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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Covid-19 is highlighting cities' unequal access to green space

In the UK, Londoners are most likely to rely on their local park for green space, and have the best access to parks. (Leon Neal/Getty Images)

As coronavirus lockdowns ease, people are flooding back to parks – but not everyone has easy access to green space in their city.

Statistics from Google show that park attendance in countries across the globe has shot up as people have been allowed to move around their cities again.

This is especially true in urban areas, where densely populated neighbourhoods limit the size of private green space – meaning residents have to go to the park to get in touch with nature. Readers from England can use our interactive tool below to find out how much green space people have access to in their area, and how it compares to the rest of the country.

 

Prime Minister Boris Johnson’s announcement Monday that people are allowed to mingle in parks and gardens with groups of up to six people was partially following what people were doing already.

Data from mobile phones show people have been returning to parks across the UK, and also across Europe, as weather improves and lockdown eases.

People have been returning to parks across the world

Stay-at-home requirements were eased in Italy on 4 May, which led to a flood of people returning to parks.

France eased restrictions on 1 May, and the UK eased up slightly on 13 May, allowing people to sit down in public places so long as they remain socially distanced.

Other countries have seen park attendance rise without major easing of lockdown – including Canada, Spain, and the US (although states there have individual rules and some have eased restrictions).

In some countries, people never really stopped going to parks.

Authorities in the Netherlands and Germany were not as strict as other countries about their citizens visiting local parks during lockdown, while Sweden has famously been avoiding placing many restrictions on people’s daily lives.


There is a growing body of evidence to suggest that access to green space has major benefits for public health.

A recent study by researchers at the University of Exeter found that spending time in the garden is linked to similar benefits for health and wellbeing as living in wealthy areas.

People with access to a private garden also had higher psychological wellbeing, and those with an outdoor space such as a yard were more likely to meet physical activity guidelines than those without access to outdoor space. 

Separate UK research has found that living with a regular view of a green space provides health benefits worth £300 per person per year.

Access is not shared equally, however, which has important implications for equality under lockdown, and the spread of disease.

Statistics from the UK show that one in eight households has no garden, making access to parks more important.

There is a geographic inequality here. Londoners, who have the least access to private gardens, are most likely to rely on their local park for green space, and have the best access to parks. 

However the high population in the capital means that on the whole, green space per person is lower – an issue for people living in densely populated cities everywhere.

There is also an occupational inequality.

Those on low pay – including in what are statistically classed as “semi-skilled” and “unskilled” manual occupations, casual workers and those who are unemployed – are almost three times as likely as those in managerial, administrative, professional occupations to be without a garden, meaning they rely more heavily on their local park.

Britain’s parks and fields are also at significant risk of development, according to new research by the Fields in Trust charity, which shows the number of people living further than a 10-minute walk from a public park rising by 5% over the next five years. That loss of green spaces is likely to impact disadvantaged communities the most, the researchers say.

This is borne out by looking at the parts of the country that have private gardens.

The least deprived areas have the largest gardens

Though the relationship is not crystal clear, it shows at the top end: Those living in the least deprived areas have the largest private green space.

Although the risk of catching coronavirus is lower outdoors, spending time in parks among other people is undoubtedly more risky when it comes to transmitting or catching the virus than spending time in your own outdoor space. 

Access to green space is therefore another example – along with the ability to work from home and death rates – of how the burden of the pandemic has not been equally shouldered by all.

Michael Goodier is a data reporter at New Statesman Media Group, and Josh Rayman is a graphics and data visualisation developer at New Statesman Media Group.