Asian city prospects for planning and urban health

ABSTRACT

The current rapid, often unplanned urbanisation across Asia has wide-ranging economic, environmental, health, and social impacts. In an attempt to document the implications of this demographic transition, the Journal of Cities & Health in collaboration with the International Society for Urban Health (ISUH) launched a special issue. This special issue is composed of seven original research papers and one commentary that present a fair geographical coverage of urban Asia. This scholarship aims to: 1) enhance the state-of-the-art understanding of health risks, social vulnerability and adaptation policies in cities across Asia; 2) present case studies where local contexts were taken into consideration to respond to local health needs and cultural preferences; 3) highlight new evidence of health risks and the impact of the built environment; and 4) examine the use of emerging digital technologies and big data across diverse sectors for a more sustainable urban living environment. In the current context of COVID-19, new challenges, insights, and opportunities for change have arisen. Specifically, some crowded Asian cities offer successful approaches in battling early outbreaks of COVID-19 and provide a model for keeping the pandemic at bay, even if they can’t completely eliminate infections. Asian cities can make changes to design spatially distanced transport and recreation opportunities and the long-term implications for both infectious and chronic diseases. This editorial challenges urban policymakers to better align city planning processes with societal goals and public values, for sustainability, health and health equity, and to hold the people of the city as the central plank in all planning processes.

KEYWORDS:

• Urban health
• Asian cities
• climate change
• sustainability
• Covid

Asia is home to almost half of the world’s urban population, and it is urbanizing at a faster pace than any other region. Recent projections from the United Nations indicate that by 2050, almost two-thirds of Asia’s population – approximately 3 billion people – will be living in its cities. As Asian cities develop, we need to recognize that this rapid, often unplanned urbanization has wide-ranging economic, environmental, health, and social effects. Cities today also face significant challenges to adapt and mitigate climate change and its health impacts and to limit transmission of COVID-19, which particularly affects urban areas. These challenges also create opportunities to apply transdisciplinary thinking to create a better understanding of context-specific knowledge and experience (Grant et al. 2017). Hence the urgent need for a platform to compile, share, debate, and provide solutions from a transdisciplinary perspective including the disciplines of spatial planning, urban design, public health, and environmental governance.

Developing the special issue focus

In the above context, the Journal Cities & Health in collaboration with the International Society for Urban Health (ISUH) launched a pre-conference workshop titled ‘Asian City Health’ with the institutional support of hosting partners at the 16^th International Conference on Urban Health including Xiamen University and Institute of Urban Environment – Chinese Academy of Sciences in Xiamen, China, November 2019. The pre-conference workshop aimed: (i) to discuss the major health issues facing Asian cities and towns under climate change and the big data era, and governance responses, particularly through the lens of spatial planning; (ii) to collect research interests, priorities, and new findings in order to shape the themes for a special issue of Cities & Health. This interactive workshop was designed and led by three of the authors of this editorial and attended by three more amongst a total of more than 50 self-selecting attendees. The call for contributions was finalised and made public as advised by the workshop.

The aim of this special issue, titled ‘Asian City Futures: Spatial form and health’, is to present high-quality new literature that explores emerging environmental planning and health issues in Asian cities. The special issue has received a diverse range of contributions original scholar research and commentaries from practitioners, policymakers, and academics, covering the following themes:

1. Cities in Asia are expanding rapidly with growing populations: What kinds of governance, at all scales from local to cross-country co-operation, are needed when the challenge is due to insufficient or unsuitable planning and infrastructure responses?

2. Development patterns in Asian cities have largely been following the well-established Euro-American model: How do we resolve the problematic and urgent implications for people’s health, health equity, and planetary health?

3. Asian cities are particularly vulnerable to climate change impacts including heatwaves, sea-level rise, air pollution, extreme weather event, and vector-borne diseases induced by atmospheric warming: What is the state-of-the-art understanding of health risks and social vulnerability, as well as adaptation policies in cities across Asia?

4. The form of urban growth is the result of many drivers within complex systems of decision-making, policies, and financial factors: What processes can tame the worst of the health and health equity impacts?

5. In the vanguard of shaping healthy and sustainable cities, we find a wide array of the built environment and transport professions: How can we manage hindrance and support for health and health equity in their remit?

6. As Asian cities increasingly embrace the emerging digital technologies and big data across diverse: What innovation, e-tools, and open-source data can plan professional and decision-makers envision?

Summary of submissions

The insights included in this issue present a fair geographical coverage of urban Asia. Two empirical studies within the Chinese urban context represent the region of East Asia. Three empirical studies – in Indonesia, Thailand, and Singapore respectively, examined the challenges in urban development and health in South East Asia. Two studies of Indian cities – one northern and the other southern (Delhi and Chennai) reflected issues in urban planning and built environment in South Asia. Finally, a commentary from Pakistan reported urban health problems in West Asia. The contributions have also covered a diverse range of disciplines communication, urban planning, cultural sociology, health, behavioural science, and public administration science.

Issue coverage

Asian cities are particularly vulnerable to climate change impacts, including heatwaves, sea-level rise, air pollution, extreme weather event, and vector-borne diseases induced by atmospheric warming. In this context, Liu (2021) examined local learning of climate change impacts or narratives, and cross-level co-operation in health response in a rapidly expanding Chinese city – Guangzhou from a communication perspective. At the same time, Chen et al. (2021) addressed the issue of insufficient or unsuitable planning and infrastructure responses by investigating how to engage older adults in active behaviours through designing the built environment in Singapore. These two studies enhanced the state-of-the-art understanding of health risks and social vulnerability, as well as adaptation policies in cities across Asia.

Development patterns in Asian cities have largely been following an established Euro-American approach to urban development. In this model, the market imperatives and land ownership tend to dominate as drivers of spatial form. The wisdom of such an approach, in terms of its ability to support population health, is facing an increasing challenge from a developing evidence base (Barton 2009, WHO 2016). The challenge now is to reconnect urban development with local contexts that respond to local health needs and cultural preferences. In our special issue, Dong and Liu (2021) examined the potential and constraints of urban green space planning within the Chinese urban planning system towards the prospects of healthy cities in China. Similarly, to highlight the importance of local indigenous knowledge for strengthening adaptation policies, van de Haterd et al. (2021) scrutinised its role in addressing environmental change and health risks in coastal Semarang, Indonesia.

Our special issue also presents new evidence of health risks and the impact of the built environment. To shape healthy and sustainable cities in emergent and rapidly-expanding urban areas in South Asia, built environment and transport professionals, in particular, need evidence on health risks and impacts of the built environment, in order to manage those risks and provide policy support for health and health equity. To fulfil this knowledge gap, Nix (2021) investigated the risks and intervention priorities in housing and energy arrangements across Delhi’s diverse settlements. Adlakha et al. (2021) examined the impact of the built environment on overweight and obesity among adults in Chennai, India.

Furthermore, Asian cities increasingly embrace emerging digital technologies and big data across diverse sectors. Our special issue has also gathered lessons learned from emerging digital technologies in urban planning. To help planning professionals and decision-makers envision a more sustainable urban living environment, Alderton et al. (2021) provided practical examples of using innovative evaluation methods for accessing the quality of urban infrastructure and thereby liveability, informed by community-level data This team measured and monitored liveability in Bangkok, Thailand, and drew lessons for achieving the UN Sustainable Development Goals.

COVID-19 and implications

The outbreak of the novel Coronavirus disease 2019 (COVID-19) poses an unprecedented threat to global health and has raised concerns about the risks of urban density (Stier et al. 2020). Linking urban density and its vulnerability to epidemics may seem like an obvious connection. But it is, in fact, misleading and runs the risk of oversimplification. The point that is most important to emphasize is that there is a difference between density and overcrowding. Crowded housing can be in cities or camps of farmworkers. Crowded workplaces can be in the country or the city. In many countries, some of the worst outbreaks were in meatpacking plants located in small towns. As public health experts have known for decades, people who live in dense, walkable, activity-friendly neighbourhoods are likely to walk and bike more often, as they live closer to essential amenities and services such as local shops, grocery stores, parks and green spaces. In dense urban areas, the coverage of high-speed internet and door-to-door delivery and collection services are readily available, making it easier for residents to stay at home, self-isolate and avoid close contact with others.

Due to economies of scale, cities often need to meet a certain threshold of population density to offer higher-grade facilities, amenities and services to their residents (Hamidi et al. 2020). Studies have highlighted that urban density supports the cost-effective provision of public services, faster emergency-response times and a higher concentration of healthcare facilities and resources, which are crucial for cities to respond during a pandemic effectively. Dense Asian megacities such as Taipei, Tokyo, Singapore, Hong Kong and Seoul, introduced timely and rigorous public health measures such as testing, contact tracing, isolation and quarantine during the early stages of the pandemic. These measures, combined with physical distancing and mask-wearing, have been effective in containing early outbreaks of the virus, despite high density raising the risk of infection. Therefore, from the perspective of flattening the curve and containing the outbreak, dense urban areas require timely and robust public health responses. Urban density has protective health benefits for chronic and communicable diseases due to greater infrastructural, financial and institutional capacity (Adlakha and Sallis 2020). Efforts are needed to reduce overcrowding, such as in slums, and to provide people with sufficient outdoor space for physical distancing. Providing people with more space to be active in their neighbourhoods is likely to have double benefits, both reducing the spread of COVID-19 by reducing crowding in the streets and lowering the risk of deadly chronic diseases. To deepen our understanding of COVID-19 in terms of urban governance, form and design, during the early sages of the pandemic in 2020 the journal solicited an international set of papers. These have been curated into a set of 51 think pieces as ‘The COVID-19 Lockdown Papers’ and published in a special issue ‘Cities, health and COVID-19: Initial reflections and future challenges’ (Ellis et al. 2021).

Closing remarks and outreach

We live on an urban planet where there are no significant counter trends to the continuing process of urbanisation. ‘Cities, with their concentration of culture, infrastructure, and institutions have long driven the progress of civilisation and have been the focus of opportunity and prosperity’ (Chan 2014). To provide equal opportunity to its citizens, urban policymakers need better to align city planning processes with societal goals and public values, including through a better understanding of how city planning impacts sustainability, health and health equity. While any vibrant city may contribute continuously to the country’s gross economic metrics; we need a planned city to ensure provisioning of sustainable essential services that promote health could ensure a continued and positive forward growth momentum. Such services include affordable housing, public transport, provision of, and access to, health care, including regularly secured livelihood to its every citizen. An inclusive city requires proper financial, infrastructure, and an approach to health coverage that needs to take a robust response to spatial planning and spatial development (Grant 2020). To make healthier urban places a reality, it is therefore absolutely imperative to hold the ‘people’ of the city, including the most vulnerable and marginalised, as the central plank in all planning processes. The authors and special issue partners, the International Society of Urban Health, consider the insights brought by Asian experts into this special issue an essential contribution towards the construction of better urban health and health equity worldwide.

Disclosure statement

No potential conflict of interest was reported by the authors.