Planning for a healthier future?

Posted by Tim Townshend, Professor of Urban Design for Health, Newcastle University

Can we plan for a healthier future by intervening in the built environment? You may be surprised to find out this is not a new idea! Indeed, the very concept of Town Planning emerged in the last quarter of the 19^th Century out of a concern for public health and to help prevent the spread of infectious diseases such as cholera.

Ebeneezer Howard - ‘slumless, smokeless’ garden cities

The resulting Victorian terraces, with fresh water supplies and internal toilets may seem unimaginative, but they were a huge improvement on what went before - and did indeed prove a boon to public health. What’s more many still provide decent homes today.

Early planning thinking was also dominated by a vision that the physical health attributes of the countryside – access to open space, clean air and fresh food could be combined with social and economic (mental health) benefits of the city – including opportunities for education, access to culture and wider social contacts. Such thinking is typified by the Garden City Movement associated with Ebenezer Howard and realised - at least in part - in towns such as Letchworth in, Hertfordshire.

Health was at the core of planning for much of the 20^th century, however, in the post-war period it became eclipsed by other issues - particularly the need for economic regeneration. Consequently, the health and well-being impacts of the way our towns and cities were developing was not considered carefully enough.

“...primarily designing around the needs of the private car - rather than humans - has been a disaster.”

In retrospect, primarily designing around the needs of the private car - rather than humans - has been a disaster.  Busy roads now cut noisy polluted swathes through communities; poorer neighbourhoods find themselves served by ‘toxic high streets’ – a deadly mix of nutritionally poor food, subprime financial services, betting shops and other potentially harmful outlets; and vast tracts of poor-quality new build housing - devoid of adequate open space, or local services - have been constructed in the suburbs.  At the same time rates of obesity (and associated health/well-being consequences), respiratory and so-called ‘lifestyle’ diseases have all soared. Moreover, these impacts are not felt equally across all neighbourhoods, and health inequalities unjustly burden the poorest in society.   

 Interlinked themes explored in Healthy Cities? Design for Well-being

It does not have to be this way, however. We can plan for a healthier future and create places that support individuals and communities to take healthier lifestyle choices. In ‘Healthy Cities? Design for Well-being’ I explore five inter-related topics and the ways in which the goal of a healthier future can be achieved.

There is for example a large and robust evidence base around our need for urban greenspace (as was highlighted so graphically during the COVID-19 lockdown period). Green (and blue) spaces in our cities not only facilitate physical activity and socialisation (positive for physical health and mental well-being) but can mitigate against issues such as, air and noise pollution, ‘heat islands’ (the significant heat increases in urban areas as compared to their surroundings) and alleviate flood risk. Crucially, however, greenspaces have also been shown to reduce stress levels and help restore cognitive capabilities - for example concentration levels - just by being there.  

Planning policies can also be used in conjunction with public health goals to tackle specific health issues. A great example of this, is the development of planning guidance and regulation to tackle the further spread of hot food takeaways – a key component of my ‘toxic high street’ concept, which I explore in more detail in the book.  While planning cannot tackle existing businesses it can limit further spread, especially in sensitive areas – for example near schools, as research has proven the link between hot food availability and overweight/obesity in older children. Issues we will explore at the Fuse Research Programme Meeting “Planning for a healthier future: Priorities and Practicalities” on May 18, 2022, at Teesside University (and available online).

Therefore by encouraging those aspects of the built environment that support healthy lifestyle choices, while constraining those aspects we know are linked with less healthy lives, healthier places are within our grasp – but this can only be achieved if we collaborate across disciplines and garner the political support required to make it happen!

Healthy Cities? Design for Well-being is available to order now

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1. Howard, Ebenezer. "Diagram of a group of slumless smokeless cities.". 1898. From Ebenezer Howard, "To-morrow: A Peaceful Path to Real Reform" [London, 1898]. https://www.aaeportal.com?id=40518. Web. 12 May. 2022.