I love people-watching. Most urban designers do. The more people in a public space, the better. The more diverse, active, extroverted, connected, playful, and affectionate people are with each other, the more there is to see and do. In this sense, the more insane a crowd is, the more livable and healthy is a city. My research on people-centered urban design does not aim to eliminate insanity from everyday life in cities. I rather seek to better understand which factors of the urban environment are stressful to pedestrians and particularly vulnerable people and how urban design can better support them in using public space.

Current city living has been related to various manifestations of stress and a higher risk for mental health problems (Lederbogen, et al., 2011). Lederbogen et al. (2013) have named a set of influencing factors for urban social stress including infrastructure, socio-economic factors, noise and environmental pollution. These remain open questions:

• Which factors of the built environment are critical in influencing subjectively perceived urban stress (PUS)
• How do these factors interact? 
• How can these factors be addressed by planning and urban design to maximize pedestrian comfort?

 
This blog entry reports on a few findings in two recent publications, in which my colleagues and I from TU Darmstadt have introduced a framework of environmental factors and spatial analysis tools shown to be useful to describe and even predict PUS in open public spaces (OPS). In a first step, environmental properties have been constructed for a sample of OPS in the city of Darmstadt, Germany, using the space syntax framework (Hillier & Hanson, 1984). These were paired to users’ ratings of spatial qualities such as loudness and subjectively perceived safety and stress (figure 2). Isovist vertice density has been shown to be weakly associated to users’ ratings of safety (r=.365, p=.09, Pearson), while global and citywide integration of a street segment have been shown closely related to PUS (r=0.432, p=0.04, Pearson) (Knöll, Neuheuser, Li, & Rudolph-Cleff, 2015). City-wide integration of streets has been closely related to actual amount of car traffic. Our findings may underline the importance of traffic calming, speed limits and walkability for measures to reduce pedestrians’ perceived stress levels.

In a recent journal article, the data has been analyzed using different types of multivariate models with the aim to predict ratings of PUS with a highly explained variance and significance (Knöll, Neuheuser, Cleff, & Rudolph-Cleff, 2017). Open space typologies (park, square, courtyard, streets) were found to be the best predictors for PUS, followed by building coverage ratio, isovist vertices numbers and syntactical characteristics (Figure 3). The isovist characteristics in particular, revealed interesting new insights and research questions. For example, visibility, as the relative size of the area that can be overseen from a given point in a space, was found positively related to users ratings of perceived stress. This was contrary to findings previously reported in indoor spaces. And it is somewhat surprising, since visibility of pedestrians by car drivers is key to reduce traffic injuries and improve overall actual pedestrian safety. In other words, people seem to feel most stressed in those areas of busy squares and streets where, in theory, they should be safest from car traffic. We conclude that to further study the isovist characteristics and their relation to percieved stress should be a priority in future research. Visibility and the geometric shape (“complexity”) of urban environments are factors that can be influenced by urban design measures such as street furniture, trees and facades (Knöll, Neuheuser, Cleff, & Rudolph-Cleff, 2017).

A model has been presented that uses a combination of environmental properties and achieves a predictive power of R2=54.6% (Knöll, Neuheuser, Cleff, & Rudolph-Cleff, 2017). These results are a first attempt to predict more complex emotions such as perceived urban stress by analyzing factors of the built environment and using standard planning tools such as GIS and Space Syntax. They extend existing models that have predicted tranquility in green spaces (Watts, Pheasant, & Horoshenko, 2014) or activities and spatial experience in streetscapes (Bielik, Schneider, Kuliga, Valasek, & Donath, 2015). The framework may be useful to architects and neuroscientists alike, who seek to identify or visualize urban configurations likely to be perceived as stressful and seek to further investigate pedestrian comfort by pairing environmental factors with geo referenced, psychophysiological effects.

References

Bielik, M., Schneider, S., Kuliga, S., Valasek, M., & Donath, D. (2015). Investigating the effect of urban form on the environmental appraisal of streetscapes. In K. Karimi, L. Vaughan, K. Sailer, G. Palaiologou, & T. Bolton (Ed.), Proceedings of the 10th International Space Syntax Symposium (pp. 119:1-13). London: Space Syntax Laboratory, The Bartlett School of Architecture, University College London.

Franz, G., & Wiener, J. M. (2008, April 3). From space syntax to space semantics: a behaviourally and perceptually oriented methodology for the efficient description of the geometry and the topology of environments. Environment and Planning B: Planning and Design , XXXV, pp. 574-92.

Halblaub Miranda, M., Hardy, S., & Knöll, M. (2015). MoMe: a context-sensitive mobile application to research spatial perception and behaviour. In Department of Geosciences and Natural Resource Management (ed.), Human mobility, cognition and GISc. Conference proceedings. November 2015, (p. 29-30). Copenhagen.

Hillier, B., & Hanson, J. (1984). The Social Logic of Space. Cambridge: University Press.

Knöll, M., Neuheuser, K., Cleff, T., & Rudolph-Cleff, A. (2017). A tool to predict perceived urban stress in open public spaces. Environment and Planning B: Urban Analytics and City Science.

Knöll, Martin, Environmental factors and tools to analyze perceived stress in open spaces. ANFA 2016: CONNECTIONS – BRIDGESYNAPSES. 23rd-24th September 2016, La Jolla, CA: Academy of Neuroscience for Architecture. Video

Knöll, M., Neuheuser, K., Li, Y., & Rudolph-Cleff, A. (2015). Using space syntax to analyze stress perception in open public space. In K. Karimi, L.  Vaughan, K. Sailer, G. Palaiologou, & T. Bolton (Ed.), Proceedings of the 10th International Space Syntax Symposium (pp. 123:1-15). London: Space Syntax Laboratory, The Bartlett School of Architecture, University College London.

Lederbogen, F., Haddad, L., & Meyer-Lindenberg, A. (2013, December). Urban social stress - Risk factor for mental disorders. The case of schizophrenia. Environmental Pollution .

Lederbogen, F., Kirsch, P., Haddad, L., Streit, F., Tost, H., Schuch, P., et al. (2011, June 23). City living and urban upbringing affect neural social stress processing in humans. Nature , 474, pp. 498-501.

Watts, G., Pheasant, R., & Horoshenko, K. (2014). Predicting perceived tranquillity in urban parks and open spaces. Environment and Planning B: Planning and Design , 38 (4), pp. 585-94.
 
Acknowledgments

I am grateful to my co-authors Dr. Annette Rudolph-Cleff, Professor of Design and Urban Development, Yang Li, PhD Candidate, both Department of Architecture, Katrin Neuheuser, PhD Candidate, Dept. of Human Sciences, TU Darmstadt, and Dr. Thomas Cleff, Professor of Quantitative Methods for Business and Economics at Pforzheim University, Germany.

by Giulia Melis
SiTI, Politecnico di Torino, Italy
 
Since ancient times, we have known that the place where we live can impact our health. Cities have always been shaped and restructured according to the needs and priorities of the time.  The Roman Empire, for instance, created a model for the planned city: with its rigid morphologic and geometric rules, the typical Roman settlement provided basic facilities and infrastructure for its inhabitants, ranging from thermal baths, to aqueducts and sewers. During the Industrial Revolution, cities had to face a new challenge: overcrowding, industrial dumps, and bad hygiene conditions were helping the spread of infectious diseases, and working class suburbs were growing too fast, without any concern about the quality of life in those areas.

That’s how laws about urban décor, cleanliness and sanitation started to be discussed: the Public Health Act (UK, 1948) is one of the first examples. This Act linked the urban design of a city with the spreading of epidemic diseases, and tried to prevent it by moving industrial production out of the city core. This model lasted until recent decades, when deindustrialization and various crises meant the need for new paradigms.
Nowadays, modern cities are starting to wonder not only how to create a healthy environment to protect the spread of epidemics, diseases, violence etc., but also how to enhance the quality of life of their citizens and their wellbeing. The waves of New Urbanism are questioning our lifestyles, and starting to re-consider the social component of city life as fundamental for granting us happiness and fulfilment.

That’s why, as a group of researchers coming from the architectural and medical domain, we became interested in mental health in our cities. As urban planners, we were interested in understanding which urban features most significantly affect our daily life, in order to identify the most urgent and promising intervention opportunities towards less-stressful urban living. And as public health experts, we wanted to know if the effects are equally distributed among the population, or whether some groups are experiencing a higher burden?

The Research

We chose an Italian city, Torino, where a huge dataset on population health is available, and looked to see if the numbers confirmed our initial theory. While a lot of researchers have already presented evidence of the importance of urban trees and parks, which can have a profoundly beneficial impact on psychological wellbeing and general mental health, not many studies have analysed the urban built environment in its complex functioning. We therefore gathered data both on the structure of the city (how dense it is, where are the parks for recreational activities, which is the mix of functions in one area) and its services (is the nearest library placed within an accessible distance? is the area well-served by public transport? Are there public sport facilities? Cinemas, theatres? etc) and we looked for connections between this data and the consumption of antidepressant drugs in the city.

The Results

Our research suggests that good accessibility to public transport, as well as a dense urban structure (versus sprawl), could contribute to a reduced risk of depression, especially for women and elderly, by increasing opportunities to move around and enjoy an active social life.

Women (of all ages) and older people (age 50 to 64) were found to be prescribed fewer antidepressant drugs when they lived in places reached more quickly by bus or train, and in places with taller average building heights, compared with counterparts in more remote or sparse areas. That connection held up even when social factors were taken into account. This means that if everybody had the same level of education, same citizenship, and were all in employment, all living in a neighbourhood that had equivalent levels of crimes and social and physical disorder, there would still be differences in antidepressant consumption according to how well the area is served by public transport and to the density and liveliness of the neighbourhood.

Challenges and decisions with the method

Antidepressant consumption is quite a strong indicator in mental health. Taking antidepressants implies that you have recognised you have a problem, actively sought help from a doctor, received a diagnosis and a prescription for antidepressant medication, and started treatment. This is a long way from starting to feel that you may be stressed or depressed. We used this indicator in our research as we were looking for solid evidence, but by doing so, it is likely that our results underestimate the phenomenon of stress and depression in the city, thus setting the stage for further and more accurate investigations and reflections.
Of course the range of density that we were able to test was limited to that of a typical European city; this range does not include the extremes of US cities sprawl and high density (which are both known to have negative effects on health).

Also, this type of large-scale data analysis can’t pinpoint causal mechanisms. But it’s not hard to speculate why transit and density might reduce stress: the former relieves the need to drive everywhere (and to own a car); the latter enhances the potential for social connectivity. For older populations, in particular, both aspects help guard against feelings of isolation or loneliness. They also stand in contrast to remote suburban living that “can have a serious impact on mental health, particularly when it results in forgone trips”.

The Conclusion
There’s still a lot to understand about the key stressors of city life, but sound advice to urban planners could already be launched: in order to address health inequalities, urban policies should invest in the delivery of services that enhance resilience factors, above all a good public transport network, in a careful and equal manner, throughout the city.

by Tracy A Marciano

Urban Planning as a means to organize people, places, concepts and practices has an interesting history. As civilization progressed, urban planning followed a parallel trajectory,  reacting to practices that outlived their usefulness. With each era, large scale redesign was at the forefront of change with small pockets of improvement on the periphery.

Contemporary discourse about urban health is primarily focused on green spaces and walkability. While both are important in the urban fabric, they are not absolute measures of ideal public health and their results are hard to quantify against the variations in symptoms and treatments for mental disorders. Introducing concepts from other fields and recalibrating them into plausible urban design initiatives is a potentially interesting approach to improve mental health in cities. In particular, as urban areas gain momentum, exploring concepts from eastern medicine such as acupuncture, aromatherapy (or horticulture therapy), directional alignment with the sun and the moon, nocturnal gardens, botanical soundscapes and energy balancing might be applied to exert a positive impact on mental health in modern cities.

As populations migrate towards urban centers at an accelerated rate, advancing improved health strategies - rather than utopia - is often being achieved through incremental improvements.

A recent movement is New Urbanism, or tactile urbanism, which seeks to align with sustainability, preservation of existing buildings and walkability.  However, as with past attempts at planning perfect cities, such as The Garden City movement, individual experience, public mental health and most importantly, the causation and impact of mental health problems have been largely excluded from the dialog.

Jamie Lerner, who served three terms as the mayor of Curitiba, Brazil uses urban acupuncture as the philosophy behind his successful initiatives.  Urban acupuncture is the mature cousin to tactical urbanism, which has suffered a bit of backlash lately as a trendy, high-concept practice of questionable long-term impact. Lerner writes in his book “Industrious mediocrity is gaining ground, along with merchants of complexity: the bean-counters and the inconclusive, never-ending researchers. But sometimes, just one stroke of creativity is acupuncture powerful enough to make progress.”

In 2007 University of Minnesota published a paper about their collaboration with Blue Cross and Blue Shield of Minnesota. This paper highlighted key findings about how to increase accessibility to nature to address mental health problems. Their research also found that social networks are important and that mental health is connected to fundamental public health issues but did not offer developed solutions with measurable results.

In most cities, areas that create tension and erratic energy and areas that can exacerbate anxiety, depression and isolation are evident. If cities are viewed as a biological system and receptive to holistic wellness plans, the philosophy of urban acupuncture may be an ideal platform to improve heath. For example, if obstructed walkways and clogged streets create tension and anxiety, a small area, such as an acupressure point along a vertical meridian line, could be addressed rather than attempting a complete urban redesign.  

Green space is prevalent in urban planning. However, an actual plan for the green space is often missing. Green space can mean a small strip of grass, or a few trees added as an afterthought. Applying other eastern principles, such as aromatherapy would be a progressive addition to the design phase. For example, if there is a lack of people using a public space where there is ample seating, adding a vertical garden with aromatic herbs may draw people to the area. Aromatherapy, or a fragrance garden, on a large scale could enhance individual experiences while reducing stress and anxiety. It also gives purpose to a vertical garden aside from aesthetics.

Incorporating vespertine gardens (night blooming) would help understand that urban areas have enormous potential after sunset; and would also align with solar and lunar lighting during the design phase. Nocturnal plants are more fragrant and assist visually impaired individuals when combined with other sensory plantings. Using balance between day/night, light/dark can create enough stability to reduce tension and anxiety.

Urban acupuncture is an intriguing starting point to reconsider conventional urban planning and design. It highlights that we are at a critical moment in time when all stakeholders can think about long term plans and how those plans will have a positive impact on mental and public health in urban centers.

Last winter I had an experience that changed the way I saw urban design.
 
It was mid-February. It was one of those days that was so cold that the city seemed to be blanketed in a mist of ice. Certainly not a day one wanted to spend outside for too long. I was on my bike, waiting to cross an intersection in downtown Edmonton. That winter was the first that I had decided to participate in winter cycling. I bought an old beater mountain bike and outfit it with some studded tires. It was the best decision I had made in a long time. Winter cycling is a lot of fun.
 
So, there I was waiting at the light, which seemed to be red for an eternity. To my right, there was a pedestrian waiting for the light to change as well. He wasn’t wearing a winter jacket, or gloves for that matter. He appeared to have mobility issues. He was pushing a shopping cart which I later realized was doubling as a makeshift walker. We looked at each other and had a moment of shared frustration as we were patiently waiting for the crosswalk man to appear. The delayed crossing allowed us time to share some small talk, so I decided to jump off my bike and stand with my new acquaintance, who I’ll call John.
 
The time finally came that we were given permission to cross. I walked with John as he slowly moved one foot behind the other whilst pushing his cart over the ruts in the snowpack made by vehicles. It was a visibly taxing process for him, and difficult for me to watch. The occupational therapist in me grew agitated with the lack of accessibility this man experienced. We neared the midway point in the intersection when the menacing stop hand began to flash, and quickly went to a full stop.  The lights had changed and we were stuck in the middle of the intersection. That’s when John said it.
 
“Sometimes I think this damn city is trying to kill me!”

John had made a valid point. While there wasn’t an explicit intention to harm him, by virtue of the way the infrastructure was designed, John was regularly put in harm’s way.
 
I have, on many occasions, uttered a similar sentiment. I primarily use cycling and walking to get around the city. I’ve cursed under my breath while waiting at signaled crosswalks that seem to take forever to allow pedestrians to cross only to give them a very short time to do so. On a regular basis, I dodged cars while attempting to use a crosswalk to get across Whyte Avenue and 102 street (Whyte Avenue is a pedestrian rich area in the Edmonton neighbourhood of Old Strathcona). I had a near miss almost every day. And I have the privilege of being an able bodied person that can quickly step back as an unknowing driver almost runs over my foot.

Reflecting on these issues, I was reminded of a workshop I took this past summer given by the Stanford Design Thinking School. I see the problems I identified as primarily an issue of design, or rather the lack of thoughtful design. Design thinking helps in creating services and products that put the user experience at the core of the design process. The foundation of the approach lies in the "empathy" step - empathizing with the user and caring about how they feel. Empathizing is done through observation of the user as well as qualitative interviewing. When something is designed with empathy in mind, the result is an experience that meets the user's needs.
 
Assessing John's experience, I'd argue that his perspective wasn't taken into account when designing that intersection. Having significant mobility issues made waiting for excessive periods of time without moving difficult. Add to that the severe cold. When he finally had the opportunity to cross, the ruts in the road created additional challenges for him. And to top it off, the time given to him to cross was certainly not enough, and left him stranded in the middle of an intersection fearing for his life.
 
John's experience with using that crosswalk was riddled with anxiety. Speaking with him afterwards, he stated: "Sometimes I feel invisible here". That really sat with me.
 
I was quite bothered by John's disclosure. To me, (beyond it being a matter of safety) it came down to dignity. John, and many others like him are hard-pressed to be able to navigate their cities with dignity. Something as seemingly trivial as pedestrian infrastructure has huge implications on how people see themselves. Having to dodge speeding vehicles on marked crosswalks (without adequate signalling to alert drivers) could communicate that that person's particular experience is not worthy of concern. Or that their safety isn't a priority.
 
So, why should we be concerned about dignity? While writing this piece, I was taken back to work I did as an occupational therapist while at the Centre for Addiction and Mental Health in Toronto.  Something I tried to be cognizant of was the concept of “dignity moments” – that I would make the utmost effort to support the dignity of my clients in every interaction I had with them. This was embodied in the way I spoke with my clients, the nuances of my body language, and the general demeanor in which I engaged with them. The reality was that most of the people I supported lived in abject poverty, had experienced significant oppression (i.e racism, gender-based violence, mental health stigma), and generally had negative experiences with numerous systems. The cumulative impact of these negative experiences took a toll on their sense of dignity.
 
I believe there is a lesson in this for cities. I’d be curious to see how built space would manifest if transportation engineers contemplated how to facilitate dignity moments for the people that used urban infrastructure.
 
It’s also important to recognize that people like John spend almost all of their time navigating and living in the urban environment.  I’d contend that the homeless are one group who most intensively access the built environments of our cities, so should have a voice in the process that goes into building the urban environment.

What would our urban landscape look like if we acknowledged that homelessness was a pervasive issue and that people did in fact live in public spaces?

We’ve seen the opposite; in cities around the world, measures have been taken to make public spaces inhospitable to the homeless. In London, a developer installed “anti-homeless” spikes to deter those looking for a place to sleep. In Tokyo, park benches were designed to make sitting and sleeping uncomfortable. And, if we’re going to explore how urban design influences our mental health, we need to acknowledge that the prevalence of mental health issues in the homeless is higher than the non-homeless populations. We have to build cities for everyone – not just the privileged.
 
I think that we have some way to go when it comes to improving the pedestrian experience in our cities. I believe that it should be at the top of our list of priorities. I think street vibrancy depends on it. I also strongly believe that cities need to be inclusive in their design; this requires that we acknowledge that not everyone drives a car (due to choice or affordability) - and that this should be reflected in the design of our streets and roadways. Design of our spaces governs our lives. It determines the way we move and the way we experience the world and accordingly influences how we see ourselves. More attention needs to be paid to this as we build our cities. While these issues may seem inconsequential to some policy makers, I am convinced that dignity lies in the details.