SUPPORTING CITY KNOW-HOW
Evidence supports what we all intuitively know, that human health and planetary health are heavily influenced by the urban environments we create. Urban policy, programmes and projects have the potential to escalate problems or to provide solutions. Cities & Health is dedicated to supporting the flow of knowledge required to support action to reduce risks for human and planetary health, many of which are a shared global concern. Our aim is to foster connections and conversations between researchers, practitioners, policy-makers, communities, and decision-makers in cities. Research for city practice includes ‘City Know-how’ briefings derived from research findings to support access to and dissemination of key lessons. The team at Cities & Health, and our two knowledge partners (International Society for Urban Health and SALUS.Global), invite you to join their networks, and contribute to the dialogue. We encourage communities, researchers, practitioners and policy-makers to consider publishing in Cities & Health to help influence urban policy.
This issue of Cities & Health comprises a leading editorial and 10 articles.
Our leading editorial, ‘The visual essay and knowledge production: towards a visually informed understanding of urban health’ follows our theme of exploring often neglected areas of knowledge for healthier place-making, in terms of both its creation and its communication. In this editorial we look at ‘the visual essay’ and its role in knowledge production. We provide a framework for compiling a visual essay including suggestions and tips for creating and presenting visual material. We have now published several visually based papers in Cities & Health and encourage more submissions to this category. We add to our growing archive in this issue with ‘Signs of pandemic times: tracing the reconfigurations of urban spaces through COVID-19 signage’ by Kazi Nazrul Fattah.
As is usually the case, each of the City Know-how policy briefings below is based on a full research article published in this issue. In addition to these, this issue contains a case study, a visual essay and a book review.
Built environment as well as cultural, religious, behavioral, and wealth factors impact participation of physical activity and sports
In megacity Karachi Pakistan, women and girls’ tendency of being overweight or obese is comparatively higher than men and boys. Sex and socio-economic status-related disparities in built environment contribute negatively to people’s health and especially for women.
For the attention of: Planners, architects, developers, and government officials who contribute to development plans.
The problem: Obesity is a common, serious, and costly disease and varies according to age, education, race, sex, and socio-economic status. Most communities in low-income and middle-income areas suffer in terms of environmental justice and face gender and socio-economic status-related disparities as well as social, cultural, and religious restrictions which deter girls and women from physical activity and sports outside or in parks and playgrounds. These inequalities lead to poor health outcomes, especially for women.
What we did and why: I selected 200-300 random study participants from six neighbourhoods. There were two from each of low-, middle-, and high-income socioeconomic status neighbourhoods. I compared the difference in overweight/obesity rate between males and females. Demographical data was included, and male and female study participants (20 years plus) completed a survey questionnaire including various cultural, religious and built environment related questions. The data were analysed through linear regression models as well as descriptive methods to understand the underlying causes of increase in overweight and obesity rate in both genders.
What our study adds: This study tests the assumption whether overweight/obesity rate is higher in males vs females in megacity Karachi, based on available Lancet data for selected Asian countries with comparison on three socioeconomic statuses.
This study affirms women’s and girls’ tendency of being overweight or obese is comparatively higher than men and boys in Karachi, Pakistan.
This study confirms various built environment, personal, religious, cultural, and socioeconomic factors work differently for both sexes and contribute to increasing BMI of (female) adults in all socio-economic classes.
Sex, cultural, and socioeconomic related disparities in built environment contribute negatively to overall people health specifically for women.
Implications for city policy and practice: This case study, by surveying people and neighbourhood environments, informs policymakers, planners, and other related organizations as to how sex, culture, religion, built environment and socio-economic status relate to inequalities faced in predominately low-income and middle-income neighbourhoods. I that health equity could be exacerbated through poor quality of recreational spaces such as parks, playgrounds and other amenities at neighbourhood scale, e.g. walkways and streets.
This case study also builds on the fact that neighbourhoods in low-income areas seem to compromise on basic and recreational facilities, with issues including, lack of cleanliness, poor maintenance, and reduced quality and area of open spaces such as parks and playgrounds.
This case study proposes that these inequalities result in the absence of facilities in low-income neighbourhood like sports fields, playgrounds, and green spaces along with other secondary spaces, such as parking and restrooms, which account for low park visitation and physical activity level by both sexes, but especially by women and girls.
This sheds light on the gap between planning practitioners, delivery mechanisms and city municipal authorities responsible for maintenance, as well as assigning equitable park distribution to all socio-economic classes.
For further information: The Association of Collegiate Schools of Planning: Faculty Women’s Interest Group.
Full research article: The role of built environment, personal, religious, cultural, and socioeconomic factors in increasing overweight and obesity rate in women vs. men: a case study of Karachi, Pakistan by Afsheen Sadaf
Water-gender-health nexus in human settlements in the Global South
Theoretical framework guiding our study.
Water quantity and quality are important for health. We used a gender lens analytical framework together with social justice theory to analyse the interplay of water, gender and health in human settlements. Our exploration provides critical research and policy insights for enhancing the liveability of human settlements.
For the attention of: Urban planners and city managers and urban leaders. Scholars researching issues of water, gender and health.
The problem: Water scarcity challenges are rife in Zimbabwe’s major cities. This led to recurrent cholera outbreaks plaguing most cities in Zimbabwe in 2008/09 and 2018, with the outbreaks prevalent in poor neighbourhoods. The water crisis reveals how urban health challenges are prevalent in poor neighbourhoods. The vulnerability of women and girls brings attention to the gendered nature of household water scarcity and vulnerabilities. The study explores women’s lived experiences in accessing water and the associated health issues linked to women’s burden.
What we did and why: We used a mixed-method approach guided by case study design. Data were collected using both primary and secondary methods. First, we undertook a document review, which helped to analyse policies and legislation relating to water, gender and health and we analysed secondary data. Second, we conducted focus group discussions, observations, photography and interviews with key informants. Focus group discussions were conducted with women to gain insights into the daily lived experiences regarding water access and the dimensions of health issues that affect women and girls. Interviews were conducted to examine how the officials perceive the issues of water, gender and health. All these primary data were then analysed.
What our study adds: In our exploration of the water, gender and health;
We found that there is pervasive water quality and quantity scarcity in human settlements in Zimbabwe.
We observed the persistence of inequalities prevalent in water service delivery in cities.
We brought methodological insights critical for other scholars researching on issues pertaining to the water-gender-health nexus.
Implications for city policy and practice: Our findings reveal that water quantity and quality scarcity are prevalent in Hopley. This scarcity disadvantages women and girls who are responsible for household water tasks. Subsequently, in addition to water-borne disease, women and girls are more vulnerable to emotional, physical, and psychological stress associated with accessing water.
There is a need for gendered policies that integrate the needs of vulnerable groups, especially women and girls.
Participatory methods need to be integrated into policy formulation and implementation.
Full research article: Exploring water-gender-health nexus in human settlements in Hopley, Harare by Abraham R Matamanda, Thulisile N Mphambukeli and Innocent Chirisa.
Can we improve food access for caregivers by expanding a nutrition program to a new grocery store?
Where do pediatric caregivers shop? Can we encourage more local food shopping by expanding a produce prescription program to a new store? A map-based analysis of grocery shopping in Flint, Michigan.
For the attention of: Hospital systems with paediatric clinics, Alternative food systems non-profits in the food retailing space, City planning offices involved in food systems work,
The problem: Many people bypass local food stores to shop at major stores, foregoing proximate food access. It is also hard to increase healthy food consumption without access to an incentive program. We wanted to understand where caregivers were shopping, so we could determine the potential effectiveness of expanding a paediatric produce prescription program to a new store site in our study area of Flint, Michigan.
What we did and why: We used GIS to determine the average distance that caregivers were traveling to access groceries, then compared that to the shortest distance they could travel to reach groceries. We then examined whether a new cooperatively owned grocery store would be closer to these caregivers, as a first step in an advocacy campaign to expand our prescription program to that store.
What our study adds: Our study provides a methodology for measuring access to healthy foods, and illustrates how this methodology can be used to inform future site selection for an expanded pediatric produce prescription program. We hope that our study encourages other pediatric clinics, grocery stores, and related stakeholders to increase their participation in incentive programs to encourage healthy food consumption among children.
Implications for city policy and practice: Cities can use this approach and data to increase the presence of food systems in their planning documents and to conduct their own case studies of food access among key population sub-groups who may be at risk for food insecurity. This data can be used to zero in on ideal locations for built environment-based interventions – not only in food systems but with related social service needs.
For further information: Details on the Pediatric Produce Prescription Program at the MSU-Hurley Children’s Hospital Pediatric Public Health Initiative.
Full research article: Nobody shops at the neighborhood store: leveraging a community’s pediatric fresh produce prescription program to inform future participating store redemption locations by Richard C. Sadler and Amy Saxe-Custack
Physical activity in outdoor spaces; factors impeding compliance with WHO physical activity guidelines
Research assistants in seaside promenade, Paço de Arcos’ beach after the interviews.
Complying with current physical activity recommendations can reduce the risk of mortality from cardiovascular diseases by 47% as well as other numerous benefits to society. Outdoor spaces that are well maintained and available to the population can boost physical activity levels, however many personal factors that can prevent people from being more active.
For the attention of: Public health professionals and researchers.
The problem: We want to know what kind of people use public space for physical activity practice and if this helps them achieve physical activity recommendations. We also want to know which factors reduce the chances to meet the public health physical activity recommendations.
What we did and why: We used a questionnaire with face-to-face interviews in public spaces in the municipality of Oeiras, Portugal (a cross-sectional investigation). The aim was measuring the amount of physical activity and sedentary behaviour; to then investigate the distinct correlated factors associated with complying with the overall, moderate, and vigorous physical activity recommendations.
What our study adds: The study showed us that public park users tend to be more physically active than the general population. In fact, we found that 75.2% of the public park users we surveyed close to physical activity infrastructure in Oeiras, Portugal met the overall physical activity guidelines from the WHO. It also showed us many personal factors that can prevent people from being more active.
Implications for city policy and practice: Our findings showed that cities must increasingly invest in building welcoming environments with good facilities for the practice of physical activity.
The fight against physical inactivity must go beyond environmental improvements and include other measures to reduce sedentary behaviour, support better sleeping habits, and also increase educational access.
Full research article: Correlates associated with the compliance for moderate, vigorous, and overall physical activity recommendations of public park users in Oeiras, Portugal by Sabrina C. Teno, Hélio Silva and Pedro B. Júdice.
Involving residents’ perspectives in healthier redesign of post-war urban neighbourhoods
Post-war neighbourhoods in industrialised countries negatively affect some health choices for residents’ lifestyles. Redesign may help to facilitate more physical activity of social interaction, for example but only effectively if also involving residents. We piloted a procedure to select locations for redesign and health determinants to be addressed, integrating data from designers, care professionals and residents.
For the attention of: Urban policy makers; practitioners working on healthy cities; community leaders.
The problem: A major challenge of urban redesign to improve city health is involving residents, urban design and health and social care professionals jointly. Such redesign is in particular needed for post-war urban neighbourhoods, built in the period between 1950 and 1970 in Europe. Urban redesign of these neighbourhood seems promising to enhance the physical activity and social connections of residents. Methods are needed to involve residents in such a process of redesign. We address this challenge.
What we did and why: We focussed on the selection of locations to be redesigned and the health determinants to be addressed. For this, we collected data from three perspectives: spatial analyses by urban designers; interviews with experts in local health and social care; and surveys among residents. Next, we organised consensus meetings covering all perspectives to select three locations to be redesigned, and to select the core determinants per location.
What our study adds: We developed an empirical procedure, addressing residents’ perspectives, based on various data sources and a consensus process. That led to selection of the following types of locations and determinants (in brackets):
An area adjacent to a central shopping mall (social interaction, traffic safety, physical activity)
A park (experiencing green, physical activity, social safety, social interaction)
A block of low-rise row houses around a public square (social safety, social interaction, traffic safety)
Implications for city policy and practice: Our procedure on the selection of locations and topics to promote health in a post-war neighbourhood is promising to be used in other settings. It can be the basis for urban interventions. For example, with redesign using virtual reality techniques to further involve residents, and evaluation after their implementation. This offers a promising approach to realise healthier cities.
For further information:
Expertise centre: Architecture, Urbanism and Health.
YouTube video: selection and design stages of the project (in Dutch, with English translation) and setup of the project: an interview with Cor Wagenaar.
Groningen, Paddepoel Neighbourhood: website of the neighbourhood council (in Dutch).
Full research article: Making post-war urban neighbourhoods healthier: involving residents’ perspectives in selecting locations for health promoting urban redesign interventions by Sijmen A. Reijneveld, Marijke Koene, Jolanda Tuinstra, Stefan C. van der Spek, Manda Broekhuis and Cor Wagenaar
How can urban technologies support older people live in neighbourhoods and cities?
An old lady dragging a shopping cart has to trot crossing the street due to a short pedestrian light time at a wide street in Beijing. Image credit: Yingying Lyu.
What existing technological devices are available to support older people in their neighbourhood and city environments as they age? Using an inventory of available and emerging technological devices, this paper finds many devices address older people’s mobility and safety as pedestrians or in motorised vehicles.
For the attention of: Urban planners and designers; policy-makers and researchers working on ageing
The problem: Around the world the population is aging. Aging brings changes in vision, hearing, mobility, and cognition, making it difficult and dangerous for older people to move around in the city. Technologies may be able to help ameliorate the challenges, allow older people to remain living in the community longer, and increase their sociability and quality of life.
What we did and why: While much has been written about technologies helping older people at homes and in healthcare facilities, less attention has been paid to technologies used in the neighbourhood and city environments, including community open spaces, streets, parks, and transportation. What new urban-scale technological devices are available to support older people age in place? The answers help cities and practitioners understand opportunities and gaps in new technological devices to create more age-friendly spaces.
What our study adds: We provide an inventory of urban-scale technological devices that support older people to use their neighbourhood and city environments more safely, effectively, and independently.
We examine the devices through two factors: the life domains they serve and the type of technology function.
We draw out implications for where technologies could be developed further.
We are then able to discuss how urban-scale technologies could serve older people better and also look at the challenges, which include affordability and coordination.
Implications for city policy and practice: The inventory of new urban-scale technology helps to equip urban planners and designers with new technological solutions in building age-friendly cities.
City policy can foster the development of technologies to encourage social interaction in outdoor spaces.
City policy could promote age-friendly services to connect older people to the devices and encourage creative business models and public programs to improve device affordability.
Planning and design practice can be used to enhance the urban infrastructure to support use of these devices.
For further information: The Healthy Places Design Lab at the Harvard University Graduate School of Design
Full research article: Technological devices to help older people beyond the home: an inventory and assessment focusing on the neighborhood and city scales by Yingying Lyu and Ann Forsyth
Cohousing as a model for social health
Conceptual map of social health, social connectedness, social capital and related concepts.
Despite some evidence the physical design and social structure of cohousing promote social capital, further research into the social health benefits is needed to support wider adoption of this model in suburban and city environments.
For the attention of: Planners, community housing providers, cohousing interest groups and researchers.
The problem: Cohousing is one form of housing design often touted as fostering social capital. However, there is a need to examine the evidence this claim is actually based on in order to see if this model should be more widely adopted in suburbia and city environments as an alternative form of housing.
What we did and why: Used 28 academic databases to locate 37 research papers for a scoping review of the social health benefits of cohousing to see the suitability of this model for improving social connectedness within suburban areas.
What our study adds: The physical design of co-housing models and social processes contribute to both bonding and bridging social capital, nevertheless, there were a number of limitations in the studies reviewed, including cross-sectional designs and small sample sizes.
A key finding and recommendation from this review is the need for more robust research of cohousing models to determine the benefits for social health
Implications for city policy and practice: Planners and developers have evidence to design cohousing communities in inner suburban areas with the physical layout required to theoretically promote social health. However, steps need to be implemented in the process (e.g. involving potential residents in the decision-making) to ensure strong connections are fostered in practice.
Those involved in existing communities should also look to more formally evaluate the success of their projects in terms of social health to ensure a greater evidence base.
For further information: HOME: A Deakin University Research Hub. Providing evidence-based, community-tailored housing and social inclusion strategies
Full research article: Cohousing as a model for social health: a scoping review by Elyse Warner, Emma Sutton and Fiona Andrews