Health and the cities of tomorrow

Below is an extract from the health dossier "The cities of tomorrow published in the Figaro newspaper on Monday 8 May 2023:

"From plague epidemics to tuberculosis, cities have always been considered less healthy places to live than rural areas. Times and issues have changed, however, and today the focus is on combating more insidious ailments: obesity, cardiovascular and metabolic diseases, cancer, asthma, depression... The list of disorders encouraged by the urban environment is long. With half of France's population living in urban areas of more than 100,000 inhabitants, major cities still have a long way to go before they take health into account in their development plans.

Yet there are many possible levers: limiting user stress by improving the connectivity of public transport lines, maintaining the mobility of senior citizens by making pedestrian routes safer, allowing everyone to relax in a green space, combating noise pollution to provide good conditions for concentration during the day and sleep at night, etc. "Today, we can no longer be satisfied with measures to ensure that the city does not cause harm: We need to take action to ensure that it is conducive to good health", says Marie-Laure Lambert, a lecturer specialising in town planning law at the University of Aix-Marseille.

Ten years behind the times

The links between urban planning and health were first highlighted by the World Health Organisation (WHO) in the 1980s. In France, it was not until the Grenelle Environment Forum in 2008 that the shift towards more sustainable urban planning began, albeit with a greater focus on the environment. "When I did my doctorate in epidemiology at the end of the 2000s in the United States, urban health was already a real research topic, although there was still little talk of it in Europe. We are ten years behind in this field," says^Professor Idris Guessous, Head of the Department of Primary Care Medicine at Geneva University Hospitals.

"Today, every town has its own PLU (local urban planning) environment. Well, I'm campaigning for global health PLUs! Why not take health issues rather than environmental issues as the starting point for devising solutions that benefit both?" asks Emmanuelle Gaudemer, Director of Development at AIA Life Designers, one of France's largest architectural firms, 60% of whose business is in the health sector. I'm not an urban planner or an architect, but I do come from the world of healthcare," she explains. This is fairly representative of our approach: to break down the barriers in design by helping all the players to collaborate, by putting users at the centre and by trying to get politicians on board, who are not always aware of the impact of projects. And without political will, even with the best ideas, nothing is possible".

It's not always easy to convince elected representatives of their responsibility for the health of their constituents. Many people still see responsibility for well-being as a matter for the individual rather than the community. Yet scientific evidence has accumulated over the last two decades to attest to the role played by environmental factors in numerous diseases such as obesity, asthma, diabetes, hypertension, anxiety, depression, etc.

The impact of measures to combat air pollution, which were the first to be put in place, is now being assessed. The banning of diesel vehicles in Tokyo in 2003 led to a 44% reduction in fine particle concentrations and a 20% drop in respiratory mortality over a ten-year period, according to a study published in Epidemiology. In the United States, studies have shown that teenagers are less likely to be overweight when the layout of the neighbourhood in which they live is conducive to walking.

Re-vegetate school grounds

Since health-promoting urban planning should be beneficial at all stages of life, some cities are starting to revegetate the courtyards of their nurseries and schools. " In Paris and Marseille, experiments are being carried out to create small green spaces that can also be accessible to the public outside school hours", explains Marie-Laure Lambert. The idea may seem like common sense, but some parents have complained about the stains of earth and grass on their children's clothes when they get home from school! An illustration of the difficulty of getting people to accept certain changes, even if they are intended to improve our health. In a survey, Dutch researchers asked people who use their bicycles to rank their motivations: "Because it's practical", replied the majority! Users are rarely motivated first and foremost by health benefits, but it is the simplification of everyday life that can lead to a change of habit. That's why it's so important to include users in the decision-making and design process from the outset.

The impact of the Covid pandemic is a case in point. Fleeing public transport, people have turned to cycling and other forms of soft mobility. " Since autumn 2020, we have been working hard to improve the links between the various routes, to make it easier to get around, not only in the neighbourhoods but throughout the city", explains Pascal Pras, vice-president of Nantes Métropole. As mayor of a small community, health is also a key concern. In Saint-Jean-de-Boiseau (Loire-Atlantique), paths have been redeveloped so that children can cycle safely to school. This has motivated parents to set up a "bike bus". And this type of local initiative carries more weight than you might think: elected representatives pay close attention to what local authorities are doing, and a successful initiative can have a snowball effect."

Extract from a report by Stéphany Gardier for Le Figaro

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