So why is urban living bad for your mental health?

Each charter’d street. Image: Getty.

Over half of the world’s population – 4.2 billion people – live in cities. This number is expected to rise, with 68 per cent of the global population estimated to live in urban areas by 2050.

Among the world’s megacities – defined as urban areas with more than 10 million inhabitants – Tokyo, Japan is the largest, with 37 million citizens. It is followed by Delhi, India (29 million) and Shanghai, China (26 million). In the UK, after several decades of rural-to-urban migration, 83 per cent of people live in urban environments – and London has become the first European megacity.

The detrimental effects of urban living on physical health have long been recognised, including higher rates of cardiovascular and respiratory disease. More recent, however, is the revelation that urban living can also have adverse effects on mental health.

The risk of developing depression – the most prevalent mental disorder in the world, characterised by low mood and feeling helpless – is 20 per cent higher in urban dwellers than those who live outside the city. Meanwhile, the risk of developing psychosis – a severe psychiatric disorder associated with hallucinations, delusions, paranoia and disorganised thought – is 77 per cent higher in urban than rural dwellers. The risk of developing generalised anxiety disorder, a state of mind characterised by feeling anxious and a sense of impending danger or panic, is also 21 per cent higher in urban than rural dwellers.

Critically, the longer you spend in an urban environment during childhood and adolescence, the higher your risk of developing mental illness in adulthood. This “dose-response” association provides indirect support for a causal relationship between urban living and mental illness.

Brain science

Support for these epidemiological findings comes from the brain sciences. In a pioneering study in 2011, researchers measured neural activation during a stress-inducing task.

As expected, all participants showed increased neuronal activation within the limbic system – a network of regions that plays a key role in our day-to-day regulation of emotion. Within this network, neural activation in the amygdala – the “fight or flight” centre of the brain – correlated with the size of the city in which an individual resided at the time of the experiment. And neural activation of the perigenual anterior cingulate cortex – a region implicated in the processing of social stress – correlated with how long a participant had lived in a city during their childhood.

Intriguingly, other studies have shown similar alterations in people who have high genetic risk of developing psychiatric disorders. This supports the notion that urban living causes changes within a network of regions implicated in the development of mental illness.


Underlying factors

Taken together, epidemiological and neuroscientific studies provide converging evidence that, indeed, people who live in urban areas are at greater risk of mental health problems. So which specific factors within the urban environment increase the risk of developing such problems?

Epidemiological studies have identified a large number of factors. Some of these highlight potential problems in the built environment, such as reduced access to green spaces and high levels of noise and air pollution. Others pertain to the social environment, such as loneliness, perceived and actual crime, and social inequalities.

These studies were based on the collection of a single snapshot per participant, and therefore could not capture the multiple and diverse environments that most people experience throughout the day. But some new studies are using smartphone technologies to collect multiple measurements as people go about their daily life. Urban Mind, for example, is a citizen-science project which uses a smartphone app to measure the experience of urban or rural living in real-time.

It’s important to recognise that those factors within the urban environment which increase the risk of mental illness are neither intrinsic nor inevitable aspects of urban living. Instead they are the result of poor planning, design and management, and could be reversed. Which takes us to the next question: could urban living be good for our mental health?

The bright side

While existing research focuses on the negative impacts of urban living on mental health, framing the accelerated urbanisation taking place worldwide as a challenge to humankind, this is an oversimplification of what it means to live in a city for at least three reasons.

First, urban living is a complex, contradictory and difficult to define phenomenon, with little in common between the resident of a deprived suburb and that of a garden city; or between the processes of gentrification and those of inner city decline. Consistent with this notion, the incidence of depression within urban areas is lower when people have access to high quality housing and green spaces.

Second, we know that all health, and mental health in particular, depends on both nature and nurture. For example, emerging evidence from epigenetics, which examines how the environment affects the expression of our genes, suggests that the impact of urban living depends on our preexisting genetic makeup.

Third, for many people, urban living can bring great benefits to mental health through increased opportunities for education, employment, socialisation and access to specialised care. Moving to a city can be the first step towards the realisation of one’s full potential, and a necessary condition to gain access to communities with similar interests and values.

Ultimately, cities offer a swath of obstacles and opportunities, freedom and captivity, which can challenge as well as nurture us, often at the same time.

The Conversation

Andrea Mechelli, Professor of Early Intervention in Mental Health, King's College London.

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

 
 
 
 

As EU funding is lost, “levelling up” needs investment, not just rhetoric

Oh, well. Image: Getty.

Regional inequality was the foundation of Boris Johnson’s election victory and has since become one of the main focuses of his government. However, the enthusiasm of ministers championing the “levelling up” agenda rings hollow when compared with their inertia in preparing a UK replacement for European structural funding. 

Local government, already bearing the brunt of severe funding cuts, relies on European funding to support projects that boost growth in struggling local economies and help people build skills and find secure work. Now that the UK has withdrawn its EU membership, councils’ concerns over how EU funds will be replaced from 2021 are becoming more pronounced.

Johnson’s government has committed to create a domestic structural funding programme, the UK Shared Prosperity Fund (UKSPF), to replace the European Structural and Investment Fund (ESIF). However, other than pledging that UKSPF will “reduce inequalities between communities”, it has offered few details on how funds will be allocated. A public consultation on UKSPF promised by May’s government in 2018 has yet to materialise.

The government’s continued silence on UKSPF is generating a growing sense of unease among councils, especially after the failure of successive governments to prioritise investment in regional development. Indeed, inequalities within the UK have been allowed to grow so much that the UK’s poorest region by EU standards (West Wales & the Valleys) has a GDP of 68 per cent of the average EU GDP, while the UK’s richest region (Inner London) has a GDP of 614 per cent of the EU average – an intra-national disparity that is unique in Europe. If the UK had remained a member of the EU, its number of ‘less developed’ regions in need of most structural funding support would have increased from two to five in 2021-27: South Yorkshire, Tees Valley & Durham and Lincolnshire joining Cornwall & Isles of Scilly and West Wales & the Valley. Ministers have not given guarantees that any region, whether ‘less developed’ or otherwise, will obtain the same amount of funding under UKSPF to which they would have been entitled under ESIF.


The government is reportedly contemplating changing the Treasury’s fiscal rules so public spending favours programmes that reduce regional inequalities as well as provide value for money, but this alone will not rebalance the economy. A shared prosperity fund like UKSPF has the potential to be the master key that unlocks inclusive growth throughout the country, particularly if it involves less bureaucracy than ESIF and aligns funding more effectively with the priorities of local people. 

In NLGN’s Community Commissioning report, we recommended that this funding should be devolved to communities directly to decide local priorities for the investment. By enabling community ownership of design and administration, the UK government would create an innovative domestic structural funding scheme that promotes inclusion in its process as well as its outcomes.

NLGN’s latest report, Cultivating Local Inclusive Growth: In Practice, highlights the range of policy levers and resources that councils can use to promote inclusive growth in their area. It demonstrates that, through collaboration with communities and cross-sector partners, councils are already doing sterling work to enhance economic and social inclusion. Their efforts could be further enhanced with a fund that learns lessons from ESIF’s successes and flaws: a UKSPF that is easier to access, designed and delivered by local communities, properly funded, and specifically targeted at promoting social and economic inclusion in regions that need it most. “Getting Brexit done” was meant to free up the government’s time to focus once more on pressing domestic priorities. “Getting inclusive growth done” should be at the top of any new to-do list.

Charlotte Morgan is senior researcher at the New Local Government Network.