EXPERT REACTION: Smarter cities make healthier people

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Reshaping our cities to be safer and more convenient for cyclists and walkers could keep us healthier, according to an international team of researchers. The authors looked at a half a dozen of the world's cities, including Melbourne, and discovered that changes such as having shops and services close to us, mixing jobs and housing across the city, and making neighbourhoods safe, attractive and convenient for public transport, cycling and walking could lower heart disease, diabetes, and pollution, and help people get active.

Journal/conference: The Lancet

Organisation/s: The University of Melbourne, Queensland University of Technology (QUT), The University of Western Australia, Swinburne University of Technology, Monash University,

Media Release

From: The Lancet

The Lancet Series: How city design and transport planning can improve health

· Case studies of Melbourne, London, Boston, Sao Paulo, Copenhagen and Delhi suggest that changes to city design and transport can have significant impact on health

· Changes in Melbourne, London and Boston to promote cycling and walking must be matched by provision of safe infrastructure for cyclists and pedestrians

A new Series, published in The Lancet quantifies the health gains that could be achieved if cities incentivised a shift from private car use to cycling and walking, and promoted a compact city model where distances to shops and facilities, including public transport, are shorter and within walking distance.

These changes could achieve significant reductions in non-communicable diseases such as cardiovascular disease and diabetes as well as increasing physical activity and reducing pollution. Importantly, in cities with high levels of private car use such as Melbourne, London and Boston, the authors say that promoting walking and cycling must be matched by improvements to infrastructure that separate motorised transport to protect cyclists and pedestrians from road injuries.

The new Series on urban design, transport and health, led by the University of Melbourne (Australia) and the University of California, San Diego (USA), is launched today (Friday 23rd) at an event at the United Nations General Assembly (UNGA) in New York.

Over half of the world’s population live in cities, and rapid urbanisation is only expected to increase in the coming years. By 2050, large cities in the USA, China and India are predicted to see their populations increase by 33%, 38% and 96% respectively. Population growth in cities means increasing demands on transport systems. Sprawling residential developments in the USA, Australia and New Zealand limit the ability of people to walk or cycle in their daily commute and make public transport expensive to deliver. Private car use has increased dramatically in Brazil, China and India leading to declines in physical activity, increases in air pollution and increased rates of road death and serious injury, all of which combine to increase overall levels of chronic disease and injury.

“With the world’s population estimated to reach 10 billion people by 2050, and three quarters of this population living in cities, city planning must be part of a comprehensive solution to tackling adverse health outcomes. City planning was key to cutting infectious disease outbreaks in the 19th century through improved sanitation, housing and separating residential and industrial areas. Today, there is a real opportunity for city planning to reduce non-communicable diseases and road trauma and to promote health and wellbeing more broadly,” says Series author Professor Billie Giles-Corti, University of Melbourne, Australia [1].

The authors of the Series identify key interventions that, when combined, encourage walking, cycling and public transport use, while reducing private car use (paper 1, table 1). These include having shops and services within walking distance, a mix of employment and housing across the city, reducing the availability and increasing the cost of parking, infrastructure that supports safe walking and bicycling, open spaces, reducing distance to public transport, and making neighbourhoods safe, attractive and convenient for public transport.

“We concluded that focussing on walking and cycling infrastructure alone is critical but not enough – to create cities that promote health needs joined-up policies and input across multiple sectors: land use, transport, housing, economic development, urban design, health and community services, and public safety” adds Professor Giles-Corti.

Series lead Professor Mark Stevenson, University of Melbourne, and colleagues designed a ‘compact cities model’ where land-use density was increased by 30%, average distance to public transport reduced by 30%, and diversity of land-use increased by 30%. They also factored in a 10% shift from private cars to either cycling or walking - a target similar to that of policies in many European cities such as Zurich. These targets were selected on the basis that they are pragmatic in most cities – for instance in Melbourne approximately 14% of private motorised vehicle trips are for trips of less than 5km and therefore a shift from car to active commuting (walking combined with public transport) for example would be feasible.

The model was applied to six cities: Melbourne, London, Boston, Sao Paulo, Copenhagen and Delhi. Health gains were predicted in all cities (table 4), with the greatest effect on reducing rates of cardiovascular disease. In addition, all cities saw increases in physical activity and reductions in air pollution from transport emissions (table 3).

In Melbourne, the model led to an estimated reduction of 19% in the burden of cardiovascular disease and 14% in the burden of type 2 diabetes. In London, the model led to a reduction of 13% in the burden of cardiovascular disease and 7% in type 2 diabetes. In Boston, the reductions were 15% and 11% respectively (table 2 & 4 [2]).

The model also predicted an increase in road traffic incidents for cyclists and pedestrians – an increase of approximately 6% in Melbourne (257 additional road injuries and 10 deaths per year), 10% in London (292 injuries; 12 deaths) and 5% in Boston (55 injuries; 2 deaths) (figure 5). However, separating pedestrian and cycling from cars was found to offset the increased road injuries and deaths (figure 7).

“The effect of interventions that encourage cycling and walking was particularly evident in highly motorised cities such as Melbourne, London and Boston, and underscores the importance of transport policies, pricing and regulation that encourage active transport via cycling, walking and public transport while discouraging private car use. These changes also need to be matched by improved pedestrian and cycling infrastructure to protect cyclists and pedestrians. Our study shows that these changes at city level could lead to real health gains,” says Series author Professor Mark Stevenson [1].

Several cities have made progress in increasing walking and cycling including London, Stockholm and Bogota (paper 3, panel 3) – for instance, motor vehicle traffic volumes across London decreased by 7% between 2004 and 2014 and cycling has increased, despite a growing population. But the authors warn that much more should be done to improve the health of cities.

"City planning policies can affect health, both positively and negatively. Sadly, it is clear that many city leaders around the world are not applying the lessons of research to make cities as healthy as possible. A continuing challenge is to improve the communication of this evidence to city leaders and find incentives for them to seek out and apply the evidence. A major incentive is that designing cities for health and active transport, rather than automobile-dependence, also makes the cities more environmentally sustainable helping cities to achieve the UN’s Sustainable Development Goals," says Series author Professor James Sallis, University of California, San Diego, USA [1].

Bill de Blasio, Mayor of New York City, in a linked Comment, emphasizes the value of parks in designing cities, he writes: “Today, the City of New York is using the power of green spaces to strengthen the overall health of our thriving metropolis, especially in low-income neighbourhoods that are grappling with health disparities… For everyone to reap the full benefits of our parks, we must invest in them wisely… A person’s access to a great park, and, by extension, to potential health benefits, should not be determined by his or her zip code.”

NOTES TO EDITORS

[1] Quotes direct from authors and cannot be found in the text of the Series.
[2] Predicted health gains were measured in DALYs (disability-adjusted life years) per 100000 population. For example, in Melbourne the compact cities model led to a health gain equivalent to 622 DALYs per 100000 population for cardiovascular disease (see table 4) – equivalent to 19% of the overall burden of cardiovascular disease in the city (3277 DALYs per 100000 population, table 2)

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Expert Reaction

These comments have been collated by the Science Media Centre to provide a variety of expert perspectives on this issue. Feel free to use these quotes in your stories. Views expressed are the personal opinions of the experts named. They do not represent the views of the SMC or any other organisation unless specifically stated.

Peter Newman AO is the John Curtin Distinguished Professor of Sustainability at Curtin University

This is a powerful new statement on the need for cities to reduce automobile dependence.

The evidence has been mounting for some time that suburbs built around the car are not healthy and the health profession have been quite slow at reaching the need to stop urban sprawl, but I welcome it.

At a time when the motor vehicle industry is running a campaign that autonomous vehicles will transform our cities, it is important to say very clearly that people sitting for long periods in cars, whether driving or being driven by a computer, is not healthy. We need to walk and cycle more or use motorised transport for short distances only.

Our evidence published recently in The End of Automobile Dependence shows that cities which are walkable are more wealthy, as well as being more healthy and using less fuel. We show that car use and GDP per capita are now decoupling.

The days of urban sprawl are over. We must regenerate our cities and ban any further outward sprawl.

Last updated: 03 Nov 2016 3:56pm
Jago Dodson is Professor of Urban Policy and Director of the Centre for Urban Research at RMIT University

I welcome the Lancet publications as they show a clear need for improved urban policy to ensure cities are healthy and sustainable.

The overriding message from these publications is that the era of car-based urban transport policy has been a failure for both the health of urban dwellers and for the amenity and liveablity of cities.

The publications' emphases on walking, cycling and public transport as key factors in urban population health should be clearly heeded by policy makers.

This research signals the need for a complete reversal of current Australian urban transport policy to take the resources wasted in building infrastructure for cars and dedicate them to public transport, accompanied by walking and cycling infrastructure.

Moreover a rethink of our transport planning institutions is needed - Australia's transport agencies were designed for the automobile age, they need to be reconfigured for the new era of sustainable and active transport.

Last updated: 03 Nov 2016 4:40pm
Tony Matthews is an Urban & Environmental planner with a strong track record in research, teaching and practice and lectures at Griffith University.

Recent and current urban and suburban design approaches in Australia and much of the world have produced a proliferation of low density, car-dependent urban areas.

Public transport access and opportunities for cycling and walking are often poor. Green space is often limited or absent in these areas, with housing and roads occupying the majority of available land area.

Human health outcomes tend to suffer as a consequence of these design approaches. Obesity, sedentary lifestyles and increased incidences of cancer, diabetes and heart disease are recognised as common consequences. These negative outcomes proliferate as the world becomes more urbanised, leading to increased pressure on health systems and public finances.

Redesigning urban spaces offers an effective means of minimising or reversing negative health outcomes.

The Lancet research demonstrates that providing better density-mixes, public transport options and dedicated cycling and walking routes can produce better population health outcomes and lower levels of traffic accidents. These actions may also reduce noise, incidents of crime and environmental pollution.

I support the research findings from the Lancet. They offer evidence-based strategies that can be championed and activated by urban planners and policy-makers in Australia, where negative health outcomes are strongly connected to poor urban and suburban design.

Last updated: 03 Nov 2016 8:31pm
Dr Mark Andrich is a sustainability and finance specialist with Sustainable Trust and PHC Projects

There is a lot of merit to this study and it highlights very significant issues, in particular the need to reduce the use of diesel and petrol cars in the city.

The health cost of vehicle emissions is second only to smoking in terms of heart and respiratory diseases, with other studies showing the cost of vehicle emissions in Australia more than $10 billion per year.

This study integrates a great deal of evidence to show that by walking and cycling more, with more green space, that people’s health and well-being will be greatly enhanced.

While the study doesn’t prove that urban sprawl is bad necessarily, it really highlights well that a lot more can be done with good planning that integrates sustainability initiatives across multiple sectors.

One critical issue that needs addressing further is how to reduce pollution and yet manage the car-based infrastructure that already exists. For example, how can new walking and cycling infrastructure co-exist with the billions of dollar worth of investment in roads. Electric vehicle promotion (e.g. installation of chargers and EVs allowed in bus lanes) will maximize the use of existing car infrastructure, but remove a lot of the damaging effects from noise and particulate matter pollution.

The study provides great data and recognition of these issues and should be recognized (and used) in urban planning in Australia.

Last updated: 03 Nov 2016 8:33pm

Dr Lennert Veerman leads the Burden of Disease and Cost-Effectiveness Unit at the University of Queensland's School of Public Health and Belen Zapata-Diomedi is a PhD Candidate at the University of Queensland

This study shows that population health can be enhanced by means of city designs and policies that support modal shift towards active transport (walking and cycling) and use of public transport.

There is now well established evidence that indicates that the city designs evaluated in this study including higher residential density and diversity of land uses (i.e. residential, commercial, park land, etc.) and shorter distance to transit facilitate physical activity.

The studies led by Professor Stevenson completes the picture for public health relevance, the quantification of potential health outcomes of achieving alternative city designs and promoting policies to decrease private motorised travel.

For Australia, the findings for the city of Melbourne indicate overall gains from reductions in chronic diseases (cardiovascular disease, diabetes and respiratory disease) of 710 averted disability adjusted life years (DALYs) (a population health measure including mortality and morbidity).

A small increase in road injuries and fatalities reduces these health gains by five per cent, so the overall health impact of active transport is overwhelmingly positive.

Driving is the dominant mode of transport in Australia, even for short distances that could easily be walked or cycled. Investing in active transport initiatives is an opportunity to help to decrease the health and economic burden of chronic diseases.

Last updated: 03 Nov 2016 4:27pm
Hussein Dia is Professor of Future Urban Mobility at Swinburne University of Technology

This series of papers brings together valuable contributions which set the scene for the complexity of urban transport and the interactions between transport, land-use, infrastructure, mobility, access and accessibility, emissions, health and well-being.
 
Together, the papers represent a call for action to address the ‘epidemic levels of physical inactivity’ in cities around the world.

The papers recognise that the existing practices in urban and transport planning and urban design are fundamental causes of these problems. The policies that were adopted in the past are now having widespread negative effects on health through reduced physical activity, social isolation, noise and greenhouse gas emissions driving climate change.

Most of these negative consequences are related to the high priority given to motorised transport in land-use and transport planning practices.
 
The papers call for a conceptual leap and renewed thinking on how we provide mobility in our cities. Rather than focusing on the infrastructure required to facilitate the physical movement of people, the emphasis should shift to provide the mobility required for access to employment, goods and services.

The studies propose that solutions with the likelihood of greatest health impact should include integrated land-use and transport policies, which prioritise investments that achieve safe and sustainable walking, cycling, and public transport while reducing private motor-vehicle dependence.
 
The modelling study on estimating the health benefits of six selected compact cities provides some valuable comparisons and insights in an Australian context. For example, the modelling shows that land-use transport policies which promote higher density, mixed land-use and improved access to public transport would result in the greatest health gains (as measured by change in metabolic equivalents as a result of transport-related physical activity) in highly motorised cities such as Melbourne (72.1 per cent).

These findings demonstrate the opportunities for policy makers to positively influence the overall health and well-being of city populations.

Last updated: 03 Nov 2016 5:52pm

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