Forging the future of healthy cities

As a young student, Professor Billie Giles-Corti thought selling good health to people would be like selling them toothpaste – simple.  Now Director of the McCaughey VicHealth Centre for Community Wellbeing at the University of Melbourne, she knows better.

“When I was a young woman working in market research, we became very excited when products we were monitoring got one per cent of market share – our clients thought this was a windfall.  But in public health, when half the population is not physically active and we’re trying to get large numbers of people to change their behaviour, a one per cent shift in market share is simply not enough.

“I started to realise there were barriers to these shifts and a need for policy to support people to change.  Coming from being very focused on the individual, I realised there needed to be structural reform.”

In 1986, the World Health Organization released guidelines to their member states saying to create the conditions for good health, people not only need to be provided with health information they need to be provided with supportive environments and healthy public policy.

“There’s an important distinction between healthy public policy and health public policy,” Professor Giles-Corti says. “Healthy public policy is the requirement for all policies to have a healthy focus.  As I developed my research career I felt this seemed like a terrific concept but that it needed to be researched to show whether or not the evidence supported the idea.  There’s actually been little focus on that area. People have been trying to change the environment but not measure the environment and the impact it has on people.”

Professor Giles-Corti started her research as a PhD student at the University of Western Australia trying to work out what healthy public policy would look like, and discovered that the way we design the built environment is a critical intervention, because it can create health and wellbeing in a passive way without people having to think about it too much.

“I took my work to the WA planning department to say: look, my results are showing that if you change the built environment you can change people’s behaviour.  To my complete surprise, they welcomed my input because they were also committed to bringing about change.”

In 2003, Professor Giles-Corti went on to create the Centre for the Built Environment and Health at the University of Western Australia and in 2011 became an Australian National Health and Medical Research Council (NHMRC) Principal Research Fellow before being appointed as the Director and Chair of the McCaughey VicHealth Centre for Community Wellbeing.

“The McCaughey Centre is unique because it covers the gamut of social determinants in health,” she says.  “Here we cover child health and wellbeing, race-based discrimination, social inclusion and stigmatisation, a person’s field of work as a social determinant of health, and urban design and health.  Community Indicators Victoria (CIV) also collects data and gives it back to the community so people and local governments can make choices about where they put their resources to create better conditions for wellbeing in their own areas.”

Professor Giles-Corti has expanded her work even further, having recently received funding for a National Centre for Excellence in Healthy, Equitable and Liveable Communities led by the University of Melbourne and in partnership with the University of Western Australia, the University of South Australia, Queensland University of Technology and the University of Queensland, bringing together all her major collaborators from the past decade.

“One of the biggest issues facing the world is the impact of chronic disease on the health system,” she says. “Chronic diseases like cardiovascular disease, diabetes, cancers and obesity all have a major impact on the health system. There’s going to be a huge cost if we can’t get people to be more active, less sedentary, to eat a healthier diet and to stop smoking, so the focus for our Centre is how to create communities that will optimise those outcomes.

“By 2050, it’s estimated that Australia’s population will double.  Our National Centre will study more than 20,000 people in the fastest growing cities in Australia to determine what cost-effective built environment interventions create healthy, equitable and liveable communities, and how these can be translated into policy and practice.”

The Centre for Excellence is also drawing on international research and partnerships including the London Olympic Village regeneration study, disadvantaged neighbourhood regeneration in Denmark and the City of New York Active Design Centre focused on how to change local government policy to develop active design guidelines across the whole city.

“The optimum thresholds for housing density and green space, the quality of green space, shop locations and designs, bike and footpath locations, access to public transport, all make a big difference to health, both mental and physical, Professor Giles-Conti says.

“You couldn’t imagine now that once upon a time we built neighbourhoods without sanitation and water.  Who would even think of that now?  We need to get to the point where we have clear evidence showing the essential infrastructure required to create liveability and the impact it has on people.

“We want to put a stake in the ground and say: these are the essentials of the 21st century community and we have a responsibility to provide everyone with these basics,” she says.

www.mccaugheycentre.unimelb.edu.au