Health and The City

Where we live directly affect how healthy we are as individuals and as communities. While ready access to traditional health facilities - hospitals and health clinics and GP surgeries - forms part of the equation, it is the impact of our built environment and how we navigate it that can help or hinder our everyday experience of healthy living . These two factors also inform the work of Australian academic and urbanist Dr Jennifer Kent, a Research Fellow, Urban and Regional Planning, the University of Sydney School of Architecture, Design and Planning.

At a recent Cities Leadership Institute's Urban Leaders Boardroom Lunch Dr Kent shared her expertise, insights and research findings on building good health into our cities. We spoke with Dr Kent following her presentation.

Dr Kent, your research has two key themes. The first relates to day-to-day mobility and more sustainable transport in car oriented cities. The second is on the general links between the built environment and health. The two are linked by the health impacts of transport in urban environments.

Can you unpack the health implications that are particularly associated with private car dependency?

Some health professionals label cars as “the new tobacco”, referring to the links between private car use and injury and death from accidents, as well as the way cars are associated with respiratory illnesses such as asthma and even lung cancer. Others point to the way cars facilitate a lifestyle that is very sedentary – we drive rather than riding a bike or walking to the nearest bus stop.

Cars are also linked to the rush and busyness that is associated with modern life – in this way cars are associated with disconnected communities, where we hurry through our neighbourhoods rather than experience the inevitable slowing down and connecting that comes from travelling by public and active modes.

But it’s not as simple to say that cars are “bad” while other modes are “good”. For many people cars are the only option – they actually facilitate connection by enabling us to access jobs, friends and family. For many cars are also a part of a healthy lifestyle, enabling access to health services, the gym, healthier food options. And any parent will tell you a car is a necessity for “good parenting” in today’s society.

As planners it’s really important that we acknowledge both sides of the coin, particularly when we are expecting people to leave the car behind and try more sustainable modes.

How different would our built environment look if other forms of transport were prioritized?

In short, more people would have more options for travelling. Our suburbs would be connected by train and light rail options which would be timely, predictable, comfortable and able to be used for the majority of trips. Our neighbourhoods would be designed for walking and cycling with networks that are shaded, connected, direct, well signed and safe. In between these would be on-demand car options such as car sharing and ride sharing.

The actually types of built environments that support these uses are generally denser than many of our suburbs are today. This is required to reduce distances between uses and provide the critical mass required for investment in alternative transport. BUT, it is not as simple as increasing density per se. The infrastructure really should be there before the density happens.

Is this something we can imagine within the current thinking about Australian cities?

I do think we can do better in Australian cities. We have the opportunity provided by a growing population to facilitate some real changes in the way we plan, build and provide for new communities.

As planners we need to be more protective of the role of planning, and have a little more pride in what we do. Planning is not “red tape” – it is the foundation of decisions and actions that will influence the lives of real people for years to come.

In your 2014 article ‘Three Domains of Urban Planning for Health and Well-being’ you identified good planning as a major contributor to getting people active, strengthening communities and providing access to health foods.

What is the definition of good planning in this instance?

I advocate that “good planning” has three tenets – the first is a prioritization of equity of outcomes. Good planning decisions are driven by the desire to produce equitable outcomes in the community.

The second is diversity. Good planning acknowledges and actively incorporates diversity. Diversity in this case does not only refer to diverse people but also diverse ways of thinking, diverse built outcomes, diverse needs, diverse histories – it’s really about seeking to understand context rather than advocating for cookie cutter solutions.

The final tenet is what I call slowing down. Good planning takes time. When we hurry the provision and management of built environments we might get some easy wins but at the end of the day we make mistakes. We need to respect that liveable cities are not built over-night.

Can you give an example where good planning has contributed to those three domains?

Through Sydney’s recent construction boom we do have some good examples emerging. Central Park, for example, is well connected with active and public transport modes which encourages physical activity over car dependence. All residents have access to a supermarket which we know from the research is the best way to provide people with everyday affordable access to fresh food. Its green and open spaces provide places for people to sit, reflect, meet friends, and just be within their neighbourhood getting exposure to nature as well as community.

Green Square and Victoria Park are other examples, and Wolli Creek and Rhodes have similar features. Two things come to mind with these places, however. First, they are not particularly affordable – we know there is a socio-economic gradient to ill-health and these places are actually the least accessible to those who need them the most.

Second, we really have no idea what the community fabric in these new places is like. Communities take time and community building in density is particularly complex. We need to do research on social cohesion in these spaces in the future.

In your recently released book ‘Planning Australia’s Health Built Environments’ you, and co-author Prof. Susan Thompson, examine the way urban structure and governance influence both our physical and mental health.

Are there particular sorts of structures that are shown to have a positive influence on the mental health of individuals, and communities?

One of the key risk factors for mental health issues is loneliness and isolation – the sense that you don’t belong in the community around you, and the reality that there is no one you can call upon in times of stress or struggle.

Planning can draw people out of the privacy of their homes and into the community, facilitating a sense of connection and belonging which in turn provides resilience to loneliness and isolation.

Parks and public open spaces give people somewhere to go that is within the community. When these places are well-frequented they feel convivial, they enable people to connect with those around them, to tolerate difference, to slow down and simply ‘be’. Social infrastructure such as community centres provide similar opportunities, as does infrastructure for walking and cycling.

Finally, let’s talk about ‘slowing down’, the third foundation of health planning. Seems we’d all love to do it but not many of us know how. What clues can we take from our built environment?

And does ‘slowing down’ connect with your current research project on dogs and cars?

Slowing down is about taking time to reflect and become a part of the places where we spend our time – both as planners and as people.

All of the elements of healthy built environments – physical activity, community connection and healthy eating – take time, and if we are constantly rushing from one commitment to the next we don’t have the time required to take care of ourselves. Built environments can help people to slow down and a lot of it is about minimising time spent travelling.

For example, by enabling people to live closer to where they work we can return precious hours lost commuting. By providing services within the local neighbourhood we can provide people with the option to shop locally and save time. By providing adequate school spaces within walking distance of children’s homes we can reduce travel times by reducing the journey to school and increasing the likelihood that extra-curricula activities are locally based (imagine getting back some of your Saturday morning!).

There are elements of the built environment that can slow people down as well. These are things that let people to stop and talk (such as seating and shade in a public space) and give people something to talk about.

That is where dogs come in! Well behaved dogs in public spaces are a fantastic talking point. They provide a point of interest and encourage people to stop and chat, or even share a smile. Research shows us time and time again that dogs are a great social lubricant and, as our cities densify and backyards shrink or disappear, we need to make sure we still provide people with opportunities to keep companion animals.

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Level 23, 45 Clarence Street

Sydney, NSW 2000, Australia

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