Annalise V Johns, London-based urban designer brings us the latest discussions from some of the most interesting urban design events around London over the last few weeks.
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The following is a reflection on the topics discussed at two recent London Society event. The first a launch of Professor Richard Sennett’s latest book Building and Dwelling: Ethics for a City, and a talk by Town Planner Colin Wilson, on How to Plan London, all of which took place amid the close of the consultation for the revised publication of the London Plan.
 
Local political challenges aside, global urban trends namely; the unforeseen impact of automation, the complex presence of plastic, the explosive rise in depression and obesity, and thanks to #metoo, a global awakening to the true reality of parity across all thinkable domains and its impact on economies, I am struck by the lack of dimension provided by these thought leaders on how best to shape a city, and one as intricate as London. Professor Sennett, Mr Wilson and the London Plan continue the age old discussions of spatial organisation; greenbelt or not, density or not, and formal or holistic design, however, in light of growing evidence illustrating the impact urbanism is having on the health of all living creatures; these responses seem rather prosaic.
 
The latest revisions to the London Plan liken it to the American Tax system. Its primary focus on “Good Growth” and “doubling the current rate of homebuilding” are devised in a framework to create a London built for sustainable transport and active travel. How possible is this when as Colin Wilson astutely pointed out, of the 180 policies found in the London Plan a mere 30 are used. It is evident from the growing number of inhumane developments being approved in London, policies are not understood and certainly not taken seriously. What is very clear is built environment experts still lack understanding as to the true influence environment has on human health and the London Plan provides no further clarity of this.  
 
A recent study published in the Lancet analyses the “salutogenic effects” natural environments have on mental health and how “urbanicity serve as background factors that potentially trigger or amplify suicidal motives.” The study goes on to say analysis carried out in the Netherlands “confirm the mental health-supporting characteristics of {…} natural environments.” More research is needed but there is a growing body of evidence showing the importance materials within the built environment have on various aspects of human health.
 
A fascinating talk was given at the Future City Catapult in London (15.03.2018) on Neuroscience for the Built Environment. Areceli Camargo shared her explorations into the neurological studies of particular materials and its impact on humans. Reflecting on the changing epidemiology by focusing on non-communicable disease as they affect women in particular, is to start with an intention beyond good growth and instead for an outcome with far reaching preventative mechanisms that result in multiple benefits to society including economic growth. Built environment professional are responsible for the communities whose lives are being shaped through design choices, therefore to create designs that do not adhere to the role of preventative health care measures are operating in vacuum. Materials now exist for streets and furniture to absorb pollutants and excesses of noise pollution. The science exists to make cities for complex natural ecosystems to thrive and reverse climate change, therefore to not adopt such approaches to all built environment working practices seems unprofessional. Progress in this area is a matter of leadership and political will, on the one hand, and of proactive and deliberate measures and accountability, on the other. We need more of all that. 

Cities should always be planned and designed based on the needs of their users. On International Women's Day, let's think for a moment about the movement towards designing cities that empower women as much as they do men. With women comprising at least half of urban populations, many have pointed out that the disciplines of urban planning and design have historically been dominated by men and consequently, by the male perspective. This is a big topic. This is just a brief overview.

Thinking about designing cities 'for' women runs the risk of reinforcing all sorts of unhelpful gender stereotypes. But this isn't about superficial, potentially patronising projects. Effective city design needs to take into account the different patterns that emerge about what different people do in the city, and what they need. In  many cases, women and men have similar needs. But research also tells us that males and females do use cities differently, all over the world, and that certain factors associated with being female tend to restrict freedom of movement within the city. Many of these needs gaps, such as caring responsibilities and work patterns, will likely narrow as society moves towards gender equality. But right now around the world, certain urban design and planning factors can create challenges to women's self-esteem and belongingness, and can restrict their likelihood of accessing healthy opportunities in the urban environment, such as access to nature, exercise, or positive social interactions.

As such, this is  a matter of social justice that affects women's ability to engage in public life. It is fundamental that cities integrate the female perspective in design and planning process, and ensure that genders can benefit equally from services such as transportation, exercise venues, parks, health and social care facilities, and all other aspects of the city. So what's currently stopping them?

According to the research, factors associated with gender in urban design and planning seem to be largely divided into two main challenges: accessibility (psychological and physical); and safety. Some examples include:

Psychological and physical accessibility

• Negotiating use of space: Women are less likely than men to negotiate and assert their legitimate use of spaces. For example, girls have been found to be  less likely to use parks when they feel they have been 'taken over' by boys.
• Caring: Women are still statistically more likely than men to be carers, particularly for children and older relatives, and often more likely to run household errands. This brings about specific needs around maneuvering prams and wheelchairs around the city, and needs for public transport to efficiently cover times and places outside the city's standard 'rush hour' plan.
  
• Toilets: Women tend to need to use toilets more frequently than men, for a range of reasons, including: menstruation, menopause, more susceptibility to urine infections due to anatomical differences, more susceptibility to urinary incontinence associated with the complications of previous childbirth, and increased risk of disorders like irritable bowel syndrome. In addition women are more likely than men to be caring for children or older people who have increased toilet needs. And transgender women may, depending on their location, may feel like they have no access to public toilets.

Safety

• All genders fear crime, but studies show that women are more likely to fear crime. Women who are caregivers may also be particularly afraid of other threats to their charges, such as traffic danger. Such safety fears limit women's psychological freedom of movement, which may affect places they feel able to use in the city.

How this all affects mental health

Exclusion, anxiety, fear and marginalisation are detrimental to our mental health. Good design helps people feel included and valued, prevents isolation, and empowers us to access places that can have a protective effect on mental health, such as health facilities, natural parks, places to exercise, or settings to socialise. Feeling able to use the city also helps create feelings of community belongingness and social cohesion.

A To-do List starter for cities to deliver urban design that empowers females as it does males

1. Women should be involved at all stages of urban design and planning processes.
2. The female perspective should be an integral part of urban design and planning decisions.
   
3. Sidewalks, public transport and access points should be designed to welcome prams and wheelchairs.
4. Public transit should be safe and invest in diverse schedules beyond the standard office rush hour.
5. Pedestrian, cycle and public transit routes should incorporate natural surveillance, good lighting, and good stewardship and maintenance, and reduce the risk of unwanted interactions.
6. Consideration could be given to subdividing some public places like parks so that one group is less likely to take over the whole space, and sections feel hospitable for different people's needs.
7. Public toilets, and places welcoming for baby changing and feeding, should be plentiful, accessible and safe.

Note: gender, urban design and mental health is a challenging intersection. This op-ed cannot hope to fully cover its many facets but is intended to inspire thought about the opportunities to design more inclusive and empowering cities. If you want to examine a different angle, please submit to this blog.

Early planning practices were predominantly focused on addressing the issues of the postindustrial city. Among these issues was access to clean waterfront spaces. As cities by the sea and large rivers expand and become more dense, access to clean waterfront spaces has become an increasable asset to overall health and public life of cities.

Key West is a south Florida town located on an island at the southernmost tip of the continental United States. Naturally much of the island’s public life and overall movement is centered around waterfront spaces or within the ocean itself. The island is among the most densely populated areas in the state. Key West has long been, and continues to be, a haven for immigrant communities, artists, the LGBTQ community and fishermen. Given that it is an extremely demographically diverse town with high density levels, the island serves for a very unique observation on public urban life, specifically public spaces.

Among the island’s most iconic public spaces is White Street Pier. The pier is a unique structure that starts at the southern end of the street by the same name and begins at the edge of the sea. The structure stretches into the ocean for several feet, removing itself from the noise pollution of the surplus of motorized vehicles the island possesses. The pier contains at its end an open space with direct proximity to the sea. The pier is lined with benches, walkways, and bike paths; not specifically delineated. The versatility of the space and its proximity to clean ocean water allows for quite a variety of uses in the space. One can observe a variety of activities ranging from fishing, to strolling and skate boarding. Considering that the island’s surface is very small, access to public spaces is limited, enhancing a convergence of many different social demographics within the public realm. The pier becomes an urban oasis from the access to fresh ocean air and lack of noise. The only sounds that can be easily heard are those coming from the sea and those generated from people, adding an additional natural element to the pier.

White street pier has a unique form of public space on a grander scale, however the island of Key
West is full of public life by the sea.

Given the overwhelming impact that urbanized areas have on people's access to silent spaces and natural amenities, a piers and other waterside walkways can be helpful in neutralizing the overstimulating effects of urban noise pollution and contributing to the overall mental health of a city.

Key West’s small roads and plentiful bike lanes offer a pedestrian and bike-friendly environment. In addition, the island boasts plentiful bike trails which are completely free of car traffic allowing for the easy movement of people. The walkway is also used as a major bike route connecting the island. The city government of Key West has led a variety of initiatives advocating for the use of bikes instead of cars and other sustainable modes of transportation. Cycle Free Key West is an initiative started by the city’s planning department as a means of promoting the use of the bike as a healthy, safe and fast alternative mode of transportation on the island in addition to promoting walkability and other sustainable modes of transit throughout the island.

The waterside walkway serves as a major sustainable and healthy means of transportation and is frequently used by locals and tourists alike. The ocean gives one a sense of peace that is often not present in urban environments. The citizens of this busy seaside town are lucky enough to enjoy this. Furthermore, given that physical health and mental health go hand in hand urban planning initiatives that promote physical activities are of the utmost importance.

For #WorldBookDay we asked our UD/MH fellows and other Twitter followers which books they would recommend that are relevant to the nexus of urban design and mental health. Behold: your UD/MH reading list. We hope you find some of these enjoyable.

Wow, so the movement is really growing. How did it all begin?

Playing Out was started by myself and my neighbour, Amy Rose, in response to feeling that our children’s lives were too restricted and that they were missing out on something we had taken for granted as children – having the freedom to play out independently and make friends on their street. For us, the main issue was that our residential street was dominated by cars and just didn’t feel like a safe or pleasant space for children to be in. 

How does a Playing Out session work?
 
The ‘playing out’ model is meant as a temporary way to give children a taste of this experience and a catalyst for longer-term change. Neighbours get together and apply to the council to close their street for a couple of hours, weekly or monthly, to create a safe space for children to play freely. There are no organised games or activities – the whole idea is for children to have the freedom to follow their own ideas and use the space as they choose. This leads to an astonishing variety of activity, from cycling, scooting and skipping, to more imaginative and invented games – or just ‘hanging out’ and getting to know each other. 
 
What is the benefit of free play for children? Physical health? Mental development? Social interaction? Community belonging?
 
All of the above! There is a lot of evidence of the general benefits of free play for children, especially in terms of emotional and mental development. The problem is that they have less and less opportunity for this, as both their time and the space available to them has become increasingly more restricted. See here for more information on the evidence of the specific benefits of the ‘playing out’ model.

For children, one massive benefit of playing out is making friends on their street. Because they have a shared sense of belonging – the street being an extension of home - you tend to see much greater interaction across the normal barriers of age, gender, ethnicity and social background, compared to play in the school playground. Often, the children who live on one street will go to several different schools and don’t even know of each other’s existence until they meet at a playing out session!
 
There hasn’t been any specific research (that I know of) on the link between street play and mental health – but it would definitely be something we would be interested in.

(UD/MH Editor: the research on play and mental health is summarised here).

How does the project affect and involve other residents?
 
Playing out is generally – though not always – initiated by parents who are motivated to change things for their own children. As a result of being involved in sessions, parents have reported feeling increased confidence to let their children play out, increased sense of belonging in their street and trust of their neighbours, and a sense of satisfaction at knowing they are giving their children something really valuable. Some mothers have even said that getting playing out happening on their street has helped them to come out of post-natal depression and overcome isolation.
 
Older residents and those without children have also been involved on many streets. For older people especially, it can be a valuable way of getting to know their younger neighbours and becoming more ‘visible’ in their community. We have even heard stories of 999 calls being avoided (for example, when an elderly person had a fall in their house) because of neighbours getting to know each other through ‘playing out’.
 
What types of streets and urban spaces are suitable for outdoor play? Is there an ideal form?
 
The main thing children need is access to safe space near their front door. It is a bonus to have somewhere with interesting, playable or natural features but really, children are not too fussy and will find imaginative ways to play in any space that is available, however dull or ugly it may seem to adults.
 
So how can people start organising their own Playing Out sessions? Is it a difficult process?
 
It’s pretty simple. Everything you need to know is on our website www.playingout.net. The first step is to talk to your neighbours and build support for the idea. Meeting other people on the street can be a great side-effect for adults involved in making it happen.
 
What has been the response of local councils and officials? Are they receptive of the program?
 
In general, councils have been very welcoming of the idea as a low-cost, community-building way of getting children outdoors and active. It really is a no-brainer for councils to support it from a public health point of view. All they have to do is put a policy in place to allow people to apply for a regular road closure and residents do all the hard work themselves! Over fifty local authorities have done this so far and we are here to help advise any other councils that are interested in supporting it.

What does this mean for public health policy?
I would just say that we need to look at the root causes of our current public health issues – especially those affecting children – and tackle those in a more radical, sustainable way. Children want to play - it’s not a chore for them. They just need to be given the time, space and opportunity to do so immediately outside their front doors.
 
What are the long-term goals of the Playing Out project?
 
Our long-term goal is for all children to have the freedom to play out safely where they live, every day. As well as political and physical changes to slow traffic and make streets and cities more people-friendly, this will mean a big shift in culture and attitude towards widespread understanding that, for children, playing out is a vital part of a healthy, happy life.

Access here

Free Play and Children's Mental Health - David Whitebread (2017), The Lancet Child & Adolescent Health

The Importance of Play - David Whitebread (2012)

Further journal research papers (you can read the abstract summary; you may need to sign in through your institution to read full text)

The Power of Outdoor Play and Play in Natural Environments  - Kemple et al (2016) in Childhood Education

Play and its role in the mental development of the child  - L.S. Vygotsky (2014) in Soviet Psychology
 
Using Nature and Outdoor Activity to Improve Children’s Health - McCurdy et al (2010) in Pediatric and Adolescent Health Care

On Saturday, walking through my south London neighbourhood, Brixton, a Valentine's Day-themed display in the local department store caught my eye. Taking up a full window display in Morleys, in a prime location right across from Brixton Station and the famous Electric Avenue, three giant red hearts enclosed three couples: a man and a woman; two men; and two women. As a gay woman, I was filled with unexpected joy. Whatever my feelings about Valentine's Day, it felt important to see my life represented in this place, my home, which has so far felt pretty far from a 'gaybourhood' (despite its LGBT+ history). I realised I had never seen a same-sex couple on the high street in Brixton, in advertising or in person. I realised that this lack of representation has been making me feel marginalised in my own community. I was filled with respect for Morleys. That department store's simple design choice had succeeded in making me feel more like I belonged.

Of course it wasn't a simple design choice. On Monday morning, I was walking my dog past the same window. The three couples were still in situ but across the glass in front of them, somebody had scrawled:

'F*CKING LIBERTY - SOMEONE SHOULD SMASH OUT THIS WINDOW!'

In an instant, my feelings about my neighbourhood changed. I no longer felt included in this community. I didn't even feel safe. I looked around, wondering whether the person who had felt compelled to express this view might be nearby, and what they (and their like-minded friends) might decide to do if I was walking past with my wife.

This experience made me think more explicitly about the relationship between sexuality, urban design and mental health. Part of designing environments that promote good mental health is achieving feelings of safety, belongingness, and community connection. When these feelings are replaced by fear, anxiety, mistrust, and marginalisation, and experiences of bullying, harrassment, abuse and discrimination, this can increase people's risk of developing mental health problems like anxiety and depression. LGBT+ people are already twice as likely to have mental health problems compared to heterosexual people, and much of that is thanks to issues like self esteem, discrimination and marginalisation.

LGBT+ people do not always find acceptance and support within their own families and communities, and often move to cities in search of community and belonging. However, cities are not always tolerant utopias.

What can urban design and planning do to promote good mental health for LGBT+ people?

There are two main approaches: first, a sense of safety and inclusion that empowers LGBT+ people to fully access the environmental factors that promote good mental health, such as access to parks, physical activity, positive social interactions. Secondly, building on the importance of pro-social places by strengthening the role of the built environment in promoting a sense of community and belongingness.

Dedicated LGBT+ venues
Much has recently been written on the topic of 'queer urban planning' (see further reading at the bottom of this page for some examples). Most of the debate has centered around the demise of venues owned by or dedicated to the LGBT+ community, and the pros and cons of protecting and maintaining these spaces of safety and connections: are they sanctuaries or ghettos? Should they have a special status?

Last night I attended an event about queer city planning at the Museum of London, curated by UCL Urban Lab. We learned that 116 LGBT+ venues have closed over the last decade or so in London, and today few remain. A positive interpretation could be that this reflects an increasingly inclusive society: perhaps LGBT+ people no longer experience the prejudice that underlies the need for dedicated venues. Or perhaps the rise of the internet and apps overlying physical space is helping like-minded people find each other and build communities in new ways.

And yet dedicated physical spaces still play important roles for minority communities. These spaces emphasise commonality. They facilitate connections, support, and freedom for people to express themselves without fear. This is especially important because such spaces may not exist in other parts of some LGBT+ people's lives. They provide an important setting to be with people who accept each other without requiring explanations, enabling them to connect, and build communities. People who have just come out of the closet (or are bracing themselves to take that step) are at increased risk of loneliness, depression, anxiety and suicide. The support and solidarity and acceptance they can find in LGBT+ venues can be an incredibly protective factor for mental health. Without such venues, people may rely on the internet and struggle to make meaningful social connections. Even meeting up in person can be complicated.  For instance, at the Museum of London event, cultural producer Chardine Taylor-Stone spoke of the overt and covert discrimination she has faced when trying to run events for LGBT+ people in venues that do not have LGBT+ management.

Another interesting argument for the importance of dedicated LGBT+-run establishments is that such venues provide much-valued 'official' visibility for LGBT+ people on the streets of their city - a gay bar on the corner of the high street provides physical proof that LGBT+ people are present and deserve to be present in a landscape. This is meaningful because heterosexual representations tend to dominate in most cityscapes.

The 'Gaybourhood'
This leads to the second major topic of discussion - the concept of 'gaybourhoods'. These are areas of town (often originating as deprived areas) where LGBT+ people gather, set up venues and over time, preferentially move in, creating neighbourhoods with populations comprising higher-than-average LGBT+ density. There are various discussions about the pros and cons of these 'gaybourhoods'. Such places can create a feeling of solidarity, and the sort of 'safety in numbers' that empowers LGBT+ people to enjoy activities that heterosexual people might take for granted, such as walking down the street holding your partner's hand, or encountering families that resemble their own. 'Gaybourhoods' enable convenient targeting of LGBT+-specific services, events and information. However, some criticisms of the gaybourhood include the self-marginalisation or 'othering' of LGBT+ people, and the association with gentrification which, over time, can lead to exclusion of these neighbourhoods' original communities - and of younger and less rich LGBT+ people.

What does this mean for urban planning and design?
At the Museum of London event, the poet Travis Alabanza spoke compellingly about their experience of belonging and being celebrated at LGBT+ club nights, and then five minutes later, in the same outfit, as exactly the same person, stepping out of the door to be reviled and abused (sometimes even by the very same people, who seemingly consider this self expression to be laudable in one place, but not acceptable in another). The importance of safe spaces where any of us feel we belong cannot be overstated. But in a diverse society,  spaces of safety cannot be restricted to a few venues dotted around an entire city. Since probably every neighbourhood in the world is home to LGBT+ people I am interested in the opportunity to move beyond specific 'queer' venues or 'gaybourhoods' (while recognising their historical and current importance) to think more about how to design and plan inclusive, thriving, diverse places for everyone. If we do not, we are simply providing fuel for distress, discrimination, marginalisation, and mental health problems.

What are the attributes of a 'gay-friendly' neighbourhood?
Between 2008 and 2011, I co-ran Gay Camberwell, a place-based initiative that increased LGBT+ inclusion and acceptance in an area of South-East London that was not previously known for these attributes. In addition to encouraging local businesses to run regular LGBT+-themed events (such as film nights, comedy shows, drag brunch, and literary events), my wife and I went to every local bar and restaurant, had drinks/food, and wrote a review on the Gay Camberwell webpage that included a rather tongue-in-cheek 'gay-friendliness' rating. To ascertain this rating, we would hold hands and gaze at each other romantically, and then look around to see if anyone was reacting or making us feel threatened. That was a bit of fun entirely lacking in valid science or even diversity of experience, but it underlies some basic principles that may be helpful for thinking about the concept of 'gay-friendly neighbourhoods' (which I shall use as shorthand for what can otherwise be termed LGBT+, LGBTQI+ or queer-friendly neighbourhoods).

I personally feel that I am in  a 'gay-friendly neighbourhood' when I can go about my day (1) feeling comfortable and safe, (2) not feeling compelled to modify my behaviour to avoid disclosure of my sexuality, and (3) not inciting reactions if I do disclose any evidence that I might be gay.

In particular:

• I feel able to safely walk along the street holding hands with my same-sex partner, or even have a peck on the cheek with no visible reactions from other people, and without fear of negative repercussions, such as people staring disapprovingly (or lasciviously), shouting rude or abusive comments, or threatening violence, or  treating me as though I am inappropriately enacting a  porn movie (all of which reactions I have regularly experienced).
• I feel welcome in bars, restaurants and other venues in the neighbourhood, incurring no visible reactions from staff or other customers regarding my sexuality (and if customers were to react negatively, staff would confidently take action to make clear this was unacceptable). Even better, I feel welcome because when they take action, it is because the people running these venues genuinely respect and value their LGBT+ clientele, rather than just acting with a 'politically correct' motivation.
  
• I see a queer presence, visibly represented: encountering other LGBT+ people/same-sex couples, gay-friendly venues, and appropriate representations in advertising, art, themed events, and in other ways throughout the neighbourhood (without incurring negative comments or repercussions).
  
• Venues display rainbow flag signage, a symbol which indicates the gay-friendliness of an establishment (though I have mixed feelings about this as it can suggest that places lacking this sign will not be gay-friendly, rather than assuming gay-friendliness is the default)
• I see recognition of historic sites or people important to the LGBT+ community
• I see space where LGBT+ people could safely hold festivals, pride parades, or other such gatherings.
• I recognise that any expressed homophobia will not be tolerated by the general public, and particularly have confidence in prompt staff and policing reactions to any homophobia
• I see LGBT+ representation on planning boards, and LGBT+ people are an explicit part of community outreach for developments in the area

Of course everyone is different, so these factors may vary for different people. They may also differ in different countries where heterosexual norms also differ. But in general, so-called gay-friendliness may start with a feeling that anybody can safely express who they are (for instance by personal clothing, haircut, etc choices, or affection expressed to their partner), whether or not that expression falls outside the so-called norm, without fear of any repercussions. Because cities are for everyone, and everyone deserves to be included.

Back in Brixton, Morleys promptly removed the graffiti. And whenever I walk past, these same-sex couples in the window still make me smile.


This is not a complete review of all of the challenges and opportunities in this interesting field, but is intended to provide food for thought. How can urban design and planning specifically contribute to making places feel inclusive for LGBT+ people?

Please reply in the comments to share your knowledge, suggestions and ideas.

Our Kind of Town seminar: Queerying London - March 22 2018

Approaching public health through the lens of environmental design is not a novel concept, with the two fields holding a long and intertwined history. In 1854, British physician John Snow investigated the spread of cholera in Soho, London, and observed the connection between facets of urban design – residential density, the location of water pumps and sewage systems – and the incidence of ill-health among the local population. Since that landmark study and throughout the enmeshed history of urban planning and public health, mental health has been included on the agenda of public health. However, mental health has typically been addressed primarily through the promotion of public parks as sites of social interaction and escape.

As understanding about the interactions between mental health and urban form deepens, this has begun to seep into government thinking. The ‘Designing Healthy Living’ report from Canada demonstrates this, illuminating the ways in which the built environment acts as a foundation for physical health and mental wellbeing. The report gathers together a wealth of research from the medical sciences and urban design disciplines.  Within it, the built environment is defined as all the infrastructure we experience, both seen and unseen, in daily life – our homes, streets, workplaces, parks, public spaces and transport systems. Healthy living is addressed in three parts – physical activity, food choices and mental wellbeing, yet crucially the report acknowledges the interconnection of these three. Moreover, recognition is given to the fact that there are other factors which influence physical and mental health – economic inequality, political contexts, social & cultural factors, which lie outside the purview of urban design to address.

The Canadian context
Today, approximately 80% of Canadians reside in urban or suburban areas. Like many North American cities, Canadian urban spaces throughout the 20th century mostly expanded through the process of urban sprawl. This development of cities outwards to create low density residential housing, and single use zoning has resulted in migration to the suburbs and daily flocking to city centres in private automobiles. A strong message against continued urban sprawl is felt throughout the report. The expanding spatial footprint of cities has been linked to increased dependence on private car ownership, sedentary lifestyles and rising levels of obesity. Sedentary lifestyles are of concern to Canadian officials due to the link with chronic diseases such as diabetes and cardiovascular disease. Dr Tam calls for long-term planning that promotes daily incidental physical activity to change sedentary habits. In addition, Canada is experiencing an ageing population, with the number of Canadians over the age of 85 years growing at four times the rate of the Canadian population (Statistics Canada 2017).  Mental health is also on the agenda for Canadian public officials, with an increase to 8% percentage of the population diagnosed with a mood disorder in 2014.  
 
Key messages on mental health from the Designing Healthy Living report
This report views public health as a confluence of three factors: enough physical activity, maintaining healthy diets and living in supportive, sociable environments. It is this last factor in which this report primarily addresses mental health. The report explicitly outlines the ways in which neighbourhoods can be designed with mental health in mind:

Social isolation and loneliness can result in stress, poor sleep, cognitive decline, impaired decision making and increased risk of depression among other effects (Cacioppo 2015). Neighbourhoods can be better designed to increase the likelihood of meeting other people and to provide places to gather. Designing green spaces, of whatever size, into our urban environments are discussed as a key tool for this. Green spaces offer opportunities for local people to walk for leisure and see others around, take part in outdoor sports, often in groups, and meet others through local conservation or gardening projects.
 
Community belonging is important for mental wellbeing, with Canadians who feel strong ties to their local community more likely to report excellent or very good physical and mental health (Shields 2008). Regarding encouraging a sense of belonging through design, aesthetic places and sites of social interaction are sought after.  Creating attractive urban spaces not only raises the aesthetic profile of an area, but has been shown to have a calming effect, reflect local culture and can build social connections. Community gardens, allotments, public art, and platforms for political engagement can encourage and enable people to become involved in their local communities and enhance ties to local areas (Cameron et al. 2013).

Urban spaces and transport systems offer up a lot of sensory stimuli with noise from cars and public transport, construction work, crowded pavements and metro systems, streetlights and noise from neighbours. For some, the excitement of the urban environment can be outweighed by the stress experienced managing sensory stimulation, inducing and heightening stress levels.  Chronic stress has an extensive array of health impacts, from heart disease to anxiety and depression (Broschot et al. 2006). Therefore, the report proposes that designing quieter places that manage unwanted stimuli is an important goal for urban designers to counter chronic stress. Commuting to and from work, school and social engagements is part of daily life for many Canadians, and another potential source for chronic stress. Over the long term, lengthy or stressful commutes are linked to poor health.  Therefore, improving commuter experience, through for example improving the efficiency of public transport systems and encouraging more people to use them or walk and cycle, can be another long-term plan to manage chronic stress for urban populations.
 
Feeling safe where you live, work and visit within a city is important aspect of mental health, as fear and direct experience of crime can negatively affect mental wellbeing and behaviour. Urban dwellers, particularly those who perceive themselves as at greater risk of crime, such as women and ethnic minority groups, have been found to actively change their behaviour within urban space as a result, such as avoiding certain places, or restricting movement to certain times of day. Crime Prevention through Environmental Design, a UN-supported program, is promoted in the report as a method to broach this issue. It promotes clear demarcation of private and public space, improved surveillance, good street lighting and reducing underused spaces. (Cozens and Love 2015).
 
Many of the design suggestions in the report are geared towards multiple mental wellbeing goals. The promotion of community gardens illustrates this well, offering quiet urban green space, places to socialise, and encouraging community belonging. Such an intervention also supports wider public health goals of increasing physical activity and access to healthy foods.

Designing for specific populations
Much of current research is based on adult populations, but the report takes steps to address how specific population groups experience the built environment, and how this in turn can be linked to mental health.
 
For children, playing outdoors and safety fears of parents are important issues for good public health. Living near green spaces can instill regular physical activity in children from a young age. Green spaces are also found to positively affect behavioural development in children: Canadian children who spend more time outdoors have been found to have better mental wellness and fewer friendship issues. Highlighted in the report is the need for challenging play for children’s mental development, where children are encouraged to assess their environment and make decisions, enabling them to develop their abilities in managing risk and judgment (Brussoni et al. 2012).
 
Given Canada’s aging population, issues around social isolation and loneliness are going to become increasingly important in decades to come. Those most at risk are identified as residents who are unmarried, have physical health problems, and are in lower-income groups. Designing for social environments and community belonging in younger years may be a way to buffer against older age social isolation. Ensuring neighbourhoods are walkable and well connected is another important design intervention, with safe, even pavements found to encourage walking and being more social into older age (Richard et al. 2013).
 
Conclusion- connection to Mind the GAPS
Overall, this is an encouraging report which places mental health firmly on the Canadian city design agenda. Connections can be made to the New Urban Agenda with the promotion of public green space, safe public spaces and community engagement. Although a Canada specific report, the design suggestions featured will strike a chord with many urban design and public health workers who find themselves working to stem the tide of urban sprawl and its effects. Many of the design features as are also seen in our Mind the GAPS Framework:

• Green places: ensure access to welcoming, attractive green spaces of all sizes.
• Active places: enable physical activity to become incidental and move away from sedentary lifestyles, ensure this remains into older age with walkable neighbourhoods.
• Pro social places: facilitate social interaction and engagement with others through public art and community gardens.
• Safe places: design spaces which are safe for residents of all age groups, where children are encouraged to play out doors.

 
Read the full report here.

Overstimulation combined with limited access to green space poses a threat to urban mental health. Urbanists throughout the decades have attempted to alleviate these challenges through the creation of parks, waterfront developments and other urban public spaces that belong to everyone and can create a sense of peace and respite in the city.  This is the case for Montreal, which experiences extreme weather conditions for half of the year, but in warmer months, the city’s inhabitants flock outdoors in search of sunlight and nature. Montreal has increased availability to these urban oases with an initiative to reinvent public spaces previously perceived as seedy and undesirable, or as insecure due to their use for parking.
 
“Ruelles Vertes”, which translates to “Green Alleys”, is an initiative that started as a residential movement in Montreal in the 1960’s and is now backed by the city government. Its objective is to add to city’s greenspaces whilst simultaneously revitalizing communities. In addition to residential efforts, the project was propelled by Eco-Quartier Montreal in the mid 90’s, a branch of city of Montreal which focuses on environmental education at a citizen level. The initiative’s participative nature is a good example of different ways in which cities can foster urban change that comes from the citizens. Residents of certain areas can apply for alleyways behind their homes to become a “Ruelle Vertes” and are provided with knowledge and resources to create urban gardens, add greenery, and bring art into their neighborhoods. It is very common for murals and decorations to be placed in the alleys. In the summer months, the beautified alleyways create an attractive space perfect for a relaxing stroll. The concealed alleyways act as green walkways that are removed from Montreal’s noisy streets and provide pedestrians with peaceful, attractive and safe walking routes. By implementing this strategy to create something new from a pre-existing element, the initiative is an example of urban revitalization at a citizen level, its finest form.

The initiative was started for a number of reasons that benefit urban communities in Montreal.  Alleyways have been perceived as undesirable and often unsafe spaces; by transforming them with nature and art, the initiative aims to help regenerate places that have been subject to urban blight. The plants and trees used by the Ruelle Vertes are native to the region and support local birds and insect species; the vegetation also helps address the heat island phenomenon, extremely common in many Montreal neighborhoods.

Beyond those benefits, this initiative has created unique and communal spaces in Montreal that support mental health and wellbeing. These green and quiet alleys expand accessible green space provision in the city; by doing so, they help create a sense of peace, safety and inspiration in places that previously had the opposite effect. They have stimulated positive changes in pedestrian security as public gardens and fostered urban safety and additional pedestrian life by slowing down vehicular traffic.

The Ruelle Vertes initiative has also stimulated public life in alleyways through the form of localized activities in the summer open to visitors and residents alike. These activities are mostly free of cost and have included films, gardening workshops, conferences, coffee-talk events, guided tours of alleys, games for children,  and concerts. Through a resurgence of public life one can observe a resurgence of public health.
 
 For more Ruelle Verte's guide to greening alleyways click here

A study by China's CDC shows that more than 100 million people in China have mental health problems and more than 16 million have severe mental illness. At the same time, China is experiencing fast urbanization and more than 100 Chinese cities now have more than 1 million residents. Can we promote people’s mental wellbeing through better design of our urban neighborhoods? In order to answer this question, our research team conducted a case study in Beijing, the capital city in China. The results of this study are published in Landscape and Urban Planning.

The survey
Our study focuses on 16 typical Beijing neighborhoods that were identified by senior urban planners from Beijing Municipal Government. Survey questionnaires were brought to the 16 neighborhoods at the end of 2015. Survey participants described their mental wellbeing and evaluated both the built and social environments of their neighborhoods. The survey results suggest that mental wellbeing varies widely in the studied neighborhoods (the neighborhood that reported the best mental wellbeing scored about 50% higher than the lowest).  Residents living in neighborhoods that are further away from the city center tended to have slightly better mental wellbeing.

So what explains such variation?

To answer this question, we measured and tested a series of factors that potentially influence people’s mental wellbeing:

1) Perceived neighborhood built environment, such as availability of green space, walkability, neighborhood safety, neighborhood accessibility to a variety of destinations, and easiness of driving and parking
2) Perceived neighborhood social cohesion which is measured based on whether and how people get along and help each other in a neighborhood
3) Observed neighborhood built environment such as land use density, mixed land use, and distance to the nearest park
4) a series of personal characteristics such as physical health, age, education, family structure, home and vehicle ownership, etc.

Neighbourhood social environment is most associated with mental wellbeing

It turns out that neighborhood social environment exerts a stronger influence on people’s mental wellbeing than neighborhood physical environment. People who reported better interpersonal relationships in their neighborhoods tended to have better mental wellbeing. Such a positive association, however, was weaker in newer neighborhoods that were built after 2000. We suspect that this is likely because social interactions and mutual assistance are declining when housing is being commercialized in newer neighborhoods. It could also be due to the fact that it takes time to form a close-knit neighborhood.

Living near a park was the main physical environment association with mental wellbeing

A few physical environment factors can also lead to better mental wellbeing. Consistent with previous findings, living close to a park helps to promote mental health. Land use density and mixed use, however, did not seem to have an impact on residents’ mental wellbeing, after taking into account of other variables. Satisfaction with neighborhood built environment had only a marginal positive effect on mental wellbeing. On the other hand, when asked if neighborhood built environment is important or very important, a majority of respondents said yes. This study found that neighborhood physical environment is important for residents, but has a minor role in determining their mental wellbeing. This finding is puzzling for us and may require more research.

The question of cars

Lastly, the study reveals a challenge that Beijing’s urban designers and planners have to face: with a quick increase of vehicle ownership, should neighborhoods be designed to be conducive for the use of private cars? Our study finds that residents who own cars tend to feel better when they live in neighborhoods that are conducive for driving and parking but vice versa for residents who don’t own cars. Designers and planners have to decide how to make a balance between walkability and easiness of driving in a neighborhood.

Note: Access to this journal paper requires payment

Dong, H., & B. Qin. 2017. Exploring the Link between Neighborhood Environment and Mental Wellbeing: A Case Study in Beijing, China. Landscape and Urban Planning, 164: 71-80. DOI: 10.1016/j.landurbplan.2017.04.005

The health and well-being of citizens is strongly associated with the living quality of the high-density urban environment, for example: crowdedness, compactness, pollution, and urban heat islands. Elderly people are particularly vulnerable as their mental health can be less resilient. We therefore need to know how our built environment affects the health and wellness of elderly people so that we can provide a better living environment for promoting active ageing in our society.

CUHK Jockey Club Institute of Ageing was established in 2014 and has been working towards making Hong Kong a global age-friendly city. We have been working on how the built environment affects mortality, geriatric depression, frailty and cognitive function. Based on a large-scale cohort study started in 2001, we obtained a wide variety of health outcomes for our research studies.

For urban designers, it is important to identify the features of our built environment that affect the health and well-being of elderly people so that we can design better living spaces for them to age healthily. We identified high risk areas for geriatric depression in Hong Kong based on the results of statistical modeling and spatial mapping.

The results of this research in brief

We found that areas experiencing rapid redevelopment have the highest association with risk of depression in older people because of the vastly changing physical and social landscape. The changing building form is associated with changes in the composition of community amenities and social environment.

Planning and design of future development will have to take into account such changes and prevent the deterioration of living quality of elderly people.

LEARN MORE

Read the full research study here: Spatial Variability of Geriatric Depression Risk in a High-Density City: A Data-Driven Socio-Environmental Vulnerability Mapping Approach

Read a South China Post article about designing an age-friendly Hong Kong.