How can city governments ensure better public health?

A Legible London sign, intended to encouraging walking. Image: Applied Wayfinding.

Crossing the street while texting could cost you your life. If you live in Honolulu, even if you survive, thanks to legislation passed earlier this year, it could also land you a hefty fine.

The Hawaiian capital is not the only city trying to get us to look up from our phone. Hayward, California, introduced snarky signs in 2015, reminding us to “Cross the road, then update Facebook.” Singapore installed LED lights on the pavement at crossings to prevent accidents involving people who don’t look up from their phones. Antwerp in Belgium and Chongqing in China have text-walking lanes, and Mumbai and San Francisco have no-selfie zones, while Rexburg in Idaho banned pedestrians from using phones when crossing the street in 2011.

The increase of urban populations around the world is putting pressure on local governments to tackle the preventable health problems caused by air pollution and lifestyle, and some cities are stepping up to the challenge. In London, for example, TfL’s Planning for the Future is investing billions of pounds to develop the city’s transport and lower emissions. And almost 100 cities have joined the World Health Organisation’s European Healthy Cities Network, which aims to improve public health.

But traditional methods of improving a populations’ health – offering free cooking classes and handing out leaflets on how to stop smoking – aren’t enough any more. In these innovative times, cities are starting to play a more involved role in changing our behaviour. Public health researchers in California, for example, installed signs in San Diego International Airport, to encourage people to take the stairs instead of the escalator, which led to twice as many people opting for the former.

But Theresa M. Marteau, director of the behaviour & health research unit at the University of Cambridge, says that far more radical change is needed. “While information-based approaches to changing behaviour can raise awareness of a need for change,” she says, “they are generally, at best, weak interventions for achieving such change.


“There is no doubt that the design of cities and towns is key to population and planetary health. Re-designing these to reduce or remove the use of fossil-fuelled vehicles and increase walking and cycling is just one such change.”

Susan Claris, a transport planner with the consultancy Arup, agrees that cities need to adjust their infrastructure. “Buildings should be designed so that the stairs are the first thing you see and they are inviting to use.” At the moment, she notes, the lifts or escalator are often the first thing you see, “with the stairs hidden away behind closed doors”.

Such re-designs are important, because cities have the potential to reshape human behaviour. The Massachusetts Institute of Technology recently published a paper titled, “Persuasive Cities: Health Behavior Change at Scale”. It argued that, “according to social cognitive theory, any well-designed environment can become a strong influences of what people think and do”, concluding: “As cities continue to grow… the design of future urban places will become more dominant in impacting human behaviour.”

The key to this level of change lies not in brand new infrastructure, but in the use of technology, according to Arup’s Claris. “Thanks to new technologies, the physical city is changing,” she says. “With sensors and cloud computing, streets are becoming smarter and more interactive. The city can now monitor and analyse activity levels, actively advocate walking and cycling routes, as well as create a layer of play, fun and games onto the streetscape.”

All this, she says, is enabling cities to play a growing role in public health and wellbeing, “away from the traditional posters, leaflets and other traditional campaigns”. By combining better design and better incentives, cities can make sure that “the healthy choice is the fun, easy, convenient and attractive choice”.

 
 
 
 

“Stop worrying about hairdressers”: The UK government has misdiagnosed its productivity problem

We’re going as fast as we can, here. Image: Getty.

Gonna level with you here, I have mixed feelings about this one. On the one hand, I’m a huge fan of schadenfreude, so learning that it the government has messed up in a previously unsuspected way gives me this sort of warm glow inside. On the other hand, the way it’s been screwing up is probably making the country poorer, and exacerbating the north south divide. So, mixed reviews really.

Here’s the story. This week the Centre for Cities (CfC) published a major report on Britain’s productivity problem. For the last 200 years, ever since the industrial revolution, this country has got steadily richer. Since the financial crash, though, that seems to have stopped.

The standard narrative on this has it that the problem lies in the ‘long tail’ of unproductive businesses – that is, those that produce less value per hour. Get those guys humming, the thinking goes, and the productivity problem is sorted.

But the CfC’s new report says that this is exactly wrong. The wrong tail: Why Britain’s ‘long tail’ is not the cause of its productivity problems (excellent pun, there) delves into the data on productivity in different types of businesses and different cities, to demonstrate two big points.

The first is that the long tail is the wrong place to look for productivity gains. Many low productivity businesses are low productivity for a reason:

The ability of manufacturing to automate certain processes, or the development of ever more sophisticated computer software in information and communications have greatly increased the output that a worker produces in these industries. But while a fitness instructor may use a smartphone today in place of a ghetto blaster in 1990, he or she can still only instruct one class at a time. And a waiter or waitress can only serve so many tables. Of course, improvements such as the introduction of handheld electronic devices allow orders to be sent to the kitchen more efficiently, will bring benefits, but this improvements won’t radically increase the output of the waiter.

I’d add to that: there is only so fast that people want to eat. There’s a physical limit on the number of diners any restaurant can actually feed.

At any rate, the result of this is that it’s stupid to expect local service businesses to make step changes in productivity. If we actually want to improve productivity we should focus on those which are exporting services to a bigger market.  There are fewer of these, but the potential gains are much bigger. Here’s a chart:

The y-axis reflects number of businesses at different productivities, shown on the x-axis. So bigger numbers on the left are bad; bigger numbers on the right are good. 

The question of which exporting businesses are struggling to expand productivity is what leads to the report’s second insight:

Specifically it is the underperformance of exporting businesses in cities outside of the Greater South East that causes not only divergences across the country in wages and standards of living, but also hampers national productivity. These cities in particular should be of greatest concern to policy makers attempting to improve UK productivity overall.

In other words, it turned out, again, to the north-south divide that did it. I’m shocked. Are you shocked? This is my shocked face.

The best way to demonstrate this shocking insight is with some more graphs. This first one shows the distribution of productivity in local services business in four different types of place: cities in the south east (GSE) in light green, cities in the rest of the country (RoGB) in dark green, non-urban areas in the south east in purple, non-urban areas everywhere else in turquoise.

The four lines are fairly consistent. The light green, representing south eastern cities has a lower peak on the left, meaning slightly fewer low productivity businesses, but is slightly higher on the right, meaning slightly more high productivity businesses. In other words, local services businesses in the south eastern cities are more productive than those elsewhere – but the gap is pretty narrow. 

Now check out the same graph for exporting businesses:

The differences are much more pronounced. Areas outside those south eastern cities have many more lower productivity businesses (the peaks on the left) and significantly fewer high productivity ones (the lower numbers on the right).

In fact, outside the south east, cities are actually less productive than non-urban areas. This is really not what you’d expect to see, and no a good sign for the health of the economy:

The report also uses a few specific examples to illustrate this point. Compare Reading, one of Britain’s richest medium sized cities, with Hull, one of its poorest:

Or, looking to bigger cities, here’s Bristol and Sheffield:

In both cases, the poorer northern cities are clearly lacking in high-value exporting businesses. This is a problem because these don’t just provide well-paying jobs now: they’re also the ones that have the potential to make productivity gains that can lead to even better jobs. The report concludes:

This is a major cause for concern for the national economy – the underperformance of these cities goes a long way to explain both why the rest of Britain lags behind the Greater South East and why it performs poorly on a

European level. To illustrate the impact, if all cities were as productive as those in the Greater South East, the British economy would be 15 per cent more productive and £225bn larger. This is equivalent to Britain being home to four extra city economies the size of Birmingham.

In other words, the lesson here is: stop worrying about the productivity of hairdressers. Start worrying about the productivity of Hull.


You can read the Centre for Cities’ full report here.

Jonn Elledge is the editor of CityMetric. He is on Twitter as @jonnelledge and on Facebook as JonnElledgeWrites

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