Designing and Implementing Urban Health Projects: Exploring Impact Assessment Tools and Best Practices
‘Creating a healthy environment for communities and citizens’ is a webinar series focusing on person-centered, health and wellbeing-steered urban planning and design. It tackles the topic of urban health from different perspectives. The first episode was dedicated to evidence-based urban health planning, approached through the lenses of policy-making. The second episode is part of the European Public Health Week 2023 and focuses on tools that exist to conduct rigorous health impact assessments of urban projects.
- Ms. Ruth Gow, Architect, and Urban Planner, Expert in Urban Planning and Housing for Healthy Cities
- Ms. Saira Ali, Landscape Design and Conservation Team Leader, City of Bradford Metropolitan District Council
- Dr. Ana Novoa, Public Health Senior Technician, Public Health Agency of Barcelona
- Mr. Richard Middleton, Townscape Heritage Scheme Project Officer, City of Bradford Council
Incorporating Health into Urban Planning
A healthy city is defined as a city that encourages and facilitates a full and healthy lifestyle, providing an environment that supports our physical health, as well as our mental well-being and happiness. The density, connectivity, and green spaces in a neighborhood can all shape an individual’s lifestyle and in turn, impact their health. Incorporating health into urban planning is therefore essential.
One tool that facilitates such a process is the free-to-use Healthy Cities Generator. Based on a systematic review of scientific research linking urban determinants to their impact on health, the Healthy Cities Generator calculates the health effects of a given urban planning action. It is a holistic tool that considers 20 features of the urban environment and links them to 30 health outcomes and health determinants in an easy-to-use interface. The tool also takes into account environmental factors such as noise or pollution that can have an effect on our health. The Healthy Cities Generator can therefore guide decision-makers, planners, and health professionals on how to incorporate health into urban planning.
The Healthy Cities Generator tool was developed in the context of the Healthy Cities action planning network financed through the URBACT program. The Healthy Cities action planning network is an initiative in which nine cities across Europe came together to incorporate the health vision into their current urban plans and transformations. Each city developed an action plan and used the Healthy Cities Generator to assess proposed actions and their expected health impacts. The positive results of the project prompted its continuation beyond the project’s conclusion, with other cities, such as Birkenhead in the UK and Barcelona, also utilizing the tool to assess urban plans and evaluate health impacts.
One of the pioneering cities in which the Healthy Cities Generator tool was used is Bradford. Bradford is the sixth largest city in the United Kingdom with a diverse population and a legacy of challenges related to its historical growth and lack of green spaces. It comprises several deprived communities that suffer from health inequalities. For instance, some deprived communities in Bradford experience a 10-year life expectancy difference compared with more affluent communities. The city therefore aimed to address these existing public health inequalities and promote well-being through urban planning interventions. The city also identified the need to change the environment and provide better lifestyles for the population, particularly focusing on behavioral change.
The URBACT project, including the Healthy Cities Generator, helped the City of Bradford in several ways. Firstly, it encouraged strategic thinking and the development of an integrated action plan to address public health issues. Secondly, the Healthy Cities Generator tool provided a means to measure the value of actions taken against public health outcomes, supporting evidence-based decision-making. Additionally, being part of a wider network allowed them to share knowledge, learn from other cities facing similar challenges, and collaborate effectively.
The City of Bradford highlighted that successfully integrating health into urban plans requires a health-in-all-policies approach and interdisciplinary collaboration between stakeholders from various departments and backgrounds. It is also key to adopt a bottom-up approach and engage the community – including hard-to-reach communities – to lead on what they want their city to look like. Lastly, having strong co-creation and co-designing processes in place instills a sense of agency and ownership in the community, leading to greater engagement and benefits.
In Barcelona, the Public Health Agency of the city used the Healthy Cities Generator tool to evaluate the impact of the Barcelona Green Axes Project, which focused on increasing urban green spaces and enhancing pedestrian and cyclist-friendly areas. In particular, the Public Health Agency of Barcelona used the tool to link urban determinants to health determinants and to assess interventions that have the potential to impact various aspects of health, including mental, and physical health, and health outcomes associated with mobility.
Lessons learned from impact assessment tools
When carrying out urban modifications, it is key to consider their impact on health inequalities. For example, there are potential inequalities that can arise from greening policies in cities, where housing prices in greener areas may increase, making them less affordable for certain communities. It is, therefore, necessary to take into account how it impacts population groups according to their age, gender, country of origin, and socioeconomic status amongst others. The evaluation and design phases of urban interventions must consider these factors to ensure that the modifications benefit all segments of the population and do not exacerbate existing inequalities. Collaborative work between different departments, such as housing, is also crucial to minimizing the negative effects of a given urban intervention. Retrofitting existing infrastructure and investing in inner-city areas can for example contribute to the overall uplift and inclusivity of the city. From the perspective of the Healthy Cities Generator tool, there are plans to expand its scope to address social issues and provide recommendations on how to avoid such inequalities.
Lastly, it is important to engage with young generations to design cities that cater to their needs and aspirations as they grow up, thus ensuring that they do not feel the need to move elsewhere. Engaging with women and young girls is also crucial, as spaces and active areas are often designed with a focus on men and boys. Addressing public health challenges related to aging, such as loneliness among the elderly community, is also important.
Conclusions and Connection with HEART
In conclusion, the webinar highlighted the importance of person-centered, evidence-based, and health-oriented urban planning and design. The Healthy Cities Generator has emerged as a valuable tool for informing and assessing the health impacts of urban planning actions, monitoring changes in public health over time as well as providing guidance for decision-makers, planners, and health professionals. The tool is particularly beneficial for small and middle-size cities and towns in developing business cases, making recommendations, and evidencing the importance of health considerations in urban plans. As shown by the success stories of Bradford and Barcelona, local authorities play a leading role in turning our cities greener and healthier. Adopting a broader strategic perspective and fostering active engagement with various stakeholders – including the community – is vital. There is also a need to address health inequalities, consider diverse demographics, and foster ownership and inclusivity in urban spaces. By creating cities that prioritize health, engage citizens, and promote well-being, we can build sustainable and thriving communities for generations to come.
In the future, the scope of the Healthy Cities Generator tool is expected to be broadened to include social determinants of health and address the impacts of urban plans on social aspects like displacement and gentrification. Sub-modules are envisioned to delve deeper into specific topics such as green and blue solutions, allowing for a more detailed analysis of their impact on health outcomes. The HEART project could provide valuable insights into the effects of blue-green solutions on health and well-being that can be integrated to further develop the tool.