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The Built Environment: Understanding how physical environments influence the health and well-being of First Nations peoples living on-reserve

Built environments are defined in this resource as the “human-made or modified physical surroundings in which people live, work and play,” a definition taken from the work of Cheadle & Tugwell. [1] This study, published by the National Collaborating Centre for Indigenous Health (NCCIH) explores how the built environment influences the health and well-being of First Nations peoples living on reserve.

The document provides a historical analysis of how Indigenous populations altered their surrounding physical and built environments to promote holistic well-being and protect the natural ecosystem. Author Roberta Stout describes how colonialism and forced relocation interrupted all aspects of Indigenous peoples’ lives, produced profound inequities, and resulted in multiple negative health outcomes for Indigenous peoples. Five elements of the built environments of First Nations peoples living on reserve that have a negative impact on residents’ health and well-being are explored:

  1. Housing
  2. Water and wastewater management
  3. Food security
  4. Active living
  5. Transportation

In her analysis, the author describes how elements such as poor ventilation and mould contribute to tuberculosis risk, how poor food access contributes to obesity, and how inadequate road maintenance in “special access” communities results in a greater number of multivehicle collisions. She highlights the lack support from government and health agencies regarding the built environment have contributed to these negative health outcomes. The article also addresses how the forced use of Eurocentric housing models that are not always suited for the geography and weather conditions of reserves has contributed to this problem.

Strategies are offered for countering the issues caused by chronic underfunding and inattention to the five aspects of the built environment listed above. These strategies include the incorporation of Indigenous planning principles in the design of the built environment on reserves, the prioritization of safe drinking water and proper wastewater management for all reserves, and encouraging the teaching traditional food-harvesting skills to younger generations.

Use this resource to:

  • facilitate discussion between Indigenous communities and public health colleagues about the built environment and its influence on health outcomes for First Nations peoples living on reserves;
  • locate the opportunities for action in policy development regarding built environments on reserves; and
  • serve as a starting point for engaging with Indigenous leaders and communities to provide space so their perspectives guide plans for built environments for Indigenous people living off reserves.


Stout, Roberta (2018). The built environment: Understanding how physical environments influence the health and well-being of First Nations peoples living on-reserve. National Collaborating Centre for Aboriginal Health. Retrieved from:

Related resources


[1] Cheadle, T., and A. Tugwell. (2014). Healthy built environment linkages: A toolkit for design, planning, health, Version 1.1. Vancouver: Provincial Health Services Authority.

Tags: Community engagement, Food security, Housing, Indigenous health, Other National Collaborating Centre, Document, Report / Document