Non-communicable diseases – Billie Giles-Corti looks at how the built environment impacts the development of NCDs.
Never before in human history have so many people been able to be so sedentary in the course of daily life.
Since World War II, technological advances have transformed the design and development of buildings and communities, the way populations are mobilized and fed, the nature of work, and methods of communication.
Industrial and home labour-saving devices – from the remote control of garage doors to televisions and everything in between – maximise convenience and minimise effort.
So compared with our parents and grandparents, feeding and clothing ourselves has never been so effortless.
But while offering convenience, our use of motor vehicles – even for short trips to the local shop – or a blower to “sweep” garden leaves, appears to be having a profound impact on the health of human populations.
Sitting to death
Diseases previously associated with affluence – cardiovascular disease, cancer, respiratory illnesses and diabetes – are now prevalent in disadvantaged populations.
The problem is so big that an emergency long-term response is required – not just by the health sector but by everyone.
The United Nations declaration calling for action on the prevention and control of non-communicable disease highlighted the need for a “whole of society effort” to tackle this enormous global problem, which is crippling already overburdened health systems.
This is a call for all hands on deck: no one sector – and certainly not the health sector – can solve this problem. Fixing up people when they are ill is not the solution.
The number of people with non-communicable diseases are growing exponentially not because we have changed genetically, but because we have changed our lifestyles in response to a rapidly changing environment.
We now sit too much, move too little and over consume energy dense food – just because we can.
The UN call for action specifically mentions the role of urban planning in the development of non-communicable diseases.
Research consistently shows that people are more likely to walk if they live in compact, pedestrian-friendly neighborhoods characterised by connected street networks, access to mixed-use planning, with presence of local destinations and higher density housing.
And that time and distance influences walking and cycling as preferred modes of transport.
Neighbourhood design has a powerful effect on active travel options of all residents, particularly young people.
Children’s independent mobility is influenced by traffic exposure and parental concerns (real or perceived) about safety, as well as access to local destinations including schools.
Locating schools in neighborhoods with disconnected street networks and heavily trafficked roads is contributing to the rapid decline in children and young people using active modes of travel.
In fact, parents chauffering their children to school are themselves contributing to the traffic congestion that makes roads unsafe for children to walk or cycle.
The power of planners
In the course of their professional lives, urban planners, transport planners, urban designers, civil engineers, property developers and architects make decisions with long-term impacts on the health and well-being of generations of residents.
They make design decisions that determine whether neighborhoods have connected street networks and footpaths so that residents – including children – can easily and safely walk to local destinations.
They decide whether shops and services are part of communities and in places where people can walk to them.
And whether communities have well-designed parks that meet the needs of a range of users from sporting groups, children, dog walkers through to our ageing population.
These planners decide whether streets are wide enough to allow access by public transport.
And underpinning all these decisions are land use and regional transport system planning policies made by state and local government and politicians.
Networking for a healthier society
So there’s an urgent need for policies that encompass social, economic, sustainability, and health policies to create more vibrant, pedestrian-friendly communities serviced by public transport.
Multiple sectors now promote active transport because of concerns about the health, social, environmental, and economic impacts of a range of agendas.
These include rising levels of obesity and inactivity, climate change, population growth, declining oil supplies and rising fuel prices.
Active transport can achieve outcomes for all of them, from improved health and traffic management through to environmental protection and climate change mitigation.
As Australian cities expand rapidly with continued growth on the urban fringe, the challenge is to adopt joined-up approaches involving creative ways of producing supportive land use and transportation planning that ensures compact pedestrian-friendly neighborhoods.
But a plan is one thing and a “populated plan” is another – new communities can take decades to build.
To ensure people on the fringes of cities are not deprived for decades, we need to move from planning to populating the plan.
New business development models that ensure access to local employment and alternative government service delivery models that provide access to local health and public transport are needed.
Without joined-up approaches, we can stick on band aid after band aid but the true nature of what ails us will remain unheeded.
This is the eighth part of our non-communicable diseases series. To read the other instalments, follow the links here:
Part One: Sir George Alleyne discusses why we need a new paradigm to tackle NCDs
Part Two: Regulating alcohol to control NCDs
Part Three: Stopping the obesity epidemic will require action on the population-level
Part Four: The results of the UN High-Level Meeting on Non-Communicable Diseases on New York September 19-20
Part Five: How plain packaging works to reduce smoking – one of the biggest causes of non-communicable diseases
Part Six: Blueprint for making medicines more affordable for everyone
Part Seven: Action on salt will mean longer, healthier lives
Part Nine: Where we come from determines how we fare – the fetal origins of adult disease
Part Ten: Social inclusion brings respect and better health Sri Lankan elders