CITY KNOW-HOW
Cities are increasingly implicated in worrying human and planetary health trends that are of growing global concern. Unwittingly, the combined impact from many decisions by city leaders, planners, and developers determine aspects of urban behaviours and lifestyle that are accelerating many of the problems. It is imperative that human health and environmental impacts become core foci for urban policy around the world. A change of trajectory is urgently needed and this will require concerted action. Cities & Health aims to be part of that change; it is dedicated to supporting the flow of knowledge, in all directions, to help make this happen.
We want to support better communication between researchers, practitioners, policy-makers, communities, and decision-makers in cities. This is the primary purpose of the City Know-how section of the journal.
‘Research for city practice’ disseminates lessons research, allowing researchers to explain new knowledge and key messages arising from their studies for city leaders, communities, and the professions involved in city policy and practice. ‘City shorts’ provide glimpses of what is being attempted or achieved ‘on the ground’ and ’case studies’ are where you will find evaluations of interventions. Lastly, ‘Commentary and debate’ extends the conversations we have in order to develop and mobilize important and innovative thinking. We invite you to join these conversations.
In order to strengthen communities of interest, we would like to include many and varied voices, including those from practitioners, politicians and policy-makers and researchers who are supporting health and health equity in everyday urban lives. Whether you are a just starting out on your journey, or an old hand, we would love to hear from you!
Marcus Grant
Editor-in-Chief, Cities & Health
Lindsay McCunn
Commissioning Editor, Cities & Health
We conclude Cities & Health volume four with an issue that contains a variety of articles to support human and planetary health through rational, inspired, and equitable city governance, policy, and practice. This selection of research and commentary will be of interest to those pursuing the path of making urban environments healthier for people and the planet. We hope that urbanists of all kinds, including policy-makers and funders, will find insight in these articles.
In the issue, we offer three shorter articles, followed by five empirical research papers. Each research paper has its own ’research for city practice’ briefing in this City Know-how section. These are short briefings aimed at informing and educating practitioners and policymakers as they augment their work ‘on the ground.’ We hope that public health and built environment professionals and policymakers will also find these digests useful because they cover a range of issues: form a cross-cultural study of health and wellbeing in adults across six cities in three continents (Europe, Africa, and South East Asia) to the details of architectural design and risk factors for the spread of tuberculosis in Mumbai, India. We also include an interesting participative study examining the ways in which built environment practitioners and researchers perceive and rank the skills required for implementation of liveable cities. As with all our City Know-hows, we ask the authors to identify who needs to know about these findings, what they should do differently or what actions they might take.
In addition, two methodological studies are reported on: one utilizes comparative methods to study walking environments in Madrid and in Philadelphia; the other develops a potential neighbourhood-level health impact scoring tool to support local assessments as decision-makers set city-wide priorities concerning resident health and wellbeing.
The three shorter articles comprise a case study, a commentary, and a book review. The case study is based on deprived metropolitan neighbourhoods in Germany and in the United Kingdom. With a comparative stance, it investigates the level of regeneration improvements and the potential for becoming a healthier neighbourhood by tracing the process of urban regeneration and assessing policies influencing health that can be tackled by urban planning. Results show that urban regeneration should provide different types of housing to support social mixing, enable increases in population to support local facilities, offer access to quality open spaces, as well as various mobility options. The commentary presents a robust call to engage and consider the role of gentrification in public health research. Finally, Hugh Barton reviews a new book ‘Healthy place-making: well-being through urban design’ by Fred London.
Taken together, the pieces selected for this issue highlight rich and varied accounts of key urban issues around the world. They also afford evidence-based considerations about new tools, ideas, and applications that align with current planning practices and policies to move toward better health and wellbeing. We hope the collection inspires you to collaborate, explore, and act to make cities healthier places to be.
Comparing worldwide health and wellbeing across six cities in three continents
The problem: Much of the current public health and environmental psychology research regarding health and wellbeing is geographically restrained and unable to make direct cross-cultural comparisons between populations.
What we did: We attempted to apply a standardised framework of analysis in order to compare health and wellbeing metrics between adults in Europe, Africa, and South East Asia in order to understand any health and wellbeing differences between geographically, socially and economically diverse cities.
What our study adds: This study indicates regional differences in subjective stress and wellbeing and the impact that both green and public spaces may have on these metrics. It adds a direct cross-cultural examination previously somewhat lacking in the literature.
Implications for city policy and practice: This research addresses the impact of different types of urban space on health and wellbeing across various global cities, as well as understanding specific local issues that may mediate these effects.
Full research article: Comparing health, stress, wellbeing, and greenspace across six cities in three continents
Authors: Chris Neale, Mònica Coll Besa, Sarah Dickin, Vanessa Hongsathavij, Piret Kuldna, Cassilde Muhoza (@https://cassildemuhoza), Pin Pravalprukskul, & Steve Cinderby (@https://s_cinderby_SEI)
City Know-how editors: Marcus Grant and Lindsay McCunn
Bad architecture and poor planning are risk factors for tuberculosis
The problem: A concentration of tuberculosis patients reside in resettlement colonies in M-East ward, Mumbai – many buildings have poor ventilation and daylighting.
What we did: We undertook a household survey and calculated sunlight and ventilation parameters in three resettlement colonies using computation models. We found an association between burden of tuberculosis and poor ventilation and poor sunlight parameters. We also reviewed guidelines for building resettlement colonies in Mumbai. We did this to demonstrate that poor policies, and their execution, may lead to preventable public health disasters like tuberculosis.
What our study adds: Our study suggests that design changes need to be made to make the colonies better places for tuberculosis patients to heal, and to prevent the further spread of infection to family members and neighbours.
Wider implications for city policy and practice: This study supports a demand for changes in policies for the building of resettlement colonies in Mumbai to reduce tuberculosis and support patients healing at home. It also has international implications where similar living situations are created by neglectful architecture and planning. In terms of health equity, we ask that policymakers treat the poor and underprivileged in a similar manner as the affluent in terms of preparing guidelines and policies for the construction of housing colonies. Our paper outlines some of the modifications to building design and practice that may be required.
Full research article: Association between architectural parameters and burden of tuberculosis in three resettlement colonies of M-East Ward, Mumbai, India
Authors: Peehu Pardeshi (@https://peehu1988), Balaram Jadhav, Ravikant Singh, Namrata Kapoor, Ronita Bardhan, Arnab Jana, Siddarth David, Nobhojit Roy
City Know-how editors: Marcus Grant and Lindsay McCunn
Developing livable cities: do we have what it takes?
The problem: One of the most popular and intuitive ways to capture quality of life in cities is by evaluating ‘liveability’. But how exactly do the built environment practitioners and researchers perceive and rank the skills required for implementation.
What we did: Participants were asked to provide a list of the skills they found most important to the development of liveable cities. Responses were synthesized into broad categories, and respondents were asked to select up to five categories that they felt were most important. Results were compared to the competency requirements for program accreditation in the fields of Public Health, Urban Planning, Architecture, Landscape Architecture, and Parks and Recreation Administration. We then connected skills ranked from top to bottom by frequency of reference by practitioners to those ranked by frequency of reference by researchers, exposing the differences.
What our study adds: We provide a first look at what skills are most important for liveable city development, plus:
A transdisciplinary perspective on how these skills are currently being taught and can be taught, and
New insights on how these translate to workforce development and team-building.
Implications for city policy and practice: It is vital to:
Keep teaching ‘soft skills’ like communication, collaboration, and community engagement and find more effective new ways to teach them.
Use workforce development to close gaps between researchers and practitioners and boost currently under-taught skills.
Consider team processes and composition when forming teams, knowing which skills each discipline brings to the table.
More information about our work at: The Developing Livable Cities initiative at the Prevention Research Center in St. Louis.
Full research article: Developing livable cities: Do we have what it takes?
Authors: Samuel Yang, Amy Eyler, Ross Brownson, Linda Samuels, Grace Kyung, Rodrigo Reis
City Know-how editors: Marcus Grant and Lindsay McCunn
Comparing walking environment in Madrid and Philadelphia using multiple sampling methods
The problem: Urban health studies usually focus on the differences between neighbourhoods in the same city; however, that approach lacks any assessment of the overarching forces affecting the city as a whole.
What we did: We compared differences in the walking environment between Madrid and Philadelphia. We used an audit tool called M-SPACES that measures:
Function (physical attributes of the street, such as the type and quality of the walking surface),
Safety (both safety for crime and traffic safety),
Aesthetics (visible features that make streets and neighbourhoods pleasant to walk), and
Destinations (community and commercial facilities in neighbourhoods, including local parks, public transportation, services, and shop).
What our study adds: We found that Philadelphia’s streets had higher scores for function (physical attributes that supported walking) and safety, while Madrid streets had greater a greater proportion of streets having at least one walking destinations. These results are key to understand which elements of the built environment could be key to uncover mass influences that operate at the city level.
Implications for city policy and practice: In order to understand which urban characteristics impact on physical activity and health, we need to understand what characterize our cities as a whole. In our study, Madrid is characterized by a higher proportion of daily walking destinations, while the streets of Philadelphia have better physical infrastructure for walking in the street.
Full research article: Walking the cities: A comparative case study for street audits in Madrid and Philadelphia using multiple sampling methods
Authors: Pedro Gullón (@https://pgullon), Usama Bilal (@https://usama_bilal), Patricia Sánchez, Julia Díez (@https://JuliaDiez91), Gina S. Lovasi, and Manuel Franco (@https://mfranco_uah)
City Know-how editors: Marcus Grant and Lindsay McCunn
A new tool for understanding neighbourhood-level drivers that impact health
The problem: The use of health impact assessments is rapidly growing and can benefit from the integration of a wide variety of available data sources, however this is a challenge.
What we did: Our work presents a method of integrating several different sources of health impact data to create a single score of potential health impacts for different areas. Putting different data sources into common units of measure using a standardization technique we then take into consideration the strength of available evidence, input from community stakeholders, and other sources of data, to weight the diverse range of variables. Finally, we combine these weighted quantities of impact into a combined health impact score, providing a relative score for a given location.
What our study adds: This study adds a tool that decision-makers, planners, and health impact assessment practitioners can use to better understand the drivers that are impacting the health of their neighbourhoods.
Implications for city policy and practice: Practitioners seeking to better understand the sources of potential health impacts, either when using a health impact assessment or some other approach to integrate multiple sources of data into the decision-making or planning process, could benefit from using this method/tool. The tool can be used to inform plans for healthy development, health impact assessments, and can provide a health-oriented evidence-base for decision-makers to consider when deliberating and setting priorities.
Links to other resources and support: https://sophia.wildapricot.org/or https://www.pewtrusts.org/en/projects/health-impact-project
Full research article: A neighbourhood-level potential health impact scoring tool to support local-level health impact assessments
Authors: John D. Prochaska (@https://DrJohnProchaska), Robert N. Buschmann, and Daniel Jupiter.
City Know-how editors: Marcus Grant and Lindsay McCunn
Research for City Practice Notes on Contributors
Dr Ronita Bardhan is an Urban Science Engineer who holds a PhD in Urban Engineering from the University of Tokyo. She was previously associated with Stanford University as a Visiting Professor. She has also been an Assistant Professor at the Center for Urban Science and Engineering, IIT Bombay, India. Currently, she is a University Lecturer of Sustainable Built Environment at the University of Cambridge, United Kingdom. She works on the niche sector of habitat design, energy decisions, and gender equality for low-income housing in Global South, especially in the slum rehabilitation housing of Mumbai. Her research informs demand-side design solutions which positively affects energy security, gender equality, and wellbeing while entailing fewer environmental risks.
Mònica Coll Besa works on the social aspects of climate adaptation, particularly working at the science-policy-practice interface addressing complex environmental issues, mainly in developing countries. Her experience includes the use of climate information for decision-making including the development and application of decision support tools and processes, capacity building and communication for adaptation planning, analysis of socio-ecological processes (e.g. including ecosystem-based and community-based adaptation), social learning, and stakeholder engagement.
Usama Bilal is Assistant Professor in the Urban Health Collaborative and the Department of Epidemiology & Biostatistics at Drexel’s Dornsife School of Public Health. His primary research interest is the macrosocial determinants of health, specifically nutrition-related conditions, and their upstream causes. Most of his work focuses on the role that city- and neighbourhood-level dynamics have in generating disease, and the use of complexity methodologies to study the emergent properties of urban environments. He has earned degrees from the Johns Hopkins Bloomberg School of Public Health (PhD), Universidad de Alcala (MPH) and Universidad de Oviedo (MD).
Dr Ross Brownson is the Lipstein Distinguished Professor of Public Health at Washington University in St. Louis. He studies the translation of evidence to public health practice and policy, with a content focus on environmental and policy determinants of chronic diseases. Dr Brownson is the author of 15 books and over 550 peer-reviewed articles. He has received numerous awards for his work. Among these, he is the recipient of the American Public Health Association’s (APHA) Abraham Lilienfeld Award for excellence in teaching and mentoring (2003) and the APHA Award for Excellence (2016).
Robert N. Buschmann obtained his Ph.D. in Population Health Sciences from the University of Texas Medical Branch. His post-doctoral training was in community-based research in the Community-University Partnership for the Study of Children, Youth, and Families (CUP) at the University of Alberta in Edmonton, Alberta. He iscurrently a research associate at CUP, focusing on improving early learning and care with a 30-year initiative to end poverty in Edmonton. Previous to his current position, he worked in community-based health research and public policy analysis and research. His research interests include early learning and care, childhood adversity, and social determinants of health.
Steve Cinderby is a Senior Researcher at the SEI centre in the University of York specialising in community resilience, wellbeing and participatory research methods. He has specialised in the development of communication approaches for improved environmental decision-making outcomes. These have been aimed at increasing knowledge sharing, improving the capacity for pro-environmental behavioural change, and boosting local community resilience and wellbeing.
Siddarth David holds a Bachelor’s degree in Lifesciences. He also has a Master’s Degree in Disaster Management from Jamsetji Tata School of Disaster Studies. Tata Institute of Social Sciences, Mumbai, India. He has been associated with the NGO Doctors For You as a senior research officer and has contributed profusely in developing the current research project. Currently, he is pursuing PhD at Karolinska Institute, Stockholm, Sweden. His research interests include Public health response in emergency and disasters, access to health services, trauma care, and bioethics.
Sarah Dickin is a health geographer working on topics at the intersection of environment, development, and human wellbeing. She has an inter-disciplinary background, holding a Ph.D. in Geography and a B.Sc. in Environmental Science and Biochemistry from McMaster University, Canada. As aResearch Fellow at the Stockholm Environment Institute (SEI), Sarah co-leads an initiative on sustainable sanitation that comprises research, policy engagement, and capacity development focused on improving understanding and uptake of sustainable sanitation, including environmental, institutional, social dimensions.
Julia Díez works in the Public Health and Epidemiology research group at the Universidad de Alcalá. Her research interests focus on the determinants of dietary behaviours, obesity, and cardiovascular diseases. Specifically, she analyses access to both healthy and unhealthy foods in the city of Madrid, and their associations with residents’ dietary patterns and cardiovascular risk. Other research interests include using participatory research methods as part of population health intervention research. As such, she is interested in engaging residents and other stakeholders in exploring how social features of the local food environment affect food purchasing habits and dietary patterns.
Dr Amy Eyler is an Associate Professor of Public Health in the Brown School at Washington University in St. Louis and the Deputy Director of the Prevention Research Center in St. Louis. Her research focus is physical activity policy and chronic disease prevention.
Manuel Franco, Social Epidemiologist, associate faculty at the University of Alcalá and adjunct faculty at the Johns Hopkins Bloomberg School of Public Health. Principal Investigator of the Heart Healthy Hoods (http://www.hhhproject.eu) studying urban characteristics in relation to eating patterns, physical activity levels, smoking and alcohol consumption. His work focuses on the social epidemiology and prevention of chronic diseases and their major risk factors. His methodological interests include the measurement of physical and social urban characteristics related to chronic diseases, the use of mixed methods, and the conduction of participatory action research methods.
Pedro Gullón MD, Ph.D., is a Postdoctoral Research at Universidad de Alcalá (Spain). He completed his doctoralprogram in Epidemiology and Public Health at the University of Alcalá where he wrote his dissertation on theintegration of different measures of walkability in the city of Madrid. His research interests are neighbourhood walkability, the role of neighbourhood dynamics on urban health inequities and the use of mixed methods.
Vanessa Hongsathavij is an independent research consultant, writer, and Ph.D. researcher at the Institute of Human Rights and Peace Studies at Mahidol University. Vanessa focuses on policy-oriented research, particularly on examining how environmental human rights are implemented and practised on the ground. With diverse experiences in Southeast Asia, Vanessa has worked as a Research Associate at RECOFTC – The Center for People and Forests, as a Research and Communications Assistant at the SEI Asia – Stockholm Environment Institute, and a Fulbright research scholar in Lao PDR.
Dr Balaram Jadhav has done his Bachelors in Ayurveda and also holds a Masters Degree in Public Health. He has been associated with the NGO Doctors For You as a Senior Research Officer for over 3 years and played an important part in developing the proposal for the current study. He is currently a consultant to UNICEF, India. His areas of interest are Public health response in disasters, Public Health system strengthening, Maternal and Child Health and health research.
Dr Arnab Jana is an Architect and holds a Masters Degree in Urban Engineering from IIT Kharagpur, India. He also holds a PhD in Urban Engineering from the University of Tokyo. He is currently an Assistant Professor at Center for Urban Science Engineering, IIT Bombay, India. His research interests include Infrastructure planning and location-allocation modelling, Application of ICT in urban and regional planning, Urban policy assessment, Econometric and behavioural modelling, and access of vulnerable communities to health care services.
Daniel C. Jupiter obtained his Ph.D. in Mathematics from the University of Michigan. His post-doctoral trainingpositions were in pure mathematics at Texas A&M University and bioinformatics at the Texas A&M HealthScience Center. More recently, he was a Research Scientist and Assistant Professor in the Surgery Department at Scott & White Memorial Hospital and Texas A&M Health Science Center College of Medicine. He has been anAssistant/Associate Professor in Preventive Medicine and Community Health at the University of Texas MedicalBranch since 2014. His research interests include lower extremity complications of diabetes, and, more recently, geographic variation in healthcare.
Namrata Kapoor is an Architect and Urban Planner who has completed her Masters’ degrees from the University of California, Berkeley. Namrata has previously worked as a consultant for various governments, think tanks, NGOs, and planning organisations. She has worked on the Mumbai Development Plan 2034 for the Mumbai Municipality, World Bank funded City Plan for the Hubli Dharwad and other similar projects. She is currently employed at Indian Institute of Human Settlements, Bangalore, India where she teaches ‘Affordable Housing Policy and Practice’. Her current research looks at the effect of land price movements on the production and consumption of housing in Indian cities and its relationship to city planning practices and urban impoverishment.
Piret Kuldna is Senior Expert of the Sustainable Development programme of SEI Tallinn Centre. She holds MSc in Environmental Policy and Sciences from Central European University, Budapest, and BSc in Biology from the University of Tartu, Estonia. Piret’s research focuses on urban sustainability, environmental policy and governance, impact assessments, nature-based solutions, knowledge brokerage, access to environmental information and public participation in decision-making
Grace Kyung is a Project Manager with Urban Strategies, Inc. Grace works as a catalyst in changing the way we plan for communities by applying a health and racial equity lens to equitable development. To do this in a just way, she works alongside communities to recognize historical circumstances and the current conditions necessary to achieve equity. Grace has a Master in Public Health and a Master in Urban and Regional Planning from the University of Illinois Urbana-Champaign.
Gina S. Lovasi, PhD, MPH is Dornsife Associate Professor of Urban Health and Co-Director of the Urban Health Collaborative at Drexel University Dornsife School of Public Health. She has published more than 100 articles in peer-reviewed journals and had the opportunity to give invited presentations on four continents. Though trained in epidemiology, she works in multidisciplinary teams to incorporate GIS data into a range of health-related research projects. In addition, she serves as an associate editor for the American Journal of Epidemiology and on the executive board for the International Society of Urban Health.
Cassilde Muhoza is a Research Associate, under the Sustainable Urbanisation Programme at SEI Africa. Her interest is in sustainable urban planning, urban green spaces, urban air pollution, urban mobility, urban water management, and off-grid electrification. She has 5 years of experience working on sustainable urbanisation, biodiversity conservation, sustainable urban mobility, urban air pollution, off-grid electrification, and integration of environmental issues (biodiversity, energy, and climate change) into urban planning policies and strategies.
Chris Neale is a researcher at the University of Virginia interested in understanding how urban and rural environments can impact health and wellbeing in a range of participants, but with particular interest in older adults. His background is in cognitive neuroscience, and he continues to use various neuroimaging methods to assess brain activity in research populations.
Dr Peehu Pardeshi holds a PhD in Biosciences and Bioengineering from IIT Bombay, India. She had been involved in public health research and service-delivery projects at the NGO Doctors For You in Mumbai, Maharashtra, India for over 2 years. Currently, she is working as an Assistant Professor at the Jamsetji Tata School of Disaster Studies, Tata Institute of Social Sciences, Mumbai, India. She is passionate about understanding the problems faced by vulnerable communities in accessing health care services and using the finding for policy advocacy.
Pin Pravalprukskul’s work focuses on agriculture, natural resource management, and rural livelihoods. Pin holds a B.A. in Environmental Studies from Wellesley College and an M.S. in Sustainable Development in Agriculture from the University of Copenhagen and Montpellier SupAgro. Her thesis assessed the climate change mitigation potential of agroforestry farms in the Kenyan Central Highlands. Pin’s interests include smallholder agriculture, climate change, gender and social inequality, sustainable consumption and science communication.
John D. Prochaska, DrPH, MPH, is an Assistant Professor in the Department of Preventive Medicine & Community Health at the University of Texas Medical Branch (UTMB). His primary research interests lie in understanding the interactions of multiple determinants of health and health disparities in vulnerable populations and communities. Previously, Dr Prochaska worked in the UTMB Center to Eliminate Health Disparities focusing on the impacts of natural disasters on community and neighbourhood-level social and environmental determinants of health. Dr Prochaska received his doctorate and masters degrees in public health from the Texas A&M University System Health Science Center in College Station, Texas.
Dr Rodrigo Reis is a Professor of public health and chair of the urban design and public health MPH specialization at Washington University in St Louis, and Associate Professor at the Urban Management Graduate Program at the Pontifical Catholic University of Parana in Curitiba, Brazil. His research focuses on built environment, active transportation, quality of life, and public health. His policy and research experience includes large built environment and community-based projects and policies in Latin America and the United States.
Dr Nobhojit Roy is a trained medical professional with a Master’s in Public Health from John Hopkins University, USA and a PhD in Public Health Sciences from Karolinska Institute, Stockholm, Sweden. He had been a Professor and Head of Department of Surgery at Bhabha Atomic Research Center Hospital, Mumbai, India for over 20 years, after which he took up a role of advisor at National Health Systems Resource Centre (NHSRC), Ministry of Health & Family Welfare, Govt of India. Currently, he is affiliated with Care India in the role of Team Leader for System Strengthening. He has also continued his affiliation with Karolinska Institute for pursuing research activities. His research interests include global surgery, trauma, surgical outcomes, and Public health.
Dr Linda Samuels is an Associate professor of urban design at Washington University in St. Louis where she teaches infrastructural urbanism studios and seminars on urban theory and sustainability. Dr Samuels was co-PI on a 2017–18 Mellon Humanities Divided Cities grant, Mobility For All By All, which aimed to increase the social and environmental benefits of St. Louis’ proposed Metrolink expansion. Her publications include ‘Top/Up Urbanism’ (2017) in Amplified Urbanism, ‘Stitches and Insertions’ in Cuff and Sherman’s Fast-Forward Urbanism (2011), and ‘Working Public Architecture’ (2010) in Places journal. She is currently writing a book with Routledge Press entitled Infrastructural Optimism.
Patricia Sánchez is currently working in the Microbiology research group at the Ramón y Cajal University Hospital and finishing her degree in Health Biology at the University of Alcalá. Since 2018 she has collaborated with the Public Health and Epidemiology research group at the same university. Her interests focus on the amount of risk factors related to cardiovascular diseases, specifically stress, and obesity.
Dr Ravikant Singh holds an MD in Preventive and Social Medicine. He is one of the founding members of the NGO Doctors For You and has been managing it for the past 12 years. He is passionate about bringing health care services to socio-economically weaker sections of the society at a cheaper price and in a convenient manner. He has been active in the implementation of preventive and curative public health measures in various underdeveloped regions in India as well as in neighbouring countries.
Samuel Yang was a Masters Research Fellow with the Developing Livable Cities project. He graduated from Washington University in St. Louis with his Master of Public Health, specializing in urban design, and is a member of the class of 2022 at Harvard Law School. He has an undergraduate degree from the University of Alabama.