It is a truism in population health work that the major determinants of our health lie beyond the health care system. Among the many professional groups whose work affects the health of people and communities, the design professions are among the most important.
By ‘design professions’ I mean architects, interior designers, engineers, landscape architects and urban planners. Their work has a significant impact on health, for better or for worse. In fact, I would argue that the most important evaluative measure of the outcome of their work is, or should be, whether it improves the health, wellbeing and quality of life of the people who live in the places they design.
One of our defining human characteristics is that we started to create shelters to protect us from the elements. Today, startlingly, we Canadians spend about 90% of our time indoors. Of the remaining 10%, half of it is spent in vehicles. This means we only spend on average an hour a day – about 5% of our time – outdoors.
When I present this information to my students and to audiences, it is usually met with expressions of surprise and disbelief. So if you find this surprising, I suggest you keep a time diary for a week and record where you spend your time; you will be surprised!
Not only do we live indoors, we now are urban dwellers. We began living in cities about 6,000 years ago and early in the 21st century, the world passed the point at which more than half of the population lives in urban areas. In Canada, we passed that point in the early 20th century, and now we are about 80% urbanized. Globally, we will be two-thirds urbanized by 2050.
Moreover, because we are 80% urbanized, we spend most of our one hour a day of outdoor time in an urban setting. So most of us spend very little time outdoors in non-urban natural areas – perhaps on average about 1% of our time. This is a problem because of the growing evidence that human wellbeing requires a connection with nature, and this is especially true for children.
Clearly the built environment is by far the most important physical environment for Canadians today, and indeed for the global population. Moreover, how we design and operate our built environment has important implications for the natural environment, affecting land use, air and water quality and natural ecosystems, which also affects our health. This makes the people who design our built environments very important shapers of our health and wellbeing. So here are some ways they can improve our health through improving our built environments.
First, we need to improve the quality of housing, especially for low-income populations, including many First Nations. The health costs of damp, unsafe and crowded housing are very high, both in human and in economic terms. In a country as wealthy as Canada, it is scandalous that in 2006, 45% of housing on First Nations’ reserves was in need of major repairs, compared to 7% for the non-Aboriginal population. The design professions need to work with social groups and governments to design simple, affordable, healthy and environmentally sustainable housing, especially for low-income and Aboriginal communities.
Second, we need to find ways to bring nature to people in the places where they lead their lives, especially in schools and neighbourhoods, but also in our workplaces. Street trees and green space help to reduce urban summer temperature, while neighbourhood parks, community gardens and school gardens can help create community connections as well.
Third, we need to stop creating urban sprawl. The health impacts of urban sprawl include decreased physical activity and increased obesity; more energy use, air pollution and greenhouse gas emissions; and more stress and loss of family time due to long commutes. More dense, mixed-use walkable communities can help offset many of these problems and lead to improved health, while being more environmentally sustainable.
The creation of more sustainable communities is itself good for health, because well-designed communities have a smaller ecological footprint. When we reduce harm to the environment, we reduce harm to ourselves.
If we truly care about the wellbeing of ourselves, our families and others, we need to design the buildings and neighbourhoods where we live, learn, work and play so that they maximize the health of the people in those places.
© Trevor Hancock, 2015
Published in the 
Times Colonist Feb 19, 2015.