Amid all the discussion about the future of healthcare there’s a side discussion that’s gaining momentum. Healthcare is one thing; health is another. Talking about health means addressing the way we live, work, consume – forming a discussion around prevention rather than treatment. If we really want to reduce the cost of healthcare, prevention is the big opportunity.
A few months ago, a fellow Gensler blogger raised this issue in relation to the workplace. The number of jobs requiring even moderate physical activity is declining, and this may be a significant contributor to rising obesity and diabetes rates. And it’s an issue for productivity: A healthy worker is significantly more productive than an unhealthy one.
But the workplace is just one component, albeit a big one, of the many spaces in which we spend our lives and that contribute to a healthy lifestyle. As the trend toward urban living increases, particularly for the knowledge workers populating those sedentary desk jobs, the way we design and inhabit our cities will matter more. I believe cities can make us healthier. But there’s a big gap between can and will, and bridging that gap will be an uphill battle.
Urban living can help us get out of our cars onto a variety of transportation modes that are both healthier and more sustainable. Increasing the number of people walking and biking may have serious public health benefits, and the density and variety of the urban landscape are boons to both. Cities can apparently make us walk faster – average walking speed increases with population – and walking faster seems to track with an increase in life expectancy. A study commissioned in 2010 by the city of Copenhagen tries to assign monetary values to cycling over driving – suggesting a $0.35 net benefit to the economy per mile ridden on a bicycle vs. a $0.20 net loss from driving. Yearly health benefits to the city are estimated at DKK 1.7 billion. That’s over $300 million in 2010 US dollars.
How our cities are designed plays a big part in this. Copenhagen has an ingrained culture of cycling, but it’s also a city that invests in its bicycle transportation network. New York City’s transportation commissioner Janette Sadik-Khan has championed cycling and public transportation measures (not without backlash) and invested heavily in the city’s bike lanes, as well as high-profile projects like the pedestrianization of Times Square and other plazas along Broadway. New York’s Active Design Guidelines, launched in 2010, help to formalize this approach and add building design strategies alongside urban design strategies. Bike sharing programs are gaining popularity worldwide, popping up in cities from D.C. to Paris to Mexico City to Beijing, adding to the viability and usage of alternate transportation modes.
Developers are following suit and recognizing the value of developments that promote health and activity. In San Francisco, Gensler is working with developer Forest City on 5M, an ambitious development project that seeks to form a “dense, urban place for working, living and gathering” and whose design principles clearly promote health and activity through “pedestrian-first” design, “engaging and accessible” spaces and an “active ground plane.” LEED for Neighborhood Development guidelines stress bike networks and storage, walkable streets, access to recreation facilities, and other alternative transportation strategies.
But there’s also a lot of work to do. In the U.S., many of the communities built in the past 50 years have regressed. Cities designed and built around the car have “engineered walking and bicycling out” of many of our communities, creating places that add to our problems rather than subtract. A culture built around freedom and independence has internalized these car-centric places – the typical rendition of the American Dream involves some sort of single-family, two-car-garage house with a white picket fence and a Ford or Chevy out front. And as other countries pursue economic growth, and the follow-on urbanization, many have emulated our failed approaches compounding the problem globally.
It doesn’t help that the positive examples people (including myself) often point to come from a standard list of Global Cities – New York, London, Tokyo, Hong Kong, Los Angeles, San Francisco… – that are far removed from the physical and cultural realities of many of the places where this problem is most pressing. And when it’s not a Global City, its Portland, Ore., or Copenhagen, Denmark (guilty again, but proud I didn’t mention Portland considering the bike talk). Those examples may be even further removed – Portland is such an anomaly that there is a television show dedicated to its particular cultural proclivities.
When I saw that the U.S. Department of Housing and Urban Development (HUD) launched a new “Sustainable Communities Resource Center” I got excited – HUD must be focusing on more than just the big, coastal cities that dominate these discussions, right? The site offers research, data, best practices, and links to more information about creating sustainable communities, including resources across a number of categories of which “Healthy Communities” is one. But a scroll through list of publications and reports quickly revealed a parallel issue.
The links that seemed most relevant to health concerns (vs. sustainability concerns): “Model Design Manual for Living Streets,” “Retrofitting the Suburbs to Increase Walking,” and “Health and the Built Environment.” All turn out to be strategies focused specifically on California (Los Angeles, Los Angeles/San Diego/San Francisco, “Southern California,” respectively). The second study even goes so far as to dismiss “sprawling metropolitan areas such as Atlanta, Houston, and Phoenix” early on in favor of California, where the opportunities are “especially golden.”
Addressing problems of health at a meaningful scale will mean contending with the realities of all our cities, not just those where it’s easiest or where we can be most opportunistic. And for the discussion to truly contribute to public health, it needs to differentiate itself from sustainability (a hybrid car, for instance, may be excellent for the environment but makes us no less sedentary). We need a new set of tactics and examples. We need to broaden the discussion. We need to tackle the cities where the opportunities aren’t “golden” to prove that this is an issue that goes beyond big, liberal, global cities.
This means not only moving inward off the coasts of the US, but considering cities globally and the variety of health considerations they pose. In China, alongside ambitious investments in rail and public transportation, Beijing, Shanghai and Hong Kong all struggle with air pollution that presents a danger to public health. And while China’s obesity problem is nowhere near the one faced in North America, obesity rates quadrupled between 1985 and 2000, stressing the need to move the discussion around urban health “beyond its roots in European and North American concerns.” While obesity and activity form the basis of one set of discussions, access to basic infrastructure and services still lacking in low- and middle-income countries cannot be ignored.
But like I said, there’s hope. A recent article in The New York Times reports that from 1998 to 2008, the percentage of potential drivers in the U.S. with licenses dropped from 64.4 percent to 46.3 percent. A report by the U.S. Public Interest Research Group marks a 23 percent drop in vehicle miles traveled alongside a 24 percent increase in bike trips from 2001 to 2009 among 16 to 34 year olds. In Shanghai, 25 percent of the population cycles to work. Maybe our obsession with the car will fade as generations change. Seizing on this opportunity will require making all our cities healthier, not just the standard set. It will require new approaches to public transportation, new development strategies that promote in-fill over sprawl and cultural changes that idolize different forms of living and transportation.
Personally, I’m optimistic. I think the trend away from car ownership is here to stay and that creative design and development solutions can help recreate more of our cities into just these places.
Then again, I do live in Brooklyn.
Tim Pittman is a member of Gensler’s research team and holds a master's degree in City Design and Social Science from the London School of Economics. His passion for cities stems from the belief that great design has a positive impact on the human experience and that the way we design our cities today will have a profound impact on how we inhabit and experience them tomorrow. Contact him at firstname.lastname@example.org.