Can cities improve our health?

A recent study has likened city air pollution to smoking a pack of cigarettes each day for 29 years. Whilst this is undoubtedly concerning, the effects of living in cities may not be limited to those which damage our lungs. Other recent studies have shown the prevalence of psychiatric disorders, mood disorders and anxiety disorders are significantly higher among people living in urban areas than those in rural areas, and air pollution has also been linked to obesity and diabetes.

Furthermore, urban environments are significant in the creation of water pollution; as more land is given over to cars, more impervious surfaces are created, leading to an increase in particulate matter and pathogens in our water. The effects of a sedentary lifestyle are also leading to alarming rates of obesity, with 40% of the world and 60% of the UK population now overweight or obese. The resulting rates of type II diabetes, which leads to heart disease, cancers, sight loss and amputations are consequently rising rapidly. So why do people live in these places, and what can we do to solve these problems?

Avoiding, ignoring, or boycotting these toxic environments is, to some extent, impossible. Alongside the economic function of cities as hubs of service, retail, work and study, humans are attracted to cities’ wider social, cultural, and recreational opportunities and increasingly, people seem to be becoming more dependent on living in these interconnected environments. In his foreword to Barton et al.’s study of health in cities Shaping Neighbourhoods for Local Health and Global Sustainability, environmentalist and sustainability campaigner Johnathan Porritt explains “telecommunications, the internet, cheap air travel and car ownership are offering us many opportunities to stay in touch…. yet at the same time there is growing evidence that people feel less connected to their local community or neighbourhood (and many feel) trapped in unsupportive, ill served communities with little prospect of escape”  (p. xi Barton et al. 2010).

The damaging impacts of cities on health, combined with feelings of disconnectedness and indisputable rising levels of social inequality are the calls to action for those working in the fields of urban planning and urban design. Barton suggests these problems can be overcome by using carefully considered neigbourhood planning and design (2010 p.10), and this suggestion is complemented by a growing number of authors who are examining the role green infrastructure plays in improving the health of citizens and which aims to make cities better “salutogenic environments” (see Ward Thompson et al. 2010).

The complex interactions between people, neighbourhoods, health, and greenspace are summarised in Barton and Grant’s Settlement Health Map (2006), which can be used to assess the impact of factors in the built environment and wider natural environment on peoples’ health and can also be used to analyse the impacts of human activities on the environment. It is built on the principle that the settlement acts as an ecosystem, with various inputs, flows and outputs. The objective of sustainable urban design is therefore to increase the healthy synergies within the settlement whilst minimising the contamination of the wider environment.

Barton urges urban designers to consider these factors to create neighbourhoods which can be salutogenic, inclusive and environmentally sustainable. His image of a sustainable neighbourhood is characterised by the following features:

• A socially balanced population, with varied housing opportunities suited to a range of incomes and types of household.
• Diversity of use – housing, business, shopping, cultural and health facilities.
• A pedestrian dominated public realm to facilitate healthy social life and a safe, human scaled environment.
• Ecologically responsive development principles which limit resource use and pollution.
• A greenspace network that provides accessible open space.

He states, “The physical environment of neighbourhoods affects health and wellbeing both directly through the quality of housing and public space, and indirectly, through impact on behaviour and the sense of community” (p.2-3 Barton et al. 2010).

It can be argued unplanned and unregulated growth of cities will result in urban sprawl, which not only damages natural physical environments, but also creates long lasting and perhaps unseen, consequences on human health. We are already seeing the impacts of car-dominated transport infrastructure, and the outcomes of our interconnected, yet sedentary lifestyle choices. Ironically, the recent pandemic has reconnected many people to the greenspaces in their neighbourhoods and communities, and studies have shown the importance of spending time in the natural environment in the maintenance of our mental health.

Catharine Ward Thompson makes the point that “the quality of the landscape in which we live our lives makes a difference to the quality of the lived experience…. yet there remain many unanswered questions about what kind of environment might offer the maximum benefits for people’s quality of life, given the increasingly urbanised nature of society and its ageing demographic structure” (Ward Thompson et al., 2010).

I think access to greenspace and green infrastructure has unquestionable positive impacts on human health, but the challenge for planners and designers is how to engrain this accessibility into daily lifestyle choices. The goals of sustainable neighbourhoods, active travel, and green infrastructure are clearly linked, and if they can be applied successfully, they can only have positive impacts on the health and well-being of people living in our cities.

A salutogenic environment maintained by green infrastructure. Source: https://commons.wikimedia.org/wiki/File:The_Social_Ecology.jpg

Glossary:

Salutogenic: The salutogenic approach or salutogenesis is a term applied in health sciences, and more recently in other fields, to refer to an approach to wellness focusing on health and not on disease (pathogenesis). Literally, salutogenesis translates to “the origins of health”, from the Latin `Salus ́ meaning Health, and the Greek `Genesis ́ meaning origin or beginning.

Health: “Health is not only the absence of disease but a state of complete physical, mental and social well- being” (WHO, 1948)

Well-being:  A de-medicalised concept of health. Pollard and Lee’s definition (2002) identifies five different domains for well-being – “physical, psychological, cognitive, social and economic”.

Green Infrastructure: “An interconnected network of greenspace that conserves natural ecosystem values and functions and provides associated benefits to human populations” (Benedict and McMahon, 2002).

References:

Barton, H. & Grant, M. (2006). A health map for the local human habitat. The journal of the Royal Society for the Promotion of Health. 126. 252-3.

Barton, H., Grant, M. and Guise, R. (2010) Shaping Neighbourhoods for Local Health and Global Sustainability.

Benedict, Mark A., and Clive Davies. (2002) Green Infrastructure: Smart Conservation for the 21st Century.

Hong Chen, Richard T. Burnett, Jeffrey C. Kwong, Paul J. Villeneuve, Mark S. Goldberg, Robert D. Brook, Aaron van Donkelaar, Michael Jerrett, Randall V. Martin, Jeffrey R. Brook, and Ray Copes (2013) Risk of Incident Diabetes in Relation to Long-term Exposure to Fine Particulate Matter in Ontario, Canada. Available at https://ehp.niehs.nih.gov/doi/10.1289/ehp.1205958  .Accessed 16.12.21

Peen J. Schoevers, R.A., Beekman A.T., Dekker, J. Review: The current status of urban-rural differences in psychiatric disorders. Available at https://www.gwern.net/docs/nature/2010-peen.pdf . Accessed 16.12.21

Rundle, A. et al. (2012) Association of Childhood Obesity With Maternal Exposure to Ambient Air Polycyclic Aromatic Hydrocarbons During Pregnancy. Available at https://pubmed.ncbi.nlm.nih.gov/20864666/  Accessed 16.12.21

Wang, M., Pistenmaa, A., Madrigano, J. et al. (2019) Association Between Long-term Exposure to Ambient Air Pollution and Change in Quantitatively Assessed Emphysema and Lung Function. Available at https://jamanetwork.com/journals/jama/fullarticle/2747669 . Accessed 16.12.21

Ward Thompson et al. (2010) Innovative Approaches to Researching Landscape and Health