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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Never mind Brexit: TfL just released new tube map showing an interchange at Camden Town!!!

Mmmmm tube-y goodness. Image: TfL.

Crossrail has just been given a £1bn bail out. This, according to the Financial TImes’s Jim Pickard, is on top of the £600m bailout in July and £300m loan in October.

That, even with the pound crashing as it is right now, is quite a lot of money. It’s bad, especially at a time when there is still seemingly not a penny available to make sure trains can actually run in the north.

But the world is quite depressing enough today, so let’s focus on something happier. On Saturday night – obviously peak time for cartographic news – Transport for London emailed me to let me know it would be updating the tube map, to show more street-level interchanges:

Connections between several pairs of stations that are near to each other, but have traditionally not been shown as interchanges, now appear on the map for the first time. These include:

  • Camden Road and Camden Town
  • Euston and Euston Square
  • Finchley Road and Finchley Road & Frognal
  • Kenton and Northwick Park
  • New Cross and New Cross Gate
  • Seven Sisters and South Tottenham
  • Swiss Cottage and South Hampstead

The stations shown meet a set of criteria that has been used to help determine which should be included. This criteria includes stations less than a 700m or a 10 minute walk apart, where there is an easy, well-lit, signposted walking route and where making the change opens up additional travel options.

The results are, well, this:

In addition, interchanges between stations have traditionally appeared on the Tube map as two solid lines, irrespective of whether they are internal or external (which means customers need to leave the station and then re-enter for the station or stop they need). This approach has now been updated and shows a clear distinction between the two types, with external interchanges now being depicted by a dashed line, linking the two stations or stops.

And lo, it came to pass:

I have slightly mixed feelings about this, in all honesty. On the positive side: I think generally showing useful street-level interchanges as A Good Thing. I’ve thought for years that Camden Road/Camden Town in particular was one worth highlighting, as it opens up a huge number of north-east travel options (Finchley to Hackney, say), and apps like CityMapper tell you to use it already.


And yet, now they’ve actually done it, I’m suddenly not sure. That interchange is pretty useful if you’re an able bodied person who doesn’t mind navigating crowds or crossing roads – but the map gives you no indication that it’s a harder interchange than, say, Wanstead Park to Forest Gate.

The new map also doesn’t tell you how far you’re going to be walking at street level. I can see the argument that a 400m walk shouldn’t disqualify something as an interchange – you can end up walking that far inside certain stations (Green Park, Bank/Monument), and the map shows them as interchanges. But the new version makes no effort to distinguish between 100m walks (West Hampstead) and 700m ones (Northwick Park-Kenton), which it probably should.

I’m also slightly baffled by some of the specific choices. Is Finchley Road-Finchley Road & Frognal really a useful interchange, when there’s an easier and more direct version, one stop up the line? No hang on West Hampstead isn’t on the Metropolitan line isn’t it? So that’s what it’s about.

Okay, a better one: if you’re switching from District to Central lines in the City, you’re generally better off alighting at Cannon Street, rather than Monument, for Bank – honestly, it’s a 90 second walk to the new entrance on Walbrook. Yet that one isn’t there. What gives?

The complete new tube map. The full version is on TfL’s website, here.

On balance, showing more possible interchanges on the map is a positive change. But it doesn’t negate the need for a fundamental rethink of how the tube map looks and what it is for. And it’s not, I fear, enough to distract from the Crossrail problem.

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