There is compelling evidence demonstrating links between the built environment and health outcomes. Providing a critical regulatory foundation for the construction of residential dwellings and public buildings, building codes are an important means to enhance health. To date, key proponents of changes to the building codes in Canada have come from the housing, construction and manufacturing industries. This paper calls for the involvement of interdisciplinary and intersectoral teams to tackle improvements to national model building code standards and provincial/territorial building code legislation. Key debates surrounding changes to the codes are described from the myriad of perspectives that will be reflected in interdisciplinary and intersectoral teams. Strategies to strengthen input on the development of building codes are considered.
MeSH Terms: Environment design, building codes
Des données de recherche éloquentes démontrent l'existence de liens entre l'environnement bâti et les résultats cliniques. Les codes du bâtiment fournissent une base réglementaire essentielle à la construction des édifices résidentiels et publics : ils représentent donc un important moyen d'amélioration de la santé. Jusqu'à maintenant, les principaux promoteurs des modifications aux codes du bâtiment du Canada sont issus des secteurs de l'habitation, de la construction et de la fabrication. Ce document lance un appel à la participation d'équipes interdisciplinaires et intersectorielles, afin qu'elles s'attaquent à l'amélioration des normes d'un modèle national de code du bâtiment, ainsi que de la législation provinciale et territoriale des codes du bâtiment. Les principaux points de débat entourant les modifications à ces codes sont décrits à partir de la myriade de perspectives qui seront adoptées par les équipes interdisciplinaires et intersectorielles. Des stratégies visant à augmenter la rétroaction sur l'élaboration des codes du bâtiment sont également prises en considération.
Termes MeSH : design de l'environnement, codes du bâtiment
Nancy Christine Edwards, RN, PhD: Full Professor, School of Nursing, Department of Epidemiology and Community Medicine, University of Ottawa
Beverley Anne Speer, MSW: PhD Candidate, Population Health, University of Ottawa
School of Nursing, Room 1118, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5
Dr. Edwards holds a Nursing Chair funded by the Canadian Health Services Research Foundation, the Canadian Institutes of Health Research and the Government of Ontario. Beverley Speer holds a Health Services/Population Health Research Doctoral Research Award.
Building infrastructure is a key determinant of health – implicated in the development of health conditions such as obesity (Frank et al. 2004), respiratory illnesses such as asthma (Spengler et al. 1994), and the occurrence of unintentional injuries (Edwards et al. 2006). Despite these well-established relationships, traditional ways of working within sectors have limited joint interdisciplinary initiatives to improve the built environment. Rao et al. (2007) have argued that a paradigm shift is required; only through re-defining the way professions work together can we begin “to translate our growing understanding of the link between the built environment and health and wellbeing into real and effective action” (1113). In this article, building codes in Canada will be examined as an arena where this shift could occur.
Successful efforts to address building codes will require well-informed teams. The aim of this article is to describe the myriad of perspectives that interdisciplinary and intersectoral teams may bring to the processes of improving national building code standards and adopting provincial and territorial building code legislation. A discussion of advances in changes to building codes in several jurisdictions is followed by a review of key debates surrounding code changes. Finally, strategies to strengthen input on the development of building codes are considered.
Advances in International Building Codes
Significant international changes to building codes reflect both recognition of their critical role in population health, and interdisciplinary and intersectoral approaches to improve them. For example, the introduction of performance-based codes1 is substantially changing the metrics considered relevant to monitor their implementation (Edwards, 2008). These new codes call for monitoring systems that capture diverse outcomes bridging health, business, construction and social welfare sectors (Pilzer 2005; Meacham et al. 2005).
Another major factor that has shaped building codes in other countries stems from advocacy for and by both seniors and individuals who are physically disabled. This has led to regulations such as the American Disability Act, a comprehensive civil rights law for people with disabilities (ADA 1990), and visitability legislation2 in both the United Kingdom and the United States (Casselman 2004a). These types of legislation have been instrumental in shaping changes to building codes. In particular, they have served to align building code standards and legislation with the issues of equity and universal design principles.
Like any policy area, there are substantial and fundamental debates that underlie changes to regulatory processes. Before considering key debates that pertain to building code changes in Canada, it is useful to review the building code revision processes in this country.
Building Code Revisions in Canada
Building codes stipulate minimum requirements for the construction of both residential homes and public buildings. In Canada, they are the product of a two-part process. Model codes are developed at the national level. Following publication of these national building code standards, provinces and territories choose whether to adopt each of the recommendations into their building code legislation.
At the national level, the creation of code standards (i.e. model codes) is the responsibility of the Canadian Commission on Building and Fire Codes (NRCC, 2010). Comprised of volunteers, approximately one third of the Commission's members are from the building industry; another third are building regulators; and the final third come from sectors including municipal affairs, consumer and safety groups, and emergency services (NRCC 2010). Codes are established through a consensus process and reviewed and revised every five years.
Following publication of the national building code standards, provinces and territories choose whether or not to adopt each recommendation into their building code legislation. The Provincial/Territorial Policy Advisory Committee on Codes is comprised of representatives from provincial and territorial Ministries responsible for building, plumbing and fire safety regulations. Seven standing committees are responsible for developing the overall technical content of the codes while task groups provide input on specific code elements. In making recommendations, task groups and standing committees consider: laboratory and community-based research evidence; codes from other jurisdictions; input from the public and from Canadian industries regarding the implications of changes to codes (e.g. potential loss of jobs); and the congruence between different code sections. Staff members with the Canadian Code Centre provide support for these processes.
It is noteworthy that, save for the issues of building egress, fire safety (e.g. requirements for smoke detectors) and the prevention of scalds (e.g. temperature regulators on hot water tanks), health disciplines have not played a significant or sustained role in this process. It is our contention that the input of a wide range of disciplines, including those from the health sector, are essential to the building code revision process.
Key Debates Regarding Changes to Building Codes
As the construction of new buildings and renovations to existing buildings must adhere to newly-adopted building codes, the introduction of new, “healthier”, building code legislation has the potential to yield both short- and long-term impacts on health. This being said, it must be recognized that such code changes are not without controversy; a number of key debates, characterized by divergent interests and perspectives, typically from within the building and manufacturing sectors, must be considered and reviewed. Dominant political perspectives within sectors underlie some of these debates.
Intruding in private lives versus public good
The first point of contention concerns the role of government in our private lives. While strong arguments for more stringent code requirements for public buildings have been successfully adopted in the national code, recommending similar requirements for private homes is seen as a more liberal response and, by some, a government intrusion into homeowners’ private property rights. This is one of the reasons there are considerable differences in the current requirements of national building code standards for stairs, ramps, handrails and guards between residential homes (part 3 of the code) and commercial buildings (part 9 of the code).
Those who argue against the merits of more stringent regulations for private homes may push for options such as insurance industry incentives and encouraging voluntary changes to manufactured products such as stairs and handrails. However, for public health professionals, policy change has become a critical means to achieve improvements in many arenas of population health (Botvin 2004; Brownson et al. 2006). This is evidenced by public health successes in tackling issues including injury prevention (e.g. legislation addressing seat belts, infant car seats, drinking or using cell phones while driving) and tobacco use (e.g. regulations about smoking in public places and private automobiles). The goals of improving public health and establishing a safer built environment may take precedence over concerns about government intrusion in private lives. Reconciling these types of divergent political viewpoints across sectors will be a key intersectoral issue in discussions about how best to use building code legislation as a regulatory lever for change.
The second debate concerns the issue of universal access or barrier-free design, that is, the accessibility of the built environment for people with varying levels of physical ability. In the Canadian model codes, there are two separate standards for the built environment: universal access requirements and residential home requirements. For example, ramps built to meet universal access requirements (part 8 of the code) are more stringent (more gradual slope, larger turning circle on landings) than those built according to residential home requirements (part 3 of the code). Thus, requirements for universal access are only currently applicable for buildings designated as universally accessible; they do not apply for general housing stock in Canada.
This narrow understanding and application of universal access requirements is, however, beginning to evolve. As issues of visitability become more prominent (U.S. Conference of Mayors 2005), our supportive housing needs increase, and the population continues to age (Edwards & MacDonald, 2008), universal accessibility is being increasingly recognized as in the best interest of all community members. For example, at provincial levels, the paucity of residential homes and public buildings being constructed to meet universal access requirements has been taken up by human rights commissions (OHRC 2002). Some provinces, such as Ontario, have also introduced legislation that aims to make building structures more accessible (AODA 2005).
The ways in which this focus on accessibility will play out with respect to building codes is still to be determined. The residual and underlying stigma that surrounds the construction of building features (e.g. wide doorways and ramps) and the installation of assistive devices (e.g. bathroom grab bars, and ramps), remains a powerful force in decision-making about code changes. Interdisciplinary and intersectoral teams are ideally positioned to address the many underlying factors that continue to thwart the integration of universal access principles into our model codes and building code legislation.
Costs versus safety
The third issue pertains to cost. While the potential health care savings brought forth through safer, injury-reducing built environments are especially compelling to health professionals, other groups may be more concerned about the cost implications of requiring changes to the built environment that will be incurred by their sectors. For example, manufacturers will be concerned about financial and job losses that may result when stricter regulations no longer permit them to sell pre-fabricated products such as stairs or handrails. Those in the housing industry will similarly have questions about whether buyers are willing to pay the additional construction costs resulting from the introduction of new codes and municipalities will be concerned about absorbing the additional costs of enforcing changes to new building code legislation. Furthermore, the direct and indirect costs of new code requirements may be inequitably distributed in the population. Although a wider tread on stairs may be a good safety feature that potentially reduces costs of injuries resulting from stair falls, this change also uses up some of the livable floor space in a home, making the change proportionately more costly (in terms of living space) for those residing in smaller homes.
Importantly, a major consideration in the incorporation of universal access features is the low cost of these changes at the time of construction relative to their high cost if changes are made during retrofitting. An eight- to twelve-fold difference in these costs has been estimated for no-step entrances and wider-doorways (Casselman 2004b). This raises an important question: Should those with physical disabilities be forced to pay for the more substantial costs of retrofitting their residential homes or should the public at large bear the cost of routinely building universal design features into residential homes?
These lines of debate are important for interdisciplinary and multisectoral stakeholders to understand if they are going to jointly enter the foray of building code changes. They call into question the types of supporting research that needs to be considered, the political ideology that underlies options for change, the metrics for success that are going to be used, the ways in which private citizens need to be involved in discussions about change, and the ways in which social factors such as stigma may influence choices.
Strategies to strengthen interdisciplinary and intersectoral input on building codes
Implementing a truly interdisciplinary and intersectoral approach to building code revisions requires a concerted and long-term strategy, intermittent input is less likely to be successful. In part, this is because such efforts must begin with an expansion of the building code evidence base. Specifically, existing evidence gaps must be identified (Edwards et al., 2006) and proactive, interdisciplinary research efforts to address these gaps put in place. As an example, the research on potential stair hazards comes from two main sources. Laboratory research studies provide the environmental specifications required to guide technical recommendations for codes and epidemiological community-based studies have demonstrated the prevalence of serious injuries and deaths resulting from falls on stairs. Missing from both sets of literature is the link between specific features of stairs and health outcomes. Although forensic studies partially fill this evidence gap, the sustained involvement of a wider set of disciplines in the building code revision process would help to highlight such gaps and stimulate needed research that bridges disciplines.
With a solid understanding of what makes buildings structurally sound, civil engineers, home builders and architects have historically been the primary proponents for modifications to building codes in Canada. In other jurisdictions, the involvement of other disciplines such as health professionals has been more strongly encouraged. For example, organisations such as the Commission for Architecture and the Built Environment, the Royal Town Planning Institute, and the Royal Institute of British Architects have promoted a better understanding of built environment health effects among those disciplines traditionally involved in development of building codes (Srinivasan et al. 2003). Canada could benefit from the experience of other countries where a wider range of disciplines have been more substantially involved in reviewing changes to building codes. Establishment of the Canadian Design Research Network is a promising initiative that may help to bridge some of our disciplinary silos.
Public input on the national building code development process is considered a critical part of the consensus-building process to update these codes. Different disciplines and sectors work with a variety of community groups and engage the public in distinctive ways. A multisectoral approach would broaden the ways in which the public might be involved. Additional public involvement might also help to address issues of stigma, by raising awareness of the inaccessibility of our built environment for some population subgroups.
In summary, interdisciplinary and intersectoral input on building code revisions processes must be sustained and substantial. This would provide a means to more fully engage concerned citizens, to fully debate building code options from different disciplinary and political stances, and to build the evidence base that is required for informed decision-making about code changes.
No one is left unaffected by the built environment. Serving as its regulatory foundation, building codes critically implicate, and thus are an ideal vehicle to influence, the population’s health and well-being. Canada’s incorporation of universal design principles in building code policy is currently behind that of the United States. As argued above and by Rao (2007), informed interdisciplinary discussions are necessary to substantially modify this reality. Through collaboration, knowledge from all disciplines and from different sectors can at once most effectively influence the environment which we inhabit. It is time for all concerned sectors to work together to construct healthier and safer building codes.
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1 Performance based codes are defined as “legal instruments intended to ensure that buildings when constructed in accordance with the regulations, provide socially acceptable levels of health, safety, welfare and amenity for building occupants and for the community in which the building is located” ; in other words, they not only indicate what needs to be done but also provide a rationale for why it needs to be done (Meacham, 2005, p.91).
2 Visitability refers to whether or not the built environment permits other homes and public buildings to be readily accessed (visited) by individuals with all levels of physical function. For instance, someone who is able to function independently in a home that has ramp access is denied being able to visit homes that you can only access with outdoor stairs.