The visual essay and knowledge production: towards a visually informed understanding of urban health

The use of visual images for communication and debate about health is burgeoning in line with technological advances. The ubiquitousness of smartphone ownership, phone photography, and online social media such as photo and video hosting services (e.g. Facebook, Instagram, Snapchat, and TikTok) is profoundly influencing how we communicate. In academic literature, however, visual approaches to knowledge production about urban health are largely ignored or misunderstood (see Davey 2010). In an increasingly visual world, Cities & Health is taking the lead as one of the few health-oriented journals that welcomes visual-based submissions as part of its transdisciplinary mission. Excellent examples of visual essays published in the journal include a report on child-friendly urban planning in Canadian and European cities with photographs and maps (Gill 2019), a discussion of fast-food advertising and obesity in Kuwait with photographs of street views (Selamet 2022), and a critical discussion about the usefulness of no-smoking signs in Bangkok with accompanying photographs (Davey 2023a). The use of image-based and image-rich articles, in research as well as in case study, is also the established culture for many of the built environment areas that Cities & Health seeks to engage. In this editorial we call for a more visually informed understanding of urban health. Since visual essays are a good starting point for thinking about how images and visual techniques can be used to generate and represent knowledge, we begin by highlighting their importance for research, education, and practice. Next, we provide a framework for compiling a visual essay including suggestions and tips for creating and presenting visual material.

The visual essay and knowledge production

In short, a visual essay is an account of a topic using an amalgamation of visual and textual material that is weaved together into a coherent article. A visual essay is distinctive in that visual material, usually photographs, conceptual diagrams or artwork, or built environment work plans and proposals, is an integral, if not focal, part of the essay.

‘To see the ordinary so intensely that the ordinary becomes extraordinary, becoming so focused, so specific about something, that it becomes something other than what it ordinarily is’.An introductory poem to Seeing with Fresh Eyes: Meaning, Space, Data, Truth (Tufte 2020, p. 4).

The visual material, together with its caption, acts as information in its own right rather than only to illustrate text or to be hardly discussed. Moreover, the word ‘essay’ is important in that a visual essay presents information in a similar fashion to a conventional written essay, that is, with a storyline and a structure (e.g. introduction, main section, discussion) and a purpose (e.g. argument, discussion, explanation). However, these features can also be achieved visually as well as textually, for example an opening image can introduce a visual essay and a closing image can conclude it (Fusco et al. 1974), and the combined power of images and text is a clear asset.

Visual essays are a relatively new development in the literature. Innovations in photography and printing in the mid-19th century led to the illustration of newspapers and periodicals, such as the Illustrated London News (Hockings 2015). Later, news stories became increasingly illustrated with high-quality photography, and photojournalism was beginning to develop, for example, in Street Life in London in the 1870s, Life in the 1880s, National Geographic in the 1910s, and Picture Post and Weekly Illustrated in the 1930s. The wide circulation of these publications showcased visual essays to the public (Fusco et al. 1974). Other milestones included the innovation in the early 1920s of compact cameras with fast lenses, such as the Ermanox and the Leica (Fusco et al. 1974), the emergence of a mass market for these products, and the increasing popularity of photography as a hobby. The small size and portability and shortened exposure-time of compact cameras meant that high-quality photographs could be taken immediately and less obtrusively and with less technical obstacles. The rise of the visual essay is also associated with a long tradition of visual research methods such as photography and ethnographic film in anthropology and sociology and, subsequently, in other academic concentrations (Banks 2001, Hockings 2021). In the built environment research, an evolution in research-by-design methodologies mirrors these developments (Lenzholzer et al. 2013; Cortesão et al. 2020), and studies are often best communicated in the form of a visually rich essay.

Visual material can be extremely rich and varied. The well-known idiom ‘A picture paints a thousand words’ epitomises its ability to capture detailed information in anticipated and unanticipated ways (Tufte 2020). A photograph of a city, especially with a well-constructed caption, for example, can convey information about its material features, culture, social processes, sensory qualities (e.g. colour, texture), affective qualities (e.g. moods, feelings, attitudes), and interconnections among people, places, and health. All this information is shown in its entirety for the viewer to interpret using their own conventions, relying only on a small prompt from the author. For example, the health map, a conceptual image of health determinants applied to human settlements, published in a short article by Barton and Grant (2006), struck a chord of understanding about cities and health and is now used world-wide in many contexts and languages (Grant 2023). The simplified Chinese version of the health map is shown in Figure 1.

Figure 1. The health map. Adapted from Barton and Grant (2006). A health map for the local human habitat. The Journal of the Royal Society for the Promotion of Health, 126(6), 252-253.

Visual essays tend to be more exploratory and personal than empirical research reports, and appreciate subjectivity as a foundation of knowledge production. They are ideal for stimulating thought, generating, and following up, ideas and queries, making observations, and conveying information and experiences and feelings about a subject. It is this very shift of perspective and epistemology that makes the visual essay a novel contribution to scholarship. This is particularly important for the health literature that is dominated by realist and positivistic ‘authority’ (see Grady 1991). Consider, for example, the photo in Figure 2 and text excerpts from Davey and Zhao’s (2021) study of tobacco-related symbols and structural forms in Yuxi city, the location of China’s largest tobacco manufacturer, in which subjectivity was fundamental.

Figure 2. Life-sized statues of tobacco farmers outside the tobacco museum in Yuxi city, Yunnan Province, China (Davey and Zhao 2021).

It took us a couple of minutes to walk to the Tobacco Museum, also situated on Hongta Mountain. Its name alone made it immediately apparent that we were at another significant site of identity construction. As we approached the museum grounds, we saw visitors taking photos of life-sized statues of tobacco farmers planting, harvesting and transporting tobacco leaf (Figure 2). The statues are symbolic in every detail. The old-fashioned farming equipment is a throwback to previous times, making tobacco production in Yuxi historically significant … Since China has a large rural population … the exhibit conveys unity with ‘the people’, acting as a reminder that many livelihoods depend on the tobacco industry. Political connotations can be drawn as the peasantry has been a major force in the establishment of the State and its present-day prosperity, again linking the tobacco industry to the nation-state. The large tobacco seedlings in the exhibit signify the high quality of tobacco produced locally by the Hongta Group in fertile land and favourable climatic conditions; these seedlings are described metaphorically as ‘golden tobacco fields’ in the exhibit label; golden or gold is often used in Chinese to describe a bumper crop. Source: Davey and Zhao (2021). Smoking and the city: A travelogue in Yuxi. The Asia Pacific Journal of Anthropology, copyright ©The Australian National University, reprinted by permission of Taylor & Francis Ltd, http://www.tandfonline.com on behalf of The Australian National University.

The authors’ interpretations in the above passage contributed to the realisation that tobacco and pro-smoking symbols were highly visible and abundant throughout the city in its architecture, landmarks, museum, and tourist sites, analogous to a gigantic tobacco advertisement that cleverly circumvented tobacco advertising restrictions (i.e. rhizomatic smoking). Its political symbolism is also important since the government has a responsibility for public health and yet the tobacco industry in China is a powerful government monopoly and income source. These important findings prompted Davey and Zhao (2021) to call for a complete ban on all tobacco-related symbolism in the city (other than anti-smoking information), and for urban planners and policymakers and others to contribute to this endeavour (i.e. rhizomatic tobacco control).

Of course, experiencing health and the city is not only a visual undertaking but multisensory, involving perception, sensation, emotion, and consciousness of our own being; an embodied understanding which is difficult to conceptualise in words but ultimately hinges on the human bodily presence as the foundation of meaning (MacDougall 2006, Rose 2016). From this perspective, an image can be regarded as a ‘corporeal image’, a distillation of that reality of experience and meaning through conveying context or caption, an image grounded in the physical presence of ‘the body behind the camera and its relations with the world’ (MacDougall 2006, p. 3). This is different to the knowledge production in written texts. Since the literature overlooks sensual and embodied aspects of experience, even though they are central to understanding the world (Johnson 2007), such a take on urban health is likely to generate significant theoretical and practical contributions to the literature.

Since poignant images and text interact with feelings, attitudes, beliefs, and knowledge, they can influence people emotionally and intellectually, in particular, they can spark empathy and behavioural and social change. Look, for example, at the visual editorial ‘To the promised land’ (Light 2019) in our special issue ‘Child-friendly Cities’, which shows a photo of a child looking out of a window, alone in an unadorned room with a simple tired mattress as a bed, a member of an undocumented family in Fresno, California. How do you feel when you look at the photo? Is there a connection between the situation depicted in the photo and your own emotions and beliefs and knowledge about the experience of living in an immigrant family? Do you think the photo can help to change public attitudes and behaviours, to improve immigrants’ lives for the better? Can it help to fix our failed immigration systems?

Poignant images can even come to represent turning points in societal change; see Perricone (2022), TIME magazine’s list of the most influential pictures ever taken, and Jacob Riis’s How the Other Half Lives (1890), a landmark book containing first-hand observations and photographs and analyses of urban poverty in New York City slums. Riis’s (1890) exposé of the squalid and unhygienic living conditions experienced by immigrants in the city inspired wide-ranging social and political reforms for the urban poor. In an example from our journal, an article we recently published documents the use of a visual-based methodology, photovoice, by a local community that led to access for funds to implement physical neighbourhood change for health (Allport et al. 2023). It is this kind of social change that is urgently needed in cities around the world to address pressing health, poverty, and sustainability issues.

Cities & Health encourages collaboration among academic and non-academic partners and audiences such as city planners, community members, decision-makers, design organisations, health researchers, practitioners, and policymakers. Visual-based articles are a useful platform for stimulating collaboration, thereby maximising knowledge exchange and impact. They help to cross-cut academic disciplines such as urban studies, health studies, and visual studies, leading to more interdisciplinary work. They are also useful pedagogical aids for teaching and learning about critical thinking, visual analysis, narrative writing and personal voice, and interpretive ability – skills typically lacking in higher education curricula (Grady 1991, Bourque and Hamerlinck 2021).

A photograph is typically thought of as objective and matter of fact, a recording of the way things are. Yet taking a photograph, and creating other visual material including annotated plans, maps and proposals, data visualisations and conceptual diagrams, is a subjective endeavour, as only certain features are photographed or recorded and in certain ways, based on the image creator’s judgement and understanding of the topic, what they think is worth capturing, and perhaps an agenda (Bourdieu et al. 1990, Harrison 2004). Images originate in, and pertain to, a particular culture and its subjective representations of reality rather than to any accuracy or truth (Fusco et al. 1974). Furthermore, photography and other forms of image production and communication can be regarded as social practices mediated by what is happening on and off camera and by relationships among the image creator, the subject, and even the audience which has its own expectations and constructs its own meanings of images (Bourdieu et al. 1990, Becker 2002). Hence, an image might be better referred to as a ‘cultural image’ (see Hockings et al. 2014), ‘social image’, or ‘subjective image’, to help think through the sociality and subjectivity of image production. A visual essay, then, serves as a window through which to access and critically engage with all these subjectivities.

Planning and compiling a visual essay

In this section, we discuss some of the key points to consider when planning and compiling a visual essay: Structure and presentation, using visual material, image analysis, reflexivity, and ethics and social responsibility.

Structure and presentation

Cities & Health publishes visual essays made up of about 6 to 12 images and two thousand words. The essay’s presentation and structure will depend on its subject and purpose (e.g. to analyse, generate insight or debate, inform, make a point, persuade, put forward diverse views, construct experiences, set an agenda) and its audience as well as your own preferences. It can be analytic, narrative, personal, poetic, provocative, thematic, and so forth, or can have a combination of styles. A narrative visual essay, for example, can tell a story about a particular health topic or phenomenon, perhaps conveyed in a linear or chronological order using images and descriptive writing and expository writing. In contrast, images and text in a thematic essay can be organised around themes or subthemes. Consistent with the journal’s aim of putting scholarship in to practice and making it relevant for non-academic audiences, we also welcome ‘applied visual essays’, for example, about project implementation, planning decisions, neighbourhood design options and proposals, and policy initiatives, in a format which you think is appropriate for practitioners. Innovative and experimental forms of writing and style and presentation are encouraged. While a visual essay can include a personal take on a subject including narration and personal discoveries, bear in mind that the journal has a special section for reflective writing: see the ‘Reflections from research, practice and design’ section in the instructions for authors as well as Grant and Thompson (2018). If your essay is based on travel to and around a city, it might be better suited to the journal’s ‘travelogue’ article category (Davey 2023b).

Using visual material

It is a good idea to assemble more images than you intend to publish, and to spend time choosing the most suitable (Fusco et al. 1974). Think carefully about the intended meanings of the images you create or select in relation to the essay’s topic and purpose and originality, for example new insights which are not available in textual communication. Give a description of each image’s meanings and context, to enable the viewer to understand what is taking place and why it has been included. Do not assume that an image is self-explanatory, as it can be interpreted in a multitude of ways, and different people can see things differently. Ambiguous images or intangible concepts (e.g. addiction, beliefs, customs, mental health, social interactions, society) can be particularly difficult to represent and decipher (see Banks 2001). Bear in mind that Cities & Health has a broad and international and interdisciplinary readership. For these reasons, although visual submissions can be compiled without much written detail (see Light’s 2019 visual editorial material as an example) or without connections between images and text, so that the reader is free to construct their own interpretations (Becker 2002), we suggest that you provide sufficient description and explanation about each image and that you also consider alternative interpretations as well as unintended issues of representation such as stereotypes.

Different types of visual material can be used in an essay: data visualisations, photographs (e.g. research photography, family photography, news photography), diagrams, drawings, maps and plans, media images, paintings, postcards, sketches, social media posts, cartoons, comic books, advertisements, etc. Since most visual essays in the literature tend to use photographs (i.e. photo essays), we believe that novel insights in health and social sciences can be gleaned from exploring other forms of visual material. Note, however, that Cities & Health has separate article types for urban design drawings and schematic plans about urban planning and design.

You can create your own images using cameras, smartphones, arts and craft materials, and other objects and materials, or you can use existing images with permission from the copyright holder (which is your responsibility to obtain) which should be fully referenced. Existing images are available from a wide range of sources such as archives, people, websites, and online databases and repositories, and these are currently underutilised in the literature on urban health. It is possible to use images from your own fieldwork or from participants in research projects (e.g. from photo-elicitation or photovoice, see Figure 3), but a research report using visual research methods should instead be submitted to the journal as an empirical paper.

Figure 3. Children in Belfast, the capital and largest city of Northern Ireland, using photography for communicating ‘healthy routes to school’ as part of an action research project that led to the adoption at city level of an action plan for child-friendly places. Published in Monaghan (2019). Engagement of children in developing healthy and child-friendly places in Belfast. Cities & health, 3(1-2), 29-39. Copyright ©Jonna Monaghan and Belfast healthy Cities, reprinted by permission.

Image analysis

You are not expected to be a professional artist or photographer, and, similarly, readers of the journal are not expected to have visual analysis skills. A visual essay and its images are likely to be taken at face value for the information they communicate about the topic, and not for aesthetics. Even so, thinking about the visual rhetoric of images (e.g. composition, depth of field, emphasis, exposure, colour, contrast, framing) will help you to create or to select informative and interesting images which communicate information effectively and perhaps even influence people’s attitudes and beliefs and behaviours in ways that improve health:

• Principles of art and composition. The way elements of an image are arranged and combined, such as colour (e.g. hue, saturation), balance, contrast, lighting, emphasis, proportion, shape, and lines, all influence visual communication.

• Characteristics of photography. Different types of focus, shot, angle, framing, and distance convey and emphasise certain information. For instance, a wide-angle shot is suitable for recording a group or setting or location or an object in relation to its context and surroundings; a close-up shot is more selective and highlights specific detail; a low-angle shot looking upwards could convey meanings such as size, power, and authority, while a high-angle shot looking downwards could convey small size or powerlessness.

• Sequencing and arrangement of images. Although each image can stand as an individual statement with independent meanings, it is situated within and adds information to the essay’s storyline; and a reader might make sense of an image in relation to preceding and proceeding images. Therefore, carefully consider the meanings and aesthetics of each image in relation to other images, the text, and the whole picture (Fusco et al. 1974, Becker 2002, MacDougall 2006), and they can be elaborated upon in the text. However, keep in mind that an essay and its images might not be read sequentially (Becker 2002).

• Captions. Each image should be labelled clearly to describe its content and importance. Like the main text, captions can be written in different styles such as descriptive, poetic, reflective, and so forth. See our examples of different caption styles in this editorial.

Excellent guides are available in print and online about these topics including useful books on visual culture and visual research methods (e.g. Rose 2016, Hockings 2021). It is not in the purview of Cities & Health to scrutinise visual aesthetics too much, as the journal is concerned more with advancing health in cities rather than with professional art and design and photography. Nevertheless, an awareness of visual rhetoric will help you to think visually and critically about your own use of images and how a topic is depicted, and you are welcome to further engage with visual studies in your work.

Reflexivity

Compiling a visual essay includes evaluating how it is shaped by your own subjectivity and epistemological assumptions within your background, beliefs, culture, experiences, and interests; how and why images were chosen or made; and how everything weaves together an understanding of the topic from your perspective (Banks 2001). It is up to you to decide how much reflexivity is needed and included in the essay and the way it is presented. Exploring subjectivity in existing images produced by other people in different cultures or time periods (and often produced for different purposes) might require some detective work (Banks 2001).

Ethics and social responsibility

Ethics guidance for conducting and publishing academic work are available from your university or employer, Taylor & Francis, professional associations, and other sources. Examples of potential issues which might arise in the compilation of visual essays include the anonymity, confidentiality, and privacy of people in images, depiction and representation and exclusion, permission to take photographs, copyright of existing images, and the distortion, editing, or manipulation of images which can range from simple enhancement (e.g. colour, contrast) through to artificial intelligence image generation. You should obtain any necessary permissions and ethics approvals before commencing. At Cities & Health we expect a visual essay to contribute in some way to understanding the health and sustainability of our cities and to achieving the United Nation’s Sustainable Development Goals. You are encouraged to explore other ways of taking on socially responsible scholarship.

Towards a visually informed understanding of urban health

Urban health is still a subject of words; such a restricted scope will place limits on many aspects of broader understanding, inclusive research, and advocacy. With transdisciplinarity and inclusive working widely acknowledged as vital to urban health, the privileging of text in conventional journal article formats must be questioned. Greater importance needs to be given to images, visual techniques, and visual epistemology in the generation, co-generation and representation of knowledge. Visual essays are an excellent platform to place visual material centre stage in an otherwise text-dominated arena. For all this to happen, we must first embrace ‘the visual’ in our work which will lead ultimately to different ways of understanding and doing urban health and perhaps to a rethink of what urban health really means. As one of a small number of health journals which welcomes and encourages visual work, Cities & Health is a springboard for cultivating a visually informed understanding of health. Looking to the future, you are invited to submit essays and empirical articles using visual material to Cities & Health.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

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Notes on contributors

Gareth Davey

Gareth Davey is Visual Content Advisor of Cities & Health. He is a visiting professor in the Faculty of Professional Studies at the University of Bolton in England, United Kingdom.

Marcus Grant

Marcus Grant is Editor-in-Chief of Cities & Health and former deputy director of the World Health Organisation’s Collaborating Centre for Healthy Cities and Urban Policy.