City design and planning can enhance many aspects of people’s lives, but what about sleep? Sleep is easy to forget because it’s a biological necessity that cannot be avoided. However, adequate sleep impacts physical, emotional, and mental health and urban planning can contribute to the sleep health of an entire community.

Design, nature and sleep

The effects of an urban environment on the mind and body revolve around green space and its impact on overall health. In as early as 1984, physicians began to notice that patients who either had a view of or spent time in a garden area recovered faster. That led to a review published in Science, wherein hospital records from 1972 through 1981 were thoroughly examined to see if patients healed faster in rooms with a view. It was concluded that a view of nature rather than a brick wall consistently shortened recovery times.
At the time, it was considered groundbreaking research. Roger Ulrich, who conducted this first review, continued his research and found several key components that contributed to improved patient outcomes. Today, these findings are regularly incorporated into modern hospital design. However, the value of his findings goes well beyond a medical setting into daily use for those not recovering from medical procedures.

Three of Ulrich’s components that led to shorter recovery times can also be applied to sleep-enhancing environments.

• Noise levels: It’s easy to understand how noise levels interfere with sleep. Residential areas with green space create distance between people and noise pollution. Trees, grass, and bushes absorb noise, creating a barrier between people and urban sounds. Whether spending time in the green space or homes and apartments built around the green space will have some protection from sleep-disrupting noise.
• Sun exposure: Sun exposure is critical to the sleep-wake cycle. The human eye has photoreceptors that absorb the blue light that results when sunlight passes through the earth’s atmosphere. A signal travels directly from these photoreceptors to the circadian region of the brain. This region of the brain controls the circadian rhythms, which regulate everything from hormone release to metabolism. Natural light helps the body sync the sleep-wake cycle to the day/night schedule. Access to natural sunlight is absolutely necessary to keep the circadian rhythms in check. In fact, many of the sleep disorders associated with old age occur because dimming eyes don’t absorb enough light to regulate the circadian rhythms. Urban design that maximizes exposure to sunlight helps the human body stay on a regular sleep schedule.
• Access to windows with a view of nature: A 2015 study published in the Proceedings of the National Academy of Sciences found that taking a 90-minute walk in a natural environment versus an urban one improved mental health. After spending time in nature, participants reported thinking less negatively about themselves and their situations. The results also showed lower activity in the region of the brain associated with depression and anxiety. While the effects may not be as strong as taking a walk in nature, a window view of nature can have a similar effect on mental health. Patients in Ulrich’s reviews and studies may not have been able to go outside, but even a window with a view improved their recovery times.

Nature restores mental wellbeing

The research begs the question as to why natural environments stimulate the brain differently than built-up urban environments. One answer lies in the different forms of human attention. When reading a book, driving, or writing, the brain pays direct attention to the task at hand. Urban settings require decision-making from navigating traffic to acknowledging strangers. It requires mental effort and discipline that can fatigue the mind.

On the other hand, involuntary attention happens without concentrated effort. The rustle of leaves, a bird flying by, or bright flowers involuntarily capture the mind’s attention without concentration. The restorative nature of involuntary attention is encapsulated in attention restoration theory. When boiled down to the basics, this theory implies that nature requires very little of the human brain to keep its attention. That in and of itself restores mental energy just like food and water restore physical energy. It entertains while requiring nothing of the brain, creating the right conditions for relaxation and, eventually, sleep.

The average adult needs a full seven to nine hours of sleep for complete restoration. Environments that can reduce stress and anxiety will naturally contribute to better sleep. Healthy sleep contributes to immune system health, appetite regulation, diet, and a reduced risk of diseases and illnesses such as diabetes, high blood pressure, and heart disease.  

While hospitals may have been the first to realize the value of green space, we now know it can improve more than recovery times, and this is a design factor no longer just for hospitals. In an increasingly urban society, it creates an environment that improves, sustains, and actively contributes to the mental and physical health of those who live in it. 

Designing for better sleep

Design that enhances sleep tends to both reduce noise and increase access to green space. Plans may require a combination of design techniques to achieve optimal conditions. For example, planning major roadways away from residential areas while using earth bunds and sound barriers to reduce the sound waves that reach residential areas. Noise-tolerant buildings and sound-proofing insulation can reduce noise even further.

Good planning for restorative sleep also makes room for green space. Planners must also consider the kind of green space people want to use. In general, large, open spaces that use the natural landscape attract more users than small parks. However, it might be necessary to get creative when finding green space. Transforming rooftops into gardens and old railways into trails are two common examples. Looking for unused or forgotten areas that can be used as green spaces can increase access and better utilize what’s already available. Residential areas with communal green space and walking access to parks creates a sense of community and can promote the mental health of residents. The key is to make them accessible and usable. Trail networks along with pedestrian-only walkways and bridges provide safer access.

Samantha Kent is a researcher for SleepHelp.org. Her favorite writing topic is how getting enough sleep can improve your life. Currently residing in Boise, Idaho, she sleeps in a California King bed, often with a cat on her face.  ​

Recent news reports have documented an increase in the number of 'rage rooms'/'anger rooms', across the globe. Corporate franchises and smaller companies have opened rage centers in Germany, Italy, Hong Kong, Atlanta, Philadelphia and many other locations catering mostly to a younger, educated, metropolitan demographic.  
 
The demand is real. Between school, work, terrorism, bullying, debt, and urban frustration, there is a lot to worry about. According to the most recent data from NAMI (National Alliance on Mental Illness), the United States alone is home 42 million people who are battling anxiety disorders (18% of the population). Additionally, frustration is a real emotion that everybody feels from time to time - frequently when someone or something is in conflict with a goal. This “strategic interference,” as evolutionary psychologists call it, pops up all over the urban landscape. For example, the vending machine might provide strategic interference to the delivery of a cold beverage, your boss might interfere with your plan to relax on the weekend by telling you to come to work on Saturday, or your objectives for the day are delayed because of interference provided by heavy traffic. Rage rooms are clearly gaining in popularity, but the long term psychological benefits have yet to be measured.

The value of aggression

From an evolutionary standpoint, there were certainly times in our ancestral past when physical confrontation was the quickest solution to a problem, and may have been adaptive in specific contexts. Resource protection, romantic rivals, and status negotiations all stand out as likely adaptive problems that gave rise to aggression as a behavioral solution. However, we don’t live in that ancestral environment anymore. We live in a modern world – often overcrowded and urban – where the adaptive solutions of the past don’t always match up with the adaptive problems we confront today. 
 
Many people still subscribe to the “aggression as a pressure cooker” model of human behavior. According to this, if you do not let off some steam, or release your aggression in a timely manner, it will manifest itself in unseemly, even dangerous ways: do not hold it in for too long or you will eventually suffer a menacing episode. Hence, the rage room. For a few bucks you can spend time liberating pent up hostility by annihilating coffee cups with a baseball bat.  It certainly sounds fun, but does it work?

Here is the issue that some psychologists have with these spaces: when you spend time thumping an inanimate object, like a pillow, or beating non-living things in a 'rage room', you may be conditioning yourself to act aggressively the next time your anxiety levels rise. So instead of opening up the escape valve on a pot of steam, you are rewarding your distressed feelings with the ephemeral pleasure that comes from throwing dishes against a wall. 
 
Rage rooms offer a place for people to act on their felt impulse to become physically violent without the mess or costs that comes with breaking their own possessions. Is this a good prescription for chronic rages?  And should urban designers even consider creating controlled environments in which the singular objective is to get out aggression?  Consider some research on the efficacy of catharsis.

Does Catharsis Work?

In a classic paper, Bushman, Baumeister, and Stack (1999) explored the success of aggressive catharsis across two social psychology experiments. In study 1, participants who read a persuasive message that aggression is a healthy way to relax and reduce anger (pro-catharsis message) expressed a greater desired to hit a punching bag than did individuals who read an anti-catharsis message.
 
In study 2, participants read the same messages before they all hit a real punching bag.  Following this, everyone was given an opportunity to act aggressively in a laboratory setting.  Those who read the pro-catharsis message and then hit the punching bag were more aggressive in the laboratory condition than people who read the anti-catharsis message.  This casts doubt on the catharsis hypothesis that carrying out aggressive acts on safe objects effectively reduces aggression.  If anything, the trend is towards an increase in aggression following catharsis.

More research is needed 

The broader societal question is: does long term exposure to aggression alongside persuasive messages that endorse aggression result in an increase in real-life aggression? It is too early to draw any conclusions about modern day rage rooms. Most research on catharsis has taken place in controlled laboratory conditions and it is not clear how well the results generalize to current commercially-available rage rooms.  Here would be a great spot for some well-designed longitudinal studies that look at the complicated interactions between frustration in urban settings, specially designed anger rooms, and the power of aggressive catharsis.
 
Conclusion
​
Urban designers and mental health professionals are interested in identifying acceptable frustration levels in cities, as well as understanding the specific ways in which the built environment creates unhealthy feelings of anxiety and anger.  The complete elimination of aggression in society may be unattainable, given the complexities of human desires and the nearly constant competition between people to meet goals. On the other hand, we should be careful before endorsing aggression just because it is dressed up as a fun afternoon demolishing toys, windows, and the kitchen sink.

Bennett, K. (2017). Adaptive function of aggression. In Zeigler-Hill, V., & Shackelford, T.K. (eds.), Encyclopedia of Personality and Individual Differences. Springer International Publishing AG. doi:10.1007/978-3-319-28099-8_1597-1
 
Bushman, B. J., Baumeister, R. F., & Stack, A. D. (1999). Catharsis, aggression, and persuasive influence: Self-fulfilling or self-defeating prophecies? Journal of Personality and Social Psychology, 76(3), 367-376. http://psycnet.apa.org/doiLanding?doi=10.1037%2F0022-3514.76.3.36

Published in the prestigious Journal of the American Medical Association last week at long last those of us interested in green space and mental health have a city-wide experimental study, and it’s good news! (South, Hohl, Kondo, MacDonald, & Branas, 2018)

KEY FINDINGS

• Creating urban green spaces reduced feelings of depression and worthlessness
• The effect was most pronounced in people with low income
• The effect did not involve active use of the green spaces
• The effect of simply tidying but not greening the spaces had minimal impact
• The effect was achieved with small-scale greening interventions

Until now, green spaces in one’s urban environment have been shown to confer a range of mental health benefits to their local populations only in observational epidemiological studies. In the most common type of these studies, snapshots of a populations’ access to green space and their mental health are measured at the same moment in time. These methodologies are of course hindered by problems for inferring causality.

The relationship between green spaces and mental health is a hugely complex one. There are a long list of ways in which the benefits are explained. The most well-evidenced mechanisms to date are: promoting exercise and socialisation, reducing exposure to air and noise pollution, reducing stress and restoring attention, and building senses of community and place attachment . These mechanisms, among many others, are hugely complex and very difficult to adjust for in observational studies despite best efforts. A common criticism which therefore arises from observational studies is whether the effect could be caused by any one of a thousand factors associated with green spaces, which could be good for mental health. Furthermore, the observational studies so far have reported widely variable results. Some have demonstrated impressive reductions in anxiety (de Vries et al., 2016) and depressive symptomatology (Triguero-Mas et al., 2015). While others have shown virtually zero impact at all (Houlden, Weich, & Jarvis, 2017). These variable results are likely in a large part due to the many confounding factors. In response, study after study, commentary after commentary, has been crying out for experimental style studies - natural experiments or randomized control trials (RCTs) – the benefits of which allow for the single issue of interest to be studied in isolation from the disruptive noise of the complex co-factors in the relationship. In RCTs of sound methodology we can be quite confident that the results we see are due to the factor we are interested in.

Step forward Eugenia South and her colleagues from the University of Pennsylvania and their RCT set in Philadelphia.
 
Green fingered Philly
 
Initially concerned with the high burden of mental health conditions, and in light of the then fledgling evidence for green space benefit, researchers extended their work which had previously shown reductions in crime rates following neighbourhood improvement projects to consider mental health outcomes (Kondo, Hohl, Han, & Branas, 2016). By early 2013 city officials in Philadelphia had identified nearly 45,000 lots of unused vacant, often derelict brownfield land across the city. Given such an opportunity authors designed their methodology to include three study arms into which randomly selected plots, grouped together into local clusters of a 0.25 mile radius, would be allocated. The first arm would be left as they were at present. The vacant plots in the second arm would be tidied up, and the third would be “greened”. The researchers would then be able to differentiate whether the “greenness” of the spruced-up space itself contributed anything to outcomes.

Random plots were selected from the master list, and random plots also from the list and within a 0.25 mile radius were included in the cluster. To be eligible for the study, lots were to be less than 5500sqft, deemed to be abandoned, and stricken with ‘blight’, for example that there was evidence of fly-tipping (dumping), abandoned cars, or numerous police reports concerning crimes associated with the lot. In total 110 clusters were formed, containing 541 lots. Over a period of two months gardeners from the Pennsylvania Horticultural Society transformed the third of these vacant plots allocated to the “greening” arm, and tidied the third in the second arm, they will continue to maintain these lots monthly for the foreseeable future.

Gardeners were instructed to follow a strict, replicable, modification process of grading the land, cleaning debris, planting grass and a small number of trees, and enclosing the space with a wooden fence with openings, in the aim of avoiding future dumping.
 
What impact on locals’ mental health?
 
In their study researchers randomly selected individuals living within the catchment areas of clusters and administered questionnaires before the intervention, and again after the intervention. There was a 77.4% success rate at interviewing the same people post-intervention at 18 months, achieving a final sample size of 342 subjects used in analysis. Questionnaires primarily consisted of key demographic information, financial status and a measure for mental health status. The short form “Kessler-6 scale” is a quick screening tool widely used for assessing poor mental health. Each question concerns a key symptom of psychological distress: nervousness, hopelessness, restlessness, depressive feelings, worthlessness, the feeling that everything is an effort, and a summary result which gives a good approximation of overall mental health and psychological distress. An annoying limitation of the short form Kessler scale is that we cannot make clinical judgments about the results: we can only identify the presence of depressive symptomatology, rather than making a diagnosis of clinical depression. However the two are of course highly related.

On to the results. Between individuals living in clusters which were greened versus those which were not, authors demonstrated significant reductions in two of the sub-categories of the K-6: depressive feelings were reduced by 41.5% and feelings of worthlessness by 50.9%(!) All other components had major drops in prevalence too. The combined figure showed impressive community wide reductions of psychological distress by 62.8% (95% CI, −86.2 to 0.4; P = 0.051). In the second arm of the study, tidying up the lots compared to no intervention produced weaker result than greening did, and while the prevalence of all psychological categories decreased, non came close to a real significance (a strong likelihood of true difference); overall psychological distress for example was reduced by 30.1% (95% CI, −74.7 to 93.2; P = 0.49).

Furthermore, and importantly, in line with other studies of green spaces in local communities and mental health outcomes (Roe, Aspinall, & Ward Thompson, 2016), evidence from this study suggests that these benefits are even more pronounced for those individuals with low incomes (in this study judged to be household income under $25,000 pa). Notably, feelings of depression dropped in this sub-group by 68.7%, (−86.5 to −27.5; P < 0.01). All other aspects dropped by large amounts, but with wide confidence intervals and without strong evidence of a true difference.

In short, authors, and readers, can conclude from this presented data, that the greening interventions conducted by these gardeners notably reduced the overall number of citizens with poor mental health, and has been especially good for reducing the number of people with depressed feelings, particularly for those with low incomes.

A call to arms for communities

The evidence presented by South and her colleagues marks an important point for green space / mental health research. For the first time, this is large scale, experimental data, which provides key, and long-needed reassurance that the work of observational studies to date is replicable when the complex web of confounding factors are evaporated away.

Furthermore this study offers much to the way in which to think about green space within urban design. Especially in conjunction with this team’s previous work on the reductions in crime rates in ‘greened’ neighbourhoods, this paper adds to the conversation about the mechanisms of action of the now-undeniable benefits of green neighbourhoods to the mental health of their residents. Recent emphasis in the debate had been placed on active use of green spaces, but this study may now shift thought back towards passive or indirect observable functions of green spaces (such as attention restoration, stress reduction and protection from nuisance environmental exposures), and promotes greenery as a key facet of improving the quality of neighbourhoods, given tidying the area alone produced only marginal benefit.

Next, we must ask environmental psychologists to consider why South’s interventions delivered improvement to rather specific facets of psychiatric symptomatology (depressive feelings and worthlessness specifically: the authors propose a renewed sense of local authorities caring about their communities as a possible explanation). Hence whether specific mechanisms of green space produce specific mental health symptom benefits? In this sense, facilitating other mechanisms with other flavours of green space interventions, perhaps larger green spaces for promoting recreation, and as community foci, other facets of psychiatric symptomatology will be addressed for an overall multifaceted tackling of community psychiatric burden.

Other important areas for consideration now should be the replication of these results across other cities, with larger sample sizes, and more rigorous, clinically validated assessments.

More than ever, we should feel renewed in a community focused approach to urban (re)design. That efforts in renewing small scale (and very small scale) blighted vacant lots in our communities (some clusters only renovating 5 lots to produce such improvements in mental health) is to be of benefit. It is highly likely that these small projects are achievable for many communities. Authors further report that these initiatives are  affordable too: in their previous work, greening improvements of this kind cost on average US$1,597, plus US$180 in yearly maintenance. Local government structures can now add “improving the mental health of my community” to the long list of reasons for revitalising derelict land that is perhaps too small and financially unappealing to property developers. Otherwise, in the spirit of work which has suggested community involvement and directorship of a community’s spaces is of multifaceted benefit through building a sense of community, of place, and of stewardship, councils might look to devolve authority of these small projects to community groups themselves. When all is said and done improving mental health is not the only outcome of improving the quality of local communities, but it is a major player in an interconnected web of community, environment and health, which the work presented here by South and colleagues could more reliably inform and encourage local and national decision makers to take a little more seriously.

de Vries, S., ten Have, M., van Dorsselaer, S., van Wezep, M., Hermans, T., & de Graaf, R. (2016). Local availability of green and blue space and prevalence of common mental disorders in the Netherlands. British Journal of Psychiatry Open, 2(6), 366-372. doi:10.1192/bjpo.bp.115.002469

Houlden, V., Weich, S., & Jarvis, S. (2017). A cross-sectional analysis of green space prevalence and mental wellbeing in England. BMC Public Health, 17(1), 460. doi:10.1186/s12889-017-4401-x

Kondo, M., Hohl, B., Han, S., & Branas, C. (2016). Effects of greening and community reuse of vacant lots on crime. Urban Stud, 53(15), 3279-3295. doi:10.1177/0042098015608058

Roe, J., Aspinall, P. A., & Ward Thompson, C. (2016). Understanding Relationships between Health, Ethnicity, Place and the Role of Urban Green Space in Deprived Urban Communities. Int J Environ Res Public Health, 13(7). doi:10.3390/ijerph13070681

South, E. C., Hohl, B. C., Kondo, M. C., MacDonald, J. M., & Branas, C. C. (2018). Effect of greening vacant land on mental health of community-dwelling adults: A cluster randomized trial. JAMA Network Open, 1(3), e180298. doi:10.1001/jamanetworkopen.2018.0298

Triguero-Mas, M., ., Dadvand, P., Cirach, M., Martínez, D., Medina, A., Mompart, A., . . . Nieuwenhuijsen, M. J. (2015). Natural outdoor environments and mental and physical health: Relationships and mechanisms. Environment International, 77, 35-41. doi:http://dx.doi.org/10.1016/j.envint.2015.01.012

“…It will need to build up to 600,000 new homes each year just to keep pace. The market ought to provide them, but governments distort it. Corruption and mismanagement of land is a problem. Builders must cope with burdensome regulations and antiquated zoning laws.” (The Economist, June 16th 2018) 
 
The above is an excerpt from an article about Cairo. Interestingly, it was the exact sentiment echoed at all of the talks and conferences I attended on the UK’s Built Environment this past week. As the anniversary of the Grenfell tower fire passes, the regulations and policies that form the foundation for housing the UK’s population, seem to be demonstrating above all else that a new inclusive growth model is needed to make places function, and to bring us into the future.
 
Interestingly the UK’s Draft National Planning Policy Framework’s (NPPF) “purpose {…} is to contribute to the achievement of sustainable development.” Sustainable development is defined in terms of an economic model and its achievement  across most of London and most globalised cities demonstrated by the  number of tall buildings that dominate these urban centres. Among the talks I attended this week, one on Land Values was held by a small interest group. The audience included developers, economists and those involved in planning and housing policy. What was clear was the frustration among all attendees regarding the lack of authority against the predominance of traders' “gaming tactics” that dominate residential high density delivery, due to the impairment of current planning policies, regulations and taxing.

While in attendance at the Vision 2019: The Future of the Built Environment event, the emphasis on well-being was endlessly recurring. The takeaway was that the sustainability agenda had now been replaced with wellbeing. What has struck me is the disconnect. Health and the built environment hold the power to create a more resilient economic model for today and the future - information we’ve known for decades. History is riddled with examples of lessons learned from residential high density. Red Roads Flats in Glasgow, Hong Kong’s Kowloon Walled City, Pruitt-Igoe in St Louis, all demonstrated the ineffectiveness of mono estates. Yet, our cities are repeating these projects and inventing new ones, as seen in blocks of absentee residents occupying the centre and the most vulnerable moving into the suburbs, exacerbating growth and health inequality. Professor Robert Gifford’s 2007 article The Consequences of Living in High-Rise Buildings provides an important reminder as to the cause and effects of environment on health. Beyond the caveats is the knowledge of what fails to serve as acceptable urban form due to its impacts on mental health, social connectivity and mobility. We are in a state of crisis, a statement echoed at many of these events this week, we are on the verge of riots in the streets because we have ignored the majority of residents who are struggling economically. This struggle cannot be ignored, because it sits at the core of local epidemics of mental and physical health, manifested by the pervading patterns of exclusion reinforced across our emerging built environment.
 
How might we change this? First, all built environment practitioners; planners, developers, architects, urban designers, engineers, need a crash course in environmental psychology. Behaviour theory explains how environment is the most influential force in human evolution. It is not a mystery why over 60% of the world’s population is dying from preventable diseases such as cancer and diabetes, nor is it a wonder why depression is the leading cause of disability worldwide. We are living in cities that are not designed for most to live in - they are designed for people to invest in.

This is what sustainable development creates: places, but not for people to live in. We need to stop being ignorant of the fact that we have NOT outgrown our biological DNA, we still possess all the characteristics of animals living in natural settings. We have only been living in an urban setting for 1% of our biological history and it is very clear this current design will lead to our extinction. A clearer understanding of the impact environment has on health, needs to be at the core of how we deliver all aspect of our urban environments.
 
Second, we need a new model, one that adapts both the environmental and economic elements in balance with human health, one Judith Rodin refers to as Urban Resilience. The Lancet review on planetary health 2015 states “the resilience approach is system oriented, take a more dynamic view, and sees adaptive capacity as a core feature of resilient social-ecological systems.”  NPPF lacks reference to personal health. It does mention community health but it does not support individual health, and this is what separates public health from planning. Public Health is focused on prevention, and the reduction of threat on the lives of individuals who vary in their (emotional, physical, educational and economic) asset base. Urban development possesses the possibility for creating not just health equality but economic justice as well, and that is the message missing from the NPPF.

The problem with a sustainable development-led purpose is it is an economic purpose that excludes human relevance, and this is at the core of our societal disconnect.  The definition of Sustainable Development is: “economic development that is conducted without depletion of natural resources”, humans are not present in this concept. The definition of urban resilience however, is “the capacity of individuals, communities, institutions, businesses, and systems within a city to survive, adapt, and grow no matter what kinds of chronic stresses and acute shocks they experience.” It is a model that enables an equilibrium of environment and health along-side growth and prosperity.
 
Marianna Mazzucato, one of the most important economic minds of our time, says in her new book: “assumptions about the generation of wealth have become entrenched, and have gone unchallenged. As a result, those who claim to be wealth creators have monopolised the attention of governments with the now well-worn mantra of: give us less tax, less regulation, less state and more market.” Our current regulations, policies and designs, clearly demonstrate a widespread obliviousness to the daily struggle of the majority of those living in urban settings, such as London, and the relationship of health issues caused by the lack of affordable, inclusive, healthy environments.
 
In conclusion I wish to share some examples that I am exploring as models for urban resilience that seem to demonstrate the Health –Environment –Economic paradigm.

Golden Lane Estate, London
Built in 1957 in the heart of the City of London, with a density of 200 persons per acre, a mixed tenure, with 60% of the site devoted to open space. Golden Lanes includes its own grocery store run by a resident who travels to the Covent Garden market daily to supply residence with fresh produce. The development includes tennis courts, a swimming pool and maintains a thriving social capital that extends generations, economic classes and cultural backgrounds.
 
Lancaster Cohousing, Halton Mill
Developed around the revitalization of a Mill supplying a source of Jobs, while generating its own energy supply, qualifying it with the highest standard of energy efficiency. Those living in the development have access to employment via a working mill and within the development which serves as a centre for wellbeing, offering services and spaces for the practice of health and wellbeing.

“If a place can be defined as relational, historical and concerned with identity, then a space which cannot be defined as relational, or historical, or concerned with identity will be a non-place.” - Marc Augé, 1995

Marc Augé’s 1995 book Non-places: Introduction to an Anthropology of Supermodernity provides a helpful articulation of the difference between space and place. Space being one that is moved through with frequency, versus a place where the built form actively participates in the animation by providing a draw for human interchange, what Augé refers to as “places of memory’. 

I found myself contemplating “space” and “place” while in attendance at The City Centre talk on “City Briefing: Public Realm” (30.05.2018) in London. Simon Glynn, the Assistant Director (City Public Realm) City of London, provided an overview of development in the City from a public realm perspective and an overview of the changes to come. Many interesting statistics were shared including the fact that the The City of London is home to 10 of the capital’s streets with the highest pedestrian volumes. Currently, these volumes reach up to 2000 pedestrians per hour. Another interesting fact was that 90% of those occupying the City are SMEs and a growing market. Let us not forget though there is a well-established residential community in The City.

The talk revolved around research on pedestrian comfort levels in the City. Over the past two years, pedestrian volumes have increased by 25% which has motivated a drastic rethink as to how the public realm needs an adaptable system to accommodate these sudden increases. The work is very much in its infancy - the first stage of consultation will take place in June 2018. None the less, the limitations presented in the City of London are unique. Mr Glynn reported that changes in built environment due to new developments take place every 18 months, which means any improvement to the public realm, beyond the paving will need to be temporary and moveable. This constraint fascinates me.
 
Environmental psychologist Lily Bernheimer’s book The Shaping of Us aptly reminds us that the early formation of our cities was made from raw materials such as wood and mud, and were designed to follow the movements of our natural geography, but also took shape in a time line that enabled us to adapt to new landmarks. The need to navigate, to adapt, never ceases in an urban setting, where our senses are continually in a state of receptive defence and our minds are continually processing. Therefore, to create a perpetual pop-up as response to the rate of change, begs the question is this a ‘space’ or a ‘place’? Could this be the next stage of urban design where every inch is fluid and belongs to no one and no point in time?
 
Scientific America published the evidence of German researchers who discovered residents of large cities have a higher measure of activity in their amygdala, the part of the brain to serve emotional intelligence and memory. Critically, the amygdala “regulates the assessment of threats and generating fear”. This evidence shows us the effect of social stress and physiological impacts on our bodies. Exposure to social stress is linked to the development of mental disorders including schizophrenia. This area of research demonstrates the biological adaptation to those who have grown up in urban settings who have adapted a different perception to threats either physical or social. Therefore, an urban dweller will have a well-developed amygdala due to prolonged activation compared to those growing up or living in “smaller cities”. 

The research highlights sensory loading on the brain. Evidence shows us there is a negative impact of being in a crowded place as it triggers our bodies to release more dopamine which it does under stress. However, couple this with feelings of loneliness or depression (which affects 350 million or 4% of the global population) the research that links urban settings and schizophrenia seem like common sense.

I recently visited The Crystal in London, home to the world’s largest exhibition on the future of cities, an essential visit for all built environment professionals. One of the animated stations illustrated the way in which smart technology will demand that we program our every move, renting and selling space on transport, access to electricity, renting all forms of space on an hour to hour basis, effectively a fluid existence in the non-place. Perhaps the City of London’s perpetual pop-up public realm is a human scale transition into the future’s faster changing pace of spaces and places? Considering the sensitivity of the human biology in regards to the unfamiliar, and reliance on memory for navigation purposes, my concerns are as follows:

1. Richard Florida’s latest book The New Urban Crisis provides some essential statistics on urban growth projections, namely that the world’s population is going to triple to 10billion, where today we have 28 cities with populations of more than 10 million, by 2150 we will have 50 or so cities of 200million. How will our brains cope with more people and more “spaces” rather than “places”?
   
2. There is a disturbing lack of understanding into the role environment plays in shaping the health of human beings. Green spaces stimulate social cohesion and facilitate social interaction - what level of quality will be possible in the non-space?
   

I am keen to see what solutions the City will find to balance the rate of change with the already faltering human health of our urban dwellers. Watch this space…

The correlation between exposure to nature and mental health benefits is arguably one of the more well-supported topics in literature that discuss links between health and the environment. Close proximity to greenery has been demonstrated to lower levels of stress and have positive impact towards users’ wellbeing, with studies have also suggesting that people living near green urban areas can help encourage more physical activity, thereby exerting a positive impact for people suffering with anxiety and depression (Cohen-Cline et. al, 2015). As I pursue my case study of Perth’s urban design in relation to mental health, this post hopes to serve as a snapshot and explore different ways green space is being implemented in one of Perth’s phoenix suburbs, otherwise known as Fremantle.
 
BOTTOM-UP GREEN SOLUTIONS AND PARTICIPATION

The place close to my heart is the City of Fremantle, 22kms south of the Perth CBD in Western Australia. Situated as a port city at the intersection of the Swan River and the Indian Ocean, Fremantle was officially recognised as a leader in sustainability in 2015 when it became the world’s second city to achieve international One Planet Certification, which is an initiative offering a framework to drive sustainable living and green, circular economies.
 
Fremantle’s Strategy 2020 recognises the benefits that green urban environments have towards community cohesion and wellbeing. With an objective to aim that “every resident and worker to have access to public open space within a 400mm walkable catchment”, the Fremantle council have adopted a number of methods and urban design tools to improve better mental health, such as:
 

• Verge Beautification Program: encouraging community engagement residents to planting native, water-wise shrubs on unused verges, offering access to free mulch and subsidised plants
• Community engagement and participation to develop pocket parks on disused pieces of land
• Ongoing contributions towards revegetation, wellbeing grants, community gardens and volunteer support.

 
Not only are these bottom-up methods developing quick, efficient green solutions in the city, but they are also helping foster social connectivity and cohesion within Fremantle’s urban community – an incredibly important factor in benefitting individual mental health. Encouraging volunteering/community participation offers a sense of wholeness and purpose within their home and thus can offer positive well-being effects. The mere act of getting community members out and about in the sun can benefit mental wellbeing through boosting vitamin D supply, regulating the circadian rhythm and improve quality of sleep.
 
By promoting community engagement as a tool to improve and encourage access to green space, Fremantle’s greening strategies have proven to be successful and continue to improve the opportunities that urban design can bring towards mental health in the area.
 
 
BARRIERS TO GREEN SPACES IN THESE CITIES
 
However, urban design plays a significant role in the level of access urban communities have to green space; factors such as time, money, distance, and transport accessibility can serve as barriers for green space access. Throughout the urban sprawl of major Australian cities, studies have shown socially-disadvantaged areas had a lesser access to green space, and thereby had less opportunities for the mental health benefits that green space provides. Australia. To combat this spatial inequality, cities such as Perth urgently need to implement improved access towards transit-oriented development and encourage more positive attitudes towards higher-density development. Fremantle has a long way to go in integrating affordable and good-quality higher-density developments with the abundance of green space it offers.
 
BLUE HEALTH = MENTAL HEALTH

As a port city, Fremantle is fortunate enough to be situated by both the ocean and river. Along the harbour there are restaurants, cafes, breweries and galleries that offer views over the water. This weekend I found myself having a coffee by the beach, sitting on an innovative piece of urban design that had reused Fremantle’s historic train lines. The water’s edge had attracted everyone from all sorts of age groups; kids dashing around in the sand, students along the benches in the sun, or the elderly peacefully strolling along the boardwalk. Intrigued by the success of Fremantle’s public activity as a low-density suburb, I had to further research into how the use of water in urban design can benefit one’s mental health or wellbeing.
 
Dr. Timothy Beatley, professor at University of Virginia and author of “Handbook of Biophilic City Planning and Design”, has discussed a lot about links between the sea, the city and mental health – terming the idea “Blue Urbanism”. It is no surprise that Fremantle, as a major port town, benefits from its adjacency to the Indian Ocean.
 
One of our UD/MH fellows, Jenny Roe, recently wrote for the Biophilic Cities Journal exploring this idea of blue health within the built environment (Roe 2018). Below I am going to briefly reiterate some of the literature Roe has discussed.
 
Studies have found that people living near coastal environments have lower Body Mass Index compared to people living inland (Wood et al. 2016; Witten et al. 2008). This evidence suggests that increasing users’ accessibility to water can improve one's chances of being physically active, which can have a range of benefits including reducing risk of obesity, diabetes, anxiety and depression. Living in marine or coastal areas has further shown people to report greater levels of happiness (MacKerron and Mourato, 2013); improved life satisfaction (Brereton et al. 2008); and better mental wellbeing (Alcock et al. 2015).
 
Access to blue space has also demonstrated its ability to reduce stress and benefit levels of wellbeing. This is supported from research done by Happy City, Street Plans, Space Syntax, and University of Virginia, which measured heart rate variability and self-reports from subjects who took a walk along a downtown waterfront in West Palm Beach (2015). The study found further positive impacts for water accessibility towards social well-being indicators (social trust and sense of belonging). The mixture of people evident during my brief time down by the Fremantle foreshore most certainly supported these results.
 
If you’d like to learn more about how green space accessibility and mental health go hand in hand, there’s a great literature review called Quality Green Space Supporting Health, Wellbeing and Biodiversity: A Literature Review. Written by Davern et al. (2017), the report offers a succinct summary of the factors involved in the design and delivery of green spaces that promote the health and wellbeing for people, with particular reference towards Australia cities. Another helpful report is Cities, Green Space and Mental Wellbeing by Jenny Roe. In terms of a specific focus on blue space, Beatley’s “Blue Urbanism” book and Roe’s feature article in the BCJ report on evidence-based studies that demonstrate how access to water within urban design can create positive mental health benefits.
 
 
REFERENCES
 
Astell-Burt, T, Feng, X, Mavoa, S, Badland, HM, & Giles-Corti, B 2014, 'Do low-income neighbourhoods have the least green space? A cross-sectional study of Australia's most populous cities', BMC Public Health, vol. 14, p. 292. Available from: 10.1186/1471-2458-14-292. [20 May 2018].
 
Badland, H, Whitzman, C, Lowe, M, Davern, M, Aye, L, Butterworth, I, Hes, D, & Giles-Corti, B 2014, 'Review: Urban liveability: Emerging lessons from Australia for exploring the potential for indicators to measure the social determinants of health', Social Science & Medicine, vol. 111, pp. 64-73. Available from: 10.1016/j.socscimed.2014.04.003. [20 May 2018].
 
Beatley, T 2014, Blue urbanism : exploring connections between cities and oceans, Washington, DC : Island Press, [2014].
 
Brereton, F., Clinch, J.P., Ferreira, S. (2008). Happiness, geography and the environment. Ecol. Econ. 65: 386-396. https://doi.org/10.1016/j.ecolecon.2007.07.008.
 
Duncan, G, Cohen-Cline, H, Cohen-Cline, H, Duncan, GE, & Turkheimer, E 'Access to green space, physical activity and mental health: a twin study', JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, vol. 69, no. 6, pp. 523-529.
 
Happy City, University of Virginia, Street Plans Collaborative and Space Syntax (2017). Happier by Design. https://thehappycity.com/wp-content/uploads/2017/04/STC-reportfinal-version-v.5.pdf.
 
MacKerron, G., Mourato, S. (2013). Happiness is greater in natural environments. Glob. Environ. Chang. 23: 992–1000. https://doi.org/10.1016/j.gloenvcha.2013.03.010.

Roe J (2018). Blue Cities for Better Health. Biophilic Cities Journal.
 
Witten, K., Hiscock, R., Pearce, J., Blakely, T. (2008). Neighbourhood access to open spaces and the physical activity of residents: a national study. Prev. Med. 47: 299–303. https://www.ncbi.nlm.nih.gov/pubmed/18533242.
 
Wood, S.L., Demougin, P.R., Higgins, S., Husk, K., Wheeler, B.W., White, M. (2016). Exploring the relationship between childhood obesity and proximity to the coast: a rural/ urban perspective. Health Place 40: 129–136. https://doi. org/10.1016/j.healthplace.2016.05.010.

Bestselling author Deepak Chopra spoke at the Southbank on May 22 on his latest book The Healing Self that surrounds personal health. Chopra, a pioneer of integrative medicine among his many accomplishments, shares his insight into this new age of responsibility for our own health, and specifically our need to make conscious preventative daily choices to offset illnesses and diseases. To remind you, the top 5 non-communicable diseases (NCDs) afflicting the human race today are; cardiovascular disease, cancer, respiratory disease and diabetes, which account for 40 million deaths each year. However, add the fifth, depression, which “is the leading cause of ill health and disability worldwide” affecting 350 million or 4% of the global population, or one in 20 people, and you begin to see how health services really have their hands full. A talk at the LSE in February on The Future of Aging stated “someone is diagnosed with dementia every three seconds.” Both sources lament the statistics of non-communicative diseases but stress the power of prevention needing to be prioritised by all of us to age more humanely. Research has shown that those who remain connected to what is going on in society, remain productive and socially engaged, are those who offset diseases such as depression and many forms of cancer. This translates into more “people {being} better able to help themselves and others to stay well and get ill less often and for shorter periods of time.” The question is: how does this translate into our urban spaces and into our evolving economy?
 
The Royal Society of Art has been exploring manufacturing in the city and how the industry has evolved. The report highlights how manufacturing serves a diversity of sectors from multinational to self-employed suppliers. More importantly the location in which this sector finds itself is equally diverse depending on the scale and typology of the output. What is most pressing is the need for more affordable manufacturing units made available to be rented across London. Interestingly, in Richard Florida’s latest book The New Urban Crisis, among the rich body evidence he shares some delicious statistics on London’s recent rise among “leading global cities for Venture Capital Investment”. Florida, reminds readers that the evidence show us that “ the world’s most innovative and creative places are not the high-rise canyons of Asian cities but the walkable, mixed-use neighbourhoods of San Francisco, New York and London.” These are the places that are safer, have higher quality of living and support a mix of talent, age and use. The key here is the walkable space. If we go back to the earlier question about aging humanely, by enabling a sustainable existence whereby people can be a part of society via their walk to work and their productive lives, then really it comes down to the design of our cities. Bringing our cities back to a human scale a scale of resilience, not a scale of siloed development.
 
The new urban crisis is one that can be solved by providing more thought to sustainable health and adapting the way in which people actively evolve over their lives, as a design tool to guide what a development should look like but also by what it should provide. Many might argue this tool to be biomimicry – an approach to innovation that emulates nature to secure sustainable solutions. If you combined the investment from Venture Capital coming into London, with the lack of affordable manufacturing space, within all of the opportunity areas London has earmarked, more students and older employees could be given the chance to activate a sustainable preventative health model.

Interestingly, only yesterday I received the latest newsletter from the New Economic Foundation, which is urging Londoners to save our Railway arches “home to thousands of small businesses all over the country”. The archways are owned by Network Rail and provide ideal affordable, local spaces for small businesses to operate at a diversity of scale and employment. They are “powering local economies and giving life to local communities.” Network Rail is about to sell off these arches to global investment firms, which seems a missed opportunity. Brexit or not, London’s population is growing, the population is ageing and the combination of better health, productivity and sustainable jobs are needed for all ages and stages of our work force. We just need a more consistent system to realise it.
 
Filmmaker Luciana Kaplan’s latest film Rush Hour documents the commute of 3 people: a Mexican beautician, a Turkish mother working in a clothing store and an American engineer. She demonstrates the losses of life that take place due to the uncompromising commute many people in urban areas endure to afford their cost of life. It is a painful truth that even in London, many have to travel too far, for too long, to be paid so little, which translates into a huge cost of non-communicative diseases. The sad truth being told in this documentary is that none of the commuters shown could prevent their life choices without the intervention of more humanely designed cities.

In the space of a week, both London First and The London Society held talks on growth. The London Society talk included a panel of four: an academic Transport Planner from University College London, an economist from the Greater London Authority, a London Architect and a spokesperson from Shelter, a homeless charity. This panel of experts explored the many aspects of growth that need to be considered to meet the demand of London’s increase in population by 2050. The most eye opening aspect of this discussion was the evidence provided by Shelter regarding the plight of homelessness, and the impact the lack of affordable housing is having on the health of the working poor and displaced in the UK. “1 in 5 English adults (21%) said housing issues had negatively impacted upon their mental health in the last 5 years. 3 in 10 {…} said they had no issues with their mental health previously”. The evidence Shelter put forth showed how “coordinated reform and investment from a government willing to make housing a central priority” could address this. Shelter’s contribution was indeed a disturbing illustration of our staggering crisis of housing and mental health, but also a compelling explanation of how this can be ratified through design and a shift in local economic reform.
 
The London First talk was hosted by VuCity, a new software that has created “an accurate interactive digital city model”. This planning tool enables detailed information relating to individual development proposals to be evaluated in situ before consent is given. The tool, dependent on the accuracy of the information it is fed, is capable of determining impacts such as wind at street level, views from a neighbouring property, daylight shadow diagrams, the list goes on. Currently, the software has been adopted by The City of London, Westminster, Southwark, and Transportation for London. The aim is for adoption across the UK to support local authorities by providing more knowledge of possible impacts, and to test the viability of design quality of developments of all shapes and sizes.
 
On the same day as the London First talk, an APPG (all-party parliamentary group) met to discuss the role of tall buildings, whether they offer a solution or not. High quality design is always emphasised as critical; however the elephant in the room is universal health and it is never placed at the heart of the argument to shape the quality of design. Mise van der Rohe (actually Louis Sullivan) is often quoted “form follows function”, which is the argument that design must relate to its intended function. The reason issues of growth, high density and tall buildings have become so emotive across London and the world, is at the heart of this is our realization that our cities are devoid of a relationship to the majority of those who occupy them. The majority in London specifically, are struggling on £25K as a combined household income, they are working long hours, they are travelling longer distances between work and home, 1 in 3 of them have mental health issues and Shelter’s evidence would suggest 100% of this has some association with housing costs, poor urban quality and uncertainty. “There are millions of people every year struggling with bad housing or homelessness” yet this remains in the back drop of arguments over tall buildings and growth.
 
In the LSE’s (London School of Economics) Conference Report: Cities, Health and Well-Being, there is much discussion about using the “LSE Cities’ mapping of health outcomes at a fine grained spatial scale which could contribute to a better understanding of health risks in different areas.” Were this system of mapping layered with the Vu City model this could be a life changing way of bridging the function with the type of form. Public Health England, located in every borough across the country, has all of the up-to-date information on local health. Would it not be simple to combine this information with VuCity and each borough to bridge this gap? It would help if copies of The King’s Fund Housing and Health report 2018, was made available to the APPG, New London Architecture and to the Department of Housing, Communities and Local Government, to inform built environment professionals of what the need looks like to empower them to design accordingly. 

Last week, I was fortunate to attend the Government’s first Design Quality and Housing Conferences in over a decade. The Ministry of Housing, Communities & Local Government hosted the Design Quality Conference: Achieving Well-Design Places. The opening statement was made by Dominic Raab MP, Minister for Housing and the closing addresses were given by Lord Taylor of Goss and Sajid Javid MP, Secretary of State for Housing, Communities and Local Government. There were a wide range of attendees including: Housing Associations, Developers, The Design Council, Homes England, Historic England, Local Authorities. The representation at this conference reunited the UK’s built environment industry. The chosen format for the event consisted of four break-out sessions focused on different themes; Engagement, Innovation, Influence from Youth, and Tools. While the themes appeared to be diverse, there was a clear and over riding message that design quality was vital for the promotion of health and wellbeing of present and future generations. Unfortunately, it was evident that there is presently a general lack of cohesion across this sector, and poor communication over the last decade has led to a significant oversight of and appreciation for the built environment in the UK. Nevertheless, while it is useful to critically conduct a self examination, a Swedish delegate suggested that the successful marrying of the modern designs to historic ones made UK cities unique in their efforts to enrich culture and enshrine localism, that was worth replicating.
 
Generating strategies to improve health and well-being pervaded every aspect of the conference. A recent article in the Lancet on Shaping cities for health reminded readers that the WHO’S Healthy Cities movement was now 30 years old and nowhere had the influence of this movement been more effectively adapted than in China. “By 2015, 259 of the 769 cities in China achieved the national Hygienic Standard. {…} The health movement has contributed greatly to the increased life expectancy of the Chinese people, from 35 years in the 1950’s to {…} 76 years in 2015.” It is apparent that Chinese policy makers are well aware that “health must be integrated in urban policies by widening participation and considering the ramifications on health of all decisions.” Here in the UK, 10 NHS Healthy New Towns have been launched. In light of this, an influential health think tank, The King’s Fund, recently published an extensive report entitled “Housing and Health: opportunities for sustainability and transformation partnerships.” (4) In addition, a bold decision has been made by the NHS to move Public Health back into local authorities in 2012, with the intention of integrating health “in urban policies by widening participation and considering the ramifications on health of all decisions”.
 
Publications describing policies and initiatives appear to be a stronger in the NHS than in the built environment industry, the absence of health professionals from this conference merely demonstrated how behind the UK is with the take up of the WHO’s Healthy Cities movement. Furthermore, sustained efforts to follow up on the good intentions expressed in this conference are now needed. A combination of environmental and health professionals are now required to come together to design and implement a comprehensive response that will address such pressing issues as: the impact of an aging population, affordable housing for the young, etc. This conference was the perfect opportunity to make those introductions, fingers crossed it won’t be another ten years for the follow up.

This week I had the pleasure of attending a London First Talk, where Dr Will Norman was the guest speaker. Dr Norman has the responsibility of occupying the first Walking and Cycling Commissioner position for the London Mayor. Dr Norman aptly reminded the audience of the challenge London faces to accommodate an additional 1.5 million more people by 2020.  This increase must be accommodated into the existing Greater London fabric. It is therefore very clear Greater London must prioritise its space for people, as opposed to vehicles, and focus on innovative ways to support liveability. This ambition is captured in the Mayor’s “Healthy Streets Approach” from the 2018 Transport Strategy, which seeks to “prioritise human health”. Dr Norman shared two anecdotal accounts, one of an elderly women, who lived across from a park where she was able to build social capital and maintain her health. Following an injury her mobility prevented her from crossing the road to her local park due to the volume of traffic which has now contributed to a decline in her overall wellbeing. I was wondering as he finished this account how many people had desisted from using the park due to the noise and intimidation from the increase in traffic and what impacts the increased noise had on the health of the local community as a whole.
 
New London Architecture (NLA) has just completed its fifth survey of tall buildings in the capital. The results showed a total of 510 buildings over 20 storeys, an increase from the 455 from the previous survey. The survey shows the majority of these buildings will be located in two boroughs containing a population of acute diversity and complex needs. Like all global cities, London at a neighbourhood level, is populated by everyone across the spectrum of poverty and affluence. Dr Norman’s call to arms to motivate Londoners to take up walking in the capital is indeed commendable and essential. However, the design detail found among the tall buildings across London, lack local relevance and each applicant lacks the expertise to viably “prioritise human health” in real terms.  For the majority of whom these towers are being filled, most are prominently absent or upwardly mobile. Recently, I attending a design review of a master plan for a high density mixed-used scheme, I was reminded yet again of the consistent apathy these schemes have for the actual liveability of mixed-use residential high density schemes next to a transport artery without access to green space. When I asked the Architect about the obvious volumes of disruptive noise set to impact the 700+ residents of this scheme, I was met with reassurance that those moving into the scheme would expect or be accustomed to such conditions. Or are they? According to The Economist’s recent article The burbs are back, “millennials were less likely to live in urban areas than young people were in 2000.” Course the narrow scope of the article does not permit a comparison of earnings of those aged 25-34 today versus those aged 25-34 in 2000. For this could be a contributing factor. However, there is a reaction from those who can’t afford to live in London but recognise the alarmingly inhumane conditions these new tall buildings bring with them.
 
Sarah Williams Goldhagen’s book Welcome to Your World details the latest cognitive neuroscience evidence that has revealed the majority of daily human cognitions are non-conscious. More importantly, this new field has demonstrated the impact details in our everyday environment have on our health, the majority of which we are not aware of. “When something happens in the world or in our minds, that “something” is always situated, in our bodies, in a given time, and in place.” (p45) Winlow and Hall in their book Rethinking Social Exclusion rightly point out the effect “non-places” have on “social excision” where “features are intended only to be looked at {…} rather than walked through and enjoyed.” (3). Goldhagen uses the example of studies surrounding a school to qualify the evidence that a “poorly designed school’s internal corridors-enervate us, so killing us with boredom that they exacerbate stress, sadness and even addiction. We want to escape, to flee to a more cognitively engaging and healthful place.” (2) Very recently depression has ranked as the most common disease affecting urban populations today. Is it not time we hold those profiting from the endless “non-place” accountable?
 
In conclusion, the second anecdotal account Dr Norman shared was one of being an observer of a group of school children. When the group was tasked with designing an alternative to public transportation for the future, it was unanimous that their vision be a city of fun places filled with space for opportunities of enjoyment. It is 30 years since the WHO began the Healthy Cities movement, clearly too few know about it.  I fear what this generation has begun has irrevocable ramification, I hope not, all generation deserve a sustainably healthy city in which to have fun.

References

1. Welcome to Your World: How the Built Environment Shapes Our Lives, Goldhagen, S.W., Harper Collins, 2017. P.4
2. The burbs are back, The Economist, Volume 427, Number 9088 (p.36)
3. Rethinking Social Exclusion, The End of the Social?, Hall, S., and Winlow, S., Sage Publications Ltd, 2013, p.124