Paper Title: Interactions between public health and ...€¦ · 1 Paper Title: Interactions between public health and Toronto’s urban fabric Leila M. Farah, PhD, Associate Professor,

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Paper Title: Interactions between public health and Toronto’s urban fabric

Leila M. Farah, PhD, Associate Professor, Ryerson University

Florian Mayer, BSc. Geography Candidate at Albert-Ludwigs-Universität Freiburg and

Mitacs Globalink Research Assistant, Ryerson University

Abstract:

This paper focuses on how, through planning and design, public and shared spaces are

contributing to the improvement of social and health conditions in the city of Toronto. As the

population of Toronto continues to rise rapidly, the capacity and quality of its health system is

being persistently put to the test. This paper unfolds in two levels: the first reviews planning

documents related to open and public spaces. The second explores how this major North

American urban centre is implementing strategies and policies for a more walkable city. Finally,

based on this research, this study proposes the itemization of hitherto individually looked-upon

health variables for a more specified, individually-tailored healthier experience of the urban

environment.

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Keywords: Healthy City, Toronto, Planning, Design, Urban Fabric

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Introduction

This paper focuses on how through planning and design, Toronto is improving the healthiness of

the city and shaping its built environment as a result. It investigates physical, mental and social

health and wellbeing through examining planning documents, guidelines and related policies.

Our findings reveal that while the city is working hard to implement changes and take healthiness

into account, more could be done to enable users to craft their individual urban journeys, by way

of choosing routes that specifically cater to their health and wellbeing needs – or choices between

what Gehl described as necessary, optional and social activities (Gehl 2011). These activities are

not meant to cure illnesses, but could help improve the wellbeing of its citizens. For example,

what kind of infrastructure and space could reduce the feeling of loneliness? What kind of spatial

arrangement and materials can help limit ultraviolet exposure? What alternative routes could

pedestrians take to ease their contact to pollutants? What types of areas encourage physical

activity and where are they placed? These are just a few of the questions asked that can contribute

to making healthier neighborhoods and, more broadly, a more livable city. We believe that by

investing more in such infrastructure, cities, wards and neighborhoods could (i) help improve the

health of their citizens; (ii) provide them with more alternatives (not just for recreational

activities but also for their physical, mental and social wellbeing); and (iii) potentially alleviate

some of the economic weight on its health system, while creating healthier individuals and

stronger bonds within their communities.

Methods and findings

First, this paper identifies and examines the relationship between urban spaces, infrastructure and

health; it maps and provides a comprehensive picture of open, green and walkable spaces and

their potential health effects (Figure 2). Second, it researches and reviews key recent planning

documents including the Toronto Official Plan, reports, policies, guidelines, Toronto Public

Health publications like the Healthy Toronto by Design series and by-laws related to public

health and design. These documents address different scales ranging from the urban to the

neighborhood, from parks and squares to parkettes, and from streetscapes to urban artefacts.

The paper proceeds as follows: first, it examines public open and green spaces, then it surveys

efforts to improve walkability in the city. Each section offers a background on the factors that

affect heath and their relation to the built environment and investigates them through an

exploration of physical, mental and social health and wellbeing. Finally, it concludes by briefly

suggesting strategies for a healthier city.

Open and/or green spaces Health Context

There is strong evidence that public open spaces contribute to health in positive ways (Kent et al.

2011). Based on this comprehensive and recent literature review, public open spaces lead to

improved physical health, especially when large, green and local, facilitating regular physical

activity (Paquet et al. 2013). Public open spaces increase the chance of incidental interactions

resulting in a perceived higher level of safety and a declining feeling of loneliness. A number of

scholars have demonstrated that these factors have positive mental health effects (Cohen et al.

2008, Koohsari et al. 2015). Furthermore, in urban settings with high population densities, noise

pollution and lack of privacy, public open spaces with appropriate greenery can help alleviate

urban stress factors (Maller et al. 2009). In the long run a built environment that motivates people

to gather can lead to a strengthening of the local community and as a result to more collective

activities like community events, recreational activities and cultural events.

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More particularly on green spaces, recent literature indicates that they contribute to public health

(Lee & Maheswaran 2011; Bowler et al. 2010, Lachowycz & Jones 2011, and Zupancic &

Westmacott 2015, cited in Toronto Public Health 2014, Toronto Public Health 2015). Further,

several studies positively associate the availability of green space with physical activity

(Lachowycz & Jones 2010: 185) and there is also evidence that green spaces can reduce the Body

Mass Index (BMI; ibid.: 186). However, the intensity of physical activity also depends on

determinants like age, gender, ethnicity, disability, psychological factors (e.g. self-efficacy,

perceived barriers) and safety (Lee & Maheswaran 2010: 218). While green spaces can facilitate

physical activity, they do not necessarily lead to it. Still, research suggests that green space has a

significant influence on health factors linked to the environment (Bowler et al. 2010). Parks,

forests, ground and roof vegetation can cool the environment on a local scale - on average around

1° C – and by lowering urban temperatures, there is a reduced risk of heat-related health impacts

(HRI) (e.g. circulation problems) especially during the occurrence of heat waves, increasing

average air temperatures and areas with an intense Urban Heat Island (UHI) (Bowler et al. 2010:

154, Zupancic & Westmacott, 2015: 7). Another environmentally-linked health effect of green

spaces is the reduction of air pollutants like ozone, sulphur dioxide, nitrogen dioxide and

particulate matter (Grundstroem & Pleijel 2014, Harris & Manning 2010, Kocic et al. 2014, and

Roy et al. 2012, cited in Zupancic & Westmacott 2015). Especially trees show the best results in

improving air quality on different scale levels (Nowak et al. 2014, cited in Zupancic &

Westmacott 2015: 22). Lastly, green spaces with a dense tree canopy protect people from direct

and indirect ultraviolet radiation and its harmful effects.

Recent studies also associate green space with positive mental health (Toronto Public Health

2015: 14); just the presence of green space in people’s life can have a significant influence on

stress reduction, lower mental distress, lower levels of ADD/ADHD, feelings of loneliness,

aggression, violence and mental fatigue (Jiang et al. 2014, White et al. 2013, Maas et al. 2008,

and Kuo & Sullivan 2001, cited in Toronto Public Health 2015). Green spaces also contribute to

a reduced noise level, which has positive influences on mental and physical heath (Islam et al.

2012, Gonzáles-Oreja 2010). Further, social benefits of green spaces, like public open spaces

encourage people to participate in community events, recreational activities and cultural events as

those spaces, especially parks, “set the stage for neighborhood social interactions” (Cohen et al.

2008, cited in Kent et al. 2011 p. 67, Zhou & Rana, 2012).

Brief Background on Open and Green Spaces in Toronto

A dynamic, cosmopolitan and rapidly growing global city, Toronto boasts a wide range of open

and green spaces accessible to the public. These include squares, “Privately Owned Publicly-

Accessible Spaces” known as POPS (City of Toronto 2014), parks, parkettes and green streets

amongst others. In addition to these, the city maintains a ‘Green Space System’ with a network of

parks and other green spaces (Toronto City Planning 2015: 28). In 2012, Toronto’s parks system

comprised 8000 hectares of city-owned and/or operated land, including over1600 parks and

adding up to a total of 12.7 % of the city’s land base (Parks, Forestry & Recreation 2013b: 7).

Additionally, there are other park-like structures (e.g. school yards, cemeteries, institution

grounds) accessible to the public. In Toronto, most residents live within a 500m-radius to a

neighboring park, comparable to an approximately five-to-ten min walk (Parks, Forestry &

Recreation 2013b: 9). Another distinctive element is trees. Toronto’s tree canopy covers about

28% of the city’s surface. The value of the urban tree canopy is estimated to be around $7.1

billion with annual ecological services of $28.2 million (Parks, Forestry & Recreation, Urban

Forestry 2013a: 9, Nowak 2013: 1). However, the forest cover is distributed unevenly across

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Toronto depending on land use and location (Nowak 2013: 7). 6 % of the total are city street

trees, 34 % grow in city parks or natural areas, whereas their majority (60 %) is located on

private property (Parks, Forestry & Recreation 2013: 9). `

Planning

The City of Toronto recognizes the health-related importance of public open spaces as it is “an

integral part of our life and social well-being” (Toronto City Planning 2015: 28). To re-enforce

the quality of the public realm in the city, the Toronto Official Plan provides a set of guidelines

for the development of streets, parks, open spaces and public buildings. First, a high design

standard is emphasised to create comfort, safety, accessibility and a unique experience (2.4

Policy 14a; 3.1.1 Policy 1; 3.2.3 Policy 1; 5.3.5 Policy 2). Second, open public spaces should be

designed in a pedestrian-friendly way and be linked to provide an extensive network of places to

meet and gather (2.3.2 Policy 3; 3.1.1 Policy 13a, 19a). Third, these spaces are and would be

organized in a manner so that natural features can contribute to the wellbeing of the people (3.2.3

Policy 1). In combination with additional urban planning policies, they help create healthy public

spaces by promoting social inclusion and wellbeing, reducing stress and mental health problems,

and fostering physical activity in order to reduce risks of chronic diseases. Green spaces are an

integral part of Toronto’s urban landscape, thus those spaces are highly protected and regulated

on different scale-levels in order to ensure and maintain them and their functions. The Official

Plan dedicates three chapters to green spaces: one on “Green Space System and Waterfront”,

another on “Parks & Open Spaces” and a third on “The Natural Environment” (2.3.2, 3.2.3 &

3.4).

The course of action and overall direction adopted by the City of Toronto is also reflected in a

report called “Active City: Designing for health” (Toronto Public Health et al. 2014, p. 9) which

emphasizes the effect of design on health, whether for better or worse.

Based on the above-mentioned policies the “TOCore Proposals Report” focuses on amalgamating

the individual characteristics and visions of the downtown area with the policy framework

delivered by the “Official Plan”. Central for this plan is a scale-based approached, with which the

downtown area is set to transform its existing public spaces and create new ones (TOCore 2016:

61).1 Also, due to the fact that Downtown is known to have one of the lowest levels of parkland

provision in the city (6 % of land covered by parkland), the document proposes to further invest

in urban forest in the Downtown area to suit the intensity of use (TOCore 2016: 76–80).

Further, the City has approached the maintenance and improvement of urban green spaces by

developing two visionary documents in coordination with the Official Plan: the “Parks Plan 2013

– 2017” (Parks, Forestry & Recreation 2013b) and the “Sustaining & Expanding the Urban

Forest: Toronto’s Strategic Forest Management Plan” (Parks, Forestry & Recreation & Urban

Forestry, 2013).

Besides the city-wide guidelines and policies mentioned above, the City of Toronto provides

multiple design standards for appropriate greening on a smaller level for instance “Design

Guidelines for ‘Greening’ Surface Parking Lots” (Toronto City Planning 2013). These guidelines

1 This approach includes seven comprehensive steps, listed as follows (TOCore 2016, p. 61 – 63): 1. The Core

Circle, 2. Ten Great Streets for a Thriving Grid, 3. Portal Parks, 4. Park District Anchors, 5. The Stich: Connecting

Downtown with the waterfront and Downtown West and East by elaborate and large-scale interventions like the

“Rail-Deck Park” – a public park on top of the rail (City of Toronto, 2016, p. 1) - or “The Bentway” – a

pedestrianized public space underneath the Gardiner Expressway (The Bentway 2016), 6. Around the Bay, and, 7.

Local Places and Over-Looked Areas.

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are based on the Official Plan and the Toronto Green Standard (TGS). They take into

consideration that parking very often tends to be functional spaces with poor landscaping,

insufficient streetscaping and lack of pedestrian safety, comfort and amenity, that also leads to

environmental challenges (e.g. UHI, extreme sun exposure) (Toronto City Planning 2013: 1). To

reduce dangerous sun exposure for the public at public and open spaces the City has implemented

city-wide Shade Guidelines “to provide UVR protection and Sun Safety measurements for

outdoor environments” (Toronto Cancer Prevention Coalition Centre 2010, p. 7). The proposed

measurement support City of Toronto staff to retrofit city facilities in order to create a sun safe

environment.

At the tree level, the City of Toronto provides the following guideline “Toronto Street Trees.

Guide to Standard Planting Options” (City of Toronto & Parks, Forestry & Recreation 2007). The

City also provides a “Tree Protection Policy and Specifications for Construction Near Trees”

(Parks, Forestry & Recreation, Urban Forestry 2016). Moreover, Toronto regulates green spaces

with by-laws including the “Street Tree By-Law” (Toronto Municipal Code Chapter 813, Article

II 2015) protecting City street trees, the “Private Tree-Bylaw” (Toronto Municipal Code Chapter

813, Article III 2015) protecting trees on private property, the “Ravine & Natural Feature

Protection By-Law (Toronto Municipal Code Chapter 658 2016) and the Parks By-law (Toronto

Municipal Chapter 608 2017).

Despite these very positive initiatives for a pedestrian friendly and greener city, some of them are

more geared toward revitalisation or beautification, while others can contribute to health. Hence,

it is important to determine, monitor and indicate more specifically the health-related aspect of

public spaces. Useful indicators toward this assessment could include noise, vibration, shade and

pollution levels.

Walkability/Pedestrianization Health Context

As a mode of transportation, walking has major impacts on public health as indicated in a

comprehensive review done by Toronto Public Health in 2012 (Toronto Public Health 2012).

Based on this 2012 study, references to walking regularly reducing the risk of overweight and

obesity are mentioned (Murphy et al. 2007, McAuley et al. 2000). Furthermore, it can decrease

cardiovascular risk (Hamer & Chida 2008), prevent Type II diabetes (Hu et al. 2003), lower the

likelihood of a stroke (Wannamethee et al. 1999) and reduce the risk of several types of cancer

(Thune & Furberg 2001, Golshiri et al. 2016, Hou et al. 2004, and Wolin et al. 2009).

In the long run, increased walkability could also decrease vehicular transport-related air pollution

significantly. Research has shown that exposure to air pollution has an impact on all-cause, as

well as cardiovascular mortality and morbidity (Hoek et al. 2002, Pope et al. 2002, and Brook et

al. 2010). There is also evidence that there is a strong causal relationship between air pollution

and a worsening of asthma (Health Effects Institute 2010), risk of lung cancer (Vineis et al. 2006)

and non-asthmatic respiratory problems (Toronto Public Health 2007). Furthermore, less

transport-related air pollution could also have a positive effect on the urban climate as it weakens

the UHI effect and results in less heat-related problems in the population (Giguère 2009). Lastly,

driving less leads to reduced noise pollution, which is related to negative health effects like

hearing impairment, sleep disturbances and cardiovascular disturbances (Goines & Hagler 2007,

Stansfeld & Matheson 2003).

Research also suggests that physical activity has a positive effect on mental disorders like

depression, anxiety and panic disorders and in general on mental wellbeing (Paluska & Schwenk

2000, Fox 1999, Taylor et al. 1985, Hassmén et al. 2000, Byrne & Byrne 1993, and Salmon

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2001). Researchers have also found that walking can be an effective way of reducing anxiety and

depression (Heesch et al. 2011).

Brief Background on Walking in Toronto

Based on the 2011 Canadian National Household Survey (NHS) 69.9 % of Torontonians drove,

23.3 % took Public Transit, 4.3 % walked and 1.2 % cycled to work (Statistics Canada 2011).

The City of Toronto has an extensive pedestrianized network which consists of 7780 kilometres

of sidewalks and 733 kilometers of walkways, pathways and recreational trails (Toronto

Transportation Services 2015: 2). However, the density and availability of sidewalks varies

across the City of Toronto and 1194 km of streets are still without any sidewalk or without

sidewalks on both sides (Ibid: 2). The 2013 Walking Habits and Attitudes Study in Toronto

indicates, that 9% of Torontonians walk to work, 22 % walk to school, 20 % walk to go shopping

and 14 % walk to leisure activities (Ipsos 2013, p. 15).

Figure 1: Glazier et al., "Walkabilty Index for the City of Toronto, by Census Tract." Toronto Community Health

Profiles Partnership. http://www.torontohealthprofiles.ca/a_documents/aboutTheData/12_1_ReportsAndPapers_Walkability_WKB_2012.pdf

With kind permission from R. Glazier.

However, time spent walking varies across Toronto with highest rates in the city centre (Ipsos

2013: 22). 95 % of the participants in the study self-assessed their neighborhood as “very

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walkable” or “somewhat walkable” depending on the two main factors “amount/quality of

sidewalks” (32 %) and “safety level” (20 %) (Ipsos 2013: 41-42). A second study has approached

walkability by developing an “Urban Walkability Index” for Toronto based on four variables

consisting of population density, dwelling density, availability of all retail and services and street

connectivity (Glazier et al. 2012). The south-central downtown area was found to have the

highest index values whereas suburban areas had significantly lower index values (Figure 1).

Furthermore, high levels of walkability correlated with less car-related, but active transport,

whereas low levels of walkability was associated with lower rates of physical activity and higher

rates of overweight in different parts of Toronto (Glazier et al. 2012: 9-10).

Planning

Since the 2002 Toronto Pedestrian Charter, pedestrianization and a growing focus on walkability

gained momentum. Pedestrian-friendly principles in association with positive health outcomes

have also been strongly integrated and recognized within the Toronto Official Plan (2.4, Policy

1). To enhance walkability, it also provides a set of guidelines related to: (i) safety [from other

modes of transports (e.g. cars, transit) (2.2 Policy 3a ii, 3b; 2.4 Policy 14a, c, d; 3.1.1 Policy 5a i,

ii; 3.1.2 Policy 2), safety through a high quality of design and maintenance (e.g. sidewalk width

and condition) (3.1.1 Policy 5a i, iii, 6a, 14; 3.1.2 Policy 1) and a safe social environment (e.g.

lighting, crime prevention)]; (ii) linkages to streets, parks and open spaces (2.2.1 Policy 2a; 2.3.1

Policy 4; 2.4 14b; 3.1.3 Policy 13a, 16; 3.2.3 Policy 1c) and mixed-use development (2.2 Policy

2d); (iii) accessibility for pedestrians (2.2 Policy 3f, g; 2.4 Policy 14a; 3.1.1 Policy 11–13; 16);

(iv) pedestrian-friendly infrastructure (e.g. curbs, lighting, tactile walking surface indicators) and

facilities (e.g. public toilets, furnishing) (2.2 Policy 3b; 2.2.2 Policy 2 i; 2.2.3 Policy 2a ii; 3.1.1

Policy 5a ii); (v) a comfortable walking environment (2.2.1 Policy 11; 2.2.3 3c iii; 2.4.14 a, b, e;

3.1.1. Policy 1) with appropriate design aesthetics [(3.1.1 Policy 1, 2) including natural features

(3.1.1 Policy 4, 6 a) and a focus on car-reduced spaces (3.1.2 Policy 2; 4.8 Policy 5 e)].

In 2009, the City of Toronto made a big step forward towards a pedestrian-friendly city when it

released the “Toronto Walking Strategy” (City of Toronto 2009). While it corresponds with the

“Toronto Official Plan”, it also “provides a long-term, comprehensive set of actions […] for

walking and the public realm” (Ibid.:7). The strategy consists of a multi-facetted set of

guidelines, of which four strategies are directly related to the built environment, including:

“integrating networks for walking” (Ibid.:24), “designing streets for pedestrians” (Ibid.: 27),

“creating spaces and places for people” (Ibid.: 31) and, focusing “on priority and tower renewal

neighbourhoods” (Ibid.: 35). The document also explicitly emphasizes the aim to become a

healthier city by encouraging people to choose active transportation over motor vehicle use

(Ibid.: 6).

On a smaller scale, but related to the above-mentioned policies, in 2006, the city implemented a

coordinated street furniture program called “Vibrant Streets” with the intention “to change how

our city streets look, function and meet the needs of residents and visitors” (Toronto City

Planning, Clean & Beautiful City Secretariat and Transportation Services 2012: 1). That program

focused on the implementation and ongoing maintenance of “a family of beautiful, functional,

technologically flexible, durable and coordinated furniture” that improves the movement,

accessibility, safety of pedestrians, as well as the attractiveness and identity of Toronto’s

streetscapes (Ibid.: 11). This was done by providing accurate design and placement guidelines to

harmonize the design, form, scale, material and placement of future street furniture investments

(Ibid.: 1).

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Another key document for Toronto’s strive towards a more walkable city is the more recent

“Toronto Complete Streets Guideline” (City of Toronto 2016), which offers guidelines for

different agents (e.g. city staff, private developers, community groups) regarding future

investments in street infrastructure in general and also addresses street design for pedestrians

(particularly, chapter IV).

Finally, at the neighborhood level there are plans for the city’s downtown area. The “TOCore

Proposals Report” directly refers to the “Official Plan,” the “Complete Street Guide” and the

“Toronto Walking Strategy,” mentioned earlier.2

Discussion: How can Toronto and cities in general become more livable?

Based on this literature and recent documents and publications’ review, one can compose a

comprehensive visualization of a number of health factors that open, green and walkable spaces

can potentially contribute to (Figure 2). The resulting picture can be a useful tool for cities to

think of their public spaces beyond beautification, revitalization and accessibility. The City of

Toronto is such a case.

Figure 2. Factors that potentially have health effects based on the reviewed literature.

2 A landmark project for the transformation of the downtown mobility system is King Street. As a busy surface

transit route, King Street shall be transformed into a “true transit-priority” street (Ibid.: 121) to further enhance

pedestrian-based commuting.

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Toronto’s motto ‘A city within a park’ is fully justified by its substantial tree canopy and

considerable areas dedicated to green and open spaces (partially indicated in figure 3). Still, the

city continues to rethink how to better connect open, green and public spaces, in other words,

how to become even more livable.

Figure 3. Isometric view of key components of the built environment that can contribute to a healthier city as

presented in this paper. Based on data from ESRI and Open Data Toronto.

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Towards this endeavor, this study proposes that health indicators are also ushered to the forefront,

and in a combined fashion. Various actors and agencies are already engaged in monitoring

individual aspects of a public space’s quality. For example, Toronto Public Health measures the

quality of Lake Ontario’s water (e.g. E. coli levels) at the Beaches neighborhood (Toronto Public

Health 2017). Another measured variable is Toronto’s walkability index. Further, University of

Toronto researchers have been monitoring air quality (Air Quality Health Index), initially

developed for the 2015 Pan American Games (Evans 2017, Suen 2017, Ministry of the

Environment and Climate Change Ontario 2010). Since this technology exists and has been

tested, it could be quite unique and helpful to implement it across key parks, streets and public

spaces. Additional individual aspects of public accessible spaces could also include noise,3

vibration and heat as well as field sports facilities and fresh food-related spots (e.g. farmers’

markets).

There are no sufficient indicators for the public that Toronto’s green, open and walkable spaces,

are indeed healthy for every individual. If so, in what ways (for example, physical activity

focused, or low noise, tranquil spaces). To reinforce the notion of a heathy city, it would

therefore be important to determine and distinguish which spaces are more focused on urban

regeneration and beautification and which ones have what positive health effects based on the

monitoring and itemization of real-time variables (heat, air and pollution levels). This extensive

network of sensors and information could help make smart decisions about urban health. An

example of specific (but limited) assessment of public space healthiness is the London-based

Wellbeing Walk that pedestrianly links three key stations (St. Pancras, King’s Cross and Euston)

to experience lower air pollution levels (Urban Partners 2017).4

The main recommendation proposed by this study is to itemize, monitor and comprehensively

present these indicators that together compose the qualities of public spaces (through, for

example, an app or other user-friendly programs). In this way, individuals can select spaces based

on specific attributes, and thus personalize and optimise the way they experience the city’s public

and accessible spaces.

Conclusion

This paper reviewed how public health and the urban fabric are related through the lens of open,

green and walkable spaces, and synthesized this information into a chart to provide a more

comprehensive picture of potential health benefits related to these spaces. Further, it surveyed

key planning documents of the City of Toronto, identifying efforts to make it a healthier

environment. Finally, it put forward a recommendation for optimizing and personalizing the

health effects of such spaces.

Further steps to move this research forward will include the creation of partnerships with

different experts, monitoring, modelling, visualising and communicating diverse information

catered to the public and to users towards making cities healthier, more livable and smarter.

Acknowledgement

3 Toronto has a Noise Bylaw. The Toronto Noise Coalition is “advocating for effective, enforceable noise

management.” (Toronto Noise Coalition 2017) 4 Toronto established discovery walks allowing individuals to visit important city landmarks but does not have the

London feature.

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This research was partly funded by the 2017 Mitacs Globalink program and a 2017 Faculty of

Engineering and Architectural Science Dean Research Fund (Travel) from Ryerson University.

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