Healthy by Design

Dr. Karen Lee believes that better community planning has long-term medical benefits.

WHEN DR. KAREN LEE, associate professor, Division of Preventive Medicine, Department of Medicine, University of Alberta and author of Fit Cities, was growing up in St. Albert, she didn’t anticipate becoming a disease detective. Before COVID-19 introduced Edmontonians to the work of epidemiologists, who knew a disease detective was even a thing?

One of the first such sleuths was Dr. John Snow, who in 1854 identified the source of cholera in one London neighbourhood: Contaminated water from a public well. By the 20th century, cholera was virtually eradicated. “We don’t have great treatment for cholera,” says Lee, “instead we’ve relied on changing our environment by building clean water infrastructure to control that disease.”

After completing her masters and residency in Public Health and Preventive Medicine at the University of Toronto, Lee was consumed by the question: If pandemics can be controlled with environmental changes, can non-communicable diseases like obesity be controlled too? In 2004, Lee was hired by the U.S. Centers for Disease Control and Prevention to use environmental changes to control non-communicable diseases.

Lee took her experience at the CDC to New York City, and with a small team set out to create a healthier city. The city’s health department took on the fast-food industry, requiring chains to display calories on menu boards. Daycares were required to serve water, not unlimited amounts of juice and sugar-sweetened beverages to children. Grocers were encouraged to move into “food deserts” (neighbourhoods that didn’t have access to healthy food) thanks to tax and zoning incentives. It encouraged stair use through signage and by painting stairways in fun colours. “In under a decade, the city reversed childhood obesity trends and improved life expectancy,” Lee says.


With 63 per cent of Canadian adults overweight or obese in 2018, Lee doesn’t believe it’s fair to blame individuals for not having willpower. “The science is showing us that if we live in unsupportive environments making it difficult to stick to our diets or exercise goals, then we will likely fail at it.”

She believes fighting obesity is a community battle that starts with how we design our communities. In Fit Cities, Lee shares ideas from all over the world. Adult exercise bikes and elliptical equipment at playgrounds? Taipei has them. Affordable rapid transit, with dedicated bus-only lanes throughout the city? Bogota has it. She hopes people will be inspired and ask, “Why not in Edmonton?”

Since returning to Edmonton in 2018, Lee has seen how much the city has increased densification and,
if you live in the core, good access to active transportation systems like LRT service, biking and walking trails. But what can we do better?

Promote stair use – “Burn calories, not electricity. Take the stairs!” Lee says signs like this can increase stair use by over 50 per cent. One Harvard study showed that climbing the equivalent of just three to five floors a day can reduce risk of stroke by 29 per cent.

Connect suburban houses to shopping areas – Lee believes connecting residential areas to the many suburban shopping areas with paths would encourage walking, as well as encourage more local shopping for a win-win.

Stop the use of restrictive covenants on supermarket sites – this restricts access to healthy food options in many older communities where grocery stores have gone out of business and new ones are unable to set up shop.

Continue to expand safe bike networks – the city recently turned a traffic lane into a bike
path along Victoria Park. If you consider that biking 15 minutes to work and back each day burns an average 10 pounds per year, that lane helps hundreds of people to not just maintain their weight, but decrease it.

Expand access to water refill stations in streets and parks – “When we are already doing road work, why not connect pipes to public fountains?” Lee asks.

Adopt the U of A’s Housing for Health Project guidelines – enable healthy communities to ensure the City, builders and design firms working on development and renovation projects include health and well-being considerations going forward.

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