Healthy Placemaking

Wellbeing Through Urban Design

Fred London

• Publisher: RIBA Publishing
• Year: 2020
• ISBN:
  9781000765045
• Edition: 1
• Topic: Arquitectura
• Subtopic: Arquitectura general

In modern-day society the main threats to public health are now considered 'avoidable illnesses', which are often caused by a lack of exercise and physical activity. Research suggests that architectural and urban design strategies play an important role in reducing the amount of avoidable illnesses by enabling physical activity through healthier streets. Practitioners must now consider how they can encourage people to lead healthier lifestyles and improve health through urban design. This book presents the path to healthier cities through six core themes - urban planning, walkable communities, neighbourhood building blocks, movement networks, environmental integration and community empowerment. Each theme is presented with an overview of the issues, the solutions and how to apply them practically with exemplars and precedents. It's an essential text that provides practitioners across urban design, architecture, master planning with the necessary knowledge and guidance to understand their role in producing healthier places and put it in to practice.

CHAPTER 1
HUMAN NATURE AND HEALTH

‘Tackling pollution and promoting active travel through compact cities also creates the right environment for physical activity. In our sedentary societies, increased levels of physical activity have proven health benefits for adults and children, reducing a number of chronic and cardiovascular diseases.’ ¹

LAURENCE CARMICHAEL

This chapter describes how the combination of societal progress and medical expertise has given rise to new health challenges that result from the 21st-century lifestyles to which we have become accustomed and take for granted. It points to the inconsistency of our behaviour in terms of how we deal with health issues in our daily lives and the relationship between human health and the health of the planet.

WE HAVE COME A LONG WAY

As we enter a food store, full of extraordinary produce from all over the world that we can take home in our cars, do we give a thought as to how much more difficult that process was only a few generations back?

Life for Homo sapiens has undergone fundamental transformations, from hunting and gathering subsistence to today’s hi-tech lifestyles. Developments include the establishment of agriculture, the growth of large settlements and the expansion of trade over ever-increasing distances – typically accompanied by exploitation, conflict and war.

Many jobs were extremely dangerous in bygone eras, when neither health and safety nor reasonable working hours were considered relevant and, as a result, life expectancies were correspondingly shorter. What doctors could do to cure the sick and wounded in the past was limited compared to the extraordinary medical knowledge of today.

In 1800s Great Britain, increasingly sophisticated agrarian economies paved the way for the Industrial Revolution. Rapid migration from rural to urban environments ensued, giving rise to unprecedented challenges, such as overcrowded housing, slums and poor sanitation in towns and cities.

The scourge of cholera was one of the biggest health problems in London until its source was identified and analysed by physician John Snow in 1854; this led to the installation of clean water systems across the developed world.

The direction of urban planning was transformed by pioneering work in the 19th and 20th centuries that produced new systems and choices for mobility. Philanthropic movements recognised the extreme social problems resulting from exploitative labour practices, and the poor health suffered by those living in woefully unhygienic conditions. One response was to fund the provision of (generally) well-built urban housing. Another was to propose new kinds of settlement where people could live and work in greener, healthier environments.

In the early phases of such initiatives, these settlements were intended to be accessed by public transport, primarily trains and underground railways. In 1898, Ebenezer Howard established the Garden City Movement, which offered oppressed employees and their families a better chance in life. This, and the rise of suburbia, was made possible by growing rail transport networks. Almost a century later, in the 1970s, this concept still played a large part in the marketing of London’s Tube system, which invited residents to ‘Come to Ruislip, where the air is fine, it’s only half-an-hour on the Piccadilly Line’.²

As settlements grew, transport became of increasing importance – the rail network being only one development of many. In 1890s London and New York the authorities were also struggling to dispose of vast quantities of manure left by tens of thousands of carriage horses. One remedy was the ‘horseless carriage’ – the early automobile. This would become the dominant force in 20th-century urban planning.

In terms of medical advancement, by the mid-20th century the UK started to benefit from spectacular improvements in medicine, whereby many previously fatal conditions became curable, and healthcare became widely accessible thanks to the establishment of the NHS in 1948. Progress was also made with better housing conditions, availability of healthier food and a raft of social reforms, including health and safety at work, that improved people’s quality of life.

But since the latter part of the 20th century, along with a well-deserved sense of achievement for these magnificent medical advances, there is also growing awareness that the amount we consume, and the ease of the lives we lead, create health problems of a different complexion. Many of these are attributable to lifestyles that have arisen as a consequence of the way our cities are planned.

SOME PROBLEMS ARE NOT NEW

The introductory pages of the 1945 County of London Plan, under the heading ‘What is Wrong’ (written as a statement rather than as a question), announces in emotive terms: ‘The [London Plan] Report lists four defects: Traffic congestion, depressed housing, inadequacy and maldistribution of open spaces and, finally, the jumble of houses and industry. An additional fifth defect is the continued sprawl of London ribboning along the roads, straggling over the Home Counties and suburbanising the whole of the surrounding country towns.’³ The case is reinforced by the caption of an aerial view of a mixed-use neighbourhood describing it as the ‘muddled use of land’.

Prepared whilst WW2 was coming to an end, this fascinating document reflects Modernism’s hallmark optimism for a rational, scientific future. In that climate it is unsurprising that ‘the jumble of houses and industry’ and ‘muddled use of land’ would be regarded as one of the many ‘defects’ in need of rationalisation.

Subsequent experience has given us a more nuanced understanding of industry, separating out the uses that can be hazardous whilst allowing the integration of ‘people-friendly’ forms of employment whose proximity to residential areas contributes to what we would now regard as an entirely positive ‘jumble’ of uses.

This County of London Plan, that inspired mid 20th-century Modernism in architecture and urban planning in the UK, treated the car as an icon for the Machine Age. Speed was the attraction, and creating the conditions for the car to be used at speed was what preoccupied the planners. Anything that might get in the way of the speeding car was to be banished from the road: ‘Fast cars must be able to move fast and be segregated from lorries and buses… However perfect the roads themselves may be, if they are interrupted by crossings – or crossroads – they will not be able to fulfil their function.’⁴

This is a prescient description of what we have long-since called a motorway. Next to the heading: ‘The Problem of Speed is relatively new to the town planner; it dates from the advent of the motor car’ is a charming diagram showing that pedestrians move at 3 mph, horse-drawn carriages at 5 mph, bicycles at 8 mph and cars at 60 mph.⁵ The 60 mph remains accurate enough in terms of motorway driving but traffic in cities has always averaged circa 10 mph which reinforces the idea that cities may not be the ideal places for cars ‘to fulfil their function’.

To repeat the statement ‘What is Wrong’, three quarters of a century later, the most obvious ‘defect’ is that the innumerable benefits offered by the private car have become so ingrained in our habits and consciousness that it is hard to distinguish the circumstances under which they cease to be an asset and start to be a liability. The extracts quoted above show that certain problems were already a major cause for concern in the 1940s; a salutary reminder of how long society has been grappling, unsuccessfully, with this challenge.

In the same way that the 1940s catered to the icon of the automobile, it is of the utmost importance that planners and designers now work towards adapting existing places and creating new ones that allow people the best opportunity to ‘fulfil their function’ – of leading their lives in environments planned to maximise health and wellbeing.

ATTITUDES TO HEALTH

WHAT ARE AVOIDABLE ILLNESSES?

The experience of wellbeing, of feeling healthy, of enjoying good health, is of immense value – but is something too often regarded as normal, taken for granted until people feel unwell. Many illnesses and injuries, both minor and serious, arise from circumstances that could not have been prevented. But the ailments variously referred to by health professionals as ‘avoidable’ or ‘preventable illnesses’ or ‘noncommunicable diseases’ (NCDs) are those that often result from choices that people have made, or that the circumstances of their lives have dictated to them. Lifestyle choices on a personal level often lead to the illnesses that damage health, but there is a broader responsibility for planners and designers to shoulder some of this responsibility by making healthy alternatives available, and encouraging their use.

The most prevalent illnesses are cardiovascular diseases, type 2 diabetes, many cancers, respiratory illnesses and mental health problems. Research indicates that aspects of urban life can be a contributory factor to all of these illnesses. Added to this list are transport related accidents, for which being ‘avoidable’ has different connotations.

Many avoidable illnesses are associated with long-term sedentary lifestyles, so overcoming the ingrained habits that caused them can be a long-term undertaking, requiring determination and persistence.

Table 1.1 sets out the main health problems that people suffer from, their causes and how to address them, followed by explanations and supporting evidence to substantiate the claims:

TABLE 1.1 Main lifestyle related health problems, their causes and how to address them

MAIN HEALTH PROBLEMS	Cardiovascular disease, type 2 diabetes, and obesity; several forms of cancer (referred to as ‘avoidable illnesses’)		Respiratory diseases, including asthma	Mental illnesses	Transport related accidents
CAUSES	Sedentary lifestyles and lack of exercise	Poor diet and food poverty	Poor air quality	Loneliness, isolation, limited social interaction and fear of crime	Interaction of vehicles with cyclists and pedestrians
ADDRESSING THE CAUSES	Enable exercise in daily life	Provide education, accessible facilities and available green spaces	Limit the causes and effects of vehicular emissions	Community facilities and safe, sociable, productive environments	Good urban and transport design

1. ENABLE EXERCISE IN DAILY LIFE

Defining the situation in uncompromising terms, The Lancet’s September 2016 report ‘City Planning and population health: a global challenge’ states that: ‘In high-income countries, time in cars, television viewing, and other screen use account for up to 85% of adults’ non-occupational sitting time. Worldwide, sedentary behaviours are rapidly rising as LMIC [Low and Middle-income Countries] shift from agricultural to manufacturing and service economies with increased use of labour-saving devices and more motorised forms of transport.’⁶ This behavioural change could indicate a rapid increase in cases of the avoidable illnesses listed above, and put further pressure on already stretched health services.

The WHO’s ‘Global action plan on physical activity 2018–2030’ responds to the situation, stating that ‘Regular physical activity is proven to help prevent and treat noncommunicable diseases (NCDs) such as heart disease, stroke, diabetes and breast and colon cancer. It also helps to prevent hypertension, overweight and obesity and can improve mental health, quality of life and wellbeing.’⁷ This is a recurring theme that is well known to a significant percentage of the population but for whom taking concerted action to overcome it is nonetheless lacking.

2. PROVIDE EDUCATION, ACCESSIBLE FACILITIES AND AVAILABLE GREEN SPACES

The Food Foundation is an independent think-tank that tackles the growing challenges facing the UK’s food system in the interests of the UK public. Its recent analysis shows that the food environment makes it too difficult fo...