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”.

 
 
 
 

Meet the Sheffield social enterprise using shipping containers to tackle the housing crisis

A shipping container, repurposed as housing. Image: REACH.

A Sheffield-based social enterprise is hoping to navigate the rocky waters of the UK housing market, by creating affordable 1, 2 and 3-bedroom homes from shipping containers.

Inspired by an episode of Grand Designs, former police officer Jon Johnson set up REACH – Recycled, Environmental, Affordable Container Homes – in January 2017. Following a small grant from charity UnLtd, the social enterprise built a prototype which it is currently showing off to interested parties from around the UK. Johnson believes it can build 6,000 units a year, helping to plug the housing shortfall and creating genuinely affordable homes.

Just 1.4 per cent of homes in large developments approved by planners in Sheffield in 2016 and 2017 met the government’s affordable definition. In Manchester, it was literally none..

“We need to build the houses people want, where they want them, rather than what developers can bully through,” says Johnson. “I’ve got 40 or 50 housing reports. Are we going to keep writing reports or are we going to do something about it?”

During Johnson’s almost 30-year career in the police force, he saw first-hand the effects that insecure and poor-quality housing can have on communities in Britain. “It underpins everything in society. Everybody needs somewhere to live,” he says. “And if you haven’t got a decent place to be, that is adding to mental or health problems. You're onto a loser from the outset.”


“Decent housing is a human right like air and water,” he goes on. “It’s always been done to us by people who don’t care about standards or quality as long as they’re making money.”

Johnson used skills learnt through his furniture recycling store, Strip the Willow, to decorate the prototype, and sourced every bit of second-hand wood he used locally. The panelling used to be a counter in a local Indian takeaway, the cladding on the roof came from a local mosque. The bedroom headboard is made out of a piano, and light fittings are made out of cymbals.

Each of his eco homes will be 60 per cent recycled, built offsite in three weeks and powered by renewable energy sources. “We aim to make use of million tons of waste we put into landfill every year,” he says.

Changing the playing field

But followers of the UK housing market will be unsurprised when Johnson says there are vested interests and serious obstacles to overcome before REACH can achieve its dream of turning a cottage industry something more substantial.

“The same people will just keep profiteering out of everyone else’s misery,” he says. “We're trying to do housing the right way. It’s about people and planet, not just profit. Housing shouldn't be about giving out millions in bonuses at end of the year.”

But REACH won't be able to build any homes without land – perhaps the biggest hurdle for them to get over.

Following the Second World War, the government freed up land and built prefab housing estates around the country. Johnson believes a similarly bold approach is needed to meet the housing demands of the 21st century.

However, the publication of the social housing green paper last week made no promises to build more social housing. It “doesn’t commit a single extra penny towards building the social homes that are desperately needed,” said housing charity Shelter.

Frustration with this situation led Johnson to set up the National Federation of Affordable Building (NFAB), which brings together organisations from across the offsite construction sector who all would like to see a change in policy. “The reason we set up NFAB was because so many SMEs have had conversations with Homes England and got nowhere.”

The current Homes England system for listing land means building companies need to have a turnover of £50m before they can even be considered for public land – a bidding process that excludes all SMEs such as REACH.

REACH does have backing from the Local Government Assocation, though. It also has Sheffield City Council on board, and is hoping the council will soon be given a piece of land to build the first nine homes, freeing up funds for its first off-site factory.

It's clear that it’s going to take some forward-thinking councils for it to succeed. “We need a Dunkirk style situation with SMEs getting some innovation into the market,” Johnson says. “The issue of land and how much its worth is entirely notional. Land is expensive because people think it is.

“If Homes England can ringfence a percentage of the land they give to the big builders every year, and have that for affordable development, we won’t have a problem because the SMEs will have somewhere to access the market instead of queueing up for massively expensive land.”

At the moment, he notes, “Big builders don’t want to do things any differently because they're protectionist of their profit margins. SMEs can’t get a look in. We need to alter that playing field.”

A sustainable trend?

One popular misconception of homes made from shipping containers is that they are too cold in winter and uncomfortably hot in summer. Some critics also suggest that say the current trend for modular housing is a fad.

But Johnson says that residents will need the heating on for only two months a year: the homes are designed using ‘Passivhaus’ principles, which optimises energy efficiency through its design.

“They are light and spacious,” he says. “It’s how we use the offset of parts of the containers. They are like adult Lego. We can use architectural glass and make some fabulous buildings.

“They’re affordable but they will look like architect-designed houses.”

The one, two and three bedroom models will be sold at £35,000, £65,000 and £90,000 respectively. There is already a large waiting list of people ready to move in once they've secured some land.

At present, “I don’t think it’s a trend,” Johnson admits. But “it will take over the market if it's done right. The tech has now caught up and modular housing can be controlled a lot more intelligently in the factory. It cuts down on construction costs, waste and theft of materials from sites. It makes the whole process of housebuilding a lot more efficient.

“It’s a once in a lifetime opportunity to get housing moving in the right direction and get sustainability on the agenda,” he concludes. “That’s not going to happen if we leave it to the big builders.”

Thomas Barrett is the editor of New Start magazine, where this story first appeared. He tweets as @tbarrettwrites.

All images courtesy of the author/REACH.