Transforming cities and health: policy, action, and meaning

Figures & data

Figure 1. The Health map (Barton and Grant 2006).

Figure 2. Cities and urban health at the heart of the SDGs.

Table 1. Digital, technological and energy innovations.

Informational technology, communications and intelligence Artificial Intelligence as fundamental advanced support within all products, services and government. 5 G data networks become the fundamental underpinning of all communication processes and the basis of Industry 4.0 smart manufacturing. Drones (on ground, under water and in the air) are brought into wide usage for moving appropriate goods, as sensors and as health and safety monitors and actors. Policies for drone ‘operational space’ are in place as part of mobility strategies. Computer vision returns and advances beyond Google glass and is associated with wearable computing and embedded chips. Virtual reality becomes extended reality and influences healthcare to real estate and environment to navigation systems Public health and health care Digital health comes of age with home-based and body worn technologies going well beyond fitness and allowing remote health monitoring and supervision for vulnerable populations and people with chronic conditions. Personalized and predictive medicine and treatment plans become mainstream Anticipation and preparedness for new forms of disease and pandemics (including risk of multi-resistant germs) are normalised across the globe Transport energy and construction Autonomous driving systems influence all mobility, including public and private mobility, agricultural vehicles, construction, large scale manufacturing. Innovations in integrated and free public transport, alongside other modes including cycling and walking plus the expansion of electric vehicles becomes the norm. All vehicles become electric with different sources – batteries and hydrogen fuel cells. Other mobility innovations continue including bio fuels. By 2023 VTOL air vehicles including taxis, ambulances etc in operation in US, Australia, Singapore, Dubai and UK. Energy storage systems supporting decentralised production of renewable energy become more mainstream. Smart building, off site fabrication and manufacture, robotic building operations become mainstream and expand to scale. Nature and food Food demands, supply and distribution and changing diets place new demands on agriculture, fishing and the associated retail and delivery systems. Tree planting, mini-forests (see Akira Miyawaki Guardian 2020), sea grasses and rewilding at scale become more common place and absorb carbon to counter other processes affecting climate change. (World Economic Forum 2018, ESPAS Europa.eu, TfL 2018 private communication, McKinsey pers. comm.)

Table 2. Innovations in urban and health futures.

Experimental projects with evaluations built in on VTOL ambulances and taxis, autonomous vehicles

Urban planning and design

Urbanisation continues to be dominant location for global population

Cities while increasing in size are also stratified

Urban planning and design becomes a crucial task for liveability and urban health

Densification is balanced with liveability both inside and outside residential and work places

Rethinking of land use categories with particular emphasis on retail, offices and mixed development

Circular thinking becomes the basis of the future economy of the city

Increase in engagement of citizens in city futures and decision-making

Health and social aspects

Reductions in inequality and health inequity

Health and well-being goals spreading in non-medical policy areas

Public space needs to be expanded as crucial to liveability

Nature, water, trees and sense of seasons becomes part of urban life

Expansion of social care and greater degree of connectivity with health care

Increasing pressure on delivering equitable access to health-related services

Use of ‘social’ and non-medical prescriptions for non communicable disease

Increasing attention on supporting population health in informal settlements

Sustainability

Cities to become carbon neutral

Air and water pollution solved with air and water quality on continuous improvement trajectory

Systemic, circular thinking and integration adopted as the mainstream approach for creating sustainable cities and places

Cities becoming smarter through the clever use of sensors, adaptability and responsive behaviour

Mobility

Transport strategies to deliver on mobility and health

Mainstreaming and prioritizing of cycling and walking

Expansion of public transport with low carbon propulsion

Car free cities and parts of cities

Transport all goes electric

New forms of goods delivery including zero carbon trucks, vans and drones

Redesigning all public realm including road space

Architecture and built environment

All architecture, built environment, and urbanism design work will aim to go beyond the standard of net zero carbon in use.

Retrofit existing buildings as a more carbon efficient alternative to demolition and new build whenever this is a viable option

Include life cycle costing, whole life carbon modelling and post occupancy evaluation, as part of fundamental scope of work.

Housing developers incorporate neighbourhood well-being outcomes into their products

Accelerate the shift to low embodied carbon materials in all work.

Large scale expansion of sustainable and affordable housing

Adopt the values developed by CABE in the UK in all design work with particular attention to lifting the design quality, sustainability, sense of place and aesthetics of buildings, the public realm and infrastructure.

(Nieuwhausen et al. 2019;own practice and research experience in London, Melbourne, Bath, Stockholm, Gothenburg, Barcelona and Bristol)

Table 3. Urban malaise.

Air pollution: In 2016, 7 million deaths were attributable to the joint effects of household and ambient air pollution (WHO 2018a), this includes deaths from cardiovascular diseases, chronic respiratory diseases and lung cancer. Around 91% of the world population was living in places where the WHO air quality guidelines levels were not met (WHO 2018b). People face disability and premature death from illnesses caused by air pollution, yet barely 1 in 10 cities worldwide reaches pollution control targets.

Physical inactivity: Worldwide, 1 in 4 adults, and 3 in 4 adolescents (aged 11–17 years), do not currently meet the global recommendations for physical activity set by WHO. As countries develop economically, levels of inactivity increase. In some countries, levels of inactivity can be as high as 70%, due to changing patterns of transportation, increased use of technology and urbanization (WHO 2018c). The global cost of physical inactivity is estimated to be INT$ 54 billion per year in direct health care, in 2013, with an additional INT$ 14 billion attributable to lost productivity – representing of 1–3% of national health care costs.

Poor nutrition: In 2014, more than 1.9 billion adults worldwide, 18 years and older, were deemed overweight while 462 million were underweight. More than 600 million were obese. 42 million children under the age of five were overweight or obese but 156 million were affected by stunting (low height-for-age). 50 million children were affected by wasting (low weight-for-height). Poor nutrition continues to cause nearly half of deaths in children under five, while low- and middle-income countries now witness a simultaneous rise in childhood overweight and obesity – increasing at a rate 30% faster than in richer nations (WHO 2019).

Housing conditions: Health conditions related to housing – such as poor access to water, poor indoor environmental quality and exposure to dangerous substances or hazards, or to infectious diseases – present an important health burden. For instance, poor or inadequate water, sanitation and hygiene (WASH) were responsible for 829 000 deaths from diarrhoeal disease worldwide in 2016. Moreover, in Europe, about 15% of all new childhood asthma can be attributed to indoor dampness and almost 110, 000 people die every year as a result of injuries at home or during leisure activities (WHO 2018d).

Source: WHO/UN-Habitat (2020)

Table 4. Examples from the many entry points for health to engage as an input and outcome in urban design and territorial planning. This list is not exhaustive but serves to indicate the value of the concept (World Health Organization and UN-Habitat, 2020).

Entry points	Some examples
By setting	Public spacesSquares, parks and gardens, streets, plazas,
	Movement corridorsLocal streets, routes to school, cycling and active transport, regional transport networks
	Green and blue space Habitat networks, riverbanks, beaches and coast, woodlands, migration corridors
	AmenitiesSchools, hospitals, markets, airports, transport-hubs
	Estates Housing estates, business parks, commercial districts, town centres, campuses
By outcome	Increasing everyday physical activity
	Better air quality
	Increasing food security and healthier nutrition
	Reducing heath inequalities
	Tackling the diabetes trend at city level
	Increasing locational access to health care
By principle	Road danger reduction Vision Zero, slower speed zones, filtered permeability, school locality measures for air quality and safer routes to school.
	Social and environmental justice Climate justice, community action, citizen led-renewal, participatory impact assessment
	Life-course strategies Child-friendly, age-friendly, dementia friendly places, places for teenagers
	Healthy CitiesHealth in All Policies, healthy urban planning, Mayoral commitments
By sector	Housing and health
	Local economy and health
	Transport and health
	Water and health
	Healthy food systems

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