Urban design and human flourishing

Welcome to this special issue of JUD focusing on human health, wellbeing, and flourishing. This issue coincides with the 25th anniversary of the Global Urban Research Unit (GURU) at Newcastle University and the establishment of a new ‘Urban Design and Human Flourishing’ theme within the centre. The theme brings together research that explores the ways in which people’s lives are influenced by the built environment and how we create, adapt, and maintain places which allow people to live healthy, fulfiling lives. But why ‘flourishing’? And how does flourishing relate to the more commonly used terms of ‘health’ and ‘wellbeing/well-being’? This is something I will return to at the end of this editorial. However, before discussing the nuances of terminology it is worth giving a very brief overview of how this field of interest emerged.

Modern town planning in Europe and North America was predicated on the notion of creating healthier places for people to live. This occurred in the wake of the emergence of ‘public health’ in the mid-19th-century. Public health pioneers were extremely interested in urban form, believing that the airless courts and passages of the industrial city led to a build-up of polluted air, filth, and disease. While the precise ways in which diseases were transmitted were often misunderstood, tackling living conditions proved a successful approach to reducing their impact. Minimum standards for streets and dwellings, though producing monotonous housing for working people, contributed significantly to improvements in their health and life expectancy.

As the 19th century gave way to the 20th, improving health was a cornerstone of ‘Garden City’ principles, with emphasis on access to fresh air, countryside, allotments, and therapeutic farms. Yet at the same time the medical profession was beginning to shift its focus away from preventive medicine in populations towards curing the individual, and chronic (non-communicable) diseases as much as infectious ones. Moreover, as the 20th century progressed, architects and planners became more ambitious in their aspirations for the city. Utopian visions of how to completely transform the way people lived and the ways in which cities functioned dominated.

With postwar reconstruction, the visionaries held sway, but only briefly. The ‘streets in the sky’ did not deliver the much-hoped-for thriving communities. They were held up for damning critique by the likes of Jane Jacobs, establishing one pillar of the field of endeavour, which became known as ‘urban design’. In the aftermath of the collapse of modernism, built environment professionals distanced themselves from anything that might be labelled ‘environmental determinism’, and urban design texts from the 1970s to the 1990s say precious little about improving human health and wellbeing.

By the late 1980s, however, public health was enjoying a renaissance among the medical profession, who were seeking collaborations with other disciplines – including urban planning – to tackle so-called ‘lifestyle diseases’ (see e.g., The Lancet 1991). The WHO Healthy Cities programme from 1986 onwards raised the profile of public health among policymakers and sought to enable local authorities and communities to create healthier places to live. However, the built environment disciplines largely remained aloof. Even the Charter of New Urbanism (Congress of New Urbanism 1996), which subsequently became closely associated with renewed interest in ‘walkable’ neighbourhoods and increasing physical activity (the focus of the Iravani and Rao paper in this issue) says nothing explicitly about human health and wellbeing.

The publication of Healthy Urban Planning: A WHO Guide to Planning for People (Barton and Tsourou 2000) marked a turning point. This work focused on the positive impact that urban planning can have on human health, drawing on the experience of settlements that were part of the Healthy Cities movement. Since that publication two decades ago, there has been a burgeoning interest (and output of research) from both sides of the urban planning/urban health debate. Much of the debate centres on the role of urban form, and therefore is of interest to those of us working in the field of urban design. Research from the early 2000s, for example, set about establishing links between urban sprawl, sedentary lifestyles, and lifestyle diseases (Frank, Engelke, and Schmid 2003). In the intervening period, however, the evidence base has grown exponentially (Barton et al. 2015; Cooper, Burton, and Cooper 2014), touching nearly every aspect of contemporary urban living and every life stage.

However, this vast amount of research has not necessarily brought consensus or clarity to the field. In the area of interest, for example, I have been most closely associated with – ‘obesogenic environments’ – the myriad of methodologies and metrics employed have often made comparison of results from one study to another extremely difficult and findings have been disparate and contradictory. Even the very definition of what constitutes a ‘healthy place’ has followed a number of pathways. This is the focus of our paper by Ann Forsyth, who examines the various models for ‘healthy’ neighbourhoods and cities. Her paper breaks these down into three overarching approaches: basic healthy places, population-based places, and those that are technology-focused. Each approach in turn contains two subcategories, making six in total. Urban designers, Forsyth observes, have been active in working on healthy built environments, for example drawing on cognate expertise in sustainability. However, there are still huge gaps in knowledge, and urban design would benefit from ‘appreciating the importance of individual and collective behaviours’. This would seem to be paramount since the basic dimensions of healthy design now appear well established – yet it is not always clear how to maximize engagement of the users of spaces.

Horney et al. focus their attention on community comprehensive plans in the US as a way of influencing community health conditions, for example by prioritizing opportunities for exercise, healthy eating, and the development of businesses that support healthy lifestyles. They are interested in how we quantify the effectiveness of plans, proposing the application of the Healthy Living and Active Design Scorecard developed by Maiden et al. (2016). Their case study, League City, a rapidly growing settlement on the Texas Gulf Coast, has an award-winning comprehensive plan. While the plan included some alignment to health priorities, the authors acknowledge that the presence of items in the plan did not necessarily lead to implementation; this is something that needs monitoring. The paper highlights the need for ‘buy-in’ at every stage of the development process.

Iravani and Rao’s paper, as stated, explores how the ten New Urbanist principles, as set out by the Michigan Land Use Institute (2006), impact public health and wellness. The outcomes they investigate are higher use of non-motorized and public transport, lower use of private automobiles, safer streets, complete community planning, and access to health resources. The study concludes that the first two New Urbanist principles, walkability and connectivity, are correlated with non-motorized modes of transportation, higher levels of physical activity, and attendant health and wellness benefits. Their literature review to analyse the other eight principles also looks promising, but again the authors point out gaps in the knowledge, concluding that further research is needed to factor in the influence of socioeconomic and demographic variables, particularly income. This introduces an important debate which flows through our final three papers, about what factors are most influential in relation to our health and wellbeing.

Our next paper by Mawer and Kiddle focuses on social health. It highlights that while health and wellbeing are largely defined by physical and mental states, social health is a key determinant of life satisfaction. The paper examines the potential of suburban shopping malls, as semi-public spaces, to be sites of community health and human flourishing. Their departure point is Oldenburg’s (1991) concept of ‘third place’, which highlights the role that malls have in social reproduction and recreation. However, while suburban malls have been increasingly recognized as important third places, in many places they are in decline due to changing consumer patterns. The authors highlight that in many communities, particularly poorer suburbs, malls are the only form of community space; yet because they are privately owned, communities are not empowered to affect their future. The authors call for a reframing of decision making and how we value community health in relation to commercial interests, which strikes at the heart of the key conundrum of how we deliver, manage, and maintain places, focusing on health and wellbeing into the future.

In our own (GURU) contribution to this edition, Jeffries et al., we turn our attention to a specific marginalized group in society: those with visual impairment. We examine how they navigate the public spaces of the city and what coping mechanisms they employ in a realm dominated by those with sight. We chose this group not only because they are under-researched in the field of urban design, but also because understanding their experiences challenges the dominance of the ‘visual’ in urban design as both process and product. Beyond this, our work seeks to question our understanding of ‘universal design’: whether it is liberating or potentially damaging as an approach to enable all citizens to live fulfiling lives in public space. We conclude that there is a need for more inclusionary practices that embed co-production of knowledge in the design, management, and maintenance of the urban realm.

The final paper by Minucciani and Saglar Onay also raises questions about universality, by asking how universal perceptions of wellbeing are; and specifically, what has greater influence over our understanding of wellbeing – age, or cultural context? Common sense might suggest that age is of greater importance, since it changes our physical and mental relations to space, and as the authors state, this ‘cannot be ignored’. However, building on previous work (Saglar Onay and Minucciani 2018) which examined daily routines in Italy and Turkey, they conclude that cultural differences are more significant. Examining a range of wellbeing requirements, they found cultural differences were consistently different between the two countries, but within each context they varied little with age. This work strongly emphasizes the importance of cultural context in relation to health and wellbeing and the problem of indiscriminate and uncritical transferring of ideas from one context to another; something that again concurs with my own research in this field.

Finally, ‘flourishing’

You will have noticed that, thus far, we’ve said very little about the term ‘flourishing’! So it is with this that I now wish to conclude. The most widely accepted definition of the word ‘health’ is the one set out in the Constitution of the World Health Organization in 1946: ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ (World Health Organisation 1946, para. 1). However, as will become apparent from the papers contained in this volume, exactly what is meant by health, or ‘healthy’, does not always coincide from one source to another. Read more widely and it becomes clear that in much research, ‘health’ is still very much medically prescribed. Wellbeing as a concept does to an extent get over this problem, offering a de-medicalized concept of health, but it is not without its own problems: it is essentially a complex construct and even the spelling (wellbeing/well-being) is disputed.

The term ‘flourishing’ is drawn from positive psychology (Keyes 2002), which suggests that the concept not only encompasses satisfaction with life, happiness, and positive psychological function, but that individuals are free to develop and reach their potential. The term was the central focus of the ‘Space to Flourish Charter’ drawn up at an international symposium on design for wellbeing in the built environment, organized by Prof. Libby Burton in 2014 (see Proceedings of the Institution of Civil Engineers 2015). For our group in GURU, flourishing is a broad umbrella term, under which we can accept research from a wide range of perspectives, without getting into definitional battles. While we are not suggesting all health/wellbeing/built environment studies adopt it, we hope it is a term that others will feel comfortable with and which will gain purchase in urban design debates; time will tell!