by Giulia Melis
SiTI, Politecnico di Torino, Italy
Since ancient times, we have known that the place where we live can impact our health. Cities have always been shaped and restructured according to the needs and priorities of the time. The Roman Empire, for instance, created a model for the planned city: with its rigid morphologic and geometric rules, the typical Roman settlement provided basic facilities and infrastructure for its inhabitants, ranging from thermal baths, to aqueducts and sewers. During the Industrial Revolution, cities had to face a new challenge: overcrowding, industrial dumps, and bad hygiene conditions were helping the spread of infectious diseases, and working class suburbs were growing too fast, without any concern about the quality of life in those areas.
That’s how laws about urban décor, cleanliness and sanitation started to be discussed: the Public Health Act (UK, 1948) is one of the first examples. This Act linked the urban design of a city with the spreading of epidemic diseases, and tried to prevent it by moving industrial production out of the city core. This model lasted until recent decades, when deindustrialization and various crises meant the need for new paradigms.
Nowadays, modern cities are starting to wonder not only how to create a healthy environment to protect the spread of epidemics, diseases, violence etc., but also how to enhance the quality of life of their citizens and their wellbeing. The waves of New Urbanism are questioning our lifestyles, and starting to re-consider the social component of city life as fundamental for granting us happiness and fulfilment.
That’s why, as a group of researchers coming from the architectural and medical domain, we became interested in mental health in our cities. As urban planners, we were interested in understanding which urban features most significantly affect our daily life, in order to identify the most urgent and promising intervention opportunities towards less-stressful urban living. And as public health experts, we wanted to know if the effects are equally distributed among the population, or whether some groups are experiencing a higher burden?
We chose an Italian city, Torino, where a huge dataset on population health is available, and looked to see if the numbers confirmed our initial theory. While a lot of researchers have already presented evidence of the importance of urban trees and parks, which can have a profoundly beneficial impact on psychological wellbeing and general mental health, not many studies have analysed the urban built environment in its complex functioning. We therefore gathered data both on the structure of the city (how dense it is, where are the parks for recreational activities, which is the mix of functions in one area) and its services (is the nearest library placed within an accessible distance? is the area well-served by public transport? Are there public sport facilities? Cinemas, theatres? etc) and we looked for connections between this data and the consumption of antidepressant drugs in the city.
This scheme illustrates the variables considered in the study as plausibly connected to mental health in urban areas.
Our research suggests that good accessibility to public transport, as well as a dense urban structure (versus sprawl), could contribute to a reduced risk of depression, especially for women and elderly, by increasing opportunities to move around and enjoy an active social life.
Women (of all ages) and older people (age 50 to 64) were found to be prescribed fewer antidepressant drugs when they lived in places reached more quickly by bus or train, and in places with taller average building heights, compared with counterparts in more remote or sparse areas. That connection held up even when social factors were taken into account. This means that if everybody had the same level of education, same citizenship, and were all in employment, all living in a neighbourhood that had equivalent levels of crimes and social and physical disorder, there would still be differences in antidepressant consumption according to how well the area is served by public transport and to the density and liveliness of the neighbourhood.
Challenges and decisions with the method
Antidepressant consumption is quite a strong indicator in mental health. Taking antidepressants implies that you have recognised you have a problem, actively sought help from a doctor, received a diagnosis and a prescription for antidepressant medication, and started treatment. This is a long way from starting to feel that you may be stressed or depressed. We used this indicator in our research as we were looking for solid evidence, but by doing so, it is likely that our results underestimate the phenomenon of stress and depression in the city, thus setting the stage for further and more accurate investigations and reflections.
Of course the range of density that we were able to test was limited to that of a typical European city; this range does not include the extremes of US cities sprawl and high density (which are both known to have negative effects on health).
Also, this type of large-scale data analysis can’t pinpoint causal mechanisms. But it’s not hard to speculate why transit and density might reduce stress: the former relieves the need to drive everywhere (and to own a car); the latter enhances the potential for social connectivity. For older populations, in particular, both aspects help guard against feelings of isolation or loneliness. They also stand in contrast to remote suburban living that “can have a serious impact on mental health, particularly when it results in forgone trips”.
Transit provides key connectivity, linked to urban mental health.
Photo from Inquisitr
There’s still a lot to understand about the key stressors of city life, but sound advice to urban planners could already be launched: in order to address health inequalities, urban policies should invest in the delivery of services that enhance resilience factors, above all a good public transport network, in a careful and equal manner, throughout the city.
by Layla McCay, UD/MH Director
EVENT REPORT: an interesting research event launching a series of discussions on feeling good in public spaces, hosted by the UK's ARCC Network at the Wellcome Trust in London, 18th November 2015.
It is unusual to attend an event that is specifically focused on the nexus of urban design and mental health. All too often in discussions about how urban design can improve health and wellbeing, the focus is on physical health, specifically on active cities. Of course physical activity can have great impact on mental health, but when it comes to a specific focus on mental health opportunities, in the words of one urban planner, ‘we haven’t a clue’.
It was therefore particularly interesting that the UK Climate Impacts Programme chose to host the first in a series of discussions focused on that very question, with the inaugural event kicking off at the Wellcome Trust in London on 18th November 2015. An audience that included designers, planners, developers, academics, and health professionals gathered for a fascinating and diverse series of talks.
Georgina Hosang from Goldsmiths, University of London summarized the links between urban life and mental health, highlighting the differences in prevalence of various mental illnesses in urban versus rural areas in the UK, highlighting increased urban rates of depression, alcohol and substance dependence, and schizophrenia. In particular, she highlighted the need for for urban designers and planners to help create spaces in the city that increase social capital, a key factor that reduces the risk of developing mental disorders. She highlighted the London Mood Project, using mobile phones to map people’s mood in different geographical locations in London. If you’re in London, why not download the app and get involved.
Rhiannon Corcoran from the University of Liverpool started the discussion of how to measure and understand the implicit and explicit effects of urban places on peoples’ feelings, thoughts and behaviour (slides). She showcased the Prosocial Space Programme and introduced research that measured people’s responses to photographs of different types of urban spaces, anticipation of threat as they walked through various areas of a city, and surveys of what people felt made a positive place to live. A different method of measuring the effect of people’s interactions with the urban environment on their mental state was discussed by Panos Mavros from the Centre for Advanced Spatial Analysis, UCL, who has interestingly been using portable EEG machines to measure people’s brainwaves as they walked around urban streets (slides).
Antonio Caperna from the International Society for Biourbanism talked us through evolutionary theories for biourbanism (slides). His theories of why humans respond positively to nature were based on the brain’s affinity to the viewing of fractal patterns (naturally occurring, complex patterns found in nature), and he argued that architecture should reflect this inherent affinity. He argued that throughout history, the body has evolved itself to its environment, and current adaptations to urban life include stress, fear, anxiety and aggression, and that we can employ principles of biophilia in urban design to enhance human interaction with the built environment.
From the perspective of the Centre for Urban Design and Mental Health, my focus was on why mental health has been sidelined in urban design discussions, prioritisation and investment. In my view (summarised in this New Statesman op-ed) a combination of stigma, concerns about the complexity of the causative factors of mental illnesses, and a vicious cycle of non-prioritisation have led to mental health becoming the Cinderella of urban design and health integration. I highlighted key areas that we believe hold particular potential for urban design in improving mental health and would benefit from further research (for more detail, see slides):
To take mental health to the ‘urban design ball’, we must not ask just what urban design can do for mental health, but what we can do to increase the knowledge, data, profile, prioritisation, and implementation of mental health improvement as part of urban design. It must be a matter of researchers, urban designers, planners, policymakers, engineers, and public health professionals explicitly asking that question when developing their plans and projects.
One major theme from this event was the challenge of accessing and translating high quality research into practical urban design: “we need evidence to back up our hunches” when it comes to mental health promotion through urban design. We must undertake, publish and share more research and experience, and find ways to translate all this information and experience into practical, evidence-based guidelines, while guarding against a one-size-fits-all approach.
Mental health can and should be at the urban design ball. This is why the Centre for Urban Design and Mental Health is planning the launch of a new journal (call for papers out now), and is publishing research, ideas, and case studies on this Sanity and Urbanity blog (submit yours) to increase the discussions, research, and people’s access to the research. We are planning discussions, consultations, and guideline development. That’s what we’re doing. As a designer, policymaker, planner, health practitioner, engineer, researcher… what will you do to help get Cinderella to the ball?
UD/MH slides from the event:
See all the slides from the event here.
Dora Jihyun Yi is a clinical psychologist from South Korea, currently undertaking a Masters degree in global health at Georgetown University. As a UD/MH research associate she has been starting to think about how to leverage links between green building and mental health.
Have you ever heard of green building? According to the US Green Building Council, green building is defined as ‘a holistic concept that starts with the understanding that the built environment can have profound effects, both positive and negative, on the natural environment, as well as the people who inhabit buildings every day’ and ‘an effort to amplify the positive and mitigate the negative of these effects throughout the entire life cycle of a building’ (Kriss, J., 2014). Green building, which is also called ‘sustainable building,’ is ‘the practice of creating and using healthier and more resource-efficient models of construction, renovation, operation, maintenance and demolition’ (US EPA: Green Building, 2014). Its aims are to reduce the adverse effects of the built environment which impacts on both human and the nature by maximizing the efficiency of energy, water and other resources, minimizing waste and environmental pollution, and improving health and productivity (US EPA: Green Building, 2014).
The USGBC created Leadership in Energy and Environmental Design (LEED) certification, a rating system to assess how the built environment meets the requirements of green building (Concrete Thinking, 2015). Nationals Park in Washington, D.C. is the first Major League Baseball stadium with LEED certification (USGBC, 2014). It uses energy-efficient field lighting, which anticipates savings of $440,000 over 25 years (USGBC, 2014). The ballpark does not only encourage visitors to use public transportation but also provides parking areas and valet services for bicycles, promoting environmentally friendly transportation without using fossil fuel (USGBC, 2014). The USGB reported that the stadium could save over 4 million gallons of water a year thanks to low-flow faucets and dual-flush toilets as well as air-cooled chillers instead of water-cooled chillers (USGBC, 2014).
But how about the impact on human health? A literature review article identified that green buildings can benefit both physical and mental health (Allen et al., 2015). For instance, green buildings designed to improve indoor air quality can reduce the incidence of workers’ asthma and allergies, which in turn, can enhance their productivity (Allen et al., 2015). Compared to a conventional hospital, a LEED-certified green hospital indicated a reduced mortality rate of patients, higher satisfaction of employees, and improved quality of care indicating a lower rate of blood stream infections (Allen et al., 2015). According to the Indian Green Building Council, green hospitals designed to maximize daylight and optimize the artificial light can reduce seasonal affective disorder, sometimes referred to as 'winter depression' (Indian Green Building Council, 2015). They found that green hospitals with more gardens and landscape are associated with positive feelings such as pleasantness and calmness for both patients and employees (Indian Green Building Council, 2015). In particular, environmental noise can lead to cognitive dysfunction as well as psychological distress for both adults and children (Stansfeld & Matheson, 2003; Weitzman et al., 2013). Green space can provide buffer to block or reduce environmental noise.
Living in an environment that incorporates green space is certainly better for our mental health. However, it can be a challenge to create large open spaces or green spaces in highly populated and small land areas such as New York City in the US, Tokyo in Japan, or Seoul in South Korea. Using innovative solutions like green roofs or rooftop gardens are one way not only to reduce environmental noises but also to make it easier to access the natural environment. The initial cost of installing a green roof may be more costly than a conventional roof, but tangible and intangible benefits of a green roof can soon offset the expenses (US EPA: Green Roofs, 2013). These roofs can reduce energy use of cooling and heating; reduce air pollution and greenhouse gas emission; slow storm-water runoff; and improve the quality of life and human health (US EPA: Green Roofs, 2013).
Green building is a fascinating and rapidly emerging concept, but its relationship with mental health, especially for specific mental illnesses, is not well documented yet. Interdisciplinary studies to find out the impacts of green buildings on mental health and multi-sectoral interventions to make our environment greener and healthier are needed for the better future.
Questions for further thought
If you have research or ideas about these questions or any others pertaining to the question of green building and mental health, please send us an op-ed to be considered for publication in Sanity and Urbanity.
1. Allen, J.G., MacNaughton, P., Laurent, J.G.C., Flanigan, S.S., Eitland, E.S. & Spengler, J.D. (2015). Green buildings and health. Current Environmental Health Reports, 2(3), 250-258.
2. Concrete Thinking. (2015). Benefits > LEED. Retrieved from http://www.concretethinker.com/solutions/LEED-Certification.aspx
3. Indian Green Building Council. Green Hospitals. (2014). Technical Bulletin. Retrieved from https://igbc.in/igbc/html_pdfs/technical/Green%20Hospitals.pdf
4. Kriss, J. (2014). What is green building? The US Green Building Council (USGBC). Retrieved from http://www.usgbc.org/articles/what-green-building
5. Stansfeld, S.A. & Matheson, M.P. (2003). Noise pollution: non-auditory effects on health. British Medical Bulletin, 68, 243-257.
6. The US Green Building Council (USGBC). (2014). Nationals Stadium. Retrieved from http://www.usgbc.org/projects/nationals-stadium
7. US Environmental Protection Agency (EPA). (2013). Green Roofs. Retrieved from http://www.epa.gov/heatisld/mitigation/greenroofs.htm
8. US Environmental Protection Agency (EPA). (2014). Green Building. Retrieved from http://archive.epa.gov/greenbuilding/web/html/
9. Weitzman, M., Baten, A., Rosenthal, D.G., Hoshino, R., Tohn, E. & Jacobs, D.E. (2013). Housing and child health. Current Problems in Pediatric and Adolescent Health Care, 43(8), 187-224.
Urban Realities Laboratory, University of Waterloo, Canada
There’s no shortage of research suggesting that cities can be bad for our mental health. The incidence of depression and psychosis is higher in cities, and though the reasons for this are not yet completely worked out, some simple explanations such as exposure to toxins and pollutants that might be found in greater abundance in cities have been more or less ruled out—most of the clues point to more psychological explanations for the malaise that some experience in dense urban environments. Some studies have suggested that the stresses that arise in dense settings may be to blame for producing psychopathologies in vulnerable individuals, and some have pointed to the problems of loneliness and isolation that can arise in cities. City dwellers have to contend with the general problem of living among thousands of strangers, and considered across the broad sweep of human history, this is a recent turn of events and one for which we are not necessarily neurologically equipped. Early humans, like the more social of our primate cousins, would have lived in small groups where everyone knew everyone and could see and understand what was happening in their small social circle most of the time.
Urban design can exert a strong influence on our patterns of behaviour and our stress levels. Both the anonymity of life in a high-rise and the isolation of automobile-centric suburban life can exact a heavy toll on urban residents. Astonishingly, a recent survey showed that one-third of Americans have never interacted with the people who live next-door to them.
But it isn’t just the maladaptive social pressures exerted on us by city environments that cause undue stress and challenges to our well-being. What some might think of as the simple aesthetic of an urban environment—the look and feel of a neighbourhood—also produces a measurable effect on our mental health. One simple and now well-studied example has to do with natural environments. We no longer think of a city’s green-space as an aesthetic bauble or as the “dessert” of city planning that should be parachuted into place as an afterthought. In the past, all too often, public places with natural landscapes were squeezed into a setting wherever they could be afforded and made to work. Now, entire urban landscapes are being dramatically transformed by the careful planning of park areas. For examples of this, one need only look at the Millennium Park Project in Chicago or the spectacular Highline in New York City. Along with the overwhelmingly positive public response to such spaces, there is plenty of hard-nosed science suggesting that exposure to scenes of nature, even very modest ones, can have a dramatic impact on public health. In one recent study, a link was made between the density of urban trees on boulevards and a host of public health variables including rates of heart disease and diabetes.
Beyond the well-documented restorative effects of green-spaces, we showed that many aspects of the urban surround can exert a strong effect on our moods, our levels of arousal, and our attraction to particular areas of the city. For example, we showed that long, unbroken, featureless facades cause passersby to become unhappy, bored, and perhaps even a little angry. In our studies of urban psychogeography in Mumbai, we discovered that in a hyper-dense city, respite from the crowding and noise of city streets in an empty place (like a quiet churchyard) can produce as much psychological restoration as a refreshing oasis of green might do in a less dense environment. We’ve also been able to show that although different types of green-spaces might have entirely different contexts and meanings (cemeteries, community gardens, traditional parks) all can produce a profound health-giving restorative response. Although we don’t yet know how these fleeting changes in thoughts and feelings that correlate with our movements through a city might translate into long-term health measures, it would be surprising if there weren’t such connections, and the current work in our laboratory is devoted to finding them.
There has never been a more pressing time for us to understand the psychological impact of urban development on the human brain.
More than half of the world’s population now live in large cities, and the construction of hyper-dense cores is taxing the abilities of city planners to provide the infrastructure that is needed to provide services and transportation to those who live and work in these dense clusters. But just as important as such bread-and-butter concerns as the provision of good public transport, power grids and sanitation are the psychological affordances of these teeming centers of human activity. With projects such as our Psychology on the Street, we are hoping to contribute to the most important discussion of all: how can urban design contribute to the mental health and resilience of a large population of overtaxed and stressed citizens? How can psychology help to make successful cities possible?
Layla McCay, UDMH Director
I took the photograph at the top of this blog while visiting Medellin, Colombia, and forgot about it until I was thinking about photographs for this website. It seems an apt basis for the first post on the UDMH blog. Medellin is a fascinating place. Named the world's most innovative city, they have shifted from a setting of danger and fear to an urban environment to be proud of. On the day I took this photograph, I visited one of the city's poorest areas to experience their game-changing public transport innovations, and admire their beautiful library. I was enchanted by the 385-metre long escalator and the 2km-long cable car, both linking this previously isolated area with the rest of the city (and in the other direction, providing easy, affordable access to a beautiful mountain park). Strolling through the streets en route to the library, I noted the numerous community spaces and the beautiful use of murals. I particularly loved the mural of a bus as it combines my delight at street art and my appreciation of public transport.
To start off our blog, here's my op-ed from the Huffington Post that was inspired by that trip, musing upon the future of reading and the library as a third space: Why We Should Let Go of Nostalgia and Embrace the Evolution of Libraries.
Sanity and Urbanity: