Objectively Healthy Cities

1. Objectively Healthy Cities Urban design for the 21st century George Weeks george.weeks@cantab.net 27th October 2012

2. 1) The Age of Pestilence and Famine Represents most of human history • Pre – industrial • High birth rates • High death rates • Basic medicine

3. 2) The Age of Receding Pandemics Late 1700s to early 1900s Industrialisation Population growth Rural – to – urban migration Expanding Urban Populations • Liverpool: 88,000 (1801) – 165,000 (1831) • Manchester: 90,000 (1801) – 187,000 (1831) • Leeds: 53,000 (1801) – 123,000 (1831) Pollution Waste disposal Overcrowding “Noxious trades” Incompatible land uses Disease Rapid urban growth Sewage

4. 20th Century Responses - Zoning Unintended consequences

5. Receding Pandemics Pestilence & Famine Industrial Pre - industrial Epidemiological Transition Degenerative & Man Made Diseases Post - industrial

6. Then and Now PREVENTABLE

7. “Despite all the technological advances in modern medicine, regular physical activity is as close as we’ve come to a magic bullet for good health.” Dr JoAnne E. Manson, Professor of Medicine, Harvard Medical School & Chief, Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital Physiology Humans are designed for movement and have evolved to have high levels of energy expenditure P T Katzmarzyk, 2010; Physical Activity, Sedentary Behavior, and Health: Paradigm Paralysis or Paradigm Shift?Diabetes;59,11

8. Benefits of physical activity Aerobics Center Longitudinal Study ~10,000 men ~3,000 women 8 years P T Katzmarzyk, Physical Activity, Sedentary Behavior, and Health: Paradigm Paralysis or Paradigm Shift?Diabetes; Nov 2010; 59, 11

9. Types of Physical Activity Recreational Direct demand Behavioural Physical Activity Utilitarian Indirect demand Environmental

10. Recreational Activity

11. Utilitarian Activity

12. Types of Physical Activity Recreational POLICY RESPONSE Behaviour – based Individual scale Physical Activity Utilitarian POLICY RESPONSE Circumstance - based Environment – scale People respond to their environment

13. Would you walk here................................................or here? Would you cycle here...............................................or here? People respond to their environment

14. Transportation Research Board (2005) “built environments designed to facilitate more active lifestyles and to reduce barriers to physical activity are desirable”.

15. }- • Proximity Walkability • Density • Mix of uses • Connectivity Residents’ assessment of their neighbourhoods’ walkability Researchers’ own prior assessment of degrees of walkability Very strong correlation (p<0.0001)

16. Measuring Urban Form (Lawrence et al, 2005) “An objectively measured walkability index was _significantly related to objectively measured _moderate intensity physical activity in adults.”

17. Studies of studies Glasgow Centre for Population Health (2006) 65 studies • Australia • Canada • Japan • UK • USA Residents of walkable neighbourhoods always tend to undertake more physical activity Hanlon P., D. Walsh and B. Whyte (2006) “Let Glasgow Flourish”; Glasgow Centre for Population Health Walkability encourages exercise,irrespective of whether or not people have an expressed preference for it. Van Dyk et al (2009)

18. Importance of utilitarianism “There was…a difference between neighbourhoods regarding walking for errands. This…is consistent with transportation research that finds no differences in walking for exercise but finds significant differences in walking for transport purposes between high- and low walkability neighbourhoods" Saelenset al, 2003

19. Recap

20. Research Implications • Neighbourhood walkability = objective measure • Walkability correlates with physical activity • Physical activity correlates with significantly lower levels of illness and better health • Walkable and bikeable mixed use environments contribute significantly to public health = Objective, public health based justification for walkable, mixed use urban design george.weeks@cantab.net