Nélida Quintero is an environmental psychologist, licensed architect, and American Psychological Association NGO Representative at the United Nations. In the first of a series for Sanity and Urbanity, she explains the upcoming UN Habitat III process and where mental health fits in.
Why the UN is so interested in cities
People are moving to cities in ever-increasing numbers around the world. Cities provide opportunities for work, and access to better services and education. Higher population densities attract greater investment, so resources become more centralized. While years ago, decentralization and distributed workforces and services seemed to be a growing trend in developed countries, the conversation on human settlements globally has been recently centered more on mega-cities and urbanization, as increasing numbers of people move into cities. By 2050, 66% of the world’s population is expected to live in urban areas, according to the United Nation’s’ World Urbanization Prospects Highlights (2014).
Cities benefit from the concentration of human labor and talent and present a more efficient way to invest capital, given that it may be more efficient to direct financial resources to a smaller number of large hospitals, work centers or schools to serve many than to distribute such resources to multiple smaller hospitals, work centers and schools distributed in lower concentration settlements, for instance. Thus, regional development that emphasizes investment in smaller towns or villages may be more difficult to finance for many countries. The greater availability of jobs, health services and educational opportunities attract people from areas where such services and opportunities are scarce, such as smaller towns and rural areas. Though around half of urban dwellers currently live in cities of 500,000 inhabitants or less, by 2030, there will be 41 mega-cities with more than 10 million inhabitants, according to the United Nations’ projections.
There are many positive aspects to city living that support physical and mental well-being and health, such a greater availability of resources and opportunities, but as cities grow and the demands of the available resources increases, conditions develop that might have an uneven negative impact on urban populations. Planning and designing cities that grow very rapidly can be challenging. Overcrowding and uneven accessibility to resources, among other issues, can lead to environments that can undermine well-being and health.
The UN is currently talking Habitat III - but where did it come from? What were Habitat I and II?
This continually accelerating process of migration into cities and towns and increase in urban populations, was already recognized in the 70’s by the international community. Given this rapid process of unplanned urbanization, which was particularly noticeable in developing countries, the need for sustainable urbanization approaches became clear, which prompted the United Nations General Assembly to convene the first Habitat conference in Vancouver in 1976. At this conference, the creation of the United Center for Human Settlements (UNCHS-Habitat), now the United Nations Human Settlements Programme (UN-Habitat) was proposed. The Second United Nations Conference on Human Settlements, Habitat II, took place in Istanbul, Turkey in 1996.
So when is Habitat III and what will happen?
The Third United Nations Conference on Housing and Sustainable Urban Development, Habitat III, will be held in Quito, Ecuador from October 17th to October 20th. At this meeting, UN countries will agree on a New Urban Agenda, based on the Habitat Agenda developed in Istanbul in 1996. The New Urban Agenda will serve to guide the process of urbanization worldwide, informed by a long preparatory process. As part of this process, experts from around the world have drafted 22 issue papers and recommendations from 10 policy units, currently accessible for review on the Habitat III website.
Each issue paper looks at researched topics related to the urban environment, underlining conditions that may need particular attention and guide policy recommendations developed by the Habitat III Policy Units. In turn the Policy Units have drafted ten policy papers that will inform the development of the New Urban Agenda to be completed and reviewed in Quito. The Policy Units are made up of 20 experts each, representing different geographic areas and constituencies. These experts were nominated by Member States and stakeholders and appointed by the Secretary General of the Conference, in consultation with the Bureau of the Preparatory Committee for Habitat III. The objectives of the Policy Units are to explore research and highlight expertise and findings on specific themes, and draft policy recommendations relevant to these themes that address approaches toward sustainable urban development.
The six areas addressed by the 22 Issue Papers are focused on:
The ten Policy Papers are:
Member states and other stakeholders involved in the process continue to provide comments and input on these papers.
Where does mental health and wellbeing fit into the Habitat III papers?
While the importance of accessibility to health services, the interaction of health and the environment, and the beneficial impacts on health of sustainable approaches feature prominently in the Issue and Policy Papers, terms such as mental health or mental illness, psychological health or well-being are not used as frequently - though mental health and well-being are addressed in connection to urban conditions and stressors, such as inadequate urban infrastructure and income inequality. The Issue Paper on Public Space, for instance, refers to the research connecting green space to mental health and stresses the need for inclusive, connected, safe, and accessible public spaces. The importance of providing, as well as maintaining, green public spaces to enhance health is also highlighted in the Urban Spatial Strategies: Land Market and Segregation Policy Paper. The Inclusive Cities Issue Paper recommends developing strategies that enhance well-being for older persons and that relate to healthcare accessibility and safety, financial security, and age-friendly features in community life and entertainment.
Some of the research on the interaction of physical places and mental well-being is mentioned in the Housing Policies Policy Paper. In the notes, it refers to a paper entitled Housing, Health and Happiness by Cattaneo. In Cattaneo’s paper, improvement of housing conditions through the replacement of dirt floors with cement floors in Mexico, was correlated not only to fewer infections, but also to lower rates of depression and perceived stress, as well improvements in cognitive development and increased satisfaction with housing and quality of life, underlining the impact the physical characteristics of housing can have on health and well-being.
So what happens now?
The first draft or Zero Draft of the New Urban Agenda is expected to be completed in May, 2016 by the Habitat III Bureau and the Secretariat, ahead of the conference in Quito. In the meantime, the preparatory process involves various events and regional meetings around the world.
For additional reading and information:
About the Author
by Ingrid Bremer, UD/MH Associate
To coincide with World Happiness Day this week, the latest World Happiness Report has just been published. The Report surveys people in 156 countries to better understand the national and regional distribution of 'happiness' and identify global 'happiness inequalities'. Of course 'happiness' is a complex term - the report defines it as an evaluation of self-reported quality of life satisfaction. Six key variables were used to help explain international variation in happiness: GDP per capita, social support, healthy years of life expectancy, freedom to make life choices, generosity and freedom from corruption.
Countries found to have the highest ranking of happiness (2013 – 2015) included Denmark (1), Switzerland (2), Iceland (3), Norway (4) and Finland (5). The countries with the lowest rankings of happiness were Benin (153), Afghanistan (154), Togo (155), Syria (156) and Burundi (157). Full results here.
While the World Happiness Report does not measure mental health per se, the Report has some interesting findings. Social support, income and healthy years of life expectancy were found to be the largest contributors to the differences in happiness between the top 10 and bottom 10 countries. In particular, the underlying social fabric of a society, including quality of social capital, was found to be integral to resilience in the face of a crisis, such as an economic crisis or natural disaster; indeed, in the event of such a crisis, the Report suggests that where there is good social support, people’s happiness may actually increase as a function of being able to work together with others towards a common good.
The rise in scientific and policy interest in sustainable happiness is evident. Countries such as Bhutan, Ecuador, United Arab Emirates and Venezuela have even designated ministers to coordinate their national efforts, and the concept of achieving ‘happy’ populations is increasingly a focus of citymakers around the world. By underlining the importance of good social support in achieving population-level happiness, this Report shows the potential for urban designers to play an active role in helping improve happiness in communities through pro-social design that enables opportunities for positive social interactions among local communities. This #WorldHappinessDay that's worth thinking about.
About the Author
by Graham Marshall
Prosocial Place Programme
On 23rd February 2016 Graham spoke at the UD/MH Dialogue and launch of the Journal of Urban Design and Mental Health at the Wellcome Trust in London. This is the transcript of that talk.
Hello; I’m a reformed urban designer and I would like to tell you the story of this catharsis and the Massive Small project that sparked it. This is a short talk and if you take nothing else away today I would like you to think about this: If we are to create and maintain healthy places we need to shift our focus from the built to the living environment.
£5k Public Realm Strategy
The project was in Bakewell, Derbyshire, where they had recently redeveloped their town centre over the former livestock market. The scheme maintained the street pattern, was built in local stone and most people were pleased with it... but something was missing.
We were commissioned to provide a quick appraisal of the public realm and provide an outline strategy for improvement - a simple palette of materials was expected by some stakeholders, with a few pointers to win Derbyshire in Bloom. Our initial observations were that:
The Grand Gathering
Our research told us that Edward the Elder called a Grand Gathering here between the many tribes of the Danes and the Vikings to broker a truce. This Gathering led to the unification of England under one King, Edwards’s son. Importantly, it established a new role for towns as centres for justice and protection, the Borough system connecting the new country together – it provided an urban focus to a new nation. The Normans loved it, finding it easy to ‘conquer’ the country with this administrative system in place! But importantly for us, a thousand years ago we established a progressive urban system focused on people and their relationships – not on buildings and architecture.
With a group of community leaders we developed a co-design approach to the project. Using Edward de Bono’s Six Hats method, we used post-it notes to record our conversations. Our first workshop discussed ‘what we knew’ and ‘what we felt’ about Bakewell. From hundreds of post-its we generated several themes:
At the next workshop we reviewed the earlier post-it notes as a basis to a discussion about ‘the future of Bakewell’. We were not talking about paving materials – we were talking about what was important to them about their town. It was clear that the role of the public realm was important to their understanding of place and by not over-facilitating we developed a deeper understanding. When we discussed the town the built environment remained the central focus – something solid they could relate to. But when we spoke about the assets, people became very passionate and it is here that they felt the purpose of the town lay - in the people – in the living environment.
There was a shift in perception.
They also realised how detrimental poor stewardship could be and it led to a discussion about the tipping point – where do we set the benchmark between success and failure? From these discussions we began to develop our Prosocial ideas about:
Key to Improvement?
At our third workshop we asked ‘what we could do to improve things’. In the discussion the focus shifted significantly from place to community and their vision. We also found that the concept of place shifted from buildings to public space - in the diagram, flanked by stewardship issues and positive assets. These shifts were from built to living environment.
The key outcome of the project was the successful establishment of a ‘Town Team’ and the identification of champions to take forward the themes of the strategy. A natural narrative emerged in the project which led to the project title of The Gatherings – the Vision.
We had a good client in the Peak District National Park Authority, who were open to our exploratory approach to the brief – we were Highly Commended in the Landscape Institute 2012 Awards for the project. The things that we learned from this Massive Small project included:
Recognition that the traditional urban design approach to the central redevelopment had UN-PLACED the town.
Prosocial Place campaigns for urban design policies built around people’s needs – instead of good design or well designed, social policy points to following the evidence towards WELL-DESIGN. We have produced a short think piece for this launch, published in the Journal of Urban Design and Mental Health, around the idea of THRIVAL in place of survival in place.
About the Author
by William Heard
Chicago School of Professional Psychology, US
By the year 2030 more than 70% of the population will be living within densely packed cities across the world. While living within groups has been a staple of our society, beginning with the early cavemen, there has been a shift in the environments that we call home. Over the course of the last few centuries, we have begun creating environments that are more organized, and packed with more people than ever before. Densely-packed cities are one example of the environments that we have cultivated in order to help deal with over-population. These cities bring with them a host of positive attributes to our health and well-being. For instance, James Hamblin (2014) mentions that cities that contained more compact street networks also showed lower levels of obesity, diabetes, high blood pressure, and heart disease.
However, along with the positive physical effects, research has shown countless negative effects on a person’s mental health. One such effect comes from the never-ending amount of stimulation that the body receives from walking around in the more densely packed areas of the cities. This stimulation puts a relentless demand on our ability to pay attention and process information. Sullivan and Chang (2011) state that if a person does not receive respite from stimulation, their brains will become fatigued to the point where they become inattentive, socially withdrawn, irritable, impulsive and accident prone. Similarly, chronic noise pollution can also contribute to children's behavioral problems in schools and daycare centers around the world. Furthermore, in the book Happy city: Transforming our lives through urban design, Charles Montgomery found that psychotic disorders, including schizophrenia, were the most common in neighborhoods where the people had the thinnest social networks. Along with schizophrenia, older adults who lack strong social ties show higher rates of mortality, suicide and overall decreased health.
Isn’t it contradictory to create spaces that are meant to be as efficient as possible when those very places are actively preventing us from reaching our peak? Luckily, along with the research on how our mental health is influenced by the environment we live in, there has also been a ton of research on how to counteract the negative influences. While the number of proposed approaches are endless, a few show promise in promoting positive environments for mental health.
One of those ideas uses green and blue spaces within urban environments to decrease stress and mental load. Wells and Evans (2003) found that the impact of life stress lowered among children who lived in neighborhoods that had natural settings. This buffering effect was replicated with adults and the elderly as well. Wells speculates that green spaces increase variability in an urban setting, thereby moderating the over-stimulation effects if people are able to see them.
Another possible explanation could be that natural settings inspire people to mingle and build social connections, thus bringing us to another well-established resiliency factor that decreases the negative effects of the urban environment. While the way we interact with our built environments is important, our overall resilience appears to come from social connections that we form and the natural settings that foster them. Social networks and the perception of social belonging and support are a buffer against depression, anxiety, and other adverse consequences that come along with living in environments that cause mental fatigue. It appears that realtors' “location, location, location” mantra has more to it than resale value; Montgomery (2013) found that the person’s social ties could be determined by the distance they traveled for work, and that the farther you travel, the less of a network you create. More specifically, it appears that people whose commute more than 45 minutes, one way were 40% more likely to get a divorce, showing that social ties aren’t just important for your overall mental health; they can also impact relationship vitality.
Much like New York’s High Line park, Chicago’s answer to the lack of green spaces within the city was to build the 606, an elevated walkway that features greenery, parks and other outdoor activities for the community. Another option is to build below. Having run out of room to build green spaces above ground, New York also created an underground park that uses filtered light to grow a natural setting.
Major cities in the United States are doing their best to find unique ways to address the unwanted mental health effects of urban settings. I am curious though: do you feel they are doing enough to foster resilience within their populations, or should they being doing more? What potentially odd but creative ideas do you have?
About the Author
by Katarzyna Klijer, UD/MH Associate
The Centre for Urban Design and Mental Health's second dialogue took place in London with five diverse speakers each talking for five minutes about their particular perspectives and experience at the nexus of urban design and mental health.
Layla McCay, the Centre’s Director, launched proceedings, and also launched the new Journal of Urban Design and Mental Health, on the theme of conscious cities, including a rather delightful video to introduce the topic.
Wendy de Silva, Architect and Mental Health Lead for the design and technology practice IBI Group was first to the stage. With extensive experience in designing facilities for mental health care, including awards for innovation and best in class design, Wendy discussed what the design of healthcare facilities to support the mental health of people in hospital can teach us about how to to leverage urban design to support mental health in the wider urban environment. With a focus on the recovery model of care, she emphasized the importance of creating places in which people feel safe, relaxed, in control, and part of a community. She proposed a range of design opportunities to support mental health such as creating free access to outside space, and empowering people to participate in useful, ordinary daily activities.
Lucy Saunders from Transport for London discussed the mental health opportunities in transport, specifically the Healthy Street Approach in London. Lucy emphasised the strong connection between physical activity and mental health and with 80% of London's public space being streets, she made the case that streets should be designed to provide a more conducive environment for people to socialise and be more physically active. She discussed whether we need to think about the monetary value of doing so, to help understand and demonstrate the benefits, and enable comparisons with values already ascribed by planners to moving traffic.
Graham Marshall discussed the Prosocial Place Programme, which he established in partnership with researchers at Liverpool and Middlesex Universities. The objective of this programme is to develop an integrated evidence based approach to urban planning, design, development and stewardship. In particular, they seek to find ways to create spaces that promote positive social interaction and belonging to improve wellbeing. Graham made the case that cities must be designed for wellness rather than only focussing on ensuring they are "well designed", and good stewardship is integral to good urban mental health and wellbeing. He called for us to switch from discussing the 'built environment' to talking about the 'living environment' to refocus priorities in architecture, planning, and other placemaking activities; to shift from an objective of 'survival' to that of 'thrival'.
Dinesh Bhurga, professor of Mental Health and Cultural Diversity at the Institute of Psychiatry at King’s College London and President of the World Psychiatric Association discussed the opportunities for urban design in addressing public health. Professor Bhurga highlighted that the rates of people with anxiety, depression and addiction are much higher in urban areas compared to non-urban areas, and that urban design plays a role in developing an environment that is supportive or detrimental to mental health. He proposed that key risk factors to be addressed to improve urban mental health are unemployment, poor parenting, and overcrowding, and with half of mental health disorders emerging before the age of 15, he identified schools as an important opportunity for positive impact - including through good design. He concluded that "mental health is far too important to just be left to the experts", and encouraged the citymakers in the room to take action.
Georgina Hosang, a lecturer at Goldsmiths, University of London and London Mood Project lead shared her experiences representing the Centre for Urban Design and Mental Health at the Unites Nations Urban Thinkers event in Kuching, Malaysia, and how mental health is currently fitting into wider Habitat III thinking. She led a participatory session of international participants that identified key barriers to the systematic integration of mental health thinking into urban design as being stigma and lack of knowledge.
After the presentations, the diverse audience from academia, architecture, interior design, transportation, urban planning, mental health, and a range of other professionals provided some energetic discussion that extended over to the reception, and lasted until the lights were turned off at the venue. Topics included whether attachment theory could apply to cities (the verdict: yes, probably); mental and physical health are two sides of the same coin and must be addressed together; positive social interaction is a key component of urban design to improve mental health, and that all the professions involved in designing and developing cities have a responsibility to talk about mental health to help reduce stigma and discrimination and drive positive impact.
Coming soon to the website: more photos of the event and videos of the presentations.
About the Author
Sanity and Urbanity: