Dystopia, utopia – or somewhere in between? Healthy City Design 2019, London, 14–15 October

ABSTRACT

A review of the 3rd Healthy City Design International Congress: ‘Designing for Utopia or Dystopia: People and Planetary Health at a Crossroads’ (held in London in October 2019) and a look forward to the next Congress in the context of 2020 as a pivotal year for health and the environment.

KEYWORDS:

• Word
• Healthy City Design congress
• planetary health

Table

Healthy City Design International is an annual congress organised by SALUS Global Knowledge Exchange in collaboration with the Royal College of Art’s Helen Hamlyn Centre for Design (www.healthycitydesign.global). The 2019 congress was held at the Royal College of Physicians, London, on 14–15 October. Around 300 delegates from 22 countries participated in the following eight streams: urban design and placemaking; homes and neighbourhoods; work and workplace; sustainable development; city planning and the public realm; place-based health; mobility, travel and transport; and smarter cities. The two days combined plenaries with parallel sessions on these streams, with extra workshops and panel discussions over breakfast and lunch allowing for more in-depth discussion. The presentations and posters are available to view by members of SALUS’s online network, individual membership of which is free.^1 ‘Although I spend much time studying these topics, I walked away with new paths and directions’ – Dan Burden, Blue Zones ‘From arts to school superzones, the ways in which we live in a complex world of connections never ceases to surprise me’ – Michael Chang, Public Health England

A critical moment for action

In the few months since the 3rd Healthy Cities Design International Congress, held with the theme ‘Designing for Utopia or Dystopia: People and Planetary Health at a Crossroads’, a future is emerging that seems to be more dystopian than ever. The climate crisis is gathering pace and humanity faces an urgent and critical choice. The impact of inaction has been made very clear in the Lancet Countdown report published in December, which set out the stark difference in impact on the life of a child born today of a ‘business as usual’ pathway versus a pathway that limits global warming to 1.5°C (Watts et al. 2019).

There is no doubt that humanity is at a critical crossroads – but, as the congress demonstrated, there are also reasons to remain optimistic that a step-change can still be achieved.

No silver bullet … but there is silver buckshot

There is, Dan Burden pointed out, no silver bullet to creating healthier cities, but there is ‘silver buckshot’. Healthy City Design 2019 provides an opportunity to see some of that buckshot and to consider what might be successful and scalable in the diverse contexts in which the participants operate. There were many examples of research programmes, local case studies, practical tools² and networks for information-sharing³ – all of which are useful for building the collaboration that is clearly needed to make progress.

The keynote speakers at each of the Healthy City Design congresses have provided an in-depth view on their diverse areas of expertise. In 2018, author and architect Carolyn Steel gave a sparkling presentation on the way in which food systems have developed in parallel with urbanisation; and in 2017, 8 80 Cities’ Gil Penalosa’s rapid-fire insights into designing cities for all ages were inspirational. This year, plenaries included an excellent introduction to air pollution from Audrey de Nazelle of Imperial College London (de Nazelle 2019) – an issue that has become part of the zeitgeist over the last few years and has recently been included as one of the major risk factors for non-communicable diseases by the World Health Organization (Linou et al. 2018). On the second day there was a lively and very informative whistlestop tour through the burgeoning evidence on the impact of the arts on health given by Daisy Fancourt (University College, London) (Fancourt 2019; see also Fancourt and Finn 2019).

As a whole, the conference was as wide-ranging as one would expect from the range of streams (see box), but some concepts bubbled to the surface throughout:

• Leadership and political will are essential to achieving planetary health – but this alone is not enough: citizen engagement is crucial to catalysing, developing and sustaining action. Mark Johnson (Civitas) noted that 10 years ago, his mission was ‘Go green and get moving’ – to which he has now added ‘and come together!’

‘People are good at defining what they need!’ – Kenji Shermer, East Devon District Council

• Lack of a shared language can pose significant challenges within a fast-changing narrative – as Jenny McNeill from NHS Devon CCG pointed out, ‘The language of planning, health and development are very, very different.’

‘A planner told me that since he had started using the language of health and wellbeing in his public consultations rather than “sustainable development”, the public engage so much more’ – Tazeem Bhatia, Public Health England

• Measure what matters! For example, if cities are no longer to be designed around the car, then measuring how easily cars can move around ‘must no longer be the primary focus’. Instead, measurement of quality of life and other intangible and subjective variables are key to fostering a change in attitude and outcomes, including assigning monetary values to things that do not normally have it (which is the aim of the social value bank, HACT).

• Physical activity and the arts are too often not built into everyday life – and this impacts on health (although neither needs to be positioned as explicitly ‘health-promoting’). As Daisy Fancourt noted, moderate physical activity and cultural engagement have about the same odds reduction for disability.

• Technology is already having a profound impact on our daily lives, and this is set to continue – whether through the increased use of the internet of things, social media or autonomous cars (the latter greeted with considerable scepticism by delegates). How can technology be used to enhance rather than subvert our experiences, both of social interaction and of the experience of place?

The challenge is not that we do not know what to do: the challenge is in implementation and in motivating policymakers and communities to appreciate that focusing on the health of planet and people together can have significant benefits for quality of life at all ages. Healthy City Design is proving itself to be a valuable annual forum for relevant actors and decision-makers to review and regalvanise around a common agenda. There was a distinct sense of frustration that more has not happened over the last 10 years – but also a feeling of optimism that this may be the moment at which things change. An increased understanding of the climate crisis is now combining with understanding that wellbeing is largely dependent on our environment, which is at last beginning to catalyse action. For example, Veronica Reynolds noted that companies in a large UK business park that, 18 months ago, were pushing for more car-parking provision have undergone a significant and sudden change in attitude towards active travel, in response to employees’ concerns about the climate emergency.

Looking to 2020

The year 2020 will be hugely important for health and the environment. It is the year that the implementation period of the Paris Agreement begins, and it is also the year after which it is suggested that global emissions must begin to fall if the world is to have any chance of achieving the 1.5°C goal (Mission 2020 2017). From a UK perspective, Glasgow is hosting the annual UN Climate Change Conference (COP26) in December (UNFCCC 2019) – and the World Health Organization is currently calling for this to be themed around health. The Healthy City Design International Congress will be held in London a couple of months before, which will be a great opportunity to feed into this conversation.⁴

Who else should be engaged in Healthy City Design 2020? Given the focus on the need for strong political will, we must hear more from those political leaders who are leading change, such as mayors who are heading up declarations of Climate Emergencies in cities, or who have signed up to the Copenhagen Consensus of Mayors (WHO/Europe 2018): what first piqued their interest and what are the avenues that they are using? It would also be helpful to understand how investors, real estate developers and innovative businesses and enterprises working in this space are applying research knowledge to deliver healthier communities and environments: how we can help them to make this more intuitive and attractive to their peers? There are also strong calls for reducing car use – so could we hear from the highways sector and innovators in new forms of mobility? And, finally, if you design a city for children then you design a city that works for the health of all – and children and young people themselves, as Greta Thunberg has shown, can provide insights and inspiration for us all.

‘[Young people] are the ones who have the new and innovative ideas, and we need to put them out front if we really want change to happen’ – Pete Ellery, National Wellness Institute, USA

And in terms of the programme? There are so many interesting case studies presented at Healthy City Design: could some of them be invited back once they are embedded and the impact has been evaluated? Not all the interest is in success: learning from mistakes is at least as important in demonstrating the way forward in developing and scaling initiatives.

‘[The Knowledge Network of the Institute for the Advancement of Mental Health (IAM)] is a place to share failure, which we don’t do enough’ – Pam Sethi, IAM, Canada

Inspiration can be found in low- and middle-income countries: can we hear more examples of successes in these settings from which higher-income countries can learn? There are also increasing numbers of tools and networks available to bring the planning, design and health worlds together: could Healthy City Design be a way to begin to gather these tools together, including in languages other than English?

Final thoughts

As Lord Nigel Crisp, author and chair of the All-Party Parliamentary Group on Global Health, told us, we are pioneers who play a key part in shifting the narrative away from ‘health care’ towards a far more extensive and holistic concept of ‘health’: ‘We need to rethink the way in which we work and deliver our services to the community and see wellness and health in terms of social indicators and metrics that better show our impact on human culture rather than just medical conditions.’

Although a fully fledged utopia remains as elusive now as it was to Thomas More and his contemporaries, there is at least a chance that we can avoid a nightmarish dystopia by taking action that is based on a positive narrative, scaled-up success and genuine partnership. There was real enthusiasm for the Healthy City Design International Congress as an important arena for building cooperation and collaboration. The congress ended with a challenge to delegates from Giselle Sebag of Bloomberg Associates: at Healthy City Design 2020, we should actively instigate interdisciplinary partnerships (including with policymakers) and implement and measure the action that we have all been talking about taking. Time is running out.

Disclosure statement

No potential conflict of interest was reported by the author.

Additional information

Notes on contributors

Katy Cooper

Katy Cooper is an independent consultant with extensive experience in the prevention of non-communicable diseases (NCDs) globally. She has recently worked with WHO/Europe, World Obesity, the NCD Alliance and the Danish Red Cross on a range of issues including NCDs and workplace health in low- and middle-income countries, NCDs in humanitarian settings, digital marketing to children, and the role of supermarkets in tackling poor nutrition. She is particularly interested in bringing environmental/climate-change issues together with the NCD agenda, including healthy sustainable diets and air pollution.

Notes

1. Videos of 85 talks and workshops from Healthy City Design 2019 are available to view at www.salus.global/journal.

2. For example, the Place Standard Tool (https://www.placestandard.scot/), developed by NHS Scotland.

3. For example, SALUS’s network to share knowledge on ‘designing a healthier society and a more sustainable planet’ (https://www.salus.global/) and the MARCH network (https://www.marchnetwork.org/) on social, cultural and community assets.

4. Since submitting this article, the extent and impact of the COVID-19 pandemic have become increasingly and frighteningly clear, with repercussions including the postponement of COP26 to 2021. The Healthy City Design International Congress 2020 is still scheduled for 12–13 October 2020, and is currently calling for papers on the overarching and timely theme of ‘Designing resilient communities: recovery, renewal and renaissance’. Within this, there will be a new stream dedicated specifically to ‘Pandemic impacts, preparedness and response’, building on lessons learnt from COVID-19.