Promoting equity in the built environment: The who, what and when
The human-made surroundings where we live, work, learn, rest and play have a significant influence on our health . Features of these built environments that worsen health are known to disproportionately affect people in lower social positions, by virtue of where they live [2,3]. For this reason, Canada’s chief public health officer has identified that bringing attention to “how the built environment contributes to widening or reducing health inequities” is a priority for promoting and improving the health of all Canadians. As we try to understand this relationship further, we think it is important to consider the following questions:
Whose attention do we need to bring to the influence of built environment on health inequities?
Although the actual planning and design of built environments often takes place outside the purview of public health, practitioners can build awareness of the connection between the built environment and health inequities by developing relationships with partners who have a more direct influence in this area. For example, public health can draw on its existing networks to help identify individuals and groups influential in the design of local built environments — city planners, government officials, politicians or private developers — with which they may want to build relationships . Such relationships can be built by making personal contact with these key influencers, finding out what is important to them and relating the goals of equity in the built environment to their priorities. The goal of building these bonds is to encourage the parties in question to consider equity in their decision-making and planning around the built environment.
What messages about health inequities and the built environment can public health promote to intersectoral partners?
Public health practitioners can use their intersectoral relationships to support planning principles linked to healthier, more equitable built environments. The BC Centre for Disease Control’s (BCCDC) Healthy Built Environment Linkages Toolkit  and the chief public health officer’s report, Designing Healthy Living,  are two resources that can connect you to evidence around healthy planning principles and design elements for the built environment.
The BCCDC has also identified two overarching planning principles to ensure that our built environments reduce health inequities rather than widen them.  First, individuals and populations experiencing marginalization need to be given the opportunity to participate and fully engage with planning and decision-making around the built environment. Community engagement is critical to identifying both the structural barriers in the built environment that contribute to inequities and how they can be addressed. Second, built environment interventions must be responsive to the unique needs and barriers of populations experiencing marginalization. Health equity impact assessments facilitate the consideration of health equity in planning and decision-making when it comes to built environment initiatives. Public health can support its intersectoral collaborators by supporting or facilitating community engagement or health equity impact assessment processes.
When should public health advocate for the inclusion of equity considerations in the design of built environments?
Beyond building and maintaining strong relationships with intersectoral partners, there are also strategic points in the planning processes where public health can influence the design of the built environment in a way that promotes health and reduces inequities . Supporting health equity’s inclusion as part of the overarching goals of municipal built environment plans, advocating for the inclusion of health equity in more detailed planning and design phases, and supporting public consultation and community engagement opportunities are all possible roles for public health. The more that public health engages with key influencers — and does so early in the planning process — the more opportunities they can have to help the design of the built environment be more equitable.
Interested in learning more?
Over the next few months, the NCCDH will be further exploring best practices for public health in the promotion of healthy, equitable built environments. On August 24, we will be hosting the webinar The Healthy Built Environment Linkages Toolkit: How can community planning and design make us healthier?, which will focus on how public health can partner with local government to encourage healthy living and prevent chronic disease. In the fall, we will release a curated reading list to connect public health practitioners and leaders with key resources to support their work in this area. Later in the fall, we will hear from voices in the field through guest blog posts and a new addition to our Public Health Speaks series. Stay tuned!
 Healthy Canada by Design CLASP. (n.d.). Health equity and community design: What is the Canadian evidence saying? Planning Healthy Communities Fact Sheet Series, No. 3.Retrieved from: https://www.cip-icu.ca/Files/Healthy-Communities/FACTSHEETS-Equity-FINALenglish.aspx
 Gelormino, E., Melis, G., Marietta, C. & Costa, G. (2015). From built environment to health inequalities: An explanatory framework based on evidence. Preventive Medicine Reports;2:737-745.
 Public Health Agency of Canada. (2017). The Chief Public Health Officer’s Report on the State of Public Health in Canada 2017: Designing Healthy Living. Ottawa, ON: Public Health Agency of Canada. Retrieved from: https://www.canada.ca/en/public-health/services/publications/chief-public-health-officer-reports-state-public-health-canada/2017-designing-healthy-living.html
 Tam, T. (2018 Jan 18). Statement from Dr. Theresa Tam, Chief Public Health Officer of Canada. Retrieved from: https://www.canada.ca/en/public-health/news/2018/01/statement_from_drtheresatamchiefpublichealthofficerofcanada.html
 Berkowitz, B. and Schultz, J. (2018). Chapter 7, Section 6: Involving key influentials to the initiative. In Center for Community Health and Development (Eds), Community Tool Box. Lawrence, KS: University of Kansas. Retrieved from: https://ctb.ku.edu/en/table-of-contents/participation/encouraging-involvement/key-influentials/main
 BC Centre for Disease Control. (2018). Healthy Built Environment Linkages Toolkit: making the links between design, planning and health, Version 2.0. Vancouver, B.C. Provincial Health Services Authority. Retrieved from: http://www.bccdc.ca/pop-public-health/Documents/HBE_linkages_toolkit_2018.pdf
 BC Centre for Disease Control (2017). Fact sheet: Supporting equity through the built environment. Vancouver, BC: BC Centre for Disease Control. Retrieved from: http://www.bccdc.ca/resource-gallery/Documents/Educational%20Materials/EH/BCCDC_equity-fact-sheet_web.pdf
Photo: Gabriel Santiago