Can places make us healthier?

A 19th century vision of ideal homes for the respectable working classes. Image: Wellcome Images.

All of us feel better when we’re surrounded by beauty and good design. It’s why we put so much effort into DIY, interior design or gardening. And it’s why for our holidays we seek out places that will make us both physically and mentally healthier than we can in our working life.

This might seem blindingly obvious. Yet public policy often points in the opposite direction. Developed societies rightly spend huge sums of money on health – hospitals, primary care, and new and old drugs account for at least 10 per cent of GDP and more in some countries.

But if you look at what we know about health there is an odd paradox. According to the Robert Wood Johnson Foundation, one of the world’s largest funders of health, summarising a huge amount of research, the causes of premature death are roughly as follows: 40 per cent behavioural patterns, 30 per cent genetics, 15 per cent social circumstance and 5 per cent environmental effects. The remaining 10 per cent is attributable to healthcare.

Given that medicine is an evidence-based field you would expect that this widely understood knowledge would be reflected in how funds are allocated. Instead, the opposite is the case. The vast majority of health spending goes to healthcare and within that to particular industries, notably pharmaceuticals.

We now take this for granted. But it wasn’t always like this. In the 19th century when rapid industrialisation and urbanisation left cities like Manchester, Birmingham and London wracked by ill-health, crime and misery, huge efforts went into dealing with the physical causes of ill-health. Vast public spending projects worked to deliver cleaner water and air; comprehensive sewers; better housing; and later such things as safe roads. These were all seen as just as important to a healthier population as better hospitals.

Indeed, there is a long history of using urban design to promote health. This thinking was integral to the great projects of Bournville and Peabody, the garden cities of the early 20th century and the new towns of the 1940s, and more recently it’s shaped the NHS Healthy New Towns initiative.

Yet health design has never had the same prestige or support as more narrowly clinical knowledge, and although much is known, little has been rigorously tested. So we can fairly safely say that hospitals are more likely to promote recovery if they make good use of nature, light and art, and if they offer privacy rather than long soulless wards. Similarly, health centres work better if they give people the scope for interaction rather than long lines of chairs or grim corridors.


But we don’t have strong evidence or detailed work on just how much impact these designs have, and even though much of this may appear fairly obvious, a moment’s reflection confirms that it’s at odds with how far too many hospitals and surgeries were designed.

The same imbalance is evident in the ways that towns and cities are planned. You can deliberately design transport and roads to make it easier to walk, cycle or run rather than always depending on cars. You can shape cities to make them full of nature, or even edible, with plenty of fruit trees for example. Planning can be used to reduce advertising of junk food near schools, to cut noise levels and to promote clean air. Much is known about how the presence of green and blue spaces – which means water, ideally in motion – can be good for mental health. Social norms can be influenced in a healthy direction, for example encouraging people to stop their cars from idling. And we’re beginning to see more systematic attention to what could be called MEEs – Mind Enhancing Environments – which can both calm and stimulate us in healthy ways.

But again there is surprisingly little rigorous evidence and surprisingly little use of systematic experiment so that when new initiatives like the Healthy New Towns one are started they have relatively little to draw on.

This under-development of health design reflects a broader mismatch in where we direct resources. Over the last few years, an ever-larger share of public funding has gone to biomedical research even as the results of that research have continued a remorseless long-term decline in terms of impact on health outcomes.

It’s not that we shouldn’t fund such vital research: it’s just that the imbalance with other fields that focus on behavioural, social and environmental influences on health has become huge, and indefensible.

Most new urban developments ignore what’s known about health design, and the situation is even worse in countries like China where cities are being built that are highly likely to be bad for physical and mental health.

We shape our buildings and our buildings shape us, as Churchill famously put it. For now, too many of them aren’t shaping us well. I hope that a new generation of doctors, architects and planners will put this right.

Geoff Mulgan is chief executive of the innovation charity Nesta.

 
 
 
 

CityMetric is now City Monitor! Come see us at our new home

City Monitor is now live in beta at citymonitor.ai.

CityMetric is now City Monitor, a name that reflects both a ramping up of our ambitions as well as our membership in a network of like-minded publications from New Statesman Media Group. Our new site is now live in beta, so please visit us there going forward. Here’s what CityMetric readers should know about this exciting transition.  

Regular CityMetric readers may have already noticed a few changes around here since the spring. CityMetric’s beloved founding editor, Jonn Elledge, has moved on to some new adventures, and a new team has formed to take the site into the future. It’s led by yours truly – I’m Sommer Mathis, the editor-in-chief of City Monitor. Hello!

My background includes having served as the founding editor of CityLab, editor-in-chief of Atlas Obscura, and editor-in-chief of DCist, a local news publication in the District of Columbia. I’ve been reporting on and writing about cities in one way or another for the past 15 years. To me, there is no more important story in the world right now than how cities are changing and adapting to an increasingly challenging global landscape. The majority of the world’s population lives in cities, and if we’re ever going to be able to tackle the most pressing issues currently facing our planet – the climate emergency, rising inequality, the Covid-19 pandemic ­­­– cities are going to have to lead the way.

That’s why City Monitor is now a global publication dedicated to the future of cities everywhere – not just in the UK (nor for that matter just in the US, where I live). Our mission is to help our readers, many of whom are in leadership positions around the globe, navigate how cities are changing and discover what’s next in the world of urban policy. We’ll do that through original reporting, expert opinion and most crucially, a data-driven approach that emphasises evidence and rigorous analysis. We want to arm local decision-makers and those they work in concert with – whether that’s elected officials, bureaucratic leaders, policy advocates, neighbourhood activists, academics and researchers, entrepreneurs, or plain-old engaged citizens – with real insights and potential answers to tough problems. Subjects we cover include transportation, infrastructure, housing, urban design, public safety, the environment, the economy, and much more.

The City Monitor team is made up of some of the most experienced urban policy journalists in the world. Our managing editor is Adam Sneed, also a CityLab alum where he served as a senior associate editor. Before that he was a technology reporter at Politico. Allison Arieff is City Monitor’s senior editor. She was previously editorial director of the urban planning and policy think tank SPUR, as well as a contributing columnist for The New York Times. Staff writer Jake Blumgart most recently covered development, housing and politics for WHYY, the local public radio station in Philadelphia. And our data reporter is Alexandra Kanik, whose previous roles include data reporting for Louisville Public Media in Kentucky and PublicSource in Pittsburgh, Pennsylvania.

Our team will continue to grow in the coming weeks, and we’ll also be collaborating closely with our editorial colleagues across New Statesman Media Group. In fact, we’re launching a whole network of new publications, covering topics such as the clean energy transition, foreign direct investment, technology, banks and more. Many of these sectors will frequently overlap with our cities coverage, and a key part of our plan is make the most of the expertise that all of these newsrooms combined will bring to bear on our journalism.

Please visit citymonitor.ai going forward, where you can also sign up for our free email newsletter.


As for CityMetric, some of its archives have already been moved over to the new website, and the rest will follow not long after. If you’re looking for a favourite piece from CityMetric’s past, for a time you’ll still be able to find it here, but before long the whole archive will move over to City Monitor.

On behalf of the City Monitor team, I’m thrilled to invite you to come along for the ride at our new digs. You can follow City Monitor on LinkedIn and on Twitter. If you’re interested in learning more about the potential for a commercial partnership with City Monitor, please get in touch with our director of partnerships, Joe Maughan.

I want to thank and congratulate Jonn Elledge on a brilliant run. Everything we do from here on out will be building on the legacy of his work, and the community that he built here at CityMetric. Cheers, Jonn!

To our readers, on behalf of the City Monitor team, thank you from all of us for being such loyal CityMetric fans. We couldn’t have done any of this without you.

Sommer Mathis is editor-in-chief of City Monitor.