What makes a city healthy?
Cities are great. They’re often the engines of business and creativity. Interesting cities capture our imagination for a variety of reasons. Perhaps it’s the wide selection of places to drink a cup of coffee, grab a late bite to eat, or brush up on a talent like music or art. There’s also the joy of living amongst people and exchanging with them our interests, our ideas and our work.
More and more of us are living in cities, especially in the developing world where the main pull factor is, unsurprisingly, jobs. But for those of us who currently inhabit cities and welcome newcomers, how do we ensure that the city we live in is healthy? Maybe where we live could be a lot healthier or do a bit better in certain areas. What do we mean by a healthy city anyway?
Having looked up the standard definitions of a ‘healthy city’, I have to admit I wasn’t impressed. Most definitions are too wordy and fail to succinctly qualify what a modern day healthy city is. To address this, I give my own definition of a healthy city.
Healthy City: A city that consistently looks after its people and environment. It has systems that support the total well-being of all that live within its area. These systems help maximise the quality of life, culture and creativity that the city offers.
This definition may seem broad but the use of words such as ‘consistently’, ‘total’ and ‘all’ are intentional. They hammer home the message that a truly healthy city is always doing what it should with maximum effort, and for everyone, whilst elevating the overall quality of the place. Well-being refers to the physical, mental and social condition of individuals.
There are thousands of urban dwellings in the world but few meet the above definition, which seems strange. Despite our ability to do so much so well in the modern era, especially technologically, we seem less capable of constructing the right systems to sustain a city that wishes to support all its citizens. For example, London is a great world city that has managed to host the 2012 Olympics, build a beautiful airport building (Heathrow’s Terminal 5), and engineer Crossrail, Europe’s biggest active construction project — all within a few years. But given this incredible ingenuity, how good is London at preventing social isolation or stress? Or how friendly is it to an elderly day-tripper? Sadly, ‘not so’ answers both of those questions.
What qualities should a healthy city have? In short, a healthy city should have good facilities that promote well-being (indoor and outdoor), strong communities and the appropriate infrastructure that enables both free movement and high quality living. Healthcare provision, whilst important, plays a much smaller role than these other factors.
In contrast, a lot of today’s cities don’t pay much consideration to these ideals. They are increasingly packed with shops and apartments that haven’t followed any big-picture planning. The parks that tend to exist were developed at least a century ago. Hyde Park, London and Cannon Hill Park, Birmingham are examples of parks developed over a hundred years ago. Central Park in New York City was created following a piece of legislation by New York State in 1853 that set aside a rectangular block in Manhattan to tackle the city’s lack of access to nature. However today, retail and property developers seem to be the main driving force behind what happens in big cities. I think its safe to say that Central Park wouldn’t have come to fruition in this day and age. The fight for prime land in central Manhattan would probably be so large that no-one would even think to go down the line of creating a not-for-profit leisure space. But any threat to Central Park now would be met with enormous resistance because it is an invaluable space in New York that offers physical and mental escape from the bustling activity of the Big Apple. We realise the value of parks and spaces when we have them and are using them, but rarely and not firmly enough when we plan urban areas. Parks and green spaces are vital to a healthy city.
Parks are often associated with activity of sorts. That could mean dedicated classes in the park (e.g. Tai Chi or Aerobics) which give the added value of keeping things outdoors. Spending time outdoors in the right environment has a significant impact on our health. There’s something quite calming about a walk through a tree-lined path. Empowering nature within a city by virtue empowers us. But it’s important to remember that it’s not necessarily the size of the green space that matters, but how close to home it is. For this reason, it’s much better to have more parks each of a smaller size spread throughout a city. This improves access for all, especially the youngest and eldest inhabitants of a city for whom a trek to the park isn’t always desirable.
Whilst parks and open spaces offer a good platform for social cohesion, there’s a lot of room for businesses to help in this arena. Businesses are the oil that lubricate the cogs of the city’s machinery, and they’re thus vital to have involved in improving health. Businesses influence how we go about our affairs. Take coffee shops for example. Going back twenty years they were hardly as abundant as they are now. Coffee shops have become a common meeting point for many. I have seen some coffee shops change their demographic throughout the day which is great to see. Having hangouts that are inclusive and enjoyable is a great way of fuelling social cohesion and breaking down barriers. Anything that encourages this improves how we see and deal with each other. These things might not measurably impact our health, but it contributes to us being nicer to one another and that’s good.
Gyms are another example of how an industry has improved our approach to health. From where I live, I have a great selection of gyms offering competitive memberships and an array of classes. Seeing more gyms with greater focus on the elderly would be a positive step forward. Initiatives like this probably need support from local health authorities to help older people enjoy the benefits as much as their younger counterparts. This could take the form of subsidised transport or membership fees. The benefits of this extend well beyond the treadmill — it gets people moving and connected. I can see how this would take the strain off our already stretched health services. Well considered initiatives such as this could help break the problem of social isolation too, which is a growing problem for the elderly in places like the US and UK, where family structures are more nuclear. It’s vital to remember that the measure of a healthy city has to be in how it treats all of its citizens, not just its most able or wealthy.
We can’t expect businesses to make cities healthy without the right framework to guide them. Making a city healthy requires a strong vision supported by good leadership, organisation and of course funding. The city authority has to take on this role wholeheartedly. It has to guide businesses and get them on board with the importance of having a healthy city, selling the vision. Subsidy could help with this. For example, lowering taxes for restaurants that source local ingredients or for those offering a selection of healthy alternatives. I mentioned this idea once in a public health meeting of a large city council in the UK and was met with ‘we don’t need to subsidise companies’. I understand there are financial constraints, but public health is about the bigger picture — it might not make financial sense now, but it will with time, especially as the jigsaw pieces forming a healthier urban environment join together. You need ways of drawing the right businesses in. Otherwise you’ll continue to have school kids eating cheap fast food on a regular basis instead.
It’s important to touch on the important role of architecture in a city. Alain de Botton’s School of Life has made a brilliant video available on YouTube called ‘How to make an attractive city’. It illustrates in an in-depth and colourful way how we ought to go about making better cities. Our favourite cities tend to be old ones (e.g. Florence or Bath). Similar to the development of parks, we seem to have been better at making nice places to live in the past. This doesn’t make sense, especially when one considers how much technology we now have to hand. We can pre-fabricate and flatpack almost anything nowadays, even good houses! Modern housing developments often fail to consider the importance of making communities. Developers instead focus on rapidly churning out small boxes with small windows to enclose their inhabitants, whilst council leaders tick off their housing targets. Bizarrely in the UK, new housing developments are planned by property developers with little or no involvement from urban planners and architects, which seems rather at odds. It’s obvious that where we live directly influences how we live and in-turn our psychological condition. High-rise social housing is not an environment to cultivate calmness and reflection, especially when contending with hectic nature of a city life. Housing developments need to be sensitive to the subtle needs of the human condition, serving people and communities first rather than profits and targets. Communities are so important to the health of a city. They don’t form by chance, but through considerate design.
Design goes further. A healthy city has to have good transport infrastructure too. That doesn’t just mean good bus and metro services, which are essential. It also means you’re able to hop on your cycle and not have to navigate through dangerous traffic. The city should be cycle friendly, but there aren’t many that are. Amsterdam and Copenhagen are real role models in this area. Oxford is quite good. London is improving but far from excellent.
Barcelona has made a bold and positive step in making much of its central area pedestrian-only. This could be the start of other cities doing the same. It’s shocking that Europe’s busiest shopping street, Oxford Street in London, also has the highest recording of Nitrogen Dioxide (a harmful chemical produced from diesel combustion) in the world — pedestrianising this busy street could be a solution. Pedestrian friendliness isn’t just about pollution control. It makes core parts of a city accessible, particularly for the elderly. As the world grows to live longer, it means more elderly people will be living in cities too. Therefore, any city wishing to be a healthy city needs to keep in mind the elderly whenever planning major projects.
Hospitals, dental surgeries or other health facilities have had little mention. That’s because these things don’t influence how healthy a city is as much as other factors. For example, there’s a sound statistical argument to favour good sewage works over hospitals to improve health because this prevents the mass spread of infectious diseases. A lot of it boils down to effective prevention — often so subtle we don’t notice it. To put this another way, ninety percent of an individuals health is determined by socio-economic factors. That means where and how you live is so much more important than whether you have a decent hospital to go to in times of need. The hospital is important, but not nearly as important as other factors. This illustrates the responsibility cities have in getting things right. A healthy city inevitably leads to healthier and happier citizens.
This piece has highlighted some of the important issues a city should address in its bid to become a healthier and more attractive place. I fully appreciate the complexity and costs involved but neither should deter our efforts. A lot goes in to making a city healthy but it’s doable with effective leadership and a strong vision. We can take inspiration from good examples such as Amsterdam, Vienna and Tokyo that show that it really can work and when it does, it’s powerful. A healthy city fuels creativity and culture. Is yours one?