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By-law Development As a Health Promotion Strategy

Contents

I Introduction
II Health promotion and by-law development
III Eight steps for developing a municipal by-law
IV Conclusion
V References
VI Resources

--submitted by Kim Bergeron, Public Health Ontario, By-law and Policy Health Promotion Field Support Specialist

I Introduction

According to the Association of Municipalities of Ontario (1), there are 444 municipalities in Ontario. These municipalities are governed by the Ontario Municipal Act, under the Ministry of Municipal Affairs, which provides the administrative structure for municipal governance.

Individual municipalities are entitled to pass by-laws when there is a need to improve or protect the general welfare of the community and when there is no relevant provincial or federal legislation in place, or when the municipality wants to strengthen existing provincial legislation. (2)

By-laws can increase health-enhancing environments and decrease health-threatening environments by creating supportive physical and social environments that enable people to have opportunities to make healthy choices (3). For example, some Ontario municipalities, such as the City of London and the Municipality of South Bruce (4, 5) have passed by-laws to create smoke-free outdoor recreation spaces to limit the exposure of young children to second-hand tobacco smoke.

II Health promotion and by-law development

According to the World Health Organization (6), health promotion is the process of enabling people to increase control over, and to improve their well-being. The Core Competencies for Public Health in Canada (7) indicate that health promotion involves strengthening the skills and capabilities of individuals, and also changing social, environmental, political, and economic conditions that impact public and individual health. Health promotion practitioners can support these fundamental aspects of health promotion through by-law development.

By-laws can be healthy public policies

The Ottawa Charter for Health Promotion (6) includes “building healthy public policy” as an important part of a comprehensive health promotion strategy. Healthy public policies are characterized by an explicit concern for health and equity. In other words, healthy public policy development includes an awareness of the possible negative impacts of policy decisions on all sectors, not just health. Healthy public policy is intended to create a supportive physical and social environment that provides the opportunity for people to lead healthy lives(6). By-laws have the capacity to be healthy public policy. By-laws may also address other Ottawa Charter strategies such as: create supportive environments, strengthen community actions, develop personal skills, and reorient health services.

For example, by-laws that promote healthy behaviours (e.g., limiting alcohol consumption, promoting physical activity, or preventing injury) can create supportive environments which make it more difficult for people to make unhealthy choices and provide opportunities for people to make healthier choices. Some by-laws have the potential to influence access to health services (e.g., transit by-laws, zoning by-laws) and affect the development of personal skills (e.g., helping people to refrain from engaging in unhealthy behaviours). The process of developing a municipal by-law may also strengthen community action as by-law development usually includes community stakeholders and residents working together in partnership.

Why support by-law development?

Researchers have found that educating people about healthy lifestyles is, by itself, insufficient. The built environment must be designed to allow people the opportunity to engage in healthy behaviours. (7)  Municipal by-laws also have the advantage of being long-lasting and able to withstand changes in municipal decision-makers. (8)

By-laws have the potential to address policies and actions outside the health sector. (9) Most departments within a municipal government (e.g., transportation, public works) do not consider health issues their primary concern. However, the by-laws supported by a municipality can enhance or hinder opportunities for healthy behaviours.  For example, a planning department could enact zoning by-laws to control urban sprawl, protect natural green spaces, and increase and integrate multi-modal transportation networks. This, in turn, may create opportunities for residents to access green spaces and engage in alternative-modes of transportation. (10) Conversely, a planning department could enact zoning by-laws that limit connectivity between land-uses for pedestrians and cyclists, thus limiting the opportunities for health enhancing choices such as walking or cycling.

It is important to note that zoning by-laws can be a significant healthy living barrier. For example, the Active Healthy Kids Canada Report Card on Physical Activity for Children and Youth in 2008 (11) reported that 96 per cent of Canadian municipalities had at least one by-law discouraging physical activity or free play such as restrictions on skateboarding, street hockey or cycling.

By-law development is also an opportunity to increase access to the key determinants of health such as income, education, housing, and employment. Household income continues to be one of the best predictors of future health status. (12) More income equals better health, less income equals worse health. (12) For example, public transit by-laws outline the conditions in which public transit services will be provided, including the fee structure. Considering that the majority of transit users in small municipalities earn a low income, the fare price listed could negatively affect their health, as a high fare means less money for rent or food. This example shows that a by-law development approach to health promotion can affect social and economic factors that influence health and illness.

III Eight steps for developing a municipal by-law

The Health Promotion Capacity Building Team at Public Health Ontario (13) has developed a roadmap for by-law development – Eight steps for developing a municipal by-law. It is called a roadmap because it functions like any map that illustrates your current location and guides you to your ultimate destination. Although the roadmap is presented as a linear process, you may find yourself at different points on the map at any time. Depending on your situation, you can start at any point in the process, or go back one or more steps if additional work is required. You may also cycle through the stages more than once. It is also important to note that allocation of effort is not equal across the different steps, but is based on your specific situation. 

Table 1: How to develop a municipal by-law

Step

Instruction

Application:
Developing a by-law governing smoke-free outdoor spaces

Step 1: Identify, describe and analyze the problem

This step includes identifying, describing and analyzing the underlying problem. What is the problem? Who is most affected by the problem? What is the origin or cause of the problem? What factors in the community affect the problem such as attitudes, values, beliefs, perceptions, economic, or political factors? The overall aim is to develop a collective understanding of the problem that needs to be addressed and gather enough information to assess if the problem can be addressed by developing a by-law.

Gather information to identify the population most affected by exposure to tobacco smoke at municipally-owned recreational settings. Determine which audience is most affected.

Determine that there is not a local, provincial or federal law that prohibits smoking in outdoor public places (cause of the problem).

Decide if developing a by-law governing smoke-free outdoor spaces could be a possible solution.

Step 2: Develop and assess by-law options

This step includes identifying by-law options and assessing their applicability to addressing the problem identified. This step involves visiting municipal websites to learn about the types of by-laws that exist, and searching the literature to see how others have utilized by-law development to address the problem. It should also include reviewing the by-laws in your own municipality and neighbouring communities to see if there are relevant by-laws that address the problem. Knowing this information could strengthen the case for by-law development.

Review municipal by-laws governing smoke-free outdoor spaces with a focus on municipal recreational spaces. Search for relevant academic studies. 

 

Step 3: Assess readiness for by-law development

 

This step involves assessing the readiness of community stakeholders (e.g., residents, community organizations, municipal decision-makers) to support the by-law options found. There are a number of methods that could be used including: conducting surveys or key informant interviews. This step will help you narrow your focus to just one or two by-law options.

Conduct a survey of recreation and sports program participants/parents and of municipal parks and recreation staff to understand their readiness to support a by-law for smoke-free outdoor spaces.

 

Step 4: Identify and understand municipal decision-makers and influencers

 

Step 4 is about taking the time to clearly identify and understand your municipal decision-makers, both elected and civil servants and those in the community who could influence your municipal decision-makers and influencers.  This will help you build support for your chosen by-law option (step five) and also help you prioritize efforts to move your by-law development process forward.

 

Search municipal council minutes and the municipal website to determine what department, and what position within the department, has responsibilities related to implementing a by-law. For example, your search found that there is a Parks and Recreation Committee (the council member who chairs the committee has been identified), a review of the minutes revealed that the Parks and Recreation Master Plan is being revised (the staff involved in this review have been identified), and that a sports association has recently made a deputation to council to create a by-law for smoke-free outdoor spaces (potential influencer).

Step 5: Build support for the by-law

 

Now is the time to mobilize support beyond your organization and create a partnership/network/ committee to help create the by-law. This step is about reaching out to community stakeholders to impart knowledge about the problem, present by-law development as a solution, explore where there is alignment between their work/mandate and invite them to engage in developing the by-law.

Write a briefing based on the information gathered to date; why there is a need for the municipality to enact a by-law for smoke-free outdoor spaces and send a copy to the municipal decision-makers and influencers identified, inviting them to engage in a dialogue about the problem.

Step 6: Draft the by-law

 

This step is the writing process. This process may include drafting a new by-law or revising a current by-law. A by-law is a legal document and, as such, there is a prescribed way they must be written. Consider reviewing the language and outline of your municipal by-laws and the language of similar by-laws that have been enacted.

Draft and finalize a local by-law for smoke-free outdoor spaces.

 

Step 7: Facilitate adoption and implementation of the by-law

 

The purpose of this step is to encourage the uptake of the by-law by municipal council. Many municipalities have procedural requirements that need to be followed in order to enact a by-law. The municipal clerk is the most knowledgeable about these procedures. Once the by-law has been enacted by the municipality, it is important to ensure there is a communication plan to educate people about the new by-law.

Contact the municipal clerk to learn about the procedural requirements for enacting by-laws and work with the committee to design a plan to meet these requirements. The committee works with the municipality to develop a communication plan once the by-law is passed.

Step 8: Monitor and evaluate the by-law

 

This step ensures that the by-law is being implemented as intended, and is having the intended impact on the problem it was designed to address.

 

Conduct a process evaluation related to the implementation process and after six months conduct an outcome evaluation that examines the impact of the by-law for smoke-free outdoor spaces. Communicate the findings to community stakeholders.

IV Conclusion

By-law development is an important health promotion strategy. Public health professionals and others interested in increasing the number of healthy public policies in Ontario should consider municipal by-law development as a strategy.

The content for this article was adapted from Municipal By-law and Public Health: A Primer to be released by Public Health Ontario in Spring 2014.

V References

Association of Municipalities in Ontario. Website. http://www.amo.on.ca/YLG

MacLean MV, Tomlinson JR. A user’s guide to municipal by-laws. 2nd ed. Markham, ON: LexisNexis Canada Inc.; 2008.

Gostin L. Legal foundations of public health law and its role in meeting future challenges. Public Health. 2006; 120: 8-15.

City of London. Smoke Free Outdoor Spaces. https://www.healthunit.com/smoke-free-outdoor-spaces

Municipality of South Bruce. Smoke-free Public Places By-law. http://www.publichealthgreybruce.on.ca/Tobacco/Tobacco_Free_Sport/South%... 2009.

World Health Organization. Ottawa charter for health promotion: An international conference on health promotion, the move towards a new public health 17–21 November. c1986. Available from: http://www.who.int/healthpromotion/conferences/previous/ottawa/en/

Mensha GA, Goodman RA, Zaza S, et al. Law as a tool for preventing chronic disease: Expanding the spectrum of effective public health strategies. Preventing Chronic Disease: Public Health Research, Practice and Policy. [article on the Internet]. 2004 [last accessed 2013 Dec 9]; 1(1): 1-6. Available from: http://www.cdc.gov/pcd/issues/2004/jan/pdf/03_0033.pdf

Nykiforuk CIJ, Atkey KM, Nieuwendyk LM, Raine KD, Reed S, & Kyle S. Edmonton, AB: School of Public Health, University of Alberta; Policy readiness tool: understanding a municipality’s readiness for policy change and strategies for taking action. 2011. Available from: http://policyreadinesstool.com/wp-content/uploads/Policy-Readiness-Tool_...

World Health Organization and the Government of South Australia. Adelaide statement on health in all policies: Moving towards a shared governance for health and well-being. [document on the Internet]. 2010 [last accessed 2013 Dec 9]. Available from: http://www.who.int/social_determinants/hiap_statement_who_sa_final.pdf

Bergeron, K,. Levesque, L. Government policies for active community design in Ontario: Challenges to achieving collaboration between five ministries. Canadian Journal of Urban Research. 2012; 21(1; Suppl): 29-54.

Active Kids Canada. Its time to unplug our kids: Canada’s report card on physical activity for children and kids. [document on the Internet]. 2008 [last accessed 2014 March 3]. Available from: http://dvqdas9jty7g6.cloudfront.net/reportcard2008/AHKCShortFormEN.pdf

Mikkonen J, Raphael D. Social determinants of health: The Canadian facts. Toronto: York University School of Health Policy and Management [document on the Internet]. 2010 [last accessed 2013 Dec 9]. Available from:  http://www.thecanadianfacts.org/The_Canadian_Facts.pdf

Ontario Agency for Health Protection and Promotion (Public Health Ontario), Chronic Disease and Injury Prevention, Health Promotion Capacity Building Services. Roadmap fo By-Law Development At a Glance. Toronto. 2013.

VI Resources

To learn more about how municipalities function and some of the issues faced by municipal decision-makers, visit: