Hamilton — Healthy Cities

A look at what makes a city healthy and a unique take on Hamilton’s mission to be the best place to raise a child.

On September 28 I had the opportunity to speak on a panel put on by Hamilton Health Sciences’ FUSE group at the Art Gallery of Hamilton to discuss ‘Healthy Cities’ and how Hamilton can meet its goals to become the best place to raise a child and age. I’ve had a month to think about & research this topic, and heard from five expert panelists who are leaders in the city. This piece is a written summary from my perspective.

What Makes a City Healthy?

Ithought for days on this topic, literally spent hours, probably in excess of ten, thinking, creating surveys, reading, writing, re-writing, getting feedback, all because I’m so intrigued and perplexed by the simple question, what makes a city healthy? And all it got me was a two word answer: healthy….people. That’s really about it.

But frankly, what is a city afterall? Collection of people. So, what is a
healthy city? Collection of healthy people. Very often we approach the topic of urban health from a policy and infrastructure perspective: bike lanes can be a cause of better health for people in a city.

Policy + Resources + Infrastructure = Healthy City

I totally disagree with this perspective because it’s actually the other way around, healthy people in a city create policy and infrastructure decisions to improve their health outcomes, through community groups or through multiple levels of government.

Healthy People = Policy + Resources + Infrastructure = Healthy City

Bike lanes are an effect of a concentration of engaged and healthy people not a cause (and they can enable healthy outcomes).


I want to explain why this is so true by borrowing a concept from economics, called forces of agglomeration. Basically the theory goes that markets with the largest agglomeration of a resource will be those
that are the most attractive to those involved with that resource. Take tech talent for example. Why do firms locate in SF when its so damn expensive? Because that’s where all the specialized talent is, and because there is idea sharing and knowledge spillover, access to capital, access to suppliers, etc. Talent goes to SF seeking jobs, employers go to SF seeking talent, and the concentration snowballs and intensifies. 

Let’s look at these forces in the context of health. Imagine you took Vancouver’s urban form (a notoriously healthy place), bike paths, yoga studios, seawalls and all and dropped it on a place like Flint, MI (unfortunatley less healthy), would you see similar health outcomes in the new Flint? Impossible to tell, but I doubt it.

Flint, “Vehicle City”
Vancouver, a cyclist’s paradise

Healthy people agglomerate in places with more healthy people, and research shows that being in a place that is diverse across economic, social, and ethnic spheres increases the average health of the least healthy people there. That is, the unhealthy people of Vancouver on average are healthier than the unhealthy people of Flint because they are surrounded by lot’s of healthy people. This matters for two key reasons, both supported by literature on neighbourhood effects on health:

  1. Healthy people provide social examples of health and social support (like when you see everyone in Vancouver running and you’re jolted to re-examine your lifestyle; or when tight knit communities improve health outcomes for all residents, beyond their immediate family), and
  2. Those healthy people in Vancouver engage with each other and the city and create outcomes that benefit all (i.e. policy, infrastructure, farmers markets, etc.). There’s a concentration of healthy people that attracts more and more and creates a spillover effect on services, infrastructure, and policies; the same virtuous cycle we saw with talent in SF.

So my point is forces of agglomeration matter for economics, and for health.

If you want to be a healthy city your goal must be, retain, attract, and empower healthy people at the core of everything you do.

Is Hamilton a Healthy City?

I think a good way to look at Hamilton through my healthy people argument is to look at a particularly interesting relationship in Hamilton and how people in the city are engaging with it: air quality and transportation.

Hamilton has the highest concentration of particulate matter in its air of any city in Ontario, the second highest levels of nitrogen oxides (NOx), and the highest levels of sulphur (Ontario Clean Air Report, Ministry of the Environment and Climate Change, 2014). Transportation causes 63% of nasty nitrogen oxides, with only 14% caused by industry according to Clean Air Hamilton (Clean Air Hamilton). It’s not even heavy industry that’s the main culprit! It’s us, it’s our transportation choices!

Today, cyclists, pedestrians, and their lungs contend with up to 5 lanes of one way traffic on King and Main

On that note, transportation mobility is an area where progress is beginning to appear with programs like SoBi, the LRT (tentatively), and work by Cycle Hamilton and other orgs. But there is a lot of work to do. As at the last Census, only 9.3% of Hamiltonians took transit to work, whereas major cities nationwide see midteens to 20% (even Calgary, Halifax, and Winnipeg). Worse, only 0.7% of people biked to work in Hamilton, which is half the national average!!!! Momentum in positive transportation planning choices shows that Hamiltonians are starting to re-examine the car centric form of the city in favour of one that prioritizes pedestrians, and there are many excellent case studies for making this shift in an intelligent way, see this great VOX Short for some examples.

sobi Bike Share

Who Are All These Healthy People?

The WHO has a beautiful summary of 11 things a healthy city needs. I’d summarize them into five categories: 1) a diverse and innovative economy 2) an engaged and tolerant community 3) safe and clean environment 4) connectivity between people and places, and 5) access to health care, and resources.

The one common denominator of all those WHO factors is engagement, and that is why healthy people create healthy cities. Healthy people engage in idea sharing, in the economy, in politics and community, in diversity, and very importantly in creating healthy outcomes for themselves and their community.

When cities are striving to become healthier places, they need to take a step back and think about what they are doing to retain, attract, and empower healthy people, because it is their critical mass of engagement that brings in other healthy people, guides and supports health policy and infrastructure and lifts the health of the whole community.

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