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Healthy communities
A recent US study revealed that access to healthcare shapes only 20% of a typical community’s health.
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Healthy cities make for healthy inhabitants

A healthy city should integrate health considerations into the planning and design of the urban environment. Clare Wildfire explains how this approach can lead to better social outcomes for people of all groups and ages.

Inhabitants of cities are becoming more engaged and speaking out on issues that affect the quality of their lives. Increased health and longevity are now as important to people as wealth and ownership of assets.

Improving health is interlinked with many of the Sustainable Development Goals, which highlight how healthy populations are essential for social, economic and environmental sustainability. And while access to good healthcare services – hospitals, doctors’ clinics and pharmacies – is important, it is not the main factor that influences health outcomes for those living in cities. A recent US study revealed that this shapes only 20% of a typical community’s health1.

The precautionary principle – do no harm – is key to the responsible development of cities, but our efforts must look beyond this to seek positive health outcomes for all. At Mott MacDonald we’ve identified seven areas where these efforts can best be targeted:

1. Pandemic resilience

A key lesson from the COVID-19 pandemic is that infrastructure within a city, such as schools, transport systems or sports and entertainment venues, can help spread communicable diseases. We can do more to prevent and prepare against pandemic threats, so that our cities and economies continue to thrive, which in turn will protect social outcomes.

The three dimensions of pandemic resilience can be understood as:

  • Absorb – introduce measures to reduce pathogen transmission, protecting health and improving user confidence
  • Adapt – be more responsive to societal needs by ensuring appropriate planning, flexibility and continuity of services
  • Transform – be more versatile and enable certain types of infrastructure to perform a different role to their usual function whenever needed

2. Green and blue infrastructure

Green infrastructure – street trees, green roofs/walls, parks, woodland, gardens, allotments – and blue infrastructure – ponds, canals, rivers, wetlands – are essential to health and wellbeing.

Planting in cities can contribute to better air quality and more pleasant microclimates. Gardens, allotments and trees can be a source of healthy food. There has been a resurgence of gardening and a huge growth of demand for allotments during the COVID-19 pandemic, largely due to the mental wellbeing they can bring. Parks, allotments, open green spaces and water features are places where all inhabitants can coexist happily and engage in a more active lifestyle.

By integrating these assets into green and blue arteries threaded through a neighbourhood, they can be valued as opportunities to promote and protect the health and wellbeing of city dwellers, and bolster the wider ecosystem.

3. Promoting healthier lifestyles

Placemaking – the considered design of public spaces – influences people’s decisions about how they commute, shop and use their leisure time. Making a clear, joined-up street and landscape strategy part of public realm design can encourage people to walk or cycle to local shops, schools, workplaces or transport hubs, and thereby instil more active and healthy behaviours in adults and children.

This strategy could include:

  • Street layouts that prioritise and create continuous safe passage for pedestrians and cyclists
  • Aesthetically pleasing routes for active mobility that feature green and blue infrastructure, and provide easy access to local amenities
  • Provision of facilities to encourage active leisure, such as green spaces, urban gardens, playgrounds, sports grounds, skate parks and swimming pools
  • Mixing retail, residential and commercial areas with active street frontage to encourage busy, well-lit thoroughfares
  • Plentiful seating to encourage older and disabled people and parents with children to enjoy the outdoors and enable them to rest during journeys
  • Clear legibility of routes and destinations

Challenging precedents in how we plan neighbourhoods can make active travel the easiest choice for the people who live in cities. But we must also recognise the need to maintain viable methods of vehicular travel for those for whom the car is a lifeline.

Healthier lifestyles are also crucial to helping tackle obesity and its associated health risks, such as heart disease and osteoarthritis. Access to healthy food options can be an issue in cities, while the provision of transport services and the zoning of food retail activities are too often uncoordinated. But thoughtful, holistic urban planning can help influence the nutritional choices and improve the diets of a city’s inhabitants.

Cities are starting to develop strategies that will see local policies encourage developers to invest in options – such as urban gardening and local food markets – to make healthy eating aspirations a reality.

4. Improving mental health

Urban communities face an increased risk of experiencing mental health problems compared to those in rural areas2. The solution lies in the concept of salutogenical cities. Salutogenesis means ‘to generate health’ and focuses on factors that support human health and wellbeing.

Research shows that spending just two hours in nature can benefit health and wellbeing3. But it’s not enough to simply add green spaces into a design and assume it will improve mental health. They must be designed to feel safe and inclusive to all, and their quality is more important than their quantity.

An Australian study showed that people with access to high-quality spaces – with good provision of well-maintained paths, shade, water features, irrigated lawns, lighting, sporting facilities, playgrounds and calm neighbouring roads – experienced better mental health than people with access to only low-quality spaces4.

5. Building social cohesion

Shortage of land in cities and high numbers of single people living in apartments can contribute to fewer community spaces, reducing opportunities for spontaneous social interaction. This can adversely affect people’s overall sense of belonging to a community.

We can avoid this by being creative and embracing the changes already happening in retail, education and culture. The lines between these are being blurred as they become more adaptable in use, supporting the creation of ‘destination’ experiences. This opens the door for innovation in designing parks, activity trails, swimming pools, urban beaches, recreation centres and public event spaces. This will strengthen opportunities for social interaction, promoting a sense of identity, belonging and cohesion.

6. Care and support of older inhabitants

Poor housing design, distribution and planning can socially isolate older people. Mixed developments providing for all generations can tackle this by creating communities that enhance social interaction.

Co-housing – intentional communities of private homes clustered around a shared space, created and run by their residents – allows older people to age independently, supported by their peers. Participating in a local community organisation, meeting others with shared hobbies, or being a member of a sports group will all contribute to the health and fitness of older people.

7. Air quality

Cities experience dangerous levels of pollution from vehicles. The UK Clean Air Strategy describes air quality as the country’s largest environmental health risk. London’s Transport Strategy is focused on minimising polluting vehicles and includes the ambitious target that, by 2041, 80% of trips in the city will be made by foot, cycle or public transport.

Green infrastructure can improve air quality and its pollution-control capabilities have been recognised56. City Trees are biotech pollution filters that capture toxins and remove pollutants using living plants and different types of mosses, purifying the air of suspended particles. It’s claimed that One City Tree is equivalent to 275 trees.

Building a healthy future

Clearly set out values and strategies covering all these areas will help steer us towards developing healthy cities that will help make healthy inhabitants. Built environment professionals and providers are up to the challenge: a toolbox of solutions already exists. Our job now is to knit them into the fabric of our designs to give city dwellers the best chance of a fair, resilient and healthy future.

1. Regional Plan Association: State of the New York Metropolitan Region’s Health
2. https://www.urbandesignmentalhealth.com/how-the-city-affects-mental-health.html
3. Nature, June 2019: Spending at least 120 minutes a week in nature is associated with good health and wellbeing
4. Social Science & Medicine, May 2012: Quality or quantity? Exploring the relationship between Public Open Space attributes and mental health in Perth, Western Australia
5. Ecological Engineering, February 2010: Quantifying the deposition of particulate matter on climber vegetation on living walls
6. Greater London Authority: Using green infrastructure to protect people from air pollution

Clare Wildfire

Global practice leader for cities, Mott MacDonald

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