The new normal: healthy cities – a global perspective

As the world plots our routes out of lockdown, we ask some of the UK’s leading researchers on healthy cities to reflect on what the pandemic has taught us.

What have we learnt about the design of our cities, of our society, of our homes, our commutes and our communities? If we are at a crossroads, which paths might we take?

Dr Anna Rutherford, director of The Architecture Centre, speaks to Dr Louis Rice, head of the World Health Organisation Centre for Healthy Urban Environments; and Dr Danni Sinnett, director of the Centre for Sustainable Planning & Environments at UWE Bristol.

What is a ‘healthy city’?

The WHO defines a Healthy City as one that creates physical and social environments that allow people to reach their full potential, support each other and adapt to future change for human wellbeing and planetary health.

Human health is impacted positively and negatively by a complexity of social, cultural, environmental and economic factors. Health is not just about NHS services – town planners, urban designers, architects play a significant part in determining the health outcomes of those who live and work in cities.

What do you think Covid-19 has revealed about the current health of our cities?

I feel Covid-19 has both exposed some of the real inequalities in our cities, and enabled us to come together in ways we perhaps haven’t before.

Some of us have our own gardens or can walk to local parks, have high streets nearby and local support networks – live in healthy places in other words. Whilst others do not, and perhaps they can only get to supermarkets by car or public transport.

Imagine each city had an annual health check, how would Bristol fare in 2020? What would our GP be saying?

There are various ‘league tables’ for cities in terms of liveability and health. They can’t be taken too literally as health is influenced by so many factors, but they include metrics on water and air pollution, crime levels, green space provision, life expectancy, healthy food/junk food outlets, healthcare provision, inequalities and wellbeing.

Against these criteria, Bristol fares pretty well on a global ranking. However, this is not an excuse to be complacent; we have high levels of inequalities amongst our population. Depending on your post-code, there are big variations in life expectancy, disability and quality of life.

City health can be thought of as a journey, not a destination. Bristol’s health should be measured in terms of how much it has improved since last year and what we hope to achieve next year.

Has the pandemic changed cities? Are some using it as a catalyst to improve citizen health?

The pandemic has radically altered cities in the short term. More than half of the world’s population has been placed in some form of quarantine or lockdown. This is the biggest social, economic and spatial ‘experiment’ in human history – and it is all focused on ‘health’.

The pandemic has been incredibly damaging to health – physically, mentally and socially. Social distancing has brought about loneliness and isolation for much of the population – and made us aware how important social contact is to our wellbeing.

Amidst the devastation Covid-19 is bringing, there are a few positives for city health. In the first few weeks of lockdown, we have all experienced the dramatic drop in car use, public transport noise pollution and congestion in cities. There are also increases in birdsong, families walking or cycling, communities getting together to support one another and quietude.

As cities move out of the first stage of lockdown – some have seized the opportunity to improve citizen health on a longer-term basis. Paris, Milan, Berlin and many other cities have temporarily converted roads into cycle and walking lanes to cater for the shift in movement in cities.

Are some aspects of health taken more seriously than others by cities?

In the long-term, most of the UK population will suffer from ‘lifestyle’ diseases as a result of a combination of poor diets, sedentary behaviour, smoking and other unhealthy activities.

At present there is insignificant action, at a city scale, to reduce these diseases, often because they are seen as ‘lifestyle choices’ and individuals should be free to make them. But this misses the importance of the places that we live in either encouraging or discouraging these behaviours.

Some cities globally are taking more action to reduce the risk of lifestyles disease. Copenhagen have redesigned their public space and now half of all commuting is done by bicycle (in the UK only 1.7% of commuting is done by bicycle). Ghent has pushed for healthier food options throughout the entire food chain from spade to plate. New York has introduced smoking bans for large sections of the city. Oslo is aiming to be carbon neutral by the end of the decade and is moving towards banning all cars from its city centre.

Have public attitudes to ‘health’ changed?

Generally people are more aware of their health, and are perhaps taking more notice of what they eat and drink, and how much exercise they do. I don’t think many people see the connection between their health and the places that they live though.

Even amongst professionals, health in new places is often thought of in terms of doctor’s surgeries and pharmacies. Some research we have been doing has suggested that ‘health’ as a term perhaps isn’t very helpful, for example, people want to see better pedestrian and cycle routes, and parks, but they don’t think of these as features that will necessarily help their health – they are more about quality of life.

Might the pandemic pose long-term risks to public health beyond the impact of the virus itself?

I worry that in the rush to withdraw from lockdown, we will cause larger health risks than those posed by the virus.

For example, poor air quality kills far more people each day than the virus, and appears to make people more vulnerable to the virus. In a rush to avoid public transport we might increase car use and make matters worse. Spending more time at home, not connecting with nature, our friends and families, will have a long-term negative impact on our physical and mental health. The rush to buy online, in a bid to avoid contact with people could devastate our already struggling high streets and local businesses.

Do you think pandemics will continue to affect health?

In the long-term there is one aspect that must be radically redressed in order to improve city health – our relationship with the natural world.

Sir David Attenborough asks for us to learn to “live in harmony with nature”. Scientific evidence suggests that Covid-19 originated in animals and transferred to humans. We have seen a rise in these types of infections, called zoonoses, and this is predicted to increase further in the years ahead.

The cause of these new diseases is linked to unsustainable and harmful human activities, such as urbanization, overconsumption of resources, pollution and the destruction of natural habitats.

If we are to avoid further pandemics such as Covid-19 we need to take radical and urgent action. There is an urgency to increase nature in urban areas by rewilding cities, improving urban agriculture, using green infrastructure, planting more trees and enabling everyday contact with the natural world. These greener city transformations will bring economic, environmental and health benefits as well as helping to reduce the risk of the next pandemic.

Has lockdown given you a different view of our city?

Lockdown has revealed how much birdsong there is! In the few weeks of calm without traffic, I have heard the dawn chorus for the first time in over a decade. Lockdown has highlighted how important the social connections are for health – and the vital role that parks and public spaces play as the setting for social life.

Yes, I have had more contact with neighbours over this period than in ten years of living on my street. We have a street WhatsApp group that have been organising shopping for vulnerable neighbours, sharing information etc. As a family, we have also been for walks along quieter routes, like the Malago Greenway, and seen more nature in the city than we did before the lockdown. It has also made me realise how lucky we are to live in a walkable part of the city.

What would one thing would you like to see Bristol do now to improve public health?

In the short-term Bristol needs to make space for people to walk and move around the city safely whilst we weather the Covid-19 pandemic – and beyond. This should prioritise neighbourhood walking in areas that have greater inequalities, not only focused on the city centre. Increase pavement widths, removing space for cars so that people can social distance while walking, cycling and running. And ban pavement parking!

Healthy Cities – A Global Perspective, a talk with Dr Louis Rice and Dr Danni Sinnett, takes place on Thursday, May 28 at 7pm via Zoom. For tickets, visit www.architecturecentre.org.uk/whats-on/the-new-normal-healthy-cities-a-global-perspective

Main photo by Shane Morgan

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