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Journal of Urban Design and Mental Health 2017;3:8
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RESEARCH
Scoping assessment of transport design targets to improve public mental health
Affiliations listed at the bottom of this paper
Urban design that promotes good mental health is becoming an increasingly interesting public health opportunity that is capturing the attention of planners, architects, engineers, and health professionals alike. Mental illness affects at least 1 out of every 4 people in their lifetime, and everybody experiences mental health problems from time to time. (1) This risk is elevated for people who live in cities by up to 40% for depression, 20% for anxiety, and may be up to double for schizophrenia. (2) The OECD assesses that the direct and indirect costs of mental illness can amount to 4% of GDP. (3)
Part of the elevated risk of mental illness in urban settings can be explained by predisposing factors, from genetics to personal experiences such as unemployment or homelessness (both risk factors for mental illness, but also urban migration drivers). However, another element is that the urban built environment can undermine many of the protective factors that support good mental health. Design interventions can focus on providing these protective factors, from a tree canopy to provide physical comfort during the summer by mitigating the urban heat island effect, to providing a safe and welcoming, amenitized public gathering space to encourage social interaction.
Transportation is an important component of any city, but opportunities for leveraging transportation design elements to promote mental health and wellbeing have not been fully explored, and specific research on transportation design factors for public mental health is in its infancy. However, evidence from other fields of urban design may point to research and innovation opportunities within the transportation sector. Key urban design factors that can affect mental health include design for: access to natural (green and blue) spaces (4,5), the promotion of physical activity (6), pro-social activity (7), safety (including wayfinding, crime, air quality, and traffic), visual pollution (aesthetics), light and sound pollution, and sleep quality (8,9). This assessment aims to apply the theory of urban design for good mental health specifically to the transport sector, identifying potential research and innovation targets in order to better leverage transportation design for mental health promotion.
Methods
At the 3rd International Conference on Transport and Health (Barcelona, 27-29 June 2017), delegates were invited to attend a workshop on urban design and mental health. These delegates had professional interest, experience, and expertise at the intersection of transport and health and had elected to attend this specialist conference, and had sufficient interest in mental health that they elected to attend this workshop. Participants were informed that the workshop activities would be used to produce results for this paper and were invited to contribute to its authorship.
Briefing: Participants received a 25-minute briefing on the definitions of mental health, the mechanisms by which cities are believed to impact mental health, and the current evidence regarding urban design factors that exert impact on mental health.
Exercise 1: Transport design factors that could impact public mental health
- Participants were asked to apply the information contained in the briefing to their knowledge of the transport sector, and in five minutes, to list as many transport-related factors as possible that they considered might influence people’s mental health and that could potentially be addressed via transport design. Participants were encouraged to think creatively with the promise of a small prize.
- Participants were asked to share aloud factors that they had identified and considered interesting.
- Participants who had not shared all their factors aloud shared them afterwards, and these extra factors were added.
- The resulting factors were analysed and grouped into themes.
- The authors analyzed and inputted potential design factors relevant to each factor.
Exercise 2: Transport design interventions that could improve public mental health
- Following Exercise 1, participants were split into 7 groups of 3-5 people allocated according to seating location convenience. Each group was given 15 minutes to develop 1-3 brief proposals of an innovative transport intervention that they considered would promote good mental health, assuming they had access to an unlimited budget. Participants were encouraged to think creatively with the promise of a small prize.
- Groups reported ‘what’, ‘why’ and ‘how’, as well as ‘who benefits’. These were summarised aloud, and further detail was provided in writing.
Results
A self-selected group of 30 delegates from 10 countries chose to attend the workshop and contributed to this scoping assessment; 24 chose to further contribute to authorship of the resulting paper.
Exercise 1: Transport design factors that could impact public mental health
The participants identified 53 transport-related factors that may impact mental health; these were categorised into 8 key themes: comfort, accessibility, dangers and disturbances, lack of control, social interactions, areas around transit access points, active transport, and use of transit time. Participants also identified 15 design factors. After the event, participants reviewed the factors online and identified further potentially relevant design factors associated with the listed transport-related factors.
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Theme |
Transport-related factors that may impact mental health |
Potentially relevant design factors |
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Comfort |
Noise |
Sound and light design Dark Skies Pedestrian lighting Noise Ordinances and noise barriers Building Insulation Tree Canopy and man-made shading Universal Design ‘Complete Street’ designs |
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Light |
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Disabilities triggered by sensory inputs (e.g. light, sounds) |
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Crowdedness, including confined and congested places |
Station layout and design Vehicle layout and design Transportation frequency Ingress and Egress Crowd management/crowd control strategies |
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Queues |
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Seating |
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Smell |
Air circulation Climate/temperature control |
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Temperature |
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Views |
Window installation Landscaping of areas outside stations and along transit routes Interior design Green/blue spaces along the routes Streetscape and biophilic design |
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Cleanliness |
Materials used in transport facilities and vehicles Air circulation |
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Look and feel of transportation facilities |
Station layout and design Lighting Colour and texture of materials used Transparency (glass) Public Information Kiosks Signage Climate Controlled Public Amenities/Facilities |
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Accessibility |
Physical accessibility for all ages and abilities (including physical access to stations, and accessibility within stations) |
Station/transport hub layout and design, including elevator location Signposting Universal Design Wayfinding Legible City Public Information Kiosks Seamless Intermodal/Multimodal Design |
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Ease of navigation |
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Connections between modes of transit |
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Financial accessibility (resident and visitor) |
Regular and visitor charging schemes Integrated Smart Card fare payment schemes that incorporate transport and parking |
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Information accessibility |
Mechanisms for ease of access and comprehension for: fares, schedules, ticket-buying and platform information. Dissemination of information to smartphones (provides helpful real-time information to users with smartphones; may disadvantage those without functioning smartphones or data access, particularly if this replaces other communication methods). Customer Service Real-time Information Kiosks Real-time transit vehicle tracking and arrival times |
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Access to work, healthcare, leisure |
Transport mapping and routing Provision of First Mile/Last Mile connections Mobility Hub Intermodal Connectivity |
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Access to walking routes |
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Access to out-of-city nature |
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Choice between modes of transport |
Transport system design and integration Intermodal Design of Stations/Transfer Points Integrated Smart Card Fare Payment Systems |
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Access transport to/from neighbourhoods (e.g. across busy roads) |
Landscaping around transport hubs Pedestrian infrastructure First/Last Mile |
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Access to smartphones for information/schedule/reservations |
Information dissemination mechanisms |
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Dangers and disturbances |
Traffic safety |
Traffic calming mechanisms Road crossings to access transport, including pedestrian refuges Cycling lanes separated from the main road Complete Streets Best Practices |
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Places conducive to crime or anti-social behaviour, or that facilitate aggression or disturbances from other transit-users |
Street lighting Sightlines with pedestrian and passenger oversight Visible security infrastructure Reporting mechanisms Transparency (eyes on the street) |
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Walking safety while using smartphones |
Ground-level signage |
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Confined or congested places |
Station layout and design High frequency of public transport Emergency and crowd management plans |
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Threat of terrorism |
Information dissemination mechanisms Sightlines with pedestrian and passenger oversight Visible security infrastructure Reporting mechanisms |
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Embarking and disembarking of vehicles for wheelchairs, prams, and people with other mobility challenges. |
Accessible design, such as ramps, platforms, belts, fasteners, etc. |
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Facilities to travel safely on vehicles for wheelchairs, prams and people with other mobility challenges. |
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Privacy of transit users’ data |
Integrity and security of database systems |
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Air pollution |
Compliant pollution control devices, monitoring and reporting Tree Canopy Traffic control and management to minimize vehicle emissions |
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Vehicle break downs |
Quality of vehicles Effective vehicle maintenance systems Emergency and vehicle break-down response systems |
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Lack of control |
Reliability of transport |
Quality of vehicles Effective vehicle maintenance systems. Effective transit management systems. |
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Waiting times: at lights, due to traffic, transit arrival |
Synchronized Corridors TSP (Transit Signal Priority) placement to dynamically extend signal green time (or truncate signal red time) to give priority to approaching transit vehicles. Placement of transit vehicle stops (near-side or far-side of intersections) |
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Strikes, either transit strikes, or strikes from other industries that affect transit (delays, aggression, social divide issues) |
Real-time information and routing advice dissemination system Offer alternatives (detours) Detours that take into account driver expectancy |
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Street closures |
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Road rage |
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Availability of car/bike parking |
Landscaping Car and bike parking facilities Signposting and information Bike Showers Bike Lockers Complete Streets |
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Social interactions |
Social contact in transit (positive and negative interactions) |
Proper sign posts |
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Feeling others are looking out for you |
Public transport workers around the stations |
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Lack of choice about who one sits next to |
Designated carriages/areas for specific populations (scholar train cars, women-only train cars, etc) |
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Customer service/friendliness (e.g. from drivers) |
Driver training in customer service;empowerment of drivers to stop anti social behaviour |
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Areas around transit access points |
Community pride |
Landscaping Routing decisions Green landscape policies Wayfinding Traffic calming mechanisms Signage |
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Social hubs around stations |
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Enhance exposure to nature during transit use (‘green commute’) |
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Speed or transportation infrastructure dividing communities |
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Transportation impacting residential noise, including sleep |
Time-sensitive routing decisions Traffic calming mechanisms |
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Active transport |
Cycle lanes |
Bike infrastructure Pedestrian infrastructure Signposting |
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Co-existence between cyclists and drivers |
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Pedestrian infrastructure |
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Access to out-of-city hiking and other exercise opportunities |
See accessibility |
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Use of transit time |
Opportunities for how time is used during transit |
Vehicle design |
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Total travel time opportunity cost: time in transit is time away from family, friends, exercise, leisure activities |
Transportation frequency Routing decisions |
Exercise 2: Transport design interventions that could improve public mental health
The 7 groups provided 10 solutions, which fit into two main categories:
Encourage green pedestrianisation, bikeability and leisure spaces in cities:
- Create green pathways for pedestrians and bike riders, forming links between parks, with connections along the way to other common destinations. Incorporate components such as greenery, streams, wildlife, play opportunities, and public art. Install good lighting and low bushes to ensure visibility and safety to encourage access for all, for instance delivering a safe pedestrian option at night. Wayfinding signs would be a helpful addition in areas frequented by non-residents of the area. This solution is based on the parkways work of famed landscape architect Frederick Law Olmsted.
- Increase nature in residential places and around bus stops, including innovations such as green walls and pocket parks. Ensure sufficient spaces to socialise, exercise and play. Green spaces also serve to reduce humidity, provide shade, and clean the air.
- In consultation with the community, ‘take back’ private space and develop into green, lush, walkable and, where appropriate, bikeable spaces.
- Create a ‘20-minute city’ with home, work, shops and facilities within a 20-minute walk of each other. Prioritise green and blue nature and ensure excellent navigation aids (including wayfinding signs) to facilitate pedestrian transit.
- Redesign urban spaces where there is a lack of pavements (sidewalks) or public spaces to encourage walkability.
Affordable, accessible public transit and reduction of car traffic:
- Create an extensive light rail/streetcar network that is free for residents to use and accessible for wheelchairs and prams. This network should provide access to key locations (such as hospitals, shopping areas, work locations, homes, etc), and run on tracks on grass beds (such as the tram on Diagonal Avenue in Barcelona), surrounded by trees. Community hubs should be formed at stations to promote social interaction and increase pride in neighbourhoods.
- Inspired by Barcelona’s super-blocks, create a ‘super-super-block’ whereby cities have a car boundary, with provision of parking and transfer to a wide range of affordable public transit and active transit options to facilitate movement within the city. This will reduce noise, pollution and crashes, and encourage active transit. A network of cities could be created, with an exterior ‘necklace’ of transit between cities.
- Make public transport extensive and free, and alongside this, increase gas prices and consider congestion pricing to disincentivise car use, reducing pollution and increasing access to travel choices for all.
- Google maps and similar wayfinding aids should work more effectively within stations to help users navigate inside complex transit hubs.
- Use of time spent in transit could be made more interesting through wide, broad windows; entertainment; themed carriages on public transport; interactive games, etc.
Discussion
While this scoping assessment was basic, it took the fairly rare opportunity of accessing a wide range of international transport and health professionals and academics, and applying their experience, skills and expertise to think specifically about the opportunities for transport design for mental health promotion. We believe this is the first time that this has been achieved.
This scoping assessment identified a wide range of transport design factors that could potentially improve public mental health. By applying the evidence base of general urban design principles for mental health, it is likely that many of these factors exert impact on public mental health in positive and negative ways. In this emerging field of research, the list of 53 factors that emerged from Exercise 1 provides inspiration for researchers in this field, and for transport professionals seeking to innovate.
The 8 key themes identified were: comfort, accessibility, dangers and disturbances, concerns around lack of control, availability of information, quality of social interactions, quality of areas around transit access points, opportunities for active transport, and ways in which people may make use of their transit time. These map well onto the factors known to impact urban design for mental health (9), and provide new opportunities for investigation.
Access to green space in the transportation context is covered well in considering how to integrate nature into the areas around transit access points as well as in-transit views, and the concept of transportation providing efficient access to out-of-city green space such as hiking trails.
Physical activity is incorporated in terms of walking and cycling infrastructure, and also taking transportation to sports and leisure facilities and out-of-city exercise opportunities. However, a focus during the conference was on the concept of public transit as active transport: after all, physical activity is usually required in order to access public transit, for instance walking or cycling to the nearest station. Perhaps inspired by these earlier conference discussions, an interesting opportunity is that of ensuring active access to public transportation for everyone by enhancing accessibility, ranging from safe road crossings to access stations, to appropriately-designed elevators and other barrier-free infrastructure, to ensuring information accessibility.
Pro-social interaction seemed to be a more challenging concept in the context of transportation, with few suggestions of specific opportunities. These included driver friendliness, and feeling a public sense of care from fellow travellers; they also included better use of areas around stations, delivering community hubs that provide pro-social activities and engender pride in the local neighbourhood. Further proposals included transportation providing efficient access to places of leisure and social interaction, and the opportunity to reduce commute time in order to maximise social time with friends and family (and indeed sleep).
Safety is a factor that supports good mental health, and many ideas were proposed. Many of these reflected placemaking norms: safety in terms of crime and traffic. However other interesting opportunities were proposed, including the roles of vehicle maintenance and air pollution.
Sleep is impacted by light and noise pollution, and this was included, though most focus on these pollutants was in the context of transit users, rather than general residents.
Other proposed factors extended beyond this framework for urban mental health but show promise and will merit further research, including:
- The impact of certain material colour/textures/etc used in the physical design of transport facilities and the spaces within and around them (the selection of natural materials over synthetic materials, eg wood versus concrete; the use of native materials over exotic materials; and bright and cheerful colors that may have a profound positive impact on perception and utilization of facilities and equipment).
- The use of context-specific design to optimize safety for users and the community, preserving the environmental, scenic, aesthetic, historic and natural resource values of the area.
- Leverage of factors that contribute to a feeling of a lack of control while in transit.
- Innovations in options for transit time use to benefit mental health.
Interestingly, the innovations proposed in Exercise 2, while following on directly from identification of the 53 diverse factors, mostly built on existing placemaking strategies: improving pedestrian infrastructure, reducing car use, increasing exposure to nature, and enhancing access to efficient public transport. These are interesting, and all valid and important strategies in the pursuit of better urban mental health and wellbeing. However, they are based on existing current thinking and incorporate few of the 53 factors identified in Exercise 1.
This brief scoping review demonstrates that there may be far more potential targets than currently appreciated when it comes to promoting good mental health through transportation design. Many of the 53 factors identified by this group point to potential design opportunities for innovation in the transport sector to promote public mental health. Further research is indicated, and these factors provide ideas for directions of study. As transport authorities increasingly develop guidelines and policies for transportation impact on public health, this will be an important field to watch, and a high-impact field in which to innovate.
Limitations
These exercises were very simple and time-limited. The transport and health professionals and academics who participated had very limited time in which to identify relevant factors and develop proposals. With more time, more factors may have emerged. Furthermore, participants were asked to undertake the exercises immediately after hearing a briefing about the links between urban design and mental health, with no other preparation, and some may have benefitted from more time to consider this information before being asked to apply it to the transport sector. Finally, though the conference focused on the links between transport and health, it attracted many participants who were primarily health-focused researchers; responses may have differed at a transport-focused conference with a greater concentration of primarily transport-focused professionals.
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About the Authors
Amal Abassi, Technion (Israel Institute of Technology), Israel
Ghassan Abu-Lebdeh, Associate Professor in Civil Engineering, American University of Sharjah, United Arab Emirates
Zakiyya Adam, PhD Student in Urban Science, Warwick Institute for the Science of Cities (WISC), University of Warwick, UK
Suzanne Audrey, Senior Research Fellow in Public Health, University of Bristol, UK
Anthony Barnett, Senior Research Fellow (Physical Activity and Active Living), Institute for Health and Ageing, Australian Catholic University, Australia
Glòria Carrasco-Turigas, Research Technician, Barcelona Institute for Global Health (ISGlobal), Spain
Ester Cerin, Professor of Urban Spaces and Active Ageing, Mental Health (including Alzheimer’s and dementia), Active Living and Built Environment, Institute for Health and Ageing, Australian Catholic University, Australia
Wafa Elias, Head of Department Ashdod, Shamoon College of Engineering, Israel
Gunnar Hand, Associate and City Design Practice Lead, Skidmore, Owings & Merrill, LLP, Los Angeles, USA
Charlotte Kelly, Senior Research Fellow (Institute for Transport Studies & Academic Unit of Health Economics) University of Leeds, UK
Nick Loder, Director, Centre of Universal Design, Australia
Marc Lüke, Scientific Associate, Transport Planning and Traffic Engineering, Technische Universität Darmstadt, Germany
Kara E. MacLeod, Analyst at Fielding School of Public Health, UCLA, USA
Claudine Moutou, Lecturer, Institute of Transport and Logistics Studies, University of Sydney, Australia
Anna Puig-Ribera, PhD, Coordinator Sport and Physical Activity Research Group (GREAF), University of Vic-Central University of Catalonia, Spain
Ewa Rykala, Warsaw University of Life Sciences, Poland
Sam Schwartz, President, Sam Schwartz Engineering, USA
Ipek N. Sener, Ph.D., Assistant Research Scientist, Texas A&M Transportation Institute, USA
Caroline Shaw, Senior Research Fellow, University of Otago, Wellington, New Zealand
Cristina Vert, predoctoral researcher, Barcelona Institute for Global Health (ISGlobal), Spain
Karen Witten, Professor of Public Health, Massey University, New Zealand
Andree Woodcock, Professor of Education, Ergonomics and Design, Coventry University, UK
Belen Zapata-Diomedi, Researcher, School of Population Health, University of Queensland, Australia
Maciej Żołnierczuk, Ph.D. student at the Department of Environment Protection, Warsaw University of Life Sciences, Poland