Repairing health through the built environment

Following their combined efforts to improve living conditions in the overcrowded and disease-ridden cities of the 19th century, the disciplines of public health and urban planning went their own ways. Only recently, after many decades, have they come together again, with growing concerns about inactivity and subsequent obesity and other chronic diseases, from hypertension to diabetes. The US leads the race to be fat. It has the highest percentage of overweight people (64.5 per cent), of whom 30.5 per cent are obese; Mexico has 62.3 per cent overweight and 24 per cent obese, Britain (61 per cent overweight, 21 per cent obese) and Australia (58.4 per cent overweight) following close behind. Mainland European countries hover around the high thirties. The lowest percentages are recorded in Japan (25.8 per cent) and Korea (30.6 per cent); obesity is probably also lower in Chad or Eritrea, but the figures aren't available.51 Being obese means that someone of 1.77 metres weighs over 95kg.

In September 2003 the two leading American public health journals, The American Journal of Public Health and The American Journal of Health Promotion, had special issues on the effects of the built environment on health, and how the design of cities can foster health-inducing behaviour. Their argument can be summarized thus: car-dominated, sprawling and pedestrian-unfriendly cities make you fat and unhealthy. And 'it is time to shift to communities intentionally designed to facilitate physical and mental health'. The situation is stark. In the US only 2.9 per cent of trips are made by walking, down from 10.3 per cent in 1960. Walking and cycling now accounts for 6.3 per cent of trips. In continental Europe, by contrast, figures range from 35 per cent to 45 per cent. And this is impacting on life expectancy. A battery of evidence from around the world is suggesting that cities that encourage incidental walking and cycling have higher levels of health. The relationship between built form and weight is clear -those areas with more sprawl and fewer sidewalks, thus encouraging greater car use, have higher levels of obesity. Additionally, those of greater isolation have higher levels of depression. The results point ideally to forms of settlement that are more dense and compact, where facilities from public transport to shopping are nearby.

The challenge for all professions concerned with the city, from the social worker to the architect, is to look at the city through the prism of health. The topic is too important to be left only to health specialists. This should involve outcome swaps. This means a planner, regeneration expert or economic development professional should ask, 'How do my plans help citizens become healthy?'

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