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CHAIM BLOG

Health Starts at Home: Housing, Neighborhoods and Urban Health Inequity

7/27/2021

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Hilary Ziraldo, Carleton University Student
​

On the day I wrote this, exactly one year had passed since the World Health Organization declared COVID-19 a global pandemic. Like every other day that year, I was at my home in Toronto, only leaving to get groceries or to exercise outside. When I ran into my mom as she headed down the stairs to her basement work-from-home setup, she liked to joke that there was “heavy traffic” on her morning commute. Joking aside, COVID-19 has changed how we interact with our physical environments. We have become increasingly dependent on our homes and neighbourhoods to support our physical and mental health needs, and this has intensified health disparities between those living in adequate and inadequate conditions. 
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​The impacts of housing on health are numerous. Overcrowding can increase the spread of communicable infections, while chronic diseases, such as asthma, are associated with substandard heating, insulation and dampness (1,2). Unsafe or unaffordable housing is also a source of chronic stress and can lead to social isolation and poor mental health (2,3,4). 

​Despite these broad consequences, 15.3% of Ontario households live in unsuitable, inadequate or unaffordable conditions, and affordable housing has been consistently de-prioritized by the provincial government (5). I find this alarming because housing is an essential human right, yet continues to be treated as non-essential by government decision-makers and the voting public.

​Due the high rates of poor-quality and unaffordable housing in Ontario, stay at home orders during the COVID-19 pandemic confined many Ontarians to unhealthy living conditions. Essential workers are also impacted because income is a determinant of housing quality, and the reality is that many frontline jobs are poorly compensated (6). For essential workers living in crowded or intergenerational households, continuing to work puts themselves and their families at greater risk due to both workplace exposures and their household conditions.

Beyond housing, our neighbourhoods can have a large impact on health. Residents are more likely to be physically active in safe, walkable neighbourhoods and to choose healthy foods when they are easily accessible (7,8). In neighbourhoods designed to facilitate gatherings, residents perceive greater social support and a stronger sense of community belonging (8). Due to the impact of neighbourhood features on health, vast disparities in health may occur between otherwise geographically close communities.
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Like quality of housing, quality of neighbourhoods is largely determined by income (6) and this cannot be fixed by simply investing in the development of low-income neighbourhoods. When lower income neighbourhoods are revitalized, gentrification may occur. Gentrification refers to the transformation of the social, economic, cultural, physical and demographic features of a neighbourhood, and often leads to the displacement of long-term and socially marginalized residents (9). In a neighbourhood impacted by gentrification, property and rental values are inflated, pushing vulnerable populations to relocate. 
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​However, there are ways to break the cycle of revitalization and displacement caused by gentrification. The City of Ottawa is incorporating public health concepts into urban growth strategies by creating ‘15-minute neighbourhoods’ (10). A 15-minute neighbourhood is one in which all (or most) daily needs can be accessed within a 15-minute walk from one’s home. The goal of a 15-minute neighbourhood is to reduce reliance on vehicles, increase social connections, and promote equity through improved access to daily needs (10). 

​At the provincial level, Ontario has tried to combat income-based disparities in access to healthy built environments through inclusionary zoning regulations (11). Inclusionary zoning is a strategy to increase affordable housing in desirable neighbourhoods. Under an inclusionary zoning system, every new housing development must be mixed income, meaning that a range of income levels can afford to live in high-quality housing within updated neighbourhoods. Inclusionary zoning has shown some success in the United States, but there is concern that provincial actions will be ineffective at the municipal level. Under the current system, the power to enforce inclusionary zoning lies with municipal governments, that will need to implement bylaws and regulations surrounding the construction of affordable housing units (12). By leaving decisions on inclusionary zoning to municipalities, substantial changes are not guaranteed. 
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​When we understand the magnitude of Ontario’s housing crisis, it is easy to support policy action, like inclusionary zoning. But, take a moment to consider your perspective if affordable housing was proposed in your own neighbourhood? As is too often the case, such a policy might be easy to support until you are personally affected. For residents living near areas allocated for affordable housing, the “not in my backyard” (NIMBY) phenomenon is both common and predictable. The NIMBY phenomenon refers to the opposition of new developments by residents when they believe the development will negatively impact their neighbourhood or property value. Classical examples of the NIMBY phenomenon include responses to safe injection sites and homeless shelters, but affordable housing is similarly affected (13). NIMBY responses are often founded in stereotypes and stigma and serve to perpetuate social inequities. One method governments and developers can use to fight the NIMBY phenomenon is to engage and inform residents throughout the planning process. Importantly, we can individually work against NIMBY-ism by discussing the value of diverse communities with family, friends, and neighbours and being leaders for social equity within our own neighbourhoods.

As I sat at my desk in Toronto with the entire province under stay at home orders, I couldn’t help but appreciate how much I relied on my home and neighbourhood over the past year. But, for many Ontarians, hiding away at home has not been a refuge from the dangers of COVID-19. Improving access to healthy homes and neighbourhoods is a complex battle involving political priorities, revitalization and gentrification, and local sentiments. As we move forwards in the COVID-19 pandemic and into its aftermath, we must do more to ensure that “home” is a healthy environment for all Ontarians. 
References:
  1. Brown, K. A., Jones, A., Daneman, N., Chan, A. K., Schwartz, K. L., Garber, G. E., … Stall, N. M. (2021). Association between nursing home crowding and COVID-19 infection and mortality in Ontario, Canada. JAMA Internal Medicine, 181(2), 229–236. https://doi.org/10.1001/jamainternmed.2020.6466
  2. World Health Organization. (2018). WHO housing and health guidelines. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK535293/
  3. Pevalin, D. J., Reeves, A., Baker, E., & Bentley, R. (2017). The impact of persistent poor housing conditions on mental health: A longitudinal population-based study. Preventive Medicine, 105, 304–310. https://doi.org/10.1016/j.ypmed.2017.09.020
  4. Tomaszewski, W. (2013). Living environment, social participation and wellbeing in older age: The relevance of housing and local area disadvantage. Population Ageing, (6), 119–156. https://doi.org/10.1007/s12062-012-9077-5
  5. Government of Ontario. (2020). Community housing renewal: Ontario’s action plan under the National Housing Strategy. Retrieved March 13, 2021, from https://www.ontario.ca/document/community-housing-renewal-ontarios-action-plan-under-national-housing-strategy/housing-needs-ontario
  6. Raphael, D., Bryant, T., Mikkonen, J., & Raphael, A. (2020). Social Determinants of Health: The Canadian Facts, 2nd Edition. Retrieved from https://thecanadianfacts.org/The_Canadian_Facts-2nd_ed.pdf
  7. Krieger, J., & Higgins, D. L. (2002). Housing and health: Time again for public health action. American Journal of Public Health, 92(5), 758–768.
  8. Public Health Agency of Canada. (2017). The Chief Public Health Officer’s Report on the State of Public Health in Canada 2017: Designing healthy living. Retrieved March 14, 2021, from https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/chief-public-health-officer-reports-state-public-health-canada/2017-designing-healthy-living/PHAC_CPHO-2017_Report_E.pdf
  9. Cole, H., Anguelovski, I., Baró, F., García-Lamarca, M., Kotsila, P., Pérez del Pulgar, C., … Triguero-Mas, M. (2020). The COVID-19 pandemic: Power and privilege, gentrification, and urban environmental justice in the global north. Cities & Health, 1–5. https://doi.org/10.1080/23748834.2020.1785176
  10. City of Ottawa. (2020). Big 5 Moves. Retrieved from https://engage.ottawa.ca/the-new-official-plan/news_feed/the-5-big-moves
  11. Government of Ontario. (2018). O. Reg. 232/18: Inclusionary zoning. Retrieved March 16, 2021, from Ontario.ca website: https://www.ontario.ca/laws/view
  12. Government of Ontario. (2020). Citizen’s guide to land use planning: The Planning Act. Retrieved March 3, 2021, from https://www.ontario.ca/document/citizens-guide-land-use-planning/planning-act
  13. Ontario Human Rights Commission. (n.d.). Human rights and not-in-my-back-yard (NIMBY). Retrieved March 15, 2021, from http://www.ohrc.on.ca/en/human-rights-and-not-my-back-yard-nimby
Link References:
  1. Talwar Kapoor, G. (2021, April 3). Successive budgets show affordable housing is clearly not a priority for Ontario. Retrieved April 25, 2021, from the Toronto Star website: https://www.thestar.com/opinion/contributors/2021/04/03/successive-budgets-show-affordable-housing-is-clearly-not-a-priority-for-ontario.html
  2. Wellesley Institute. (n.d.). Ontario announces evidence-based inclusionary zoning regulations and action shifts to the municipal level for implementation. Retrieved March 16, 2021, from https://www.wellesleyinstitute.com/ontario-announces-evidence-based-inclusionary-zoning-regulations-and-action-shifts-to-the-municipal-level-for-implementation/
  3. Keenan, E. (2016, January 2). The good and bad of Toronto NIMBYism. Retrieved April 26, 2021, from the Toronto Star website: https://www.thestar.com/news/gta/2016/01/02/youre-a-toronto-nimby-now-what.html
Picture References:
  1. Archibald, A. (2019). Liberals for inequality: NIMBYism and affordable housing In American cities. Retrieved March 16, 2021, from Pax on both houses website: http://paxonbothhouses.blogspot.com/2019/08/liberals-for-inequality-nimbyism-and.html
  2. Government of Ontario. (2021). Ontario Ministry of Health. Retrieved March 17, 2021, from https://www.facebook.com/ONThealth/photos/a.546566125392952/3516644231718445
  3. Ottawa Public Health. (2020). Health and the built environment. Retrieved March 17, 2021, from https://www.ottawapublichealth.ca/en/public-health-topics/health-and-the-built-environment-.aspx
This blog was originally written as part of the HLTH5402 course.
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How the COVID-19 Pandemic May be Harming Our Relationships with Our Bodies

7/8/2021

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Katie Vick, Carleton University Student
Introduction
A common concern expressed by many people throughout the pandemic has been the fear of weight gain from being cooped up inside. Gyms are closed, banana bread recipes are trending, and the weight gain of the coined ‘Quarantine 15’ is on folks’ minds (1,2). Recent research reports negative changes in diet, exercise, and body image worldwide since the pandemic began (3,4,5,6). While one might expect body image comparisons to dissipate with social distancing, this has not been the case. To the contrary, these unprecedented times have forged new opportunities for body image concerns to creep into our consciousness - perhaps in more pervasive ways than before. 

Social Media
Up to 80% of people report spending more time on social media during the pandemic, and this had no doubt been helpful to connect people during isolation,. However, there has been a concurrent shift in the tone of social media content. On the one hand, there is a greater frequency of posts about exercise and diet, and a prevalence of blatantly weight-stigmatizing and fat-phobic body image memes and comparisons, and so it is no surprise that body image issues are rising (7,8). On the other hand, the increased exposure to unrealistic presentations of happiness, accomplishment and appearance can also be harmful. These idealistic posts can prompt social comparisons that are associated with poor self-esteem. I began to notice myself making these comparisons during my morning scroll: Everyone was exercising and eating well… Was I supposed to make my banana bread and eat it too? From what I could tell, everyone on Instagram had their quarantine routine together except for me.
Influencers are not only individual sources posting about personal weight-gain concerns. Some nations, such as England, have made it a part of their public health strategy to promote healthy eating and exercise routines throughout lockdown. While well-intentioned, these posts can be harmful to people vulnerable to body image concerns (7,9). When even the government is telling you to do more despite doing everything that you can to just stay sane (which, for some of us, means to avoid compulsively worrying about the number on the scale), it is easy to feel like you aren’t doing enough to be a health goddess.
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Video Conferences
One study found that video conferencing also affected body satisfaction. Many workplaces have been relying on video conferencing tools during social distancing. We are forced to look at ourselves through others' eyes during video calls much more than we otherwise would. I don’t know about you but having a virtual mirror for three hours of my day is less than ideal, especially when my girlfriends always seem to have their hair and makeup on point in every. single. zoom. call.
We usually see our faces directly beside others in the meeting, creating opportunities for direct comparisons (often with many people at once) and self-criticism. Women’s tendency to pay more attention to appearance means that they might be engaging in these comparisons more often, contributing to greater zoom fatigue amongst women compared to men (10). In response, some people have started to use filters to improve their appearance. Using filters can be detrimental by creating unachievable beauty standards, intensifying the problem (11,12).
Women have generally reported poorer mental health than men during the pandemic, and this effect exists with body dissatisfaction (13,9). Women reported being more bothered than men by changes in appetite in response to lockdown stress. This might be because women are exposed to more weight-stigmatizing social media messaging.
Women also tend to engage in more 'fat talk' or discussions about their pandemic-related weight concerns. I find this particularly interesting with my coworkers, as I have never seen many of their faces due to masking procedures; we have these conversations without even knowing what the other person looks like!  

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What Now?
Experts say that these effects are part of our diet culture (1,2). While the memes might make us feel connected or lift our spirits, they also reinforce the idea of 'good' and 'bad' foods, body shapes and behaviours. The science is clear that weight gain, especially during times of stress (e.g., a global pandemic?!?!) is very complicated. However, social media posts about ‘thinspo,' fad diets, and exercise to avoid lockdown-related weight gain often associate extra pounds with being lazy or unmotivated. This false information can be very stressful.
Some people are noticing the return or escalation of unhealthy thoughts and behaviours (9,14,15). Research has found that relationships with food have become more negative throughout the lockdowns, with people restricting and bingeing more than they did pre-pandemic (7,5,6). Some people have reported anxiety about being unable to exercise or to buy guilt-free foods during gym closures and food scarcity (7,6). Due to the unpredictability of lockdowns, for many, what they eat is a form of control (16). With social distancing, there is also little accountability. Friends have confided to me that a ‘lack of supervision’ enabled them to restart unhealthy patterns. Fortunately, some are reaching out, with professionals who were interviewed in Calgary reporting an increased demand for eating disorder supports.
In conclusion, the isolation and stress experienced during the COVID-19 lockdowns are hurting our relationships with food and bodies as we spend more time alone and in the digital sphere. We need to continue to pay attention to our loved ones' wellbeing, especially those are predisposed to body image issues, or who have a history of disordered eating. We need to change how we respond to ourselves and others. Instead of validating a friend’s weight concerns, challenge them to be critical of diet culture, identify ways that their bodies feel strong, and acknowledge that their body is doing what it can to keep them healthy and functional in a challenging time. 

References:
  1. Livingston, M. (2021, February 26). Gained the Quarantine 15? How to stop shaming yourself for pandemic weight gain. cNet. https://www.cnet.com/health/stop-body-shaming-yourself-for-quarantine-weight-gain/
  2. Rubin, C. (2020, August 8). Don’t be ashamed of those extra pounds. The New York Times. https://www.nytimes.com/2020/08/08/at-home/coronavirus-weight-gain.html
  3. Ahuja, K. K., Khandelwal, A., & Banerjee, D. (2021). ‘Weighty woes’: Impact of fat talk and social influences on body dissatisfaction among Indian women during the pandemic. International Journal of Social Psychiatry. Advance online publication. https://doi.org/10.1177/0020764021992814
  4. Pfund, G. N., Hill, P. L., & Harriger, J. (2020). Video chatting and appearance satisfaction during COVID-19: Appearance comparisons and self-objectification as moderators. International Journal of Eating Disorders, 53(12), 2038-2043. https://doi.org/10.1002/eat.23393
  5. Phillipou, A., Meyer, D., Neill, E., Tan, E. J., Toh, W. L., Van Rheenen, T. E., & Rossell, S. L. (2020). Eating and exercise behaviors in eating disorders and the general population during the COVID-19 pandemic in Australia: Initial results from the COLLATE project. International Journal of Eating Disorders, 53(7), 1158-1165. https://doi.org/10.1002/eat.23317
  6. Termorshuizen, J. D., Watson, H. J., Thornton, L. M., Borg, S., Flatt, R. E., MacDermod, C. M., Harper, L. E., van Furth, E. F., Peat, C. M., & Bulik, C. M. (2020). Early impact of COVID-19 on individuals with eating disorders: A survey of ~1000 individuals in the United States and the Netherlands. International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1101/2020.05.28.20116301
  7. Branley-Bell, D., & Talbot, C. V. (2020). Exploring the impact of the COVID-19 pandemic and UK lockdown on individuals with experience of eating disorders. Journal of Eating disorders, 8(44), 1-12. https://doi.org/10.1186/s40337-020-00319-y
  8. Pearl, R. L. (2020. Weight stigma and the “Quarantine 15”. Obesity, 28(7), 11180-1181.
  9. Robertson, M., Duffy, F., Newman, E., Bravo, C. P., Ates, H. H., & Sharpe, H. (2021). Exploring changes in body image, eating and exercise during the COVID-19 lockdown: A UK survey. Appetite, 159, 105062. https://doi.org/10.1016/j.appet.2020.105062
  10. Smith, L. (2021, April 15). Is Zoom’s UX subtly sexist? Fast Company. https://www.fast
  11. Burnell, K., Kurup, A. R., & Underwood, M. K. (2021). Snapchat lenses and body image concerns. New Media and Society. Advance online publication. https://doi.org/10.1177/146144821993038
  12. Tremblay, S. C., Tremblay, S. E., & Poirier, P. (2021). From filters to fillers: An active inference approach to body image distortion in the selfie era. AI and Society, 36, 33-48.
  13. Kwong, A. S., Pearson, R. M., Adams, M. J., Northstone, K., Tilling, K., Smith, D., Fawns-Ritchie, C., Bould, H., Warne, N., Zammit, S., Gunnell, D. J., Moran, P. A., Micali, N., Reichenberg, A., Hickman, M., Rai, D., Haworth, S., Campbell, A., Altschul, D.,…Timpson, N. J. (2021). Mental health before and during the COVID-19 pandemic in two longitudinal UK population cohorts. The British Journal of Psychiatry. Advance online publication. https://doi.org/10.1192/bjp.2020.242
  14. Rodgers, R. F., Lombardo, C., Cerolini, S., Franko, D. L., Omori, M., Fuller-Tyzkiewicz, M., Linardon, J., Courtet, P., & Guillaume, S. (2020). The impact of the COVID-19 pandemic on eating disorder risk and symptoms. International Journal of Eating Disorders, 53(7), 1166-1170. https://doi.org/10.1002/eat.23318
  15. Schlegl, S., Maier, J., Meule, A., & Voderholzer, U. (2020). Eating disorders in times of the COVID-19 pandemic – Results from an online survey of patients with anorexia nervosa. International Journal of Eating Disorders, 53(11), 1791-1800. https://doi.org/10/1002/eat.273374
  16. Underwood, C. (2020). Eating disorders among teens and adults surge during pandemic. CBC News. https://www.cbc.ca/news/canada/calgary/eating-disorders-pandemic-covid-19-teens-adults-1.5841047
Link references:
  1. Baines, S. (2020, October 20). You’re not done with banana bread: A psychologist reveals all. The Conversation. https://theconversation.com/youre-not-done-with-banana-bread-a-psychologist-reveals-all-148370
  2. Fetters, A. (2013, May 8). ‘An epidemic, basically’: A conflicted weight-loss blogger on #Thinspo. The Atlantic. https://www.theatlantic.com/sexes/archive/2013/05/an-epidemic-basically-a-conflicted-weight-loss-blogger-on-thinspo/275671/
  3. Hewagalamulage, S. D., Lee, T. K., Clarke, I. J., & Henry, B. A. (2016). Stress, cortisol and obesity: A role for responsiveness in identifying individuals prone to obesity. Domestic Animal Endocrinology, 56, S112-S120. https://doi.org/10.1016/j.domainiend.2016.03.004
  4. Hunt, E. (2019, January 23). Faking it: How selfie dysmorphia is driving people to seek surgery. The Guardian. https://www.theguardian.com/lifeandstyle/2019/jan/23/faking-it-how-selfie-dysmorphia-is-driving-people-to-seek-surgery
  5. Jan, M., Soomro, S. A., & Ahmad, N. (2017). Impact of social media on self-esteem. European Scientific Journal, 13(23), 329-341. https://doi.org/10.19044/esj.2017/v.13n23p329
  6. Kwong, A. S., Pearson, R. M., Adams, M. J., Northstone, K., Tilling, K., Smith, D., Fawns-Ritchie, C., Bould, H., Warne, N., Zammit, S., Gunnell, D. J., Moran, P. A., Micali, N., Reichenberg, A., Hickman, M., Rai, D., Haworth, S., Campbell, A., Altschul, D.,…Timpson, N. J. (2021). Mental health before and during the COVID-19 pandemic in two longitudinal UK population cohorts. The British Journal of Psychiatry. Advance online publication. https://doi.org/10.1192/bjp.2020.242
  7. Lewallen, J., & Behm-Morawitz, E. (2016). Pinterest or thinterest?: Social comparison and body image on social media. Social Media and Society, 2, 1-9. https://doi.org/10.1177/205630516640559
  8. Nesi, J., & Pristein, M. J. (2018). Using social media for social comparison and feedback-seeking: Gender and popularity moderate associations with depressive symptoms. Journal of Abnormal Child Psychology, 43(8), 1427-1438. https://doi.org/10.1007/s10802-015-0020-0
  9. Sun, R., Rieble, C., Liu, Y., & Sauter, D. (2020). Connected despite lockdown: The role of social interactions and social media use in wellbeing. Advance online publication. https://psyarxiv.com/x5k8u/
  10. Vogel, E. A., Rose, J. P., Okdie, B. M., Eckles, K., & Franz, B. (2015). Who compares and despairs? The effect of social comparison orientation on social media use and its outcome. Personality and Individual Differences, 86, 249-256. https://doi.org/10.1016/j.paid.2015.06.026
This blog was originally written as part of the HLTH5402 course.
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Online Study Recruitment: Pandemic Pets

7/6/2021

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 ​Pandemic Pets aims to understand how our relationships with our pets have evolved over the course of the pandemic, and how they might change after the pandemic. Currently, we are looking for participants to help us to understand this process.

You will be asked to complete an online survey now, and after the pandemic (likely fall of 2021 or winter of 2022, pending health restrictions). For your time you will be compensated by either an Amazon, or other ethical shopping site e-gift card of $5.00 CAN, or a donation of equal value to an animal shelter, for completing each survey. Your participation at each time point is entirely voluntary, and you may withdraw at any time. Each survey takes approximately 25-30 minutes, and your responses will be confidential.

To be eligible, you must be 18 or older, own a cat or dog, living in Canada or the U.S., and fluent in English. There are no physical risks in this study but you may experience mild discomfort when responding to questions on stress, feelings of loneliness, or mood.

​If you are interested, please go to: https://carletonu.az1.qualtrics.com/jfe/form/SV_7WID0smvpkCxHw2 or email Sarah Kirkpatrick-Wahl at [email protected] or Kiri Sidhu at [email protected]. You may also contact Dr. Kim Matheson at [email protected]

The ethics for this project have been approved by the Research Ethics Board at Carleton University (Clearance #115831). If you have any ethical concerns about this study, please contact the Carleton University Research Ethics Board-B by email at [email protected].
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