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  • Jo Waters — United Kingdom

Coronavirus could spur reforms to improve health of city dwellers

The number of people living in cities is projected to rise from 55 % to 68 % of the world’s population by 2050, according to the United Nations. Strong leadership and multi-sectoral planning can make our cities far healthier for human habitation

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The novel coronavirus and fossil fuel emissions that contribute to climate change are the two biggest challenges the world faces in mid-2020. Both are acutely apparent in cities. The covid-19 pandemic has hit densely populated urban areas harder than more sparsely populated rural regions. Pollution levels, from both vehicles and industrial emissions, are highest in big centres of population such as Mexico City, Beijing and Delhi.

“Challenges like covid-19 and climate change make the importance of planning for healthy cities more urgent; by highlighting city planning issues, they create a unique opportunity and impetus for change,” says Melanie Lowe, a public health lecturer at Melbourne’s Catholic University in Australia. “Lockdown policies and the need for physical distancing during covid-19 reinforce the need to support local living,” she adds. City living also increases the risk of developing non-communicable diseases (NCDs). Efforts to fight covid-19 and climate change with better urban design and planning can help reduce the risk factors. Encouraging active transport such as cycling and walking can reduce the risk of developing obesity and type 2 diabetes, as can restricting the spread of fast food outlets. Similarly, providing more outdoor green space can improve mental health and give people more space to take exercise.

Singapore Green spaces in urban areas promote mental well being and support good physical health 

The risks of city living

NCDs are responsible for an increasing share of global deaths and those associated with urbanisation are one of the central challenges facing cities. A large proportion of these deaths relate to the urban built environment. Pollution, industrial emissions, lack of green space and safe streets for walking, plus the stress of inner-city living and poor-quality housing all adversely affect the health of city dwellers. Cities are especially fertile environments for coronary heart disease, type 2 diabetes and respiratory illnesses, as well as obesity, largely driven by the greater access to fast food outlets and physical inactivity.

Increasingly though, public health bodies are joining forces with academics, city council transport and housing planners, environmental groups, sports clubs, and industry to prevent and reduce the problems.

“There’s now a move away from the emphasis purely on individual lifestyle choices, because sometimes people don’t feel they have choices and that they are constrained by their income or their environment,” says Helen Pineo, lecturer in sustainable development and healthy built environment at University College, London. “It’s about moving the conversation away from individual lifestyle choices and thinking more about how the economic and social structures of cities, including the urban environment, can support good health.”

There are also significant gaps between policy intentions and what is delivered on the ground

Barriers to city health

Joint planning across the board is the key to meeting health and environmental challenges, Lowe says. “Creating healthy and liveable cities requires the input of many sectors, including transport, urban design, housing, economic development, energy, social and health services and education,” she adds.

A key obstacle to making cities healthier places in which to live is poor policy and lack of integrated planning, says Lowe. Inadequate access to infrastructure and services can disadvantage some but not others. She cites the example of a new housing estate without public transport or shops or schools, making residents more car-dependent or with few opportunities for social interaction. “It is difficult and costly to retrofit urban developments, so a lack of planned development is a missed opportunity.”

Her research in Australia has revealed a disconnect between government policy aspirations to create healthy neighbourhoods and actual policy targets for walkability, public transport access and public open space. Too often the policies do not support the aspirations, says Lowe. “There are also significant gaps between policy intentions and what is delivered on the ground,” she adds. Even modest targets for housing density and other liveability aims are not being met.

Lowe emphasises that there are many determinants of health in cities, including creating healthy and safe neighbourhoods with affordable housing, all linked by walking, cycling and public transport to open spaces, jobs and education. Transport planning is key, she observes. The balance of healthy versus unhealthy food stores in neighbourhoods can shape the diets of residents. Green space supports mental health by providing access to our natural element and also encourages recreational physical activity.

The Melbourne example

In recent years, Lowe says, interest has grown in creating “20 or 30 minute neighbourhoods” in Melbourne, where people can access most of the amenities they need within a short distance of home, either by walking, cycling or public transport. The advantages of such “village life” have come to the fore during the covid-19 pandemic, she says. Pilot programmes in 2018 launched the easy-access neighbourhood policy and cities in other countries, such as Portland in the US Northwest, have a similar model.

“With people restricted from moving about cities and encouraged to work from home, providing local living destinations has never been more important. Crowded public transport can be problematic during a pandemic, but for physical activity and associated health outcomes, the solution is not for everyone to drive,” Lowe says. “Supporting people to walk and cycle where possible and providing appropriate transport infrastructure is essential, freeing up space on public transport for those who really need it.”

Another priority brought to light by the effects of pandemic lockdowns is the need to re-model streets and public spaces to create more space to enable people-powered mobility and make cycling, walking, roller-blading and other means of active transport safe to pursue.

“Right around the world we are seeing cities widen footpaths, remove car parks, pedestrianise streets and improve bike lanes to cater for increased rates of walking and cycling, while allowing safe physical distancing,” Lowe says. She points out that liveable cities are climate resilient cities as the policies improve air quality and make climate mitigation actions possible, such as creating space for surface drainage solutions. Plan Melbourne identified the need for an integrated government approach to creating 20-minute neighbourhoods, one which encourages different government departments to work together. Potential benefits of local neighbourhoods identified in the plan include reduction in pollution and CO2 emissions, halving the transports costs of households, easing pressure on transport and enhancing a sense of community and social cohesion.

China Danish architects Dissing+Weitling created Xiamen’s Bicycle Skyway to enable safer and healthier city mobility

Strong leadership is key

Strong leadership was also key to making Denmark’s capital, Copenhagen, recognised as one of the world’s healthiest cities. Copenhagen became a WHO Healthy City in 1987. The UN’s Happiness Index report has ranked it as one of the happiest places to live in the world. According to one analysis using data from the World Bank, Copenhagen ranks second overall out of 146 European cities for quality of life, has a high quality of green space, the second largest proportion of people walking and cycling, the second lowest CO2 emissions and more than 10% of GDP spent on healthcare.

An incredible 62% of the city’s population walk or cycle and 41% cycle to work, partly because the city is designed for bicycles first, cars second. Promoting cycling has been key to improving the city’s environment and the health of its citizens. Cycling has increased by 15 to 20% since the city established separate bike lanes in the early 1980s. Car journeys have fallen over the same period.

“When we talk about the Copenhagen example, we talk about leadership, as they had strong leaders and they took a decision to make space for bicycles,” Pineo explains. In the early days, that was not popular—there are images of car drivers and cyclists having fights—it wasn’t a smooth ride. But by working to shift public opinion so people realised that cycling was more convenient, cheaper, and good for their health, attitudes changed.”

With people restricted from moving about cities and encouraged to work from home, providing local living destinations has never been more important

How Leicester is fighting diabetes

Some cities are identifying their population’s biggest health problems and working across boundaries to tackle them. Leicester, a small UK city of 340,000, has the highest prevalence of diabetes in the UK at 9% of the population. Its obesity rate is 55% and more than half of city dwellers take no exercise. In July 2020 Leicester made new poor health headlines when a renewed outbreak of covid-19 made it the first UK city to be put into lockdown for a second time.

In 2018 the city launched a coalition between doctors at the city’s diabetes centre (the biggest diabetes research centre in Europe), city authority planners, several elite sports clubs, the city’s Interfaith Council and Leicester university academics, as well as the local National Health Service clinical commissioning group. “We wanted to look at how we could tackle diabetes from beyond a medical point of view,” says Melanie Davies, professor of diabetes medicine at the university.

Leicester has joined the Cities Changing Diabetes (CCD) movement, a joint initiative launched by Novo Nordisk, a Danish pharmaceutical company, University College London, and the Stena Diabetes Center in Copenhagen. It aims to improve care for people with diabetes and prevent and reduce incidence of the disease in 26 cities worldwide.

Leicester city centre is now one of the largest conjoined pedestrian areas in the UK. The provision of a more segregated cycling infrastructure, with a central hub and spokes into residential areas, has helped the city promote walking and cycling to work. Within weeks of the covid-19 lockdown, the city authority was able to install emergency bike lanes for key workers.

Previous initiatives promoting activity and sport were well designed, but often not targeted at the right groups or geographical areas of the city, Davies adds. “Programmes were not joined up and the messaging was not always consistent. To some extent we were working in silos.”

The Leicester CCD programme has featured elite sports clubs launching walking cricket sessions targeted at over 50s and healthy goals activity sessions for all-female groups. Chefs in the city’s faith centres are receiving healthy eating education and council food hygiene experts are advising retailers on making fast food healthier. Local doctor practices are now directing patients who could benefit from exercise to a network of green gyms and sports courses.

“We are trying to show what effects we can have through a behaviour programme run by professional sports clubs and researchers and how we can upscale that to a wider population,” explains Deirdre Harrington, a lecturer in physical activity and sedentary behaviour at Leicester university.

The initiative has led to the creation of 31 outdoor green gyms in every ward of the city, giving people free access to a place to exercise, says Adam Clare, deputy mayor of Leicester City Council. “The people of Leicester are already reaping benefits, with participation in sport activities rising and the demographics of who is participating shifting, too,” he adds.

Cities will need to support the health of their populations in the aftermath of the pandemic as well as at the height of the crisis. Urban planners already have a number of tools for redrawing existing cities and designing new with the aim of combating both NCDs and climate change. •

TEXT Jo Waters — PHOTO Rasmus Hjortshøj, Miguel Sousarkje & Ma Weiwei


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