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Healthy Cities Setting and Environment

A. Introduction "Hot Town, Summer in the City"

B. Conditions for Health: the Toronto Healthy City Model
i) A Healthy City - Toronto's 3 Es
ii) Integration of Bureaucracies/Stakeholders
iii) Key Strategies

C. Smog & Air Quality Issues
i) Smog Pushes Death Rates Up in Canadian Cities [Report]
ii) Ontario Doctors Call for Cleaner Air - Ground Level Ozone Position Paper
iii) Smog Season Starts Early in Toronto [Globe & Mail article]

D. Summer Heat & the Homeless

A. Introduction Summer in the City

Hot town, summer in the city
Back of my neck gettin' dirt-'n'-gritty
Bend down, isn't it a pity
Doesn't seem to be a shadow in the city
All around people lookin' half dead
Walking on the sidewalk, hotter than a match-head

[By Lovin' Spoonful http://www.execpc.com/~suden/summerin_thecity.html ]

For the past few weeks this refrain from a 1969 song has been running through my head, as Ontarians sweltered through an unusual heat wave for May. With June has come a cooler temperature, but not a decrease in air quality alerts and UV index warnings, particularly for urban dwellers. Added to increased social and economic pressures of urban life, the city environment is seemingly a difficult place to live and work in summer as well as winter. However, a refreshing outlook on urban life and health promotion came with the recent issue of Promotion & Education (the journal of the International Union of Health Promotion & Education IUHPE), where there is an good article on the Toronto Healthy City model and activities.

This week's feature looks at the good news of "Summer in the City" first - with the model of Healthy Communities and Cities, and why the partnerships and collaboration between a wide diversity of stakeholders at a municipal/local level works to act on health, environment and economic issues in an integrated way. The key points of the article are included here - readers are encouraged to seek out the full article or contact the Toronto Healthy City Office directly for more information. Following the view of a model of a "healthy city setting", there's a look at some of the environmental challenges facing urban dwellers - particularly with recent research and reports on the link between air quality and death rates in Canadian cities. Look for more information on this topic to come in the Canadian Journal of Public Health's special issue on environmental health, due to be published this week.

The third message in this [belated] bulletin includes two more items related to this theme - resources for teachers and students on Skin Cancer - prevention, diagnois, and treatment, with the emphasis on treatment - and the release of the Ontario Quality of Life Index report for 1997. Your comments and contributions are very welcome!! Please reply to this message or send an email to Alison@opc.on.ca

Alison Stirling

"CONDITIONS FOR HEALTH: THE TORONTO HEALTHY CITY MODEL"
by Fran Perkins & Meg Shields(and others)in Promotion & Education
Vol V #1 1998 pp 9-14. [highlights from the article]

The following highlights of an article are taken from the IUHPE Journal. For more information on the journal contact IUHE/NARO - 1015, 15th St. NW, Suite 300; Washington DC 20015 USA.

To contact the Toronto Healthy City Office:
East Tower, 100 Queen St. West, Toronto ON M5H 2N2
Tel: (416) 392-0099 Fax 416-392-0089
e-mail hco@city.toronto.on.ca
Web-site: http://old.city.toronto.on.ca/4service/hco/hco.htm

At the local level the Healthy Cities/Communities movement plays a unique role in city government in addressing "conditions for health". It promotes innovation and change in local health policy, advocating new approaches for the publics health. The Toronto Healthy City, established in 1989, is a model for local governance that crosses all sectors.

I) A HEALTHY CITY - TORONTO'S 3 ES
The Toronto Healthy City Project was developed in recognition that most things affecting the health of the population lie outside the health care sector. This approach is the determinants of health model.

The Healthy City Project advocates the use of 3 basic strategies:

- the integration of the Healthy City 3Es in all aspects of work, including partnerships, local government, projects, research
- interdepartmental/intersectoral partnerships; and
- local government as a key player in resolving health issues

The 3E components of the Healthy City model are defined as Environment, one that is viable (i.e., supports human and non-human life), liveable, and sustainable; Economy, one that is equitable, sustainable and adequately prosperous; and Equity within a community that is liveable and genial.

II INTEGRATION OF BUREAUCRACIES/STAKEHOLDERS
Interdepartmental - The move is on within local government to strategically break down the walls between departments, and the bureaucracy. "There can be no place for 'silo' mentalities in this new
structure" [1996 Toronto city Executive report].

Intersectoral - partnerships are key to the success of the Healthy City and to the city's commitment to good governance. Healthy City staff use 3 main "tools" to implement strategies - visioning, analysis and action.

III KEY STRATEGIES
a) Moving the Healthy City Vision: requires influencing the political decisions of city council through identification of issues, provision of an analytical framework, eliciting community participation, and
providing innovative models for action developed with diverse partners.

b) State of the City Reporting - provides citizens and elected officials with meaninful information about the city, comparable over time with other cities and across smaller units. Measures include
quality of life indicators, municipal performance measures, and variations. See Also: The State of the City's Health -- Implications for Public Health; February 19, 1998
http://www.city.toronto.on.ca/health/state_health.htm

c) Intersectoral Action through Coalition & Partnership Development - building on shared ownership while balancing issues of equity, environmental sustainability and economic vitality.

d) Building Community Capacity - facilitating communities to develop skills, methods, approaches and resources to work on solving local and city wide issues.

e) Community Participation/ Strengthening Community & citizen input into governance - this process helps facilitate the identification of issues, gaps and trends for new policies.

f) Innovation - creating opportuniti4es for innovation, supporting change by spreading knowledge of innovative methods, creating incentives for innovation and recognizing achievements.

g) Healthy Public Policy - explicit concern for health and equity in all areas of policy development and implementation.

The success of applying all the healthy city strategies is reflected by the degree to which policies that create healthy urban environments are in effect throughout the civic administration. Success is seen when communities, homes, schools, workplaces and other parts of the city become healthier settings in which to live, work and play.

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C. SMOG PUSHES DEATH RATES UP IN CANADA'S CITIES

Saturday, May 30, 1998 The Globe and Mail
By Martin Mittelstaedt

Breathing the heavily polluted air in Canadian cities is deadly, according to a study conducted by three federal scientists. Polluted air is having a noticeable effect on the rate at which people die:
Mortality climbs measurably when smog is at its worst.

Residents of Quebec City were most affected. The death rate there surged 11 per cent, from an average of 7.7 deaths a day to 8.6, during periods of high air pollution. Researchers were unsure why the increase was so marked. The study also found higher mortality levels associated with dirty air in the other 10 cities investigated, which covered most of Canada's major urban areas and a total population of 10.8 million. London at 10.6 per cent and Hamilton at 10.3 had the next-largest increases in smog-induced mortality levels, while the smallest increases, 3.6 per cent, were found in Windsor and Edmonton. Air-pollution levels varied among the cities studied. No region had uniformly higher or lower levels of contaminants.

For the other cities covered by the study, the increased risk of death during high-pollution episodes was: Montreal 8.4 per cent, Ottawa 4.8, Toronto 6.5, Winnipeg 6.4, Calgary 9.7 and Vancouver 8.3.

The study, described as one of the most extensive undertaken in the world, reviewed more than 800,000 deaths that occurred over an 11-year period and found that levels of common air pollutants, such as ozone and sulphur dioxide, are playing a role in when people die.

Until now, most air-pollution research has focused on the death risk attributed only to the breathing of extremely small pollution particles, but this study looked at the effects of the broad soup of pollutants contained in city air said Richard Burnett, a scientist with the environmental health directorate of the federal Health Department and one of the authors of the study.

The study is to be published next week (June 10) in the Canadian Journal of Public Health. The researchers found that mortality rates in Canada could be reduced by cutting the amount of sulphur contained in gasoline to California levels. Although there have been some improvements in air quality in Canada because of pollution-control measures adopted in the 1980s, there are concerns that increased gasoline use and deregulation of the electric-power industry, a heavy fossil-fuel user, will erode these gains.

The study did not offer reasons for the differences and Mr. Burnett said more research would be needed to investigate the phenomenon. The researchers studied all the non-accidental deaths that occurred in the 11 Canadian cities from 1980 to 1991 and compared the number of deaths with air-pollution levels. The data were adjusted for seasonal and daily death patterns. In Canada, more people die in winter than in summer, and mortality rates tend to be slightly lower on Sundays than
other days of the week.

Although the research was able to determine that smog kills people, Mr. Burnett said, further work must be done to evaluate what the deaths actually mean. Mr. Burnett said researchers do not know whether pollution is killing people who "would have died shortly anyway." He said more research is needed to establish who is dying during pollution episodes and why.

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ONTARIO'S DOCTORS CALL FOR CLEANER AIR
[taken from the OMA news release May 12]

Recently the Ontario Medical Association released a position paper on air pollution that said smog is responsible for 1,800 premature deaths in Ontario each year. The study shows that the air Ontarians breathe causes illness and premature death. As a result, the association representing Ontario's 23,000 doctors is calling for more stringent ambient air controls in the province.

The OMA's paper reviews recent medical research and concludes that ground-level ozone, acid aerosols and particulates in the air in the Great Lakes Basin make people sick in both urban and rural communities and cost the health care system millions of dollars annually. Summer is the worst time of year for stagnant air to blanket the countryside. Children and the elderly throughout the province are particularly at risk.

The OMA's Executive Director of Health Policy, Dr. Ted Boadway commented "If Ontario's doctors, industry, government and Ontario citizens cooperate to reduce air pollution in this province, an
enormous economic burden will be lifted from the health care system."

The OMA position paper recommendations focus on steps both physicians, industry and governments can take to raise awareness about air pollution and reduce emissions from coal-burning power plants, cars and trucks, transborder and other sources of pollution. "The health effects of ground-level ozone, acid aerosols and particulate matter" is posted on the OMA website at http://www.oma.org/pcomm/pressrel/1998/may12.htm. Key recommendations are attached.

Media contact:
Jennifer Tracey, OMA, Manager,
Community Relations (416) 340-2960

OMA GROUND LEVEL OZONE POSITION PAPER
http://www.oma.org/phealth/ground.htm

This paper was prepared by Judith MacPhail, project manager and researcher, with direction and support from Dr. Ted Boadway, executive director, Ms. Carol Jacobson, director, and Ms. Patricia North, project officer of the Ontario Medical Association (OMA) Health Policy Department.

The development of this position paper was supported by the Helen McCrea Peacock Foundation. This paper may be reproduced for use as an advocacy document providing authorship is acknowledged.

TABLE OF CONTENTS
Executive Summary
1. Introduction
2. Background
3. Air Pollutants: Their Sources and Distribution
4. Adverse Health Impacts of air pollution: An overview
5. Summary Of Research Related Health Effects Of Air Pollution
6. Summary of Research Related Health-Care System Effects of Air Pollution
7. Recommendations
8. Conclusion
Glossary of Terms
Resource List
Appendices
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SMOG SEASON OFF TO A HOT AND HEAVY START

Wednesday, May 20, 1998
By Kim Honey and Jane Armstrong [Globe & Mail

The warm-weather trend has public-health officials worried that the worst is yet to come. "Everything is early this year," said Franca Ursitti, a researcher for the city's environmental-health office. "It's got everybody wondering, `Are we talking more of the same?' "

The air-quality index, which quantifies air-pollution levels, pegged Toronto's air quality as poor on May 15, with high ozone levels -- the first time this has occurred in May in 10 years. The air-quality index
ranges from zero to 100. The smaller the number, the better the air. Any reading over 50 is considered poor; May 15th it was 59.

Air-quality meteorologist Duncan Fraser said Toronto has not experienced such an early episode of ozone smog since 1988, the year the province started the air-quality index.

Climatologist Bryan Smith said temperatures for the first three weeks of the month have been five degrees above the May average of 12. So far, 1998 has been the warmest year since the government began keeping records in 1840. "If this trend persists, we could end up with more warm days, which may translate into more air-quality problems," Mr. Smith said.

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D. WORKING WITH THE HOMELESS DURING HOT WEATHER

The initial question came from Josefine Wendel and was posted on Community-Health list, then re-posted to click4HP list by Alison Stirling]

>Given the current high outside temperatures in the area, they [program working with the homeless] are looking for education materials with instructions for their clients on how to prevent overheating, heat stroke, dehydration and such.

> Does anyone know of such materials, or has suggestions on organizations to be contacted for information?

In response to this request: without question, this is as serious a problem as cold temperatures in winter months. In fact, studies show that the majority of homeless deaths do not, I emphasize, do not
occur in winter months. There are the obvious suggestions of lots of liquids, hats, sunscreen, air conditioned spaces, etc. However, without adequate shelter, both emergency shelter that has air
cooling devices or permanent housing, this problem will not go away. The Homeless Subcommittee of the Toronto Advisory Committee on Homelessness is asking for a report from Dr. Sheila Basrur the
Medical Officer of Health on the possibility of a Hot Weather Alert, whereby in hot/humid days, emergency locations that are air-conditioned would be opened and made available for those who are homeless or living in hot rooming houses.

Please note, Cathy Crowe does not work at Street Health. She is a street nurse and work at Queen West Community Health Centre; running a Nursing Outreach Program there. Cathy Crowe can be reached at (416) 703-8482x117 or email: crowe@NETSERVER.WEB.NET