How can we build healthier cities?

Cambridge, 1935: the city has always been cyclist friendly. Image: Hulton Archive/Getty.

“When a man is tired of London, he is tired of life; for there is in London all that life can afford,” said Samuel Johnson in the 18th century. For Johnson, the rich tapestry of London life and the myriad cultural assets clearly outweighed any downsides of city dwelling.

For others, though, city life is a grind. Public transport is overcrowded, house prices are soaring, traffic is at gridlock and diesel fumes hang almost perceptibly in the air. Little surprise, then, that people do become tired of London, even if not of life itself.

Even if issues such as air pollution are taken out of the equation, living in a city can be bad for your health – not good news considering that the World Health Organization estimates that, in 2017, the majority of people live in urban areas.

A study published in 2014 by Dr Manjinder Sandhu from the Cambridge Department of Medicine suggested that increasing urbanisation of rural areas in sub-Saharan Africa might lead to an explosion of the incidence of stroke, heart disease and diabetes. Yes, moving to towns and cities provides better access to education, electricity and hospitals; but town and city dwellers become less active, their work becomes less physical and their diets worsen.

“If this pattern is repeated across the globe – which we think it will – then we could face an epidemic of obesity, diabetes and other potentially preventable diseases,” says Sandhu. “Local and national governments need to take this into consideration when planning infrastructure to try and mitigate such negative effects.”

As far as healthy cities go, Cambridge has a lot going for it. Its population has higher than average levels of education and is physically active. Cambridge has been nicknamed “the cycling capital of Britain” – the sight of bicycles leaning against walls is as iconic as that of punts passing under the Bridge of Sighs. But as the city expands and house prices rocket, more and more people are living in neighbouring villages and towns, where cycling to work along winding, congested country lanes can be less appealing than driving.

In 2011, the world’s longest guided busway opened, connecting Cambridge with nearby Huntingdon and St Ives along a former railway line. An integral part of the busway was a cycle path along its route – and this appears to have helped nudge people in the right direction. A study led by Dr David Ogilvie from the Medical Research Council (MRC) Epidemiology Unit found that, among people who commuted into Cambridge from within a 30 km radius, those who lived closer to the busway were more likely to increase the amount of active” commuting they did, particularly cycling.

“Commuting is a part of everyday life where people could include a bit more physical activity without having to think about it very much or make time for it,” says Ogilvie. “When new infrastructure integrates opportunities for walking and cycling, we see people shifting their commuting behaviour.”

Ogilvie’s research is, he says, “contributing bricks of evidence to a wall that’s slowly being assembled from across the world of the health benefits of investing into this kind of infrastructure”/ While such benefits are often alluded to in business cases, until now the evidence to support them has been limited.

There are ways to integrate more pedestrian-friendly environments in existing infrastructure, he says, citing examples such as those in the Netherlands – now being introduced in some areas of London – where traffic is slowed to walking pace and the divisions between pavement and road are deliberately blurred, cuing drivers to share the space.

With more thoughtful urban planning, Ogilvie says, it should be possible to design towns and cities as environments that promote not just physical activity, but improved health and wellbeing – “in short, a place where people want to live”.

“Sprawling cities with retail parks on the fringes are not conducive to doing your shopping on foot,” he says. “People are more likely to walk and cycle around their neighbourhood if it is safe, well connected and has good local amenities. And getting people out on the streets not only gets them active, it also increases social interactions and a sense that it’s safe to be on the streets.”

Dr Jamie Anderson from the Department of Architecture is also interested in the relationship between the built environment and our broader wellbeing. As part of his PhD project with Professor Koen Steemers (architecture) and Professor Felicia Huppert (psychology), he did a study of another Cambridge initiative, the housing development known as Accordia.

Since the first residents moved into their homes in the mid-noughties, Accordia has won numerous prizes, including the Royal Institute of British Architects Stirling Prize, for its innovative mixing of private and public spaces. Yet surprisingly, says Anderson, no one had done a detailed study of the impact on its residents.

Accordia. Image: Jamie Anderson.

One of the interesting approaches taken by Accordia was to focus on communal spaces rather than private gardens: only one in five homes has its own garden. Given the stereotype of the British as a very private people, how did people respond? Did people spend time chatting outdoors with their neighbours, or did they shut themselves away and draw the curtains?

The results, explains Anderson, were mixed. While one middle-aged couple missed having their own garden and were now on a long waiting list for a local allotment, one mother described the communal gardens as “crucially important”: she had suffered from postnatal depression and, with her husband away at work all day, she told Anderson that she “wouldn’t have got through her depression” without the interactions that the adjacent communal areas provided.

“In terms of behaviours that we associate with physical health and positive mental health – so people interacting with each other, children out playing, for example – we found clear positive associations with Accordia’s outdoor neighbourhood spaces,” he adds, “but when we looked at people’s subjective wellbeing, it wasn’t as clear cut.”


With Accordia, Anderson was evaluating an already established development, but he now has a chance to influence a project at the planning stage. Part of the Northern Powerhouse project will see a £110m culture venue in Manchester named The Factory after the eponymous record company behind such iconic bands as Joy Division and Happy Mondays.

Under a fellowship from the Engineering and Physical Sciences Research Council, Anderson, in collaboration with engineering firm BuroHappold, is carrying out a Health Impact Assessment (HIA) of the proposed new site. He’s looking at factors that might influence health and wellbeing, from the lighting in office spaces, through to educational opportunities for young people from deprived communities and the restaurants within the venue.

HIAs are currently voluntary, but are set to become mandatory for significant developments across the UK in 2017, and can help architects and designers improve their submissions for planning application. How effective they’ll be is unclear, warns Anderson. “You might have some really strong evidence, but the final decision is a blend of opinion from various stakeholders, so you could end up with a watered-down version of what’s needed.”

He remains optimistic, however: “We’re moving in the right direction. By building consideration of health and wellbeing into the planning process, it should raise the bar and hopefully we will see many more cycle lanes, more inviting and better options for active transport, and maybe fewer fast-food shops.”

“I don’t know what makes me stay / The city life just ain’t the same,” sang New Order, one of Factory Record’s best known signings, in 2001. Perhaps the work of Cambridge researchers will help make cities attractive – and healthy – places to stay.

This article previously appeared on the University of Cambridge’s website, and appears here under a creative commons licence.

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Is Britain’s housing crisis a myth?

Council housing in Lambeth, south London. Image: Getty.

I’ve been banging on about the need for Britain to build more houses for so long that I can no longer remember how or when it started. But at some point over the last few years, the need to build more homes has become My Thing. People ask me to speak at housing events, or @ me into arguments they’re having on Twitter on a Sunday morning in the hope I’ll help them out. You can even buy a me-inspired “Build More Bloody Houses” t-shirt.

It’s thus with trepidation about the damage I’m about to do to my #personal #brand that I ask:

Does Britain actually have enough houses? Is it possible I’ve been wrong all this time?

This question has been niggling away at me for some time. As far back as 2015, certain right-wing economists were publishing blogs claiming that the housing crisis was actually a myth. Generally the people who wrote those have taken similarly reality-resistant positions on all sorts of other things, so I wasn’t too worried.

But then, similar arguments started to appear from more credible sources. And today, the Financial Times published an excellent essay on the subject under the headline: “Hammond’s housebuilding budget fix will not repair market”.

All these articles draw on the data to make similar arguments: that the number of new homes built has consistently been larger than the number of new households; that focusing on new home numbers alone is misleading, and we should look at net supply; and that the real villain of the piece is the financialisation of housing, in which the old and rich have poured capital into housing for investment reasons, thus bidding up prices.

In other words, the data seems to suggest we don’t need to build vast numbers of houses at all. Have I been living a lie?

Well, the people who’ve been making this argument are by and large very clever economists trawling through the data, whereas I, by contrast, am a jumped-up internet troll with a blog. And I’m not dismissing the argument that the housing crisis is not entirely about supply of homes, but also about supply of money: it feels pretty clear to me that financialisation is a big factor in getting us into this mess.

Nonetheless, for three reasons, I stand by my belief that there is housing crisis, that it is in large part one of supply, and consequently that building more houses is still a big part of the solution.

Firstly I’m not sold on some of the data – or rather, on the interpretation of it. “There is no housing crisis!” takes tend to go big on household formation figures, and the fact they’ve consistently run behind dwelling numbers. Well, they would, wouldn’t they? By definition you can’t form a household if you don’t have a house.

So “a household” is not a useful measure. It doesn’t tell you if everyone can afford their own space, or whether they are being forced to bunk up with friends or family. In the latter situation, there is still a housing crisis, whatever the household formation figures say. And there is plenty of anecdotal evidence to suggest that’s the one we’re living in.

In the same way I’m not quite convinced that average rents is a useful number. Sure, it’s reassuring – and surprising – to know they have grown slower than general prices (although not in London). But all that figure tells you is the price being paid: it doesn’t tell you what is being purchased for that payment. A world in which renters each have their own property may have higher rents than one in which everyone gets one room in an over-crowded shared flat. It’s still the latter which better fits the label “housing crisis”.

Secondly, I’m entirely prepared to believe we’ve been building enough homes in this country to meet housing demand in the aggregate: there are parts of the country where housing is still strikingly affordable.

But that’s no use, because we don’t live in an aggregate UK: we live and work in specific places. Housing demand from one city can be met by building in another, because commuting is a thing – but that’s not always great for quality of life, and more to the point there are limits on how far we can realistically take it. It’s little comfort that Barnsley is building more than enough homes, when the shortage is most acute in Oxford.

So: perhaps there is no national housing crisis. That doesn’t mean there is not a housing crisis, in the sense that large numbers of people cannot access affordable housing in a place convenient for their place of work. National targets are not always helpful.


Thirdly, at risk of going all “anecdote trumps data”, the argument that there is no housing crisis – that, even if young people are priced out of buying by low interest rates, we have enough homes, and rents are reasonable – just doesn’t seem to fit with the lived experience reported by basically every millennial I’ve ever met. Witness the gentrification of previously unfashionable areas, or the gradual takeover of council estates by private renters in their 20s. 

A growing share of the population aren’t just whining about being priced out of ownership: they actively feel that housing costs are crushing them. Perhaps that’s because rents have risen relative to wages; perhaps it’s because there’s something that the data isn’t capturing. But either way, that, to me, sounds like a housing crisis.

To come back to our original question – will building more houses make this better?

Well, it depends where. National targets met by building vast numbers of homes in cities that don’t need them probably won’t make a dent in the places where the crisis is felt. But I still struggle to see how building more homes in, say, Oxford wouldn’t improve the lot of those at the sharp end there: either bringing rents down, or meaning you get more for your money.

There is a housing crisis. It is not a myth. Building more houses may not be sufficient to solve it – but that doesn’t meant it isn’t necessary.

Jonn Elledge is the editor of CityMetric. He is on Twitter as @jonnelledge and also has a Facebook page now for some reason. 

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