​By: Hadiya J. Khuwaja

In the global conversation about urban parks and mental health, one dimension often remains understated: how women perceive and navigate safety in public parks.

While parks are celebrated for their restorative benefits - offering peace, stress relief, and a vital connection to nature - for many women, especially in culturally complex contexts like Islamabad, Pakistan, parks are not unconditionally accessible havens. They are contingent spaces, where the promise of well-being is unbalanced by persistent concerns about safety, visibility, and belonging.
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Islamabad, the capital city of Pakistan, is nestled at the foothills of the Margalla Hills and offers a unique urban backdrop. It is the country’s only purpose-built city, designed by Greek architect Constantinos Doxiadis, who envisioned it as a series of zones with quadrilateral residential sectors carefully integrated with public parks and green spaces. At its heart lies Fatima Jinnah Park – commonly known as F-9 Park – a sector-wide green space envisioned as Islamabad’s central hub for public recreation and leisure.​

Compared to other cities in Pakistan, Islamabad enjoys a relatively abundant provision of parks and natural areas. Yet, as is common across much of South Asia, public spaces remain predominantly male-dominated. The city’s formal planning, while orderly and green, cannot fully insulate women from the social and environmental dynamics that continue to shape their experiences of urban parks.

Drawing on my recent research – a mixed-methods study examining park access and mental well-being in Islamabad (part of my graduate thesis research at NUST Islamabad) – a layered reality emerges: women’s engagement with parks is deeply intertwined with spatial justice, emotional security, and the right to public space.
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The study, conducted with 354 participants across Islamabad’s major urban development zones, revealed notable gender imbalances. Only 26% (n=91) of respondents were female, while 74% (n=263) were male (Graph 1).

​Among all respondents, approx. 10% (n=34) cited safety and security concerns as barriers to park visitation. Strikingly, 70% (n=24) of those who raised safety concerns were women, compared to just 30% (n=10) men, highlighting how safety is not just a design issue, but a lived gendered experience that restricts equitable access to parks (Graph 2).

​This sharp disparity underscores not only women’s heightened vulnerability within public spaces but also their limited engagement with them. The low proportion of female participants may itself reflect broader structural barriers – social norms, safety fears, and mobility restrictions – that systematically discourage women’s active presence in urban parks.

Parks as Potential Sanctuaries – If Safe
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This tension between the potential and the reality of parks came into sharp focus in early 2023, when a woman was assaulted by two armed men in Islamabad’s Fatima Jinnah or F-9 Park - one of the largest and, ostensibly, safest public parks in the city. Despite interventions such as linking over 200 park cameras to the Safe City Authority and increasing police patrols, another deeply unsettling event occurred in early 2025. Late in the evening, a mother and daughter were assaulted and mugged in the same park. The suspects attacked the women, robbed them, and warned they “shouldn’t be in the park at this hour” - a chilling reminder of the gendered boundaries imposed in Pakistan’s male-dominated public spaces.

In my study, respondents consistently emphasized that parks hold significant potential to enhance mental health – offering relaxation, optimism, and emotional restoration. Yet, this potential was not unconditional. Safety concerns were not peripheral; they were central.

Key concerns included:

• Fear during evening hours due to inadequate lighting
• Anxiety over harassment and mobile phone snatching, especially in dark, unpatrolled areas
• Family-imposed restrictions, particularly for young women, reflecting broader societal anxieties about public visibility

​For many women, parks were not simply spaces of leisure, but carefully navigated environments – where each visit was weighed against perceived risks. These patterns point to a deeper structural issue: the design and governance of our cities often fail to prioritize gendered experiences.

Spatial Justice and Gendered Access

This raises a critical question:

If parks theoretically exist for all, but practically exclude women, can we truly call them equitable urban spaces?

In Islamabad, safety issues are less about isolated incidents and more about chronic structural neglect – embedded in physical design, maintenance, and governance. These gaps manifest in several ways:
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• Inadequate street lighting and secure pathways

Many parks lack proper lighting, especially along jogging tracks, entrances, and inner paths – a basic feature that significantly affects women’s comfort and safety after sunset.

​​Even larger parks like F-9 Park, often seen as vibrant in daylight, experience a dramatic shift after dusk: 

​During the day, families and individuals use its open paths and shaded walks, showcasing its potential as an inclusive public space. 

But after sunset, dim (or no) lighting and dense tree cover create poorly visible zones, making the park feel fragmented and unsafe, particularly for women and solo visitors. 

​The central pavilion called Baradari glows in the distance as surrounding areas remain dimly lit, highlighting uneven illumination and the contrast between formal landmarks and underused open spaces at night.
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• Minimal or absent security personnel, signs of neglect and informal exclusion

In many neighborhood (or sector-level) parks, the lack of visible security presence – guards, community monitors, or police – amplifies the risk of isolation and assault. Structural neglect also manifests in subtle forms of exclusion – such as lack of basic amenities like greenery and shaded sitting spaces.

Mental Health: The Uneven Promise

When women felt safe, parks provided a multitude of mental health benefits: calmness, rejuvenation, clarity of thought, and a rare reprieve from daily pressures.
When they felt unsafe, the very same spaces became sources of anxiety, exclusion, and compounded stress.
This paradox - parks as both healing spaces and sites of tension - is not unique to Islamabad. From London’s night-time public realm debates to Mexico City's pink public transport initiatives, gendered safety concerns shape how women globally engage with urban environments.
Islamabad’s experience mirrors a broader global urban challenge: When parks are designed without a gendered understanding of safety, they risk reinforcing inequality, even as they aspire to promote public health and well-being.
 
Toward Solutions: Designing for Women's Safety and Inclusion

Several design and policy interventions are urgently needed to reclaim parks as inclusive, healing spaces:

• Enhance lighting along pathways, entrances, and communal areas to extend safe access into evening hours.
• Ensure clear sightlines through strategic landscaping - beauty must not compromise visibility.
• Embed community surveillance, combining security personnel, CCTV, and participatory neighborhood watch initiatives.
• Create women-centered spaces within parks, such as fitness zones, family-friendly gathering areas, and culturally sensitive programming that encourages women's presence without isolation.
• Engage women directly in the design, planning, and ongoing governance of parks, ensuring they are active co-creators, not passive users.
  
  

In Islamabad - and across the Global South - reclaiming public parks as inclusive, restorative spaces for women is not a luxury. It is a long-overdue right. Parks must be places where all citizens, regardless of gender, can feel safe, seen, and free. Public parks are not just places of leisure - they are essential to mental well-being, social inclusion, and equitable urban life. Yet for many women, the simple act of walking, jogging, or sitting alone in a park remains fraught with risk and social scrutiny. Safety, dignity, and freedom of movement in public spaces must be non-negotiable. Making parks genuinely accessible to women means rethinking not just security infrastructure, but also challenging the deep-rooted norms that dictate when, where, and how women should exist in public. It is about transforming parks from contested terrains into spaces of healing, visibility, and belonging.

Final Reflection

In her book Death and Life of Great American Cities, Jane Jacobs - ahead of her time - emphasized that urban safety relies not on isolated security measures but on "eyes upon the street" - organic, community-driven oversight.

Drawing from examples of several city parks, Jacobs stressed that parks must be busy, lively spaces to feel safe and inviting. Empty or poorly used parks, no matter how beautifully designed, often become areas of danger and neglect. Successful parks, Jacobs explained, share key traits: they offer a diversity of uses, are bordered by active streets and buildings, and attract a mix of users throughout the day. In contrast, parks that are isolated, monotonous, or serve a narrow demographic tend to fail, lacking the continuous, casual surveillance provided by a vibrant community.

Islamabad’s parks often lack this vibrancy, leaving safety fragile and access unequal, particularly for women. Poor lighting, disconnected layouts, and minimal passive surveillance contribute to parks becoming isolated, especially during critical evening hours. In a city where women’s presence in public spaces is already constrained by cultural and social barriers, the absence of "eyes on the park" heightens their sense of vulnerability.

To truly realize parks as safe and inclusive spaces, urban planners must move beyond installing security cameras and posting guards. Instead, they must design environments that naturally encourage diverse, everyday use - families picnicking, elderly people strolling, teenagers playing sports. It is this constant, pluralistic presence that weaves an invisible yet powerful net of safety, embodying the vision Jacobs laid out for truly vibrant and secure public spaces.
 
Public parks are powerful equalizers - but only when they are truly public.

When women must navigate these spaces with fear or restraint, the health and social benefits that parks promise become unevenly distributed, undermining their fundamental purpose.

As we reimagine healthier, more inclusive cities, the everyday safety and dignity of women must shift from being a peripheral concern to a central design priority.
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Because the right to safety, serenity, and joy in public space should not depend on one’s gender - it should be guaranteed.

Have you noticed the sudden explosion of e-bikes on our streets?  With speeds reaching 28 mph and rising crash rates, our current bike lanes may no longer be up to the task.
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As a Fellow at the Centre for Urban Design and Mental Health, I'm pleased to announce that my multidisciplinary team has received National Science Foundation funding for our project: "Bicycle infrastructure for all: Understanding users' comfort and safety perceptions to prepare for an e-bike future"

E-bikes are transforming urban mobility patterns, offering citizens increased range and accessibility while reducing car dependency. However, their greater speed, weight, and size create unique safety concerns that can directly impact both perceived and actual wellbeing in urban environments.
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Urban stress, safety anxiety, and transportation inequity all represent significant mental health challenges in modern cities. Our research addresses these concerns directly by investigating how different bicycle facilities affect both traditional cyclists and e-cyclists' perceptions of comfort and safety—key components of urban mental wellbeing.

​Our study employs an innovative socioecological methodology that recognizes the complex interplay between physical infrastructure, social dynamics, and psychological response. We will specifically investigate how different bicycle facilities affect both traditional cyclists and e-cyclists' perceptions of comfort and safety. Using a novel socioecological approach, we'll analyze surveys, interviews, trip trajectories, and street imagery, incorporating generative AI to advance our methods.

We're partnering with transportation agencies, bikeshare operators, and cycling advocates throughout the project to ensure practical applications. Our findings will help planners make evidence-based infrastructure investments that enhance safety and promote transportation equity.
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The e-bike revolution represents a pivotal opportunity to redesign urban spaces with mental wellbeing at the forefront. By understanding how infrastructure affects users' comfort perceptions and behavior, we can help planners make evidence-based investments that enhance both physical safety and psychological security—creating cities that truly nurture mental health through thoughtful design.

​Please find out more here. 

Speaking of Psychology: Designing cities to improve mental health, with Jenny Roe, PhD
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On the Speaking of Psychology podcast by the American Psychological Association, environmental psychologist Dr. Jenny Roe shares how urban design can play a powerful role in shaping mental well-being, and why cities must be built with psychological health in mind.

Dr. Roe is a Fellow at the Centre for Urban Design and Mental Health and co-author of Restorative Cities, written alongside Centre founder Dr. Layla McKay. Her insights are rooted in evidence and advocacy, calling for a new kind of city: one designed to heal.

Here are a few takeaways worth reflecting on:

Nature isn’t a luxury, it’s a lifeline
Access to greenery, no matter how small, helps reduce stress, restore focus, and improve mental health outcomes. From city parks to street trees and rooftop gardens, the evidence is clear: nature heals.

The built environment can connect or isolate us
Thoughtfully designed public spaces, walk-able neighborhoods, and inclusive design help build trust, connection, and belonging, which are all key for resilient communities.

Equity in design is essential
The benefits of restorative urban design shouldn’t be reserved for the privileged. Dr. Roe advocates for inclusive planning that reaches all communities, especially those historically and systemically under-served.

Big changes aren’t always required
Even temporary or small-scale interventions, like pop-up parks or traffic-free zones, can make a measurable impact on mental health.

Cities like Paris and New York are showing what’s possible
From green corridors to car-free initiatives, cities around the world are beginning to prioritize mental well-being in their planning.
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Dr. Roe’s message is simple but urgent: mental health should be a central goal of urban planning and design isn't just about aesthetics, it's about health, dignity, and human connection.​

APA Podcast Post:

• Speaking of Psychology: Designing cities to improve mental health, with Jenny Roe, PhD

About Jenny:

• Jenny Roe, PhD

Restorative Cities Book:

• Restorative Cities: Urban Design for Mental Health and Wellbeing (Bloomsbury, August 2021)

UD/MH is proud to be an Event Partner with Healthy City Design (HCD2025) again this year.  

Now in its 9th year and set to be hosted at the iconic arts venue, the Lowry, MediaCity in Salford, Greater Manchester on 14–15 October 2025, the Congress is at the forefront of new knowledge and innovation.
As we build the cities of tomorrow, connecting investment to health as a foundation for economic and social development is critical for the future prosperity of communities where opportunities are available for all to thrive.

The Healthy City Design International Congress, Awards & Exhibition is a global forum for the exchange of knowledge on the research, policy, practice and investment in designing healthy and sustainable cities and communities.

The Congress attracts researchers, practitioners, community voices, investors and policy makers from around the world committed to advancing health and health equity and sustainable development at the centre of the way we plan, develop and invest in our cities and communities.

The Call for Papers have been launched, with the deadline on 28 May.

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

Design, nature and sleep

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

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

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

Nature restores mental wellbeing

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

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

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

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

Designing for better sleep

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

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

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

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

The value of aggression

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

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

Does Catharsis Work?

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

More research is needed 

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

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

Kevin Bennett is an Assistant Teaching Professor of Psychology and Director of the Personality and Human Performance Lab (PHPL) at The Pennsylvania State University, Beaver Campus, USA.  His research focuses on how people engage with social and physical environments. 
Twitter: @ModernMindsPsy

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

KEY FINDINGS

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

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

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

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

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

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

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

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

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

A call to arms for communities

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

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

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

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

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

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

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

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

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

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

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

Jacob King is a UD/MH Associate and junior doctor practising in UK. His main interest concerns the association between green space exposure and mental health, and how we can design interventions to promote this relationship.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

References

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

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.
Want to share what's being discussed in your city? Email us.

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.

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.

October 10th is International Mental Health Day and this year's theme is mental health in the workplace. Unemployment is a major risk factor for mental health problems, and being employed usually protects our mental health. But since we spend a large portion of our days working, our work environment can have a wide range of effects on our wellbeing. This can affect how we feel, our relationships with friends and family, and importantly, our mental health. A challenging workplace can contribute to and exacerbate problems like stress, anxiety, depression, and drug and alcohol use, while a supportive environment can help staff thrive.

The World Health Organization says: "A negative working environment may lead to physical and mental health problems, harmful use of substances or alcohol, absenteeism and lost productivity. Workplaces that promote mental health and support people with mental disorders are more likely to reduce absenteeism, increase productivity and benefit from associated economic gains. "

Workplace design for better mental health

Many of mental health challenges at work stem from relations with colleagues, degree of support, and working hours - but design also plays a role. In developing a workplace that supports mental health, let's look at some of the opportunities for workplace design. Then at the end, watch architect, Shigeki Irie, discussing how he implemented these ideas in his design of the new Coca-Cola Japan HQ LEED Platinum building in Tokyo.

Nature: Natural settings are good for our mood and stress; they can also increase stamina and concentration, which may affect productivity. Nature can be integrated into the workplace in various ways, including views, plants and water features within the office, and nature analogues such as materials and patterns (e.g. use of wood) and other decor (e.g. artwork) that evoke nature.

Physical activity: Workplaces should be set up in ways that encourage regular physical activity in the course of people's ordinary workday, such as designing buildings that favor the use of stairways, and providing other exercise opportunities.

Social interaction: Workplaces should encourage appropriate social interaction, both formally and informally. This may involve routing decisions around the workplace, design of rest areas and meal areas, and also connect to community linkage. Being in an office building all day can create feelings of disconnection and isolation: how can designers counteract this and maintain a sense of place and connection to the local community?

Circadian lighting: Many workplaces are indoors and a lack of natural light can affect people's sleep. Since sleep is an important protective factor for mental health, and poor sleep can exacerbate mental disorders. Leigh Stringer, author of The Healthy Workplace, says: "Circadian lighting in workplaces takes into account natural and artificial light, a certain intensity of light at the desktop height level, and the presence of high light levels for a certain amount of time during the day.  Even if your workspace is lit at 500 lux, which is more than enough light for reading and most work tasks, it will not necessarily reset sleep schedule."

Choice and control: Feeling in control of your workplace environment reduces your risk of workplace stress. This includes being able to set up or select different styles of work spaces depending on individual preferences, for example providing multiple settings, or flexible use of individual work stations. It also includes being able to control noise - sometimes background noise can help people concentrate; other times it provides a stressful distraction.

CASE STUDY: Coca-Cola HQ, Tokyo

At our UD/MH Tokyo dialogue, Shigeki Irie, the architect in charge of the LEED Platinum Coca-Cola Japan HQ design, explained how he integratated principles of good mental health into the design of the building. To deliver nature exposure, physical activity, social interaction, circadian lighting, and community connection, he used a 'handshake design' to deliver a staircase running up the side of the building whose glass walls provide views of greenery and local streets. This staircase constitutes a venue in itself, with 'communication steps' to hold meetings,  to relax and to have lunch. Also for lunch, he brought the office's cafeteria, previously underground, to an area overlooking a park, so that the room is now bright and surrounded by nature. He further enhanced connection and communication through opening up the office to enable people to see each other, and by enacting the Japanese concept of engawa, creating a welcoming area where the outside and inside interact (a concept rather like the American porch). And increased physical activity opportunities by creating bike parking and showers - unusual for a Tokyo office building.

Designing for good mental health is the responsible choice - and it makes good business sense. Read more about mental health in the workplace.

Today, October 1st, is International Day of Older Persons. This year the theme is enabling and expanding the contributions of older people in their families, communities and societies at large. The World Health Organization recognizes that a key component of achieving this is through the creation of age-friendly environments:

Urban design for ageing populations?

From the perspective of architects, planners and other city designers, age-friendly environments contribute to good mental wellbeing by enabling older people to access nature, meet friends, get exercise, conduct useful tasks, and participate and contribute to their communities. By enabling these actions, good design can enable participation in the community for people of different abilities, improving quality of life, and reducing the risk of mental health problems like loneliness and depression, including for people with dementia.

Mind the GAPS

Urban designers and planners can particularly contribute by designing high quality spaces by 'Minding the GAPS':

• Green spaces: Provide access to well-maintained natural surroundings that older people can enjoy; these should include seating, public toilet facilities, and protection from the weather.
• Active spaces: Enable physical activity, particularly walking, through: barrier-free design, appropriate seating, toilet facilities, crossings that permit enough time for  all pedestrians to cross the road, and pavements that are wide and even with low curbs and wheelchair access points, and that are free of hazards.
• Pro-social spaces: Encourage positive, natural social interactions, including in multi-purpose inter-generational spaces, and in settings that facilitate affordable activities.
• Safe spaces: Are safe in terms of crime, traffic, falls, and wayfinding. A symptom of dementia is disorientation, so environments should be easy to navigate, e.g. make use of clear landmarks, clear signs at eye level at key decision points.
• Services: A range of services (shops, healthcare, library, banks, cafes, post offices, social options, etc) should be clustered near where older people live, and be easily accessible to enable people to conduct their activities of daily living. Transport should also be accessible.

Read more: Download the World Health Organization Global Age-Friendly Cities Guide (2007) and check out Wisconsin's example of a Dementia-Friendly Communities toolkit.

Join: Is your city an age-friendly city? Join the World Health Organization's network.