DESIGN DETERMINANTS OF HEALTH Prescription, Principles

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DESIGN DETERMINANTS OF HEALTHPrescription,
Principles Practice

• joseph aicher, md, mph, frcpc
• atlantic health sciences corporation

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• Are there factors in the built environment that
  promote health?

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• Or promote disease?

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• Would communities designed with a greater
  emphasis on health be much different from
  communities now being built?

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• Are rapidly growing cities
• in Taiwan, Asia, South America
• and Africa inappropriately using resource
  intensive (North American) cities
• as their model
• for growth?

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• Do planners, architects, engineers and
  decision-makers who control the development of
  built environments consider the full health
  implications of their work?

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• There is a widespread belief that urban areas are
  inherently hazardous to our health.

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• Great plagues and disasters have routinely
  ravaged cities throughout the world.

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• Cities, both old and new are often grimy and
  miserable.

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• Many seem
• to tolerate
• them as evil necessities.

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• However, cities, indeed communities of all sizes
  can provide tremendous resources to promote human
  health.

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• Unfortunately, they often fall short of this
  ideal.

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GOAL/CHALLENGE Is there a simple, effective
model to examine how we can build healthy cities?
STRESS/SUPPORT MODEL To explain/understand the
importance of separate but interacting
environmental factors that
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STRESS
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SUPPORT
The ability or adaptability of a person to
maintain a high level of health.
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• BUTwhat is health?
• NOT just the absence of disease.

Healthy
Sick
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Rather a continuum
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• A systematic survey reveals a panorama of
  possible health
• Stressors
• Supporters
• that can be examined

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• Distinguishing between what is a stressor and
  what is a supporter
• is not always clear

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Stressful situations can strengthen a persons
inner resistance or resilience and therefore
may be beneficial long-term
Mastery of stressors/challenges
vs. Avoidance
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• COMMUNITY DESIGN INTERVENTIONS
• Prescriptions (Rx) can be directed in four
  different ways

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COMMUNITY DESIGN INTERVENTIONS

• Minimize unwanted stressors in the environment.
• 2. Provide supportive environments allowing
  people to deal with other unwanted stressors more
  effectively.
• 3. Maximize individual control to allow people to
  position themselves in optimal environments.
• 4. Encourage positive patterns of mastery vs.
  avoidance of life challenges.

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• Q U E S T I O N S ?

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• The stress support model can be used to
• Assess existing community forum
• Evaluate existing plans, policies and strategies
• Develop new healthy plans, policies and
  strategies.

In a comprehensive/ Holistic way
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• Without clearly understanding how community
  design affects the
• physical
• biological
• chemical
• social
• psychological
• environment,
• Unknown stressors are unleashed
• Opportunities for support are missed.

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Too often, community design happens in a
fragmented way.
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CMHC
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bellevue
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victoria
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• The cost of developing these low density
  (healthy?) car based communities is staggering
  
• Perhaps better spent on
• Sewage (biological stressor)
• Immunizations? (biological supporter)
• Education (social supporter)
• Etc
• etc

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habitat
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People walking
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