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.

 
 
 
 

Green roofs improve cities – so why don’t all buildings have them?

The green roof at the Kennedy Centre, Washington DC. Image: Getty.

Rooftops covered with grass, vegetable gardens and lush foliage are now a common sight in many cities around the world. More and more private companies and city authorities are investing in green roofs, drawn to their wide-ranging benefits which include savings on energy costs, mitigating the risk from floods, creating habitats for urban wildlife, tackling air pollution and urban heat and even producing food.

A recent report in the UK suggested that the green roof market there is expanding at a rate of 17 per cent each year. The world’s largest rooftop farm will open in Paris in 2020, superseding similar schemes in New York City and Chicago. Stuttgart, in Germany, is thought of as “the green roof capital of Europe”, while Singapore is even installing green roofs on buses.

These increasingly radical urban designs can help cities adapt to the monumental challenges they face, such as access to resources and a lack of green space due to development. But buy-in from city authorities, businesses and other institutions is crucial to ensuring their success – as is research investigating different options to suit the variety of rooftop spaces found in cities.

A growing trend

The UK is relatively new to developing green roofs, and governments and institutions are playing a major role in spreading the practice. London is home to much of the UK’s green roof market, mainly due to forward-thinking policies such as the 2008 London Plan, which paved the way to more than double the area of green roofs in the capital.

Although London has led the way, there are now “living labs” at the Universities of Sheffield and Salford which are helping to establish the precedent elsewhere. The IGNITION project – led by the Greater Manchester Combined Authority – involves the development of a living lab at the University of Salford, with the aim of uncovering ways to convince developers and investors to adopt green roofs.

Ongoing research is showcasing how green roofs can integrate with living walls and sustainable drainage systems on the ground, such as street trees, to better manage water and make the built environment more sustainable.

Research is also demonstrating the social value of green roofs. Doctors are increasingly prescribing time spent gardening outdoors for patients dealiong with anxiety and depression. And research has found that access to even the most basic green spaces can provide a better quality of life for dementia sufferers and help prevent obesity.

An edible roof at Fenway Park, stadium of the Boston Red Sox. Image: Michael Hardman/author provided.

In North America, green roofs have become mainstream, with a wide array of expansive, accessible and food-producing roofs installed in buildings. Again, city leaders and authorities have helped push the movement forward – only recently, San Francisco created a policy requiring new buildings to have green roofs. Toronto has policies dating from the 1990s, encouraging the development of urban farms on rooftops.

These countries also benefit from having newer buildings, which make it easier to install green roofs. Being able to store and distribute water right across the rooftop is crucial to maintaining the plants on any green roof – especially on “edible roofs” which farm fruit and vegetables. And it’s much easier to create this capacity in newer buildings, which can typically hold greater weight, than retro-fit old ones. Having a stronger roof also makes it easier to grow a greater variety of plants, since the soil can be deeper.


The new normal?

For green roofs to become the norm for new developments, there needs to be buy-in from public authorities and private actors. Those responsible for maintaining buildings may have to acquire new skills, such as landscaping, and in some cases volunteers may be needed to help out. Other considerations include installing drainage paths, meeting health and safety requirements and perhaps allowing access for the public, as well as planning restrictions and disruption from regular ativities in and around the buildings during installation.

To convince investors and developers that installing green roofs is worthwhile, economic arguments are still the most important. The term “natural capital” has been developed to explain the economic value of nature; for example, measuring the money saved by installing natural solutions to protect against flood damage, adapt to climate change or help people lead healthier and happier lives.

As the expertise about green roofs grows, official standards have been developed to ensure that they are designed, built and maintained properly, and function well. Improvements in the science and technology underpinning green roof development have also led to new variations on the concept.

For example, “blue roofs” increase the capacity of buildings to hold water over longer periods of time, rather than drain away quickly – crucial in times of heavier rainfall. There are also combinations of green roofs with solar panels, and “brown roofs” which are wilder in nature and maximise biodiversity.

If the trend continues, it could create new jobs and a more vibrant and sustainable local food economy – alongside many other benefits. There are still barriers to overcome, but the evidence so far indicates that green roofs have the potential to transform cities and help them function sustainably long into the future. The success stories need to be studied and replicated elsewhere, to make green, blue, brown and food-producing roofs the norm in cities around the world.

Michael Hardman, Senior Lecturer in Urban Geography, University of Salford and Nick Davies, Research Fellow, University of Salford.

This article is republished from The Conversation under a Creative Commons license. Read the original article.