Words by Katie Puckett
Prevention is better than cure, and smart technologies can only go so far. The only realistic solution for the future of healthcare is to keep people well for longer — which means reshaping the urban environment in a way that promotes health rather than hindering it.
“Cities concentrate people and resources in one place, which creates hazards but also very real opportunities for improving health,” says Chris Naylor, senior policy fellow at UK health charity The King’s Fund. “Regardless of the country, the evidence about what shapes the health of the population is pretty consistent, and healthcare isn’t the biggest determinant.”
Naylor, who has researched the role that cities play in health around the world, says that more than half of the variation in population health is down to three key determinants: the environmental and social conditions in the places where we live, our economic situation, and our behaviour and lifestyle. “Cities play a really important role because they influence all three. We should be creating compact, walkable, mixed-use developments that encourage social interaction and make it easier for people to be active. We should be doing everything we can to inspire and enable healthy eating, and to create places for play and leisure for all ages.”
Are successful cities inherently unhealthy? In The Economist’s latest index of the most liveable cities, Tokyo is the only large city ranked in the top ten — the rest are small or medium-sized, led by the Austrian capital Vienna.
Cities taking a stand
City leaders are playing an increasingly influential role, often ahead of national governments. Polluting vehicles, unhealthy foods and smoking may be legal, but they are being made unwelcome in various forms at city level.
- In Paris, the most polluting vehicles are banned from entry and whole areas are car-free on Sundays
- New York’s introduction of mandatory calorie labelling in 2008 helped pave the way for federal adoption later on; its 2002 ban on smoking in public places has yet to reach federal level
- In Berlin, every year the amount of space given to cars decreases and the cycle network increases
- Amsterdam’s Healthy Weight programme prohibited advertising of unhealthy food targeted at children, and only tap water and healthy packed lunches are allowed in primary schools
Neither is there any crossover at all with the 20 most dynamic cities in JLL’s City Momentum Index, which is dominated by India and China. But there must be an intersection between health and success, says Naylor — “If you have a really unhealthy population, that’s bad economically in terms of reduced productivity, absence from work and welfare expenditure.” The global depression looming as an indirect result of COVID-19 is ample evidence of the economic importance of good health.
Main article: the future of healthcare
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The emerging science of wellness is starting to yield an evidence base on the relationship between health and environment. Building standards such as WELL and Fitwel monitor aspects such as biophilia, ergonomics and whether a building nurtures mental health. Studies in office environments have found that good ventilation can increase cognitive scores by 101%, for example, or that workers seated next to windows sleep for 46 minutes longer at night. The WELL Community standard, launched in 2017, applies these principles across whole districts. As cities become smarter, urban designers will have many more tools to improve outcomes. “Once we have high-speed wireless networks, and people are wearing devices tracking their health data, we will be able to use AI and rich data sets to promote health and wellness,” says Kevin Cassidy at WSP.
In Copenhagen, city authorities have collected data on pedestrian and cyclist movements for years, providing quantitative evidence for policy making. “In many cities, this kind of detailed data is simply unavailable,” says Naylor. “If cities are to reorient planning and other activities to place greater emphasis on population health, this must be reflected in the types of data they collect — what matters must be measured.”
Planners and designers should prioritize the social determinants of health as they develop tomorrow’s smart cities, says Howard University’s Michael Crawford, addressing factors such as transportation, food security, job opportunities, affordable housing and safety. “If you do not have access to nutritious food, diabetes medication alone will not help you effectively manage your condition. If you have a prescription but no pharmacy within your community, what good is that prescription? Technology can help address some of these barriers.”