The Big Picture

What is a healthy community?

The health of a community overall has always had a big influence on the health of the people who live there. For example, we now know that our postal code has as much influence on our health and well-being as our genetic code¹. In other words, where we live, work, learn and play has a significant impact on how long and well we live.

A healthy community is one in which multiple sectors collaborate to improve the conditions that influence our health and well-being.

What is meant by ‘health and well-being’?

The World Health Organization describes health as, “… a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Well-being refers to the presence of the highest possible quality of life including good living standards, robust health, a sustainable environment, vital communities, an educated populace, balanced time use, high levels of democratic participation, and access to and participation in leisure and culture.

World Health Organization. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946

PlanH addresses three critical and interconnected themes that are required for a healthy community

Healthy People

Local conditions support healthy behaviours and choices where people live, work, learn, and play.

Healthy Society

Vibrant places and spaces cultivate belonging, inclusion, connectedness and engagement.

Healthy Environments

Well-planned built environments and sustainable natural environments support all citizens to thrive, now and in the future.

―A healthy city is one that is continually creating and improving those physical and social environments and expanding those community resources that enable people to mutually support each other in performing all the functions of life and in developing to their maximum potential.
(Hancock and Duhl, 1986²)

Why take action on healthy communities

The health of British Columbians is changing, and not for the better. One in three British Columbians is living with at least one chronic condition¹, and one in four British Columbian adults is obese². What is truly alarming is that these numbers are on the rise as our lifestyles become more sedentary and we make fewer healthy food choices. To compound the problem the cost of health care in our province is escalating. In the last decade, health care costs have doubled to consume over 40% of the provincial budget.³

That’s the bad news.

The good news is that we can build the conditions that support the health and well-being of all British Columbians. These conditions for health begin right in our communities—where people live, work, learn, and play.

What the data is saying:

• Chronic disease is pervasive – One in three British Columbians is living with one or more chronic conditions which consume approximately 80% of BC Health Care budgets.⁴
• People are not active enough – 50% of adults and 91% of children and youth do not get recommended levels of physical activity⁵
• Obesity is on the rise – 26% of children in Canada are overweight or obese⁶ Canada’s childhood obesity rates are among the highest in the developed world – rates have almost tripled since 1978⁷
• Our population is aging – By 2031, seniors in BC will account for 25 percent of the total population⁸
• Our communities are designed to have us use our cars instead of our feet – Research shows that suburban developments tend to be built with low-density, single-land use neighbourhoods and street networks that are poorly suited to walking.⁹
• Many of us struggle to buy healthy local food – Research shows some populations in BC, particularly low income, single parent, aboriginal and rural, have difficulty accessing healthy fresh locally produced food.ⁱ
• Health inequities exist in BC – BC has a large number of populations who experience poorer health than the general population— for example, people living in poverty, those with mental illness, Aboriginal people and new immigrants.¹⁰

“The kind of communities that we develop is a more important determinant of health status of the population than the kind of health care we construct.”

Vancouver Island Health Authority, Understanding the Social Determinants of Health, 2006

What influences our health?

Evidence shows that 75% of factors that influence our health occur outside the healthcare system¹¹.

Many factors combine together to influence the health and well-being of individuals and communities. Factors such as the context in which we live, our access to healthy food and transportation options, one’s income and education level, as well as our social networks and access to social services all play a role in determining our health. This has led to a great amount of attention being paid to the health of communities, rather than only to the health of individuals (see Figure 1 below).

Figure 1. The Health Map: determinants of health and well-being¹²

Many effective actions to influence the key determinants of our health take place at the local level and are led by multiple sectors and citizens working together.

How to build healthy communities

While there is no single formula to creating a healthy community, a ‘healthy communities approach’ is based on the guiding principle that communities themselves determine their preferred vision for the future. As such, communities need to develop their own action plan to improve the quality of life of residents based on the community’s specific characteristics, needs and assets.

What is known internationally as ‘the healthy communities approach’ considers the social, economic, environmental, and physical factors that influence the health of individuals and communities. It is based on five strategies that build on a community’s existing capacity to improve community health and well-being: community involvement, political commitment; healthy public policy; multi-sectoral collaboration; and asset-based community development.  

The healthy communities approach calls for collective action, in which all the sectors— local government as well as health, community, non-profits and other groups as well as individual citizens— work together for a common purpose.
Duhl & Hanock, 1997

Community Involvement

People cannot achieve their full potential for health—physically, socially and mentally—unless they are able to participate in the decisions that impact their well-being. Thus, community involvement and participation are vital for the success of local health objectives. Moreover, there is evidence to suggest that empowerment and engagement of individuals is in and of itself health promoting¹.

A healthy community provides many different ways in which its members can interact with each other to exchange information about needs and resources, become engaged in the planning and decision-making processes that affect them, and work together to achieve common goals.

For more on actions local governments can take on citizen engagement, please go here.

Societies that enable all citizens to play a full and useful role in the social, economic and cultural life of their society will be healthier than those where people face insecurity, exclusion and deprivation.
World Health Organization. Social Determinants of Health: the solid facts.

Inter-Sectoral Partnerships

In a healthy community all sectors – including government, health, business, education, community services, and the voluntary sector – recognize that the health of their community is everyone’s business and work together to support community health and well-being.

Local governments have a key role to play in creating healthy communities, but they cannot play this role alone. The healthy communities approach doesn’t require local governments to assume responsibility for things that fall under the jurisdictions of other orders of government. Rather, it asks locally elected officials to ensure that their decision-making reflects an inclusive, collaborative approach to building communities that are vibrant, sustainable and health promoting on multiple levels.

A key partner for local governments in healthy communities work are regional health authorities. To learn more about partnerships with health authorities, go here.

A healthy municipality is essentially one that has managed to achieve a social pact between civil society organizations, institutions from various sectors, and local political authorities to commit to carry out health promotion actions, with a view to provide the population with a good quality of life.
World Health Organization. Healthy Communities & Municipalities: Mayor’s Guide to Promoting Quality of Life

Political Commitment

While creating a healthier community is a larger task than local government alone can undertake, the role of local government is central to the whole process. High-level political commitment (from Mayors and Councils) has been a centerpiece of the healthy communities’ movement worldwide.²

Healthy public policies seek to create a supportive environment that enables people to live a healthy life, make healthy choices and transform social and physical environments.
World Health Organization.  Healthy Communities & Municipalities: Mayor’s Guide to Promoting Quality of Life

Elected officials and staff can demonstrate their commitment to a healthy community by providing leadership and decision-making that considers health and well-being in policy decisions and planning as well as in the type of partnerships that are developed and maintained.

Healthy Public Policy

‘Healthy public policy’ refers to the development of policy in non-health sectors, such as transportation or food policy, that is designed to improve the health of the population. Healthy public policy is especially important at the local level because many influences on our health—transportation options, community design, recreation opportunities, and access to healthy food choices—occur in our communities where we live, work and play.

Asset-Based Community Development

An ‘asset-based’ approach to community development empowers both individuals and communities by focusing on community strengths and on the skills, knowledge and assets of individuals. Traditional approaches to issues such as poverty, obesity, and homelessness have tended to focus on the deficiencies in communities—the things that aren’t working. The result has been a ‘needs based’ approach where ‘experts’ come in from outside the community to provide interventions.

In contrast, an ‘asset-based’ approach supports communities to build on their own strengths, knowledge and skills to shape their own solutions. Support from outside the community may still be provided, but the communities are leading the way and defining the course of action.

For example public health staff, local government (perhaps in community planning) staff, and possibly community organizations as well (depending on the workshop and context.)

Who can build healthy communities

Building healthy communities requires multiple sectors to work together, and no single partner can do it alone. Some of the sectors that play a key role in building healthy communities include:

Local Governments

From the earliest days of community building in British Columbia, cities and towns have been concerned with community health. Historically, the focus of local government public health efforts was on the prevention of infectious diseases like smallpox, diphtheria, typhus, cholera, and tuberculosis. From these public health efforts grew many of the basic local government services that we know today such as public works, community planning, housing, building inspection, fire protection, police, and parks.ⁱ

Today, planning in communities across BC addresses a broad range of policies and services which focus on the social, economic, environmental and physical aspects of communities. Local governments routinely make decisions and allocate resources for transportation, community design, housing, parks and recreation, and community services. Many local governments also adopt policies related to food security, social planning and tobacco use in public areas. These decisions and policies all contribute profoundly to the health and well-being of citizens.

Many would be surprised to learn that the greatest contribution to the health of the nation over the past 150 years was made, not by doctors or hospitals, but by local governments. Our lack of appreciation of the role of our cities in establishing the health of the nation is largely due to the fact that so little has been written about it.”

Dr. Jessie Parfitt, in “Healthy cities and communities: Past present and future.” National Civic Review, Spring ‘97. Vol.86 Issue 1 p.11

For more on the role of local governments, see the PlanH guide.

Regional Health Authorities

Regional health authorities in BC govern, plan, and deliver health services within their large regional jurisdictions. They are responsible for identifying health needs, allocating resources and delivering health services in their area.

Health professionals working for your regional health authority understand the health challenges in your region. They have access to local health data, funding, expertise and resources which can help local governments to better understand and address the heath challenges in the community.

Public health staff can work with local governments to help create health-promoting and health-protecting policies, plans and programs that contribute to healthy built and social environments. They can also provide valuable information about health data for your community and region.

Local Schools and School Districts

Local schools and school districts frequently partner with local governments to develop joint use agreements to maximize the use of community facilities and playfields. A number of initiatives are happening across BC to promote healthy schools, such as:

• Healthy Schools BC
• The Hub for Active School Travel
• DASH BC

Community Organizations and Non-Profit Partners

Not for profit organizations and community groups are critical partners in healthy community initiatives. Community organization representatives offer valuable expertise, knowledge, and relationships with diverse groups in the community. Community partners can play a number of key roles:

• Provide expertise to a local government healthy communities advisory committee;
• Give feedback on local policy and planning processes related to healthy communities;
• Partner with municipalities in the development and delivery of community projects;
• Outreach to and engage citizens, including diverse populations (e.g. new immigrants, aboriginal populations, youth, seniors, etc.) in healthy community plans, decisions and programs.
• Deliver programs, services in the community—for example, community gardens, recreation programs, or neighbourhood association projects.

Learn more about increasing public involvement including civic engagement and community capacity building here.