight rates for all births and for singleton births in Wellington-Dufferin-Guelph were below the provincial rate from 2005-2009. Additionally, the small for gestational age calculation from 2006-2011 showed that WDG had a lower percentage of babies born below the 10th percentile for their gestational age and sex than the province. Interestingly, this trend was reversed for the 2006-2011 high for gestational age calculation. In all years except 2010, WDG had a higher percentage of babies born above the 90th percentile for their gestational age and sex.
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Health Hazard Investigation of a Transformer Station

Introduction

In July 2012, the Ontario Ministry of the Environment (MOE) requested the assistance of Wellington-Dufferin-Guelph Public Health (WDGPH) in following up on health complaints of a group of residents in the Wellington-Dufferin-Guelph area in relation to a wind turbine sourced step-up transformer located in proximity to their homes. In response to this request, WDGPH initiated an investigation as per the Standards.
 
The purpose and scope of the investigation was to collect and review existing information including all available test results to determine if a human health hazard exists and to make recommendations based on the currently available peer reviewed evidence to date. WDGPH proceeded with the investigation without prejudice and is responsible for the recommendations contained within the report.
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Community Picture: Health Status of Wellington-Dufferin-Guelph

Public Health has a vital and enduring role in our community

Message from the Medical Officer of Health, Dr. Nicola Mercer
This report is the first health status report from the newly created Health Analytics team. It was produced in partnership with the Healthy Communities Partnership
Initiative. Wellington-Dufferin-Guelph (WDG) Public Health is committed to gathering, collecting, and analyzing community data to help inform program planning, service delivery, and policy development.  As a result, I am pleased to present and share with our community partners the 2012 Community Picture: Health Status of Wellington-Dufferin-Guelph report. This document will serve as a local snapshot of current health status trends in the areas of sociodemographics; physical activity, sport and recreation; injury prevention; healthy eating; tobacco use and exposure; substance, and alcohol misuse; and mental health.
 
Collaboration and continuous commitment to building lasting partnerships is a pillar of the WDG Public Health Strategic Plan (2011–2016). We know that the health of our communities cannot be attained without strong partnerships and a collaborative effort. In 2010, our healthy communities’ partnership initiative hosted community consultations with organizations and political leadership throughout Wellington, Dufferin, and Guelph. A common theme throughout the consultations was the need for relevant, good quality local data to inform decision making across a broad spectrum of agencies, partners, and political bodies. This report is the first in a series to be released by WDG Public Health which will help us work with community partners to identify local priorities and assess our collective progress in meeting and addressing these priorities.
 
Public Health has a vital and enduring role in the health of our community. WDG Public Health strives to be a leader in data collection, analysis, surveillance, and
evidence-informed practice. The information contained within this report identifies the starting point for the health of Wellington County, Dufferin County, and
the City of Guelph. As a Public Health agency, we will continue to work with all sectors to create a community where every individual has the opportunity to reach
their highest level of health. As Dr. Arlene King, the Chief Medical Officer of Health of Ontario stated in her 2010 Annual Report, “it is time to shift our focus from health care to prevention. Public health is, quite simply, about prevention. It is about fewer people getting sick. It is about fewer people getting injured. It is about more people living long and healthy lives.”
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