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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It’s not all cool bridges and very real concerns: In defence of Teesside

Just one of the many interesting bridges you’ll find in Teesside. Image: Stephen Jorgensen-Murray.

The latest entry in our ‘In Defence Of’ series...

I have to start this with a disclaimer: I’m not writing this from anywhere in Teesside. I’m writing this from Germany, where I live and work. Some of you may remember being told by Norman Tebbit, that instead of complaining that we can’t find jobs, we should get on our bikes (or, more recently, by IDS to get on a bus), and I did. I’m paid well here, to do a job that doesn’t really exist in Teesside. And yet, every time I go home to visit my family, I almost wish I’d stayed.

This isn’t going to be a very straightforward take – I’m hoping to pay my respects to Stockton, Middlesbrough and Hartlepool as well as my native Billingham – but Teesside isn’t a very straightforward place. What county is it in? Cleveland, Stockton-on-Tees, Durham or North Yorkshire depending on how old you are and where you’re standing. I always had great fun ordering online and trying to guess which of the unfamiliar options on the dropdown menu would get my parcel to me.

But regardless of where you draw the lines, Teesside is still there.

Our accent is similarly hard to pin down: Geordie, Mackem, Yorkshire, even Scouse, depending on who’s imitating us. I’ve been pegged as Irish, American and South African by determined people in the past. Our slang is stolen from Scotland, Northumberland, Newcastle and Yorkshire, and, not satisfied, some words are purely our own. Hoy, shan, howay, dinner nanny. We have as many words for classless people as the Romans did for murder.

But regardless of how it sounds to you, Teesside still talks.


On a map of the UK, Teesside sits as an isolated blob of civilisation between the Dales and the sea. Half-urban, half-rural, half-seaside, half-inland, half industrial estate and half nature reserve. A Labour heartland with a Tory mayor. Places that sprang up fully formed in the ICI rush of the 1950s, but that still have Viking place names.

We’ve been portrayed in fiction by Richard Milward, in song by Maximo Park, in statistics by Lady Florence Bell and in cinema by Sir Ridley Scott (our chemical works and power plants inspired the look of Blade Runner). More recently, we’re being portrayed in documentary in The Mighty Redcar, and in the media as an area of left-behind, white working class racists who all voted Leave. But while most of the area is whiter than the average, Middlesbrough mirrors the UK average for racial diversity and has been assigned to resettle more refugees than any other town in the UK – and more than its cut-back council can look after.

And when you look at the numbers, the proportion of the population of Teesside who voted to leave the EU is much less than many other areas. (And yes, of course I voted Remain from my now slightly more precarious home in Frankfurt, joining 100,000 other Teesside Remainers.)

We’re pitied for the loss of the Teesside steelworks and derided for blaming the EU for it (when of course it was our own government’s sabotaging of EU attempts to block Chinese steel dumping that drove that knife in). Even the people who profess to be on our side take our angry, uneducated racism as fact, baking it into the premises of their arguments, which consist of addressing our “racist but real concerns”, and how to reach us.

But whether you understand us or not, whether you miss the point or not, we’ll continue to exist, long after we’ve been forgotten again.

Billingham town centre. One of the first pedestrianised town centres in the UK. Image: Stephen Jorgensen-Murray.

Still, while we’re in the spotlight, why not see what we have to offer? Come to see our rather wonderful collection of interesting bridges. See where the first public steam train ran, from Stockton to Darlington. Visit Mima, the modern art gallery in Middlesbrough and the 1960s utopia of Billingham’s pedestrianised town centre. Feel slightly uncomfortable around all the things that are named for Captain Cook (though the replica of the Endeavour at Stockton riverside is impressive regardless on your thoughts on its captain – and it’s the best you’ll see until they work out whether they’ve found the real one yet). Wander Middlesbrough’s thriving student/hipster district on Linthorpe RoadD – despite being a punchline during my youth, Teesside University has become a respected institution. Visit Billingham’s Folklore Festival in August, where as schoolchildren we’d watch troupes of folk dancers from across the world open-mouthed, and get their autographs afterwards as though they were celebrities.

Fried chicken, white sauce and cheese make the Teesside parmo. Perfect. Image: Stephen Jorgensen-Murray.

Try a parmo. Try the Billingham Catholic Club’s real ale, and stay for the bingo, which is called by a man with the most acrobatic mental arithmetic skills I’ve ever seen. Try a lemon top ice cream from Pacitto’s in Redcar and wonder why no one else has ever done this before. Lemon sorbet and vanilla ice cream! Together at last!

While you’re at the beach, take a ride on the Saltburn Cliff Lift, the oldest operating water-balance cliff lift in the UK. Pretend Saltburn is sort of in Teesside while you’re enjoying the view. Look out on beaches black with sea coal, washed up from undersea seams and nearby coal mines. Visit the golf course by Seaton Carew to catch a glimpse of a curlew or two, and watch the young seagulls pick up golf balls to crack them open by dropping them from a great height. Visit Seal Sands, whose owners can be observed lazing on the estuary banks whenever the tide is out. Or visit Saltholme, the RSPB nature reserve, where you can see avocets, Britain’s weirdest-looking and most beloved seabird.

Nature coexists with industry on Teesside. Image: Stephen Jorgensen-Murray.

Go white water rafting, bell boating or paddleboarding at the Tees Barrage, where there are so many seals that they’ve had to put up guards to keep them out of the way. The Tees used to be too polluted even to support salmon and trout, and now we have too many of one of Britain’s largest native mammals. The return of the seals to the Tees was the first documented case of seals returning to an industrial area. You’d be surprised at how well nature can thrive in the shadow of industry, colonising the quiet fields and marshy ponds on private land that are never disturbed, haunted by sika deer and shelducks, redshanks, knots, stonechats.

Teesside has plenty to offer. What it doesn’t have is the jobs to keep its younger generations from having to get on their bikes and leave. We aren’t aliens, or Jacob Rees-Mogg’s army of goblin henchbrexiteers. We’re just like you, but with more seals and fewer employment opportunities.