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”.

 
 
 
 

To boost the high street, cities should invest in offices

Offices in Northampton. Image: Getty.

Access to cheap borrowing has encouraged local authorities to proactively invest in commercial property. These assets can be a valuable tool for cities looking to improve the built environment they offer businesses and residents.

Councils are estimated to have spent £3.8bn on property between 2013 and 2017, funded through the government’s Public Works Loan Board (PWLB) at very low interest rates. Offices accounted for half of this investment, and roughly a third (£1.2bn) has been spent on retail properties. And local authorities were the biggest investor group for UK shopping centres in the first quarter of 2018.

Why are cities investing? There are two major motivations.

First, at a time when cuts are squeezing council revenue budgets, property investments can provide a long-term revenue stream to keep quality public services up and running. Second, ownership of buildings in areas marked for redevelopment allows councils to assemble land more easily and gives them more influence over the changes taking place, allowing them to make sure the space evolves to meet their objectives.

But how exactly can cities turn property ownership into successful place-making? How should they adapt the buildings they invest in to improve the performance of the economies?

Cities need workers

When developing the city’s property offer, the aim should be to get jobs back into the city centre while reducing the dominance of retail space. For councils who have invested in existing retail space and shopping centres, in particular, the temptation may be to try and retain their existing use, with new retail strategies designed to reduce vacancies.

But as the Centre for Cities’ recent Building Blocks report illustrates, the evidence points to this being a dead-end. Instead, cities may need to convert the properties they own so they house a more diverse group of businesses.

Many city centres already have a lot of retail – and this has not offered significant economic benefit. Almost half (43 per cent) of city centre space in the weakest city economies is taken up by shops, while retail only accounts for 18 per cent of space in strong city centre economies. And many of these shops lie empty: in weaker city centres vacancy rates of high-street services (retail, food and leisure) are on average 16 per cent, compared with 9 per cent in stronger city economies. In Newport, nearly a quarter of these premises are empty, as the map below shows.

The big issue in these city centres is the lack of office jobs – which are an important contributor to footfall for retailers. This means that, in order to improve the fortunes of the high street, policy will need to tackle the barriers that deter those businesses from moving to their city centres.

One of these barriers is the quality of office space. In a number of struggling city centres, the quality of office space on offer is poor. But the low returns available for private investors mean that some form of public sector involvement will be required.


Ownership of buildings gives cities the opportunity to reshape the type of commercial space on offer. Some of this will involve improving the existing office stock available, some will involve converting retail to office, and some of will require demolishing part of the space without replacing it, in the short term at least. Without ownership of the land and buildings on it, this task becomes very difficult to do but will be a fundamental part of turning the fortunes of a city centre around.

Cheap borrowing has provided a way not only for local authorities to generate an income stream through property investment. but also opens up the opportunity to have greater control over the development of their city centres. For those choosing to invest, the focus must be on using ownership to make the city centre a more attractive place for all businesses to invest, rather than hoping to revive retail alone.

Rebecca McDonald is an analyst at the Centre for Cities, on whose blog this article first appeared.