Health beyond the headlines
Korea-Seoul-Cheonggyecheon-2008-01 (1)

Breaking Ground on Urban Health

With urbanization on the rise, symposium looks at how to improve health in cities

By Tim Paul

Published May 15, 2014

Where we live matters for our health. And more and more of us are living in cities—an amazing 80 percent of the world in the near future, according to one estimate. Knowing this, how can we harness the urban environment to improve the health of those of us living there?

This question is ground zero of a new Urban+Health program organized by Columbia’s Mailman School of Public Health and Graduate School of Architecture, Planning, and Preservation (GSAPP). On April 22, the two schools inaugurated the program with a daylong symposium at the GSAPP Studio-X space downtown during which experts from both fields swapped healthy city strategies from bike paths to birthing rooms. “If you’re really serious about cities,” said Dr. Mark Wigley, dean of GSAPP, “in the end, you’re going to be serious about health,” and vice versa.

The urban health conversation has been ongoing for more than a hundred years. Beginning in the middle of the 19th century, well before the discovery of antibiotics, the battle against widespread urban infectious disease was won using the built environment of the city itself, observed panelist Dr. Karen Lee, senior adviser on the built environment and healthy housing at the New York City Department of Health and Mental Hygiene. For instance, the construction of New York’s Croton Reservoir in 1842 helped wipe out cholera. Today’s principal adversary is chronic disease stemming from a lack of access to healthy food; an environment that discourages walking and cycling; and air pollution from industrial development and automobiles. Once again, the urban environment is being drafted into service.

“Creating spaces for walking is a panacea. No medicines can do this.”

New York is renowned for being ruled by pedestrians (think John Travolta in “Saturday Night Fever”). But just how much walking do New Yorkers do, and what makes them pound the pavement? Panelist Dr. Andrew Rundle, associate professor of epidemiology, at the Mailman School, explores these questions using GPS monitors to track how people move about their neighborhood block-by-block and matched it with the street’s “walkability”—a measure Rundle borrowed from urban planners that refers to how much a neighborhood’s built environment encourages walking and biking: two activities that have clear links to good health. It turned out that half of New Yorkers walk more than national recommendations. And surprisingly, the amount of crime in a neighborhood has little effect on pedestrian activity. Proximity to walk-up retail and subways matter more.

“Creating spaces for walking is a panacea,” said keynote speaker Dr. Carlos Dora, coordinator of the interventions for healthy environments unit at the World Health Organization. “No medicines can do this.” Over the last decade, New York City has taken up this philosophy, aggressively reshaping the five boroughs to promote physical activity, by adding bike lanes, bus lanes, and pedestrian plazas—interventions that have the advantage of being relatively modest investments.

While new technologies like self-driving taxis and buildings constructed using 3D printers are around the corner, low-tech solutions are needed. This is particularly urgent in the growing number of urban slums, said panelist Dr. Gina Lovasi, assistant professor of epidemiology at the Mailman School, who with colleagues at GSAPP recently spent time in the favelas in Rio de Janeiro. Dr. Lynn P. Freedman, professor of population and family health at the Mailman School, gave a case study on her experience with a simple, but highly effective intervention in the slums of Dhaka, Bangladesh, where following the introduction of clean birth rooms integrated into slums, the number of women giving birth at home plummeted.

In designing cities, aesthetics matter… Natural lighting in stairwells and other design elements make a big difference.

While the successes are remarkable, there are some areas of the urban health project that are underdeveloped. According to Dora, too much attention has been paid to studies looking for the drivers of illness—the effects of air pollution, for example. “We focus on disease because it’s so dramatic,” he said. Instead more research is needed to weigh the effectiveness of various interventions. Unintended consequences like gentrification are another serious concern. Reshaping neighborhoods may exacerbate health disparities and shorten life expectancy. Inequality must be considered when planning interventions, noted Dr. Lovasi. New York City’s new bike share program does not extend to neighborhoods with the highest obesity rates, she added.

Watch video courtesy of GSAPP:

In designing cities, aesthetics matter. Even with the apparently simple task of getting people to take the stairs. Natural lighting in stairwells and other design elements make a big difference, said Karen Lee. This kind of insight is only possible when public health experts partner with designers, architects, and planners. The moment is ripe for collaboration, agreed Hilary Sample-Meredith, associate professor of architecture, planning and preservation at GSAPP.

“While the spark of ideas may come from someone’s imagination,” said Mailman Dean Linda P. Fried, “there are public goods [like healthy cities] that we can only accomplish together.”

Read about what speakers had to say about related benefits to integrating public health into urban design.

Featured photo: The Cheonggyecheon in Seoul is a stream that was restored as part of an urban renewal project to create more park space. It had been covered by an elevated highway. Taken by Michael Sotnikov.

This article also appeared on the Mailman School of Public Health. Edited by Joshua Brooks.

Elevate the conversation

 
The views and opinions expressed on this website are solely those of the authors and do not represent those of the Department of Epidemiology, the Mailman School of Public Health, or Columbia University.