land use questions and transportation planning for any realistic and practical climate emergency action to be realized.

There are numerous health problems connected to climate change, including cancers, cardiovascular disease, fertility problems, asthma, adverse birth outcomes, disabilities, diabetes and stroke. A recent Globe and Mail editorial points out that climate change presents a concern for cities across Canada and suggests the need for collective action by all municipalities. “City councils will need to be climate leaders. How we build our cities going forward will go a long way in shaping our collective climate future.”

Climate change actions depend on decarbonizing our systems. Environmental engineering researcher Dr.

Alexandre Milovanoff recently wrote in The Conversation that, “The road to decarbonization is long and winding…Governments need to massively invest in public transit, cycling and walking infrastructure to make them larger, safer and more reliable. And we need to reassess our transportation needs and priorities.”

Air pollution is increasingly considered the most important environmental health risk worldwide (Dias, 2018). Increased levels of pollution, endocrine-disrupting chemicals and high volumes of traffic and industrial activity are connected to ill health (Brophy et al., 2012; Crouse et al., 2010; Gilbertson & Brophy, 2001; Gilbertson & Brophy, 2018; Gray et al., 2017; Hystad et al., 2014; Luginaah et al., 2012;

Mordukhovich et al., 2016; Morello-Frosch et al., 2011; Pan et al., 2011; Rudel & Perovich, 2009;

Schettler, 2014; Villeneuve et al., 2017; Wu et al., 2016). Higher levels of exposure to fine particulate matter PM2 and other exogenous exposures are associated with elevated disease rates (Gray, Evans, Taylor, Rizzo & Walker, 2009; Gomez et al., 2010; Nudelman et al., 2009; Engel, Rasanaygam, Gray & Rizzo, 2018; Pederson et al. 2020; Niehoff et al., 2020).

Environmental health research shows us that health is not just a medical issue (Marmot & Wilkinson, 2005; White et al., 2013; WHO, 2019). Multi-level strategies to create safer, healthier environments are necessary for health promotion and illness prevention. The World Health Organization’s Ottawa Charter for Health Promotion states: “Health promotion is the process of enabling people to increase control over, and to improve, their health…not just the responsibility of the health sector, but goes beyond healthy life-styles to well-being… strategies and programmes should be adapted to the local needs and possibilities of individual countries and regions to take into account differing social, cultural and economic systems” (WHO, 1986). Urban sprawl runs counter to this conception of health.

The socio-ecological model of health illustrates how multiple interacting environments contribute to health (Bronfenbrenner, 1977; Schettler, 2015 CHE, 2020). People live within families, communities, ecosystems, and planetary-level conditions. Policies, regulations, legislation, and interventions can be directed at the technological, built, food & agriculture, chemical, socioeconomic, psychosocial and global environments (CHE, 2020). The health of any part of the nested set of relationships depends on the interactions. Opportunities for interventions in these spaces that lead to illness prevention are possible if we take scientific knowledge and apply it to create multi-level strategies.

When science tells us that people living in areas with high volumes of air pollution, especially vehicle exhaust, are at a higher risk for disease, why would we not control the volume of pollutants or develop alternative plans to reduce pollution? Systemic changes — regulations, legislation, policies — with the public’s protection is fundamental to health promotion and illness prevention.