Healthy Toronto by Design: Promoting a healthier built environment.

Chronic diseases, obesity and sedentary lifestyles are some of the health challenges facing Canada today. There is increasing recognition and evidence that the way our cities are planned, designed and built can contribute to these problems. Many of the policy levers to address the built environment exist outside the health sector and at the municipal level in areas such as urban planning, transportation, parks and recreation, and housing. The challenge for the public health sector is to build and sustain partnerships and collaboration across various sectors to ensure that health is considered in built environment policies. As the public health unit for the city of Toronto and part of the municipal government, Toronto Public Health is in a unique position to provide leadership, advocacy and support for healthy municipal public policies related to the built environment. This article provides some examples of CLASP (Coalitions Linking Action and Science for Prevention) initiatives undertaken to help create support for healthy public policies in the built environment and suggests that the "Healthy Cities" approach is a useful framework to promote policy change in the built environment at the municipal level.

A scripted activity study of the impact of protective advice on personal exposure to ultra-fine and fine particulate matter and volatile organic compounds.

We evaluated the impact on personal exposure to air pollutants of following advice which typically accompanies air quality advisories and indices. Scripts prescribed the time, location, duration and nature of activities intended to simulate daily activity patterns for adults and children. Scripts were paired such that one individual would proceed with usual activities (base scenario), whereas the other (intervention scenario) would alter activities as if following advice. Other than commuting, where the intervention group walked or used public transportation rather than riding in personal vehicles, this group generally spent less time outdoors. Ultra-fine particles (UFPs), particulate matter of median aerodynamic diameter less than 2.5 mum (PM(2.5)) and total volatile organic compounds (VOCs) were measured using samplers carried by individuals during the course of daily activities. During daytime activities (e.g., work, daycare) constituting the largest share of sampling time (approximately 6 h per day), the intervention group experienced a 14% reduction in exposure to UFPs (P=0.01), a 21% reduction in exposure to PM(2.5) (P=0.08), and an 86% increase in exposure to VOCs (P=0.02). Other findings included an 89% increase in exposure to UFPs (P=0.02) and a threefold increase in exposure to VOCs (P=0.08) in the intervention group during evening cooking. Following smog advisory advice results in reduced exposures to some pollutants, while at the same time increasing exposure to others. Advice needs to be refined giving consideration to overall personal exposure.

Anatomy of heat waves and mortality in Toronto: lessons for public health protection.

BACKGROUND: Periods of unusually hot weather, especially in temperate climates, carry with them a burden of morbidity and mortality, particularly in urban areas. With lessening debate on its origins, and signs of global warming already apparent, it is becoming imperative for public health practitioners to recognize and predict the risks of "heat waves", and to develop protective community responses to them. This study makes use of historical data and a methodology developed previously to examine the pattern of hot weather experienced over the last five decades in the City of Toronto, and to assess the associated burden of mortality. METHODS: Synoptic classification of air masses based on meteorological data for Toronto was used, to assign the annual mean burden of illness (in terms of elevated mortality) associated with hot weather and air pollution. Then, coefficients relating daily mortality risk to historical daily weather and air quality data were determined with a model system that (for each air mass) assessed the factors that contributed to day-to-day variability in mortality. RESULTS: Over the period of study, there were 120 (95% CI: 105-135) heat-related deaths on average per year, with great variability from year to year, reflecting the variability of hot weather. Mortality was greatest in July and August, when the greatest number of multi-day heat episodes occurred. Furthermore, the longer the episode, the greater was the daily risk for mortality. INTERPRETATION: The method can be used to forecast the risk of heat-related mortality, and to facilitate the development of public health responses to mitigate that risk.

Should people be physically active outdoors on smog alert days?

BACKGROUND: Given the importance of physical activity to well-being, there is a need to encourage people to be physically active year-round. At the same time, many people are vulnerable to adverse health effects from air pollution, especially on smog alert days. This study was undertaken to determine when air pollution levels tend to be lowest so that the public can modify strenuous outdoor activity accordingly. METHODS: Existing hourly air pollution data for Toronto were analyzed to determine how pollutant levels varied from hour to hour throughout each 24-hour day, to identify the times when pollution levels are at their lowest on average. RESULTS: Pollutant levels vary throughout the day, with concentrations of some pollutants (such as ozone, particles and sulphur dioxide) being highest during mid-day, and others (such as carbon monoxide and nitrogen dioxide) being highest with morning rush hour. Overall, pollutant concentrations tend to be lowest before seven a.m. and after eight p.m. INTERPRETATION: The public should be encouraged to maintain regular physical activity outdoors while monitoring any air pollution-related symptoms. The intensity of outdoor activity should be reduced, or activities replaced with indoor exercise, at those Air Quality Index (AQI) levels that trigger individual symptoms and when AQI values exceed 50. Where possible, strenuous activity should be taken when and where air pollution levels tend to be lowest, namely early in the morning and in low-traffic areas. More research is required to guide development of health protective advice on exercising when air quality is poor.