Are our developments really improving health?

+ Evaluation will help designers refine their design solutions and to pursue the most effective interventions for healthier cities.

To address the pressures of growing and ageing urban populations, I think our cities need to be made of high quality places that contribute positively to our physical and mental health.

We know that the built environment has an important impact on our health, and that healthier cities are linked to more resilient people, places and profits. However, there is less evidence to show how well we are designing our living and working environments to improve wellbeing. Are our design solutions actually delivering the health outcomes that we intend? 

In a similar way to reviewing treatment for a health condition, I believe that planners, designers, developers, property managers and government need to review and evaluate developments to understand their health outcomes. Health Impact Assessment is one way that effects of proposed interventions are considered during the development of a project. But Arup’s Design protocol for mobilising healthy living suggests that understanding the actual effects is less common. 

This lack of ‘follow-up’ makes it difficult to identify whether we’re making the right interventions. This can relate to challenges such as inconsistent data, the need to evaluate over time and a potential lack of incentives for those planning and delivering projects compared to those managing urban interventions.

The drive towards more preventive healthcare recognises that the healthier people are, the less strain we put on our healthcare systems. Regular physical activity has been shown to reduce the risk of mortality by up to 30%, depression by up to 30%, cardiovascular disease by up to 35% and the list goes on. And the World Health Organisation places insufficient physical activity as one of the ten leading risk factors for death worldwide. Despite knowing the benefits, we’re still not active enough.

There is growing interest from developers and investors in using land assets and built environment interventions to contribute to preventive healthcare. In the UK, the NHS has announced ten Healthy New Town demonstrator sites as testing grounds for developments that contribute to improved health. While in the US, Tampa aims to be the first WELL Certified city district implementing measures that promote better quality of life to residents and visitors alike.

To optimise the potential of investments such as these, we can learn lessons from built environment interventions that have attempted provision of healthier places to live and work in the past. 

Considering evaluation at inception and understanding the changes in people’s health before and after interventions will help to decipher effective approaches to planning for wellbeing. Whether that be buildings that promote interaction, public spaces that provide respite and connect us with our communities, or streets that encourage us to walk and play

In the UK, understanding what makes an effective intervention is being progressed by organisations such as the What Works Centre for wellbeing. I’ve also learnt of evaluation already happening including the RESIDE residential environments study in Perth, which assessed the effect of the West Australia Planning Commission’s liveable neighbourhoods guidelines over nine years, finding that for every 10% increase in overall policy compliance, participants were 53% more likely to walk in their neighbourhood. While in Amsterdam, initiatives aiming to connect and engage the community through health values are using mobile apps to create spaces that the community values as well as supporting local evidence bases on health. 

Evaluation will help designers refine their design solutions and to pursue the most effective interventions for healthier cities. And since persuasive narratives are crucial for explaining the intangible outcomes and benefits of healthier cities to decision makers, there is also an opportunity to demonstrate the benefits of, and incentives for, investment in healthy developments in the future. 

How can we help and encourage our clients and collaborators to follow-up urban interventions to improve health and wellbeing?