No more excuses: Why we need a shared approach to build healthier cities
Cities have always required different public bodies to work together to create spaces that are able to meet the needs of local residents.
When the fast-growing urban districts of Victorian England cleared slum areas and implemented sanitation measures to improve living conditions 150 years ago, it brought the separate disciplines of city planning and public health worked together. In doing so they created the foundations of the modern, high-functioning city.
Over the course of the 20th century, the close linkages between these two distinct professional groups were gradually loosened to the point where many of the shared priorities around improving the health of city dwellers were lost.
Today, however, there is again momentum around the need to encourage more joint working between public health and urban planning professionals to make our cities healthier places in which to live and work. And that momentum is global.
The built environment of the city exerts a huge influence on the health of its citizens: policy initiatives and planning decisions around urban space that positively affect air quality, noise control, levels of physical activity or access to green space, fresh food and positive social contact play a vital role in helping to keep us physically and mentally healthy.
When urban planners and designers ignore or override wider health considerations, they turn cities into unhealthy places and put additional pressure on healthcare services to cope. This is particularly so as urban populations not only grow rapidly but feature older people requiring higher levels of care.
Plenty of excuses have been trotted out for why city planners and public health professional each retreated into their respective silos over time – and there are challenges now in bringing them back together.
One can point to a weak evidence base for a shared approach, the sheer complexity of planning healthier cities, or a dominant focus on public health priorities such as cutting smoking, alcohol and drug use rather than looking at wider determinants associated with the built environment.
But the time for excuses is over and there is now wide consensus that the schism between the two must be healed. Central to a more holistic approach is to view urban health and wellbeing as total ‘ecosystem’.
The key elements of this health ecosystem would include such things as active travel, promoting healthier alternatives to travelling by car such as walking and cycling, and better housing, with more efficient insulation, safer stairs and more natural light leading to better health outcomes.
This whole picture would embrace new spatial strategies that make better use of rivers, canals and waterways for health purposes, for instance, or rethink how to connect dense, compact neighbourhoods with green spaces and local food produce.
And it would embrace new ways of working so that jobs are more conveniently located for urban workforces, workplace policies offer a less stressful balance between work and life, and workspace itself is designed to support better health – not impair it – by placing a greater focus on exercise and mobility, social interaction, access to natural light and good air quality.
Can all this be achieved? Around the world, city authorities are starting to seize the initiative. Urban planners as well as developers, architects and agents right across the property chain – they all have a proactive role to play in an urban health strategy of prevention, not just cure.
The public health mission and reformist social agenda that characterised Victorian cities are back on the table.
Jeremy Myerson holds the Helen Hamlyn Chair of Design at the Royal College of Art, London. He is co-convenor of the inaugural Healthy City Design 2017 Congress, which takes place on 16-17 October 2017 at the Royal College of Physicians, London. He is also is Director of WORKTECH Academy.