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.

 
 
 
 

Cycling on London’s Euston Road is still a terrifying experience

Cyclists on the Euston Road. Image: Jonn Elledge.

The New Road, which skirted the northern boundaries of London’s built up area, first opened in the 1750s. Originally, it was intended to link up outlying villages and provide a route to drive sheep and cows to the meat market at Smithfield without having to pass through the congested city centre. 

As with bypasses and ring roads the world over, however, it increasingly became congested in its own right. Today, you won’t often find livestock on the route, which is now Marylebone, Euston and City roads. But you will find up to six lanes of often stationary buses, cabs, and private vehicles. In a city whose centre is largely free of multi-lane highways, London’s northern ring road has long been the sort of abomination that you avoid at all costs.

But now, somewhat surprisingly, the road is seeing yet another new use. Earlier this week, the first phase of a temporary cycle lane opened on the Euston Road, the middle section of the route which runs for roughly a mile. As London rethinks roads throughout the city, this addition to the cycling map falls solidly into the category of streets that didn't seem like candidates for cycling before the pandemic.

It is, to be clear, temporary. That’s true of many of the Covid-led interventions that Transport for London is currently making, though those in the know will often quietly admit to hoping they end up being permanent. In this case, however, the agency genuinely seems to mean it: TfL emphasized in its press release that the road space is already being allocated for construction starting late next year and that "TfL will work with local boroughs to develop alternate routes along side streets" when the cycle lane is removed.

At lunchtime on Friday, I decided to try the lane for myself to understand what an unlikely, temporary cycle lane can accomplish. In this case it's clear that the presence of a lane only accomplishes so much. A few key things will still leave riders wanting:

It’s one way only. To be specific, eastbound. I found this out the hard way, after attempting to cycle the Euston Road westbound, under the naive impression that there was now a lane for me in which to do this. Neither I nor the traffic I unexpectedly found myself sharing space with enjoyed the experience. To be fair, London’s cycling commissioner Will Norman had shared this information on Twitter, but cyclists might find themselves inadvertently mixing with multiple lanes of much, much bigger vehicles.

It radically changes in width. At times the westbound route, which is separated from the motor traffic by upright posts, is perhaps a metre and a half wide. At others, such as immediately outside Euston station, it’s shared with buses and is suddenly four or five times that. This is slightly vexing.

It’s extremely short. The publicity for the new lane said it would connect up with other cycle routes on Hampstead Road and Judd Street (where Cycleway 6, the main north-south crosstown route, meets Euston Road). That’s a distance of roughly 925m. It actually runs from Gower Street to Ossulton Street, a distance of barely 670m. Not only does the reduced length mean it doesn’t quite connect to the rest of the network, it also means that the segregated space suddenly stops:

The junction between Euston Road and Ousslston Street, where the segregated lane suddenly, unexpectedly stops. Image: Jonn Elledge.

 

It’s for these reasons, perhaps, that the new lane is not yet seeing many users. Each time I cycled the length of it I saw only a handful of other cyclists (although that did include a man cycling with a child on a seat behind him – not something one would have expected on the Euston Road of the past).


Though I hesitate to mention this because it feeds into the car lobby’s agenda, it was also striking that the westbound traffic – the side of the road which had lost a lane to bikes – was significantly more congested than the eastbound. If the lane is extended, it could, counterintuitively, help, by removing the unexpected pinch points at which three lanes of cars suddenly have to squeeze into two.

There’s a distinctly unfinished air to the project – though, to be fair, it’s early days. The eastbound lane needs to be created from scratch; the westbound extended. At that point, it would hopefully be something TfL would be keen enough to talk about that cyclists start using it in greater numbers – and drivers get the message they should avoid the Euston Road.

The obvious explanation for why TfL is going to all this trouble is that TfL is in charge of the Euston Road, and so can do what it likes there. Building cycle lanes on side nearby roads means working with the boroughs, and that’s inevitably more difficult and time consuming.

But if the long-term plan is to push cyclists via side roads anyway, it’s questionable whether all this disruption is worth it. A segregated cycle lane that stops without warning and leaves you fighting for space with three lanes of buses, lorries, and cabs is a cycle lane that’s of no use at all.

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