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Municipal transportation policy as a population health intervention: estimating the impact of the City of Ottawa Transportation Master Plan on diabetes incidence

  • Trevor ArnasonEmail author
  • Peter Tanuseputro
  • Meltem Tuna
  • Douglas Manuel
Special Section on Why Public Health Matters Today: Population Health Intervention Research
  • 26 Downloads

Abstract

Intervention

Physical inactivity is an important behavioral risk factor for chronic disease in Canada. Individual-level strategies are used in clinical medicine to target individuals for preventive intervention based on one or more risk factors. In contrast, this study examines the impact of a population-level intervention: a municipal policy outside the healthcare sector that influences the built and social environment.

Research question

What is the preventive effect of a municipal transportation policy to increase active transportation on a chronic disease outcome measure—diabetes incidence—when it is viewed as a population-level health intervention to increase physical activity?

Methods

The impact of increases in active transportation for regular commuting to work in the city of Ottawa, Ontario was modeled to estimate number of diabetes cases prevented over 10 years. As a health-sector comparison, the reduction in incidence was equated to an individual-level approach to prevention targeting those who are inactive, meant to represent a clinical preventive intervention.

Results

The population-level policy shift could prevent as many as 1620 incident cases of diabetes over 10 years, the largest number prevented by increases in public transit use. This population effect was equal to 17,300 inactive individuals or 12,300 inactive individuals > 45 years old undertaking a clinical preventive intervention to increase physical activity.

Conclusion

The results demonstrate why public health matters today as population-level interventions that exist as policies outside the healthcare sector, supported by public health, may have an unrecognized and therefore underappreciated impact on population health.

Keywords

Active transportation Physical activity Diabetes Public health Policy 

Résumé

Intervention

La sédentarité est un important facteur de risque comportemental de maladie chronique au Canada. Des stratégies individuelles sont utilisées en clinique pour cibler les personnes qui ont besoin d’une intervention préventive parce qu’elles présentent un ou plusieurs facteurs de risque. Notre étude, par contre, porte sur l’impact d’une intervention en population : une politique municipale hors du secteur des soins de santé qui influence le milieu bâti et l’environnement social.

Question de recherche

Quel est l’effet préventif d’une politique municipale visant à accroître le transport actif sur un indicateur de résultat de maladie chronique—l’incidence du diabète—quand cette politique est considérée comme une intervention sanitaire pour accroître l’activité physique dans la population?

Méthode

Nous avons modélisé l’impact des hausses du recours au transport actif pour se rendre au travail à Ottawa (Ontario) afin d’estimer le nombre de cas de diabète évités sur une période de 10 ans. Par mesure de comparaison avec le secteur de la santé, la baisse d’incidence a été assimilée à une démarche individuelle de prévention ciblant les personnes sédentaires, afin de représenter une intervention clinique préventive.

Résultats

Un tel changement de politique touchant l’ensemble de la population pourrait éviter jusqu’à 1620 cas incidents de diabète sur 10 ans, le plus grand nombre de cas étant évités par les hausses de l’utilisation des transports en commun. Cet effet populationnel était égal à 17,300 personnes sédentaires ou à 12,300 personnes sédentaires de > 45 ans ayant suivi une intervention clinique préventive pour accroître leur niveau d’activité physique.

Conclusion

Nos résultats montrent que la santé publique importe encore aujourd’hui, car les interventions en population qui existent sous forme de politiques hors du secteur des soins de santé mais avec le soutien de la santé publique peuvent avoir un impact méconnu, et donc mal apprécié, sur la santé des populations.

Mots-clés

Transport actif Activité physique Diabète Santé publique Politique (principe) 

Notes

Acknowledgements

The authors thank Inge Roosendaal, MPl, and Cameron McDermaid, MHSc, at Ottawa Public Health for their perspectives on how the public health sector in Canada supports municipal planning and policy to promote healthy built environments. We also thank Laura Rosella, PhD, for assistance in applying DPoRT to the CCHS Public Use Microdata File and Meaghan Mahadeo for editorial review of the manuscript.

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Copyright information

© The Canadian Public Health Association 2019

Authors and Affiliations

  1. 1.Department of Community Health and Epidemiology, Faculty of MedicineDalhousie UniversityHalifaxCanada
  2. 2.Public Health Medicine UnitOttawa Public HealthOttawaCanada
  3. 3.Bruyère Research InstituteOttawaCanada
  4. 4.Ottawa Hospital - Civic CampusOttawa Hospital Research InstituteOttawaCanada
  5. 5.Ottawa Hospital - Civic CampusInstitute for Clinical Evaluative SciencesOttawaCanada
  6. 6.Department of Medicine, Division of Palliative CareUniversity of OttawaOttawaCanada
  7. 7.Department of Family MedicineUniversity of OttawaOttawaCanada
  8. 8.School of Epidemiology, Public Health and Preventive MedicineUniversity of OttawaOttawaCanada

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