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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. 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 knowledge partners (International Society for Urban Health and SALUS.Global), invite you to join their networks, and contribute to the dialogue. We encourage all our stakeholders to consider publishing in Cities & Health to help influence urban policy.
This special issue of Cities & Health comprises our third collection of articles focussing lessons from COVID-19.
This issue comprises twelve research papers, each has a ‘City Know-how’ summary in this article.
Our first COVID-19 issue, published in 2021, captured over 50 bite-sized insights in what we refer to as ‘The Lockdown Papers’. That paper provides thematic links to all its contents covering; governance, inequality, food environments, living conditions, environmental quality, mobility and open space. The collection provides highly relevant and often profound insights into a unique ‘natural experiment’, forced on towns and cities worldwide.
In the current issue, a useful overview of early place-based research can be found in ‘COVID-19 and cities: a systematic review of early urban studies’. The relevant City Know-how is titled ‘What can city policy-makers do to mitigate the effects of pandemics on urban life?’
The COVID-19 global crisis led to profound insight; we will need that learning to make human settlements healthier and more equitable for communities, and healthier for the planet.
Understanding the community and social determinants in mental health inequity: the impact of mass social distancing during COVID-19, USA
Main determinants of mental health during the COVID-19 pandemic
Target audience: World Health Organization; National public health officials; Local and community public health experts.
The problem: Early COVID-19 studies found relationships between social distancing and mental health problems (anxiety and depression) but their complexity in the contexts of unequal individual capacity and uneven community attributes remains untested.
What we did and why: To reveal the complexity in terms of health inequity, we used a series of statistical models, plus nationally representative and COVID-19-specialized data from the Household Pulse Survey administered by the U.S. Census Bureau between April 23, 2020, and June 7, 2021.
Our study’s contribution: We found that:
Lack of community capacities during the pandemic (e.g. poverty and transit use) and individuals’ economic vulnerabilities (e.g. income loss, food insufficiency, housing instability) exacerbated mental illnesses as social distancing measures were prolonged
A more stringent stay-at-home order was found to be related to an increased risk of experiencing anxiety, depression, and their comorbidity.
The negative impact of the stay-at-home order on mental illnesses is unequal across subpopulation groups of different ages, races and ethnicity, income, and household size
Impacts for city policy and practice: Our findings suggest that:
The psychological impact of social distancing order can be determined by combining the effects of both individual and community capacities.
Our study, which supports others, demonstrate the need to improve the physical environment to implement more sustainable health policies in different communities and cities across the world.
Further information: U.S. Centers for Disease Control and Prevention (CDC): Official indicators of anxiety and depression during the COVID-19 pandemic in the U.S.
Full research article: Understanding the community and social determinants in mental health inequity: the impact of mass social distancing during the COVID-19 pandemic by Jin Hui Lee, JungHo Park & Min Sook Park.
Did neighbourhood amenities affect youth mental health during the pandemic?
Pop-up public space in Montreal, Quebec, Canada. Credits: Alexander Wray.
Target audience: Local public health professionals, Youth social workers, Community organizers, and Park planners
The problem: The COVID-19 pandemic disrupted youth milestones such as school graduation ceremonies, transitions to higher education, and entrance into the labour force. Given the school closures and public health protective measures that occurred in London, Ontario, Canada, many youth limited their daily activities to parks and restaurants in their local neighbourhoods. These disruptions and changes to youth behaviour from the pandemic may have impacted their mental health and stress levels.
What we did and why: We undertook a survey of youth, aged 13 to 19 years old, in London, Ontario, Canada from June to September 2020. Survey questions were developed in consultation with youth themselves, rendering questions that sought to understand impacts from the pandemic based on their own perspectives. Questions covered demographics, health behaviours, and their experiences during the pandemic. We also gathered information about their neighbourhood context to understand how the local environment affects their mental wellbeing.
Our study’s contribution: Our study:
Finds some youth had better mental health as compared to before the pandemic
Adds knowledge about the differences in mental wellbeing outcomes from the pandemic between suburban and urban dwelling youth
Counters assumptions made about the protective benefits of parks, instead identifying private amenities as more impactful among youth
Suggests there are inequitable differences in impacts from the pandemic between girls and boys
Impacts for city policy and practice: Practitioners should consider the following:
Examining how youth engage with the public realm, and in turn, what is missing from the public realm to engage youth
Providing more tailored social and cultural programming to youth at a local level
Consider how digital platforms showcase food-oriented amenities that are available in local neighbourhoods, and modify interactions with the public realm
Our findings suggest local policymakers and practitioners could play a role in addressing youth mental health and stress levels through the following actions:
Directly incorporating youth perspectives in the planning and programming of the public realm.
Emulating in public spaces the socialization opportunities, which often include food, drinks and leisure together, that are provided by private ‘third places’ outside of home and school.
Providing more tailored social and cultural programming to youth at a local level, as is done for younger children and older adult populations.
Consider how digital platforms showcase food-oriented amenities that are available in local neighbourhoods, and modify interactions with the public realm to reflect near ubiquitous access to smartphones among youth.
Further information: QuaranTEENing Project page
Full research article: Neighbourhood influences on youth mental health and stress levels during the first six months of the COVID-19 pandemic by Alexander Wray, Gina Martin, Kendra Nelson Ferguson, Stephanie E. Coen, Jamie A. Seabrook & Jason Gilliland.
Neighbourhood green spaces and wellbeing among universities students in England during the COVID-19 pandemic
University of Southampton
The COVID-19 pandemic restrictions and the switch to online learning impacted the life of university students. We looked at wellbeing in relation to use of greenspaces during the 3rd ‘lockdown’ in England.
Target audience: City neighbourhood planners, general population, university community health committees, and university students.
The problem: Pre-pandemic, university students were identified as a group with low levels of wellbeing. The pandemic forced universities to pivot to online education, limit access to campus, and restrict socialization within campus accommodations, creating a situation furthering the risk of lower wellbeing. While well-designed healthy neighbourhoods can have important impacts on the health and wellbeing of residents, particularly through greenspaces, little is known about wellbeing in relation to greenspace during the pandemic among university students.
What we did and why: We aimed to document wellbeing during the COVID-19 pandemic restrictions among university students in England in relation to use of outdoor greenspace. To this effect, in April-May 2021, during the third ‘lockdown’ in England, we ran an online questionnaire study across 4 universities. Our aim is to contribute to the existing body of literature on outdoor greenspace and wellbeing, in support of neighbourhood public green planning.
Our study’s contribution: Our findings show that:
Compared to pre-pandemic averages, students 18-34 reported significantly lower wellbeing
No sex-based differences were identified in mental wellbeing
Access to quality greenspaces appears to be more important for wellbeing than quantity of greenspaces
Greenspace quality was a significant predictor of positive mental wellbeing above and beyond physical activity and social connectedness
Impacts for city policy and practice: Neighbourhoods (and university campuses) would benefit from continual green access planning. Emphasis should be placed on quality of greenspaces, these health-oriented environments confer mental wellbeing benefits and should be encouraged.
Further information: Universities UK mental wellbeing framework: “StepChange: Mentally healthy universities”
Full research article: Neighbourhood greenspaces and mental wellbeing among university students in England during the COVID-19 pandemic: an online survey under lockdown by Anaïs Lemyre, Benjamin W. Chrisinger, Emma Palmer-Cooper & Jane P. Messina.
An ‘adaptive bubble strategy’ incorporating the built environment to maintain older adults’ health and wellbeing
Apartment block, Edmonton, Alberta, Canada.
Target audience: Built environment planners and designers; Senior housing developers; Public health practitioners and policymakers.
The problem: During the COVID-19 pandemic, virus transmission prevention strategies including the lockdown of public spaces and implementation of stay-at-home order can limit older adults’ opportunities to engage in the broader community, healthy living activities, and psychological wellbeing maintenance.
What we did and why: We conducted a case study of older adults in an independent-living building and the surrounding neighbourhood in Edmonton, Alberta, Canada. This study allowed insights into how an adaptive bubble was established and how the built environment can support an adaptive bubble to protect older adults from virus transmission while helping them to maintain healthy living activities and psychological wellbeing.
Our study’s contribution: Complex and nuanced relationships between human and nonhuman factors that support and challenge an adaptive bubble strategy are elaborated in:
Building interiors: as central to the bubble since this is where residents conduct daily-needed activities and attend congregate activities;
Neighbourhood environments, as the extension of the bubble that affected residents’ outdoor activity engagement;
Building edges, as spaces balancing residents’ needs for connecting with the world outside the bubble and protecting themselves within the virus-safe bubble.
Impacts for city policy and practice: The adaptive bubble strategy can be considered by communities with building and neighbourhood environments as a way to support both the prevention of virus transmission as well as the maintenance of healthy living activities during the ongoing pandemic, the upcoming recovery phase, and future epidemics.
Further information: Housing for Health team. Alberta, Canada
Full research article: ‘We are developing our bubble’: role of the built environment in supporting physical and social activities in independent-living older adults during COVID-19 by Hui Ren, Megan Strickfaden, John C. Spence, Jodie A. Stearns, Marcus Jackson, Hayford M. Avedzi & Karen K. Lee.
Expert and lay judgments of pathogen transmission risk using visible cues
Sample images for significant visible cues.
How do people conceptualize pathogen transmission risk in cities using visible cues?
Target audience: Urban planners, Architects, Policy makers, Public health officials.
The problem: Urban and architectural environments are rich with visible cues that occupants can use to infer the transmission risk of different pathogens, such as COVID-19, but it is unclear which cues members of the public use to make these inferences, and how these cues compare to those used by experts.
What we did and why: We asked participants to rate a series of images of urban and architectural environments on their perceived pathogen transmission risk. We then correlated these ratings with objective assessments of the characteristics of those spaces to uncover associations. We replicated the same analysis using expert assessments of pathogen transmission risk, and we compared the correlations between expert raters and lay raters.
Our study’s contribution: This study provides data on which visible cues members of the public use to render judgments about pathogen transmission risk in the diversity of urban and architectural environments they occupy. Moreover, this study provides a comparison between conceptualizations of risk between members of the public and experts, which is a meaningful comparison in light of the fact that the two groups can deviate in conceptualizations of risk.
Impacts for city policy and practice: The data from this study is useful for designers interested in created spaces that are perceived as posing a “low” pathogen transmission risk. They are also useful for health policy decision makers by providing insight into the nature of the pathogen transmission risk conceptualizations held by members of the public. This information can be used to create more “nuanced” public health policies in the event of future pathogen outbreaks.
Full research article: Investigating expert and lay judgments of pathogen transmission risk in urban and architectural environments by David Borkenhagen & Colin Ellard.
COVID-19: Highlighting the negative impacts of odour pollution in the built environment
Target audience: City council planning and housing officers, Urban planning community, Housing regulations officers.
The problem: Bad smells and odour pollution are known to have a negative influence on our mental and physical wellbeing. This is a problem that is often overlooked and does not get the attention it should considering the negative impacts it causes. Greater consideration should be given to this type of air pollution and more study is needed into the implications of this type of pollution on our everyday lives.
What we did and why: I compared odour complaints made to London Councils in spring 2019 and 2020, looking at the impact of the COVID-10 lockdown restrictions. This showed a significant increase in the number of complaints made between 2019 to 2020 with the implementation of lockdown restrictions. This research highlights an often-overlooked type of air pollution. This topic is important as people continue to work from home which seems to have been a factor in the increase in complaints.
Our study’s contribution: This study highlights a type of air pollution that can negatively impact mental and physical wellbeing, and I think it is a missed opportunity if air pollution of this type is not considered when planning new buildings and renovating older houses. This project demonstrates how odour pollution is clearly impacting residents and emphasises a need to combat this issue especially if we are to continue working in a hybrid way for the foreseeable future.
Impacts for city policy and practice: There are a few keyways in which this research could have city policy and practice implications:
Rethinking the notion of odour in the city and city planning.
Taking complaints about odour seriously and finding ways to tackle the health implications of this type of air pollution.
Stricter rules for landlords regarding odour pollution in rented accommodation – especially if we are to continue to work from home so much.
Further information: For further information on the general subject, see Distributed Network for Odour Sensing Empowerment and Sustainability (D-Noses). A project empowering citizens to become a driving force for change and has co-created tools and a map to measure the problem and co-design solutions of odour pollution across Europe.
Full research article: Investigating the impact of COVID-19 lockdown restrictions on odour com-plaints made to London Borough Councils in Spring 2020 compared to Spring 2019 by Harriet Barton.
City compactness and COVID-19
Extract from the conceptual framework of our study
Target audience: Urban planners, city and regional planning organizations, urban policy makers
The problem: The physical structure and layout of urban environments can have a significant impact on COVID-19 spread. There is little research being conducted on how such development condition may have different outcome during different phases of COVID-19.
What we did and why: We conducted a research study that employed multivariate regression analysis to investigate the impact of demographic characteristics, social distancing measures, healthcare capacity, and urban form indicators on COVID-19 infection and death rates. The purpose of the study was to explore the associations between these variables and COVID-19 rates to gain insights into the role of urban form in the pandemic’s outcomes.
Our study’s contribution: Our result reveal significant associations between several variables and COVID-19 rates. Notably, the compactness index, used as a measure of urban sprawl, showed mixed results, with a positive relationship observed during the lockdown phase and a negative relationship during the post-lockdown period. Additionally, a higher percentage of the black population, older age, and lower educational attainment were found to be positively correlated with case and death rates.
Impacts for city policy and practice: The research highlights the importance of considering both demographic and urban form factors when analysing the impact of COVID-19 on urban areas. City authorities and policymakers can use this information to make informed decisions about strategies for urban growth, housing policies, social distancing measures, and healthcare capacity planning.
Full research article: Relationship between urban form and COVID-19 severity: impact of compactness during the lockdown and post-lockdown periods by Md Hamidur Rahman & Angela Antipova.
Insights on behaviour changes, the pandemic, and the Sustainable Development Goals in Hong Kong
Masked Hong Kongers in Wan Chai District during the pandemic in 2020. Source credit: Photo by Alison Pang on Unsplash.
Target audience: Researchers and scholars studying behavior shifts due to a global pressure, in this case, a pandemic, in relation to sustainability in the city; City policymakers working towards innovative post-pandemic strategies and interventions to achieve the SDGs.
The problem: Cities pursue ways to integrate sustainability into their development plans. The pandemic, despite its miseries and sufferings, was touted as an opportunity to achieve the SDGs. Yet, we know little how pandemic-induced lifestyle changes and resulting behavioral shifts facilitate or hinder the fulfilment of the SDGs. We also know little whether these changes are temporary, driven solely by necessity and whether individuals will revert to pre-pandemic behaviors once the crisis subsides.
What we did and why: We extensively reviewed 208 media and academic sources published from March 2020 to July 2021 to correlate behavioral shifts with the SDGs and ranked 75 SDG sub-targets in the context of Hong Kong during the pandemic using Saaty’s Analytical Hierarchy Process.
Our study’s contribution: We found that four SDGs emerged as prominent in Hong Kong: SDG3 (Good Health and Wellbeing), SDG8 (Decent Work and Economic Growth), SDG1 (No Poverty), and SDG10 (Reduced Inequalities). Our findings reflect the significant impacts of the pandemic on these goals, especially on public health, the economy, and vulnerable communities in Hong Kong.
Impacts for city policy and practice: Our analysis provides a crucial framework for devising post-pandemic strategies to achieve Hong Kong’s SDG targets. It also offers valuable insights for policymakers and stakeholders involved in Hong Kong’s sustainable development efforts. In particular, freedom of movement allowed and curtailed by city policy changed behaviours suggesting their primary significance in nudging sustainability behaviors. However, these policies also inadvertently impacted behaviors related to mental health, leading to increased suicide rates, particularly among the youth. City policy and practice, thus, could advocate more for human well-being, especially in the context of mental health.
Full research article: Behavioural responses to the COVID-19 pandemic and their implications for Sustainable Development Goals in Hong Kong by Olivia Anne D. Perez, Laurence L. Delina & Benjamin Steuer.
Boxed in: Changes in apartment residents’ health behaviours following the COVID-19 lockdown – a longitudinal cohort study from Australia
Apartment complex. Image from iStock.
Target audience: Policy-makers, planners, developers, academics
The problem: Australia’s housing context has long been characterised by low-rise detached homes, but rapid population growth has prompted a recent boom in apartment construction. Apartment residents may be more vulnerable to the negative impacts of COVID-19 stay-at-home orders due to the distinct constraints and stressors of apartment housing, but empirical research on this population is scarce.
What we did and why: Our study adds to the literature on the health impacts of lockdowns by examining longitudinal changes in the health behaviours of Australian apartment residents. Participants (n=159) completed a survey between 2017-2019 and a follow-up survey in 2020 following a six-week national lockdown.
Our study’s contribution: Our results demonstrated that behaviours were both positively and negatively impacted. Residents reported increased walking for recreation, sleep duration, and home cooking frequency, but also reported decreased walking for transport and greater sitting time. Similarly, weight/BMI also increased.An important strength of this study is the longitudinal examination of a cohort of apartment residents using data collected pre- and post- mandatory stay-at-home orders. Moreover, our study does not focus on a single outcome, but a wide range of health and lifestyle behaviours.
Impacts for city policy and practice: Given the likelihood of future pandemics, a renewed policy focus on apartment space and layout provisions that better facilitate home-based activity is required to mitigate the health risks of lockdown conditions for those living in apartments.The findings underscore the importance of understanding the specific impact of the pandemic on different populations, including apartment residents, to inform public health policies and interventions.
Full research article: Boxed in: changes in apartment residents’ health behaviours following the COVID-19 lockdown – a longitudinal cohort study by Alexandra Kleeman & Sarah Foster.
Integrating nature and workplaces in a post COVID-19 world: Building Back Better
Systems map of the reinforcing loops. Processes that should encourage employers to integrate more nature into their workplaces. This map can be best read starting with the increases in ‘quality of workplace-integrated nature’ leading to the intended health outcome – ‘workforce health and wellbeing’. The feedback loop is ‘closed’ by connecting increasing workforce health and wellbeing with the value attributed to workplace-integrated nature, which in turn is used to bring more nature into the workplace.
Target audience: Urban planners, public health professionals, property management professionals
The problem: Increasing urbanisation in the developed world has been linked to a concomitant rise in non-communicable disease. Despite this, research suggests we can intervene by improving access to, and the quality of surrounding nature in order to improve health and wellbeing.As work commitments often limit people spending more time in nature, we explore whether bringing more nature into our workplaces could positively influence the health and wellbeing of employees and the local population.
What we did and why: We explore the health benefits of being ‘in nature’, the barriers and benefits of bringing ‘nature’ into the workplace, and whether workplace nature-based solutions could improve the health and wellbeing of the workforce. We focused on ‘workplace-integrated nature-based solutions’ because of the well-established link between nature and health and the additional benefits this has in improving climate resilience of communities.
Our study’s contribution: The literature we have reviewed suggests that the expected outcomes from pursuing nature-based solutions in the workplace include:
Improved health and well-being of the working-age population
Improved health and well-being of the surrounding local population
Reduced social inequalities in health and wellbeing
Reduced cost to the health and social care system
Fewer sick days and greater work productivity
Environmental benefits and climate resilience
In addition to recommending key areas for future research, we have identified 18 perceived or real barriers that need to be addressed in the process of improving the integration of nature into the workplace.
We encourage employers to extend this method in order to develop a shared understanding of barriers specific to your workplace and to work on systemic solutions that work for you in your setting.
Impacts for city policy and practice: Our findings are relevant to several city-wide processes; including office district planning, policy around building approvals, policy-relevant to street furniture, greenspace policy and policy about active travel and access to greenspace.
Further information: Healthy Urban Microbiome Initiative; understanding the hidden value of nature in urban environments.
Resilience Frontiers Programme, UNFCCC; understanding why bringing nature into our cities is the future of resilient urban environments.
C40 Cities; understanding what the major cities of the work think is the future.
Full research article: Integrating nature and workplaces in a post-COVID-19 world: building back bet-ter by Jennifer Allen, Rupert Lloyd & Chris Skelly.
Mind, body and blood: investigating the changes to health and wellbeing when outdoors?
Design of the study.
Target audience: Organizations involved in nature-based solutions or Green Care activities, health promotion professionals, and communities.
The problem: There has been an increased desire to use nature to tackle health inequalities, especially due to the recent covid-19 pandemic but also through prescribing access and activities outdoors. In particular this has been growing in the United Kingdom in the form of community gardens and care farms, but we need to increase our understanding of the impacts on health to further advocate for the expansion.
What we did and why: We raise awareness of the value of interventions such as community gardens and care farms, while advocating for radical methods to be embedded in research and present their use in a case study based around these sites.
Our study’s contribution: We add:
Awareness of interventions and research in the use of nature for health and wellbeing
An outline of pilot radical methods employed for use in research projects.
A discussion of the limitations of interdisciplinary methods within the world of health geography
Impacts for city policy and practice: We suggest an increased awareness of the value of outdoor spaces across all populations, but research into the field being done so in a careful and crafted way to ensure protection of participants when investigating the impacts of health and wellbeing.
Full research article: Mind, body and blood: advan-cing green care through innovative methodologies within the field of health geography by Louise M. Mitchell, Michael Hardman, Michelle L. Howarth & Penny A. Cook.
What can city policy-makers do to mitigate the effects of pandemics on urban life?
Target audience: Urban researchers and specialists (urban planners and designers), policy-makers, municipalities, as well as general audiences, particularly those interested in healthy cities and public health.
The problem: The COVID-19 outbreak resulted in severe consequences in the medical field and other areas, including urban planning, education, society, economy, etc. These effects put people’s lives at risk around the globe. Although plenty of studies have been carried out in this area, the lack of a comprehensive guide is the main obstacle to adopting appropriate strategies and policies in cities and urban areas.
What we did and why: The aim of this study was to conduct a systematic review of published research articles on ” COVID-19 and urban studies.” This was done by selecting 63 high-quality articles and analyzing their content based on “publisher,” “origin of research,” “methodology,” “scale,” “subject,” and “solutions.” We believe the thematic classification of the investigated topics and the proposed solutions can be helpful and practical tools for urban researchers and policymakers.
Our study’s contribution: In terms of urban design and urban space:
The impact of COVID-19 on urban spaces
Creating mass communication and controlling the spread of the pandemic through the environmental qualities of urban spaces
Designing flexible spaces with collective presence along with social distancing
In terms of physical-spatial and social dimensions along with resilience literature:
The importance of housing and its classification
Density
Social inequality
The psychological-social damage to certain groups
Urban vulnerability during pandemics and preparation for future crisis
Impacts for city policy and practice: Planning and designing urban spaces with a focus on social interactions using creative approaches is the priority in urban planning and design. It also requires exploring scenarios based on place, sustainability, and resilience, as well as government policies for public welfare and the use of collaborative design. Thematic recommendations have also been provided in housing and architecture, smart cities and technology, urban management, environmental sustainability, transportation, and socioeconomic issues.
Further information: UN report: COVID-19 in an Urban World; UNESCO: Cities’ responses to COVID-19; WHO: COVID-19 and social determinants of health, Urban Health; UN-Habitat: Urban Health
Full research article: COVID-19 and cities: a systematic review of early urban studies by Maryam Roosta, Alireza Gholami & Fatemeh Shahvaran.