Urban Design and Human Flourishing

Creating Places that Enable People to Live Healthy and Fulfilling Lives

Tim G. Townshend

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000374933
• Edition: 1
• Topic: Architecture
• Subtopic: Urban Planning & Landscaping

The built environment influences health and well-being in a myriad of ways. Some neighbourhoods are plagued by busy roads that are a constant source of danger, noise, and air pollution. In some cities there is inadequate green space for children to play and socialise safely. Yet, this book argues, it does not have to be this way. With focus on human health, well-being, and flourishing, this book explores the ways in which people's lives are impacted by the built environment and how we can create, adapt, and design healthy and inclusive places.

The volume explores the relationship between urban design and human flourishing and initiates broad discussions around relevant questions such as 'What is a healthy place?', 'What influences our perceptions of built environment more? Is it our age or our cultural background?'. The book includes six chapters from internationally renowned authors who attempt to unpack some of the key aspects that urban designers need to consider in order to create places that enable – rather than constrain – individuals and communities to live rich fulfilling lives.

This book will be of great value to students, scholars, and researchers interested in urban design, planning, and in exploring how built environment impacts health and happiness.

The chapters in this book were originally published as a special issue of the Journal of Urban Design.

What is a healthy place? Models for cities and neighbourhoods

Ann Forsyth

Abstract

What is a healthy place? Focusing on the scale of the neighbourhood and city, this paper outlines six overlapping types of environments that chart the range of current thinking: healthy built environments, collaborative healthy cities, age-friendly/all-age communities, child-friendly communities, healthcare industrial cities, and smart health environments. The first three are based on a public health perspective and the fourth on child development concepts, with a comprehensive view. The last two deal mainly with the economy, personal information, and behaviour. If combined with the others, however, they might increase public interest and aid health monitoring and evaluation.

Introduction: approaches to building healthy places

Many planners and urban designers are interested in designing healthier neighbourhoods, districts, and cities but wonder how to do so. The answer depends on how they define health and how comprehensive the approach needs to be. This paper proposes three categories of healthy cities and neighbourhoods divided into six specific types. They are conceptually distinct and chart the range of what is being proposed in urban design, planning, and urban development as a healthy place. They include basic healthy place types, specifically healthy built environments and collaborative healthy cities; population-based lenses, chiefly age-friendly/all-age communities and child-friendly communities; and technology-focused places, both healthcare industrial cities and smart health environments.

These models have different histories and emphases. They range from more comprehensive approaches that focus on working to change communities physically, programmatically, and institutionally to those emphasizing individual behaviour and economic activity. Readers of the Journal of Urban Design are likely most familiar with the first type, healthy built environments. Governments and developers may ask them to design the fifth type, healthcare facilities and health related industrial areas, branding this as a health campus or park. They may be intrigued by the last type, smart health environments. However, understanding the entire landscape of approaches highlights how urban designers can interact with community-level health promotion programmes. These enlist multiple disciplines, diverse organizations and agencies, and the wider public in a holistic approach.

Currently, this range of alternatives is not easily identified, as they are dealt with in different literatures and championed by diverse disciplines. This paper fills that gap, if in a preliminary way. The paper first examines key challenges in studying multi-dimensional approaches to healthy places, explaining how the types were identified. It then introduces the six types and outlines them in terms of basic ideas, methods, and examples. It concludes that the first four types, while potentially very comprehensive, are often only partially implemented, leading to underwhelming results. In contrast, the health technology types may have only modest health benefits in themselves, creating a healthy economy, monitoring unhealthy behaviour, or treating illness after it occurs, however they can generate excitement. If melded with the other types they might increase interest in the more comprehensive models.

Charting the types’ origins

The six types of healthy neighbourhoods and cities come from different but overlapping traditions (Table 1). The first three types draw on a range of sources including the nineteenth and early twentieth century public health and garden cities movements that promoted a role for governments in creating healthier places via infrastructure, community design, and local programmes. Their immediate antecedents, however, were a set of debates starting in the 1970s focused on the wider social determinants of health and the ability to influence health at a population level through policies and programmes outside of healthcare delivery (Hancock and Duhl 1986; Hancock 1993). Advocates of health promotion pointed out that genetics and other biological features, such as age and gender, are key in health. However, other dimensions also play a role including: behaviour; social circumstances such as education and income; and the physical and social environment from toxic products and workplace safety to road accidents (McGinnis, Williams-Russo, and Knickman 2002; Davies et al. 2014). While physical places may have a minor direct influence on health, they are also the settings in which behavioural choices are made, enlarging their influence. The fourth type, the child-friendly city, draws more strongly on work in child development and child rights but shares a focus on human development and well-being (van Vleit and Karsten 2015). The types can be combined; for example, in Europe members of the European Healthy Cities Network have adopted age-friendly strategies (Green 2013).

Table 1. The six types of healthy places.

Category: Basic healthy places	Idea: Develop a physical and/or institutional structure supportive of health
Types:	Key fields: public health, urban planning, urban design, sustainability
Healthy built environments	Methods:
Healthy communities	• Evidence-based guidance
collaborations	• Processes to combine local, expert, and research knowledge e.g. health impact assessment
	• Ongoing collaboration among sectors
	• Affordable housing/service options
Category: Population-based lenses	Idea: Focus on population groups with health vulnerabilities and wide relevance
Types:	Key fields: public health, gerontology, education, child development
Age-friendly/All-age communities	Methods:
Child friendly communities	• Neighbourhood physical structures that focus on the young and/or the old
	• Mechanisms to engage people in relevant decision making
	• Programming for child development and ageing, e.g., education, exercise
	• Multiple affordable housing/service options
Category: Health technology cities	Idea: Harness innovative technology to create a healthy economy and/or assist in heath monitoring and promotion
Types:	Key fields: healthcare, technology, business
Healthcare industrial cities	Methods:
Smart health environments	• Economic development strategies e.g., science cities, anchor institutions, innovation cluster development
	• Monitoring and assistive technologies

While small scale versions of these types can be created by one organization, at the scale of the neighbourhood or city they need collaborations among different groups and organizations (RTPI 2009; APA 2017). These types also share a commitment to health equity – defined as paying attention to the needs of the most vulnerable including the young, old, those with low incomes, with pre-existing health problems, or otherwise marginalized in society (WHO 2018).

The health technology city types come from different origins. The healthcare industrial city uses healthcare and related industries – such as research or manufacturing–to generate economic development. It creates a healthy city via a healthy economy based on healthcare. The smart health environment focuses on the health of the individual, fostered using monitoring, treatment, and technology-aided assistance. Neither necessarily takes a comprehensive view of health promotion in the sense of looking at multiple health issues, health determinants, and vulnerable populations. They may merely provide healthcare jobs, measure bad health, and suggest individual-level solutions. However, they have stimulated interest among the public, professions, governments, and businesses. They could be enriched with ideas from the other types to make them into robust versions of healthy places.

Methods

A work of conceptualization, the paper draws on a review of research and practice in the area of healthy environments. Creating this typology involved defining key dimensions of healthy city and neighbourhood proposals and then synthesizing the diverse research and practice literatures.

Defining healthy environments

A key issue is defining the healthy neighbourhood or city. The answer varies with the populations served; the health issues of greatest concern; the values or theories of the proponents of the healthy place; and the wider social, cultural, economic, and political context. Identifying types of healthy places logically involves grappling with at least six key issues, examined below – healthy populations, health-promoting features, comprehensiveness, time, human versus environmental health, and the need to do more than change or develop a physical space.

One way to judge a healthy place might be to look for places where the healthiest people live. This requires agreement on the definition of health – whether a narrower definition of physical health; a broader World Health Organization-style definition of physical, mental, and social well-being; or a still broader sense of satisfaction with health and quality of life. Certainly, it is possible to find specific places with larger numbers of healthy residents and workers. For example, Blue Zones are areas where people live longer (bluezones.com). But such better health may well be explained by education, income, policies, social support, health behaviours, or other features unrelated to planning and design. Even if such a place has been developed or promoted as a healthy city, and houses those with measurably better health, the reason for better health may be self-selection as those wanting a healthy lifestyle, or predisposed in other ways to be healthy, move somewhere they imagine will support them. This dimension is thus a complex one.

Alternatively one might propose that a healthy city is a place that has features thought to be health promoting such as trails or well-baby clinics. However, some dimensions, such as mixed use, might be helpful for one population, such as adult workers wanting to walk to do errands, but problematic for others, such as older people worried about being jostled on busy footpaths (Forsyth, Salomon, and Smead 2017). This particular issue can be managed through planning and design, but points to the ne...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Citation Information
• Notes on Contributors
• Introduction: Urban design and human flourishing
• 1 What is a healthy place? Models for cities and neighbourhoods
• 2 Validating a comprehensive plan scoring system for healthy community design in League City, Texas
• 3 The effects of New Urbanism on public health
• 4 Suburban shopping malls as spaces for community health and human flourishing: an Aotearoa New Zealand case study
• 5 Challenging the visual: learning from the mobility narratives of visually impaired persons
• 6 Well-being age and space
• Index