Kevin Lam is a third-year medical student at McMaster University

Picture of Lawrence Loh

Lawrence Loh is Associate Medical Officer of Health at Peel Region, Ontario, and Adjunct Professor at the University of Toronto Dalla Lana School of Public Health


Suburbs, and later exurbs, became central to the Canadian lifestyle during the automobile boom in the 1960s and 1970s. Cars were sold as the future and urban planners created suburban neighbourhoods that quickly became the primary venue where people lived and learned. Suburbs were touted to be cleaner and safer spaces, far away from “derelict” urban cores, where people went only to go to work. From this idyllic image, suburban built environments have since developed various distinct characteristics, typically defined by “commercial strips, low density, separated land uses, automobile dominance, and a minimum of public open space.”

Having reshaped many cities in North America, the suburban model has gone global. Around the world, the suburban forms of major cities such as Mississauga (Toronto), Surrey (Vancouver), Limert Park (Los Angeles), Footscray (Melbourne), and Prospect Park South (New York) share these similar characteristics. But it’s becoming clear that suburban living doesn’t necessarily promote wellbeing. In fact, urban sprawl is not healthy.

Recently, Active Design Guidelines were created as a collaboration between city planners and public health professionals, when they realised that physical and mental wellbeing are essential to healthy communities. Deployment of such guidelines is intended to improve wellbeing by increasing physical activity, promoting greater social cohesion, and improving environmental health.

However, most Active Design Guidelines are from dense urban environments like New York, Toronto and Melbourne, and often were not created specifically for suburban or exurban settings and often the urban ones do not all apply to suburban areas. Recommendations for small block sizes, curb extensions for congested sidewalks, and maps and signage for calories burned to next transit stop, are not useful, for example. Urban guidelines are less applicable to the majority of Canadians who live in suburbs today.

The need for suburb-specific Active Design Guidelines is clear: time and time again, it has been shown that typical suburbs are not the promised lands they were sold as.  And the key characteristics that challenge health in the suburbs are also what makes them different from urban areas: automobile dependent infrastructure, single-use zoning, and relatively low density housing.

The need to travel by car is one of the defining characteristics of suburbs in North America. Zoning restrictions that that limit large expanses of  land for building housing  and the low density form that drives sprawl creates long distances between the places people want to go and it’s almost impossible for suburb-dwellers to reach places to shop and work by anything except for motorized transport – typically in private automobiles. Dependence on cars is a main driver for sedentary behaviour and poorer self-reported health as well as associated conditions such as obesity, diabetes and hypertension, leading to poor health, worsened quality of life and increased spending on healthcare.

Evidence is also accumulating that suburban developments cost governments a lot more money than the taxes they generate in the long term, resulting in significant diversion of resources towards upkeep away from health and community services. Researchers in the United States have found that denser neighbourhoods cost less overall: for every 10% increase in compactness, there is a 3.5% decrease in transportation costs even after adjusting for income. Similarly, a study in Spain showed that sprawl has increased infrastructure costs by 7 per cent and housing and local police costs by 2 per cent.

The absence of Active Design Guidelines specific to suburban settings is especially pressing in a time when rising living costs in city centres is pushing lower socioeconomic families out of city centres and promoting greater population growth in suburban settings. The absence of Active Design Guidelines for suburbs thus presents the potential for exacerbation of differential health status between those who can afford to live in dense urban cores and those who must choose to live in the surrounding suburbs.

Creating suburban guidelines will help public health professionals and urban planners communicate better. This will help them in making existing suburbs better and support the creation of new suburban developments that plan to put health first.

In speaking with experts, we identified some specific ideas. For example, large malls might be a focal point for re-engineering the suburban built environment rather than moving to amend zoning laws to permit mixed-uses of land. Furthermore, simple solutions may not be the best answer, such as the belief that open spaces in large-scale developments might function well. One expert we spoke to mentioned that “the [use of open spaces] depends on the design and programming; [I have seen] open space in [city] suburbs that are big but empty” – pointing to the low population density in suburban settings that would likely limit the possibility of reaching optimal use and capacity in oversized open spaces.

Experts also noted that deployment of suburb-specific Active Design Guidelines would require substantial political will – particularly to address conflicts such as the construction and use of cycle lanes, which would effectively increase travel times and decrease driving speeds for motorists. Some even suggested that the development of dedicated infrastructure for cycling would only be useful in the suburbs if they are entirely separated from motorized traffic – which is very different from thinking in urban guidelines.

What’s clear is that the cost of simply allowing suburban growth to go unchecked without considering that the long-term health impacts are simply too great. Urban planners and public health officials need to work together to address these problems. But let’s remember that the challenges facing dense urban areas are not the same as those facing the suburbs.