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Thursday, 3 May 2012

Healthy Build Environment Part 3: Health and social services, food stores and fast food outlets

Have you looked around your community?  Where are the shopping centres?  Where are the fast food outlets?  Where are the doctors and dentists located?   Where are social agencies located? Where is the local income housing located?

Perhaps not surprising the body of literature supports that food depots and those with fresh foods tend to aggregate to large shopping centres, which tend to be located in suburban, middle income areas.   Some urban area studies have clearly demonstrated that socioeconomically challenges neighbourhoods actually have less access to food and in particular fresh food supplies. In contrast, fast food outlets are often located on the margins of lower income areas – at times precluded from becoming established in middle and upper income neighbourhoods. 

In large centres the hospitals used to be on the community fringes when they were built, many are now integral to the downtown areas.   In smaller centres the hospital is often located in a prime community location away from the stresses of the downtown environments.  Doctors may aggregate near the hospital, but certainly tend to become established in mid to upper income neighbourhoods.  Lower income neighbourhoods can at times be without any medical services.  Likewise with dentists.  Of course these private health care profession businesses are going to where income can be maximized and risks minimized.  Not necessarily through any malice, just a function of making solid business decisions.

In contrast, look where social agencies are ghettoed, often expected to provide service to the most needy and aggregating where the need is.  An appropriate choice, just one that further ghettoizes the area and precludes social integration.  

Lower income housing is relegated to the least healthy locations.  Close to major roads, industrial areas, existing low income neighbourhoods.   Community living housing, halfway houses, group homes and homeless shelters can find getting established in such neighbourhoods is without the hassle and public outcry that locating in middle income settings may entail.  

It is just a description of what happens.  Perhaps the simple description is sufficient to suggest that where such blatant and obvious geographic correlations exist – healthful planning and purposeful development could overcome such problems.  

Public Policy interventions to affect built environment were reviewed in a national working sessions in 2011 NCC on Healthy Public policy workshop proceedings   and fact sheets on some of these topics and others like impact on safety are accessible through the national collaborating centre on environmental health  NCC on environmental health fact sheets     

The built environment defines our wellbeing.   As we discuss the built environment, lets be sure we understand the multiple diverse impacts that currently exist and then test and modify to ensure that better outcomes can be achieved.  Lets not wait 50 years to figure out that the process isn’t working for everyone.  


  1. Cathy Richards3 May 2012 at 17:14

    Great post Dr. P. I like how you showed that so many decisions that result in inequity and unhealthy environments are 'logical' due to our current multiple systems (or lack thereof) that focus on singular goals rather than common/interconnected ones.
    It's a crazy world. Keeps us working.

  2. Another good one and food for thought. Effective trusting relationships (with municipal planners and others) are once again essential for health equity. The "weave" of health equity (via action on SDOH)is complex, yes. But not impossible if political and public will is fostered. That of course implies health authority support for local level action.