Elsevier

The Lancet

Volume 388, Issue 10062, 10–16 December 2016, Pages 2912-2924
The Lancet

Series
City planning and population health: a global challenge

https://doi.org/10.1016/S0140-6736(16)30066-6Get rights and content

Summary

Significant global health challenges are being confronted in the 21st century, prompting calls to rethink approaches to disease prevention. A key part of the solution is city planning that reduces non-communicable diseases and road trauma while also managing rapid urbanisation. This Series of papers considers the health impacts of city planning through transport mode choices. In this, the first paper, we identify eight integrated regional and local interventions that, when combined, encourage walking, cycling, and public transport use, while reducing private motor vehicle use. These interventions are destination accessibility, equitable distribution of employment across cities, managing demand by reducing the availability and increasing the cost of parking, designing pedestrian-friendly and cycling-friendly movement networks, achieving optimum levels of residential density, reducing distance to public transport, and enhancing the desirability of active travel modes (eg, creating safe attractive neighbourhoods and safe, affordable, and convenient public transport). Together, these interventions will create healthier and more sustainable compact cities that reduce the environmental, social, and behavioural risk factors that affect lifestyle choices, levels of traffic, environmental pollution, noise, and crime. The health sector, including health ministers, must lead in advocating for integrated multisector city planning that prioritises health, sustainability, and liveability outcomes, particularly in rapidly changing low-income and middle-income countries. We recommend establishing a set of indicators to benchmark and monitor progress towards achievement of more compact cities that promote health and reduce health inequities.

Introduction

Significant global health challenges are being confronted in the 21st century, including increases in unhealthy diets, physical inactivity, non-communicable diseases (NCDs), injuries from road trauma, and obesity, combined with population growth, rapid urbanisation, and climate change, prompting repeated calls to rethink approaches to prevention.1, 2, 3, 4, 5 Decisions about housing, food, water, energy, transport, social services, and health care6 will profoundly affect the health, wellbeing, and safety of growing and ageing urban populations.4, 6, 7 With the world's population estimated to reach 10 billion people by 2050, and 75% of this population living in cities,5 city planning is now recognised as part of a comprehensive solution to tackling adverse health outcomes.5

Associations between city planning and health are not new. In the 19th century, planning curbed infectious disease outbreaks in industrialising cities through improvements in sanitation and housing and separation of residential areas from industrial pollution.8, 9 In the 21st century, well planned cities have the potential to reduce NCDs and road trauma and to promote health and wellbeing more broadly. This could be achieved by reducing automobile dependency, traffic exposure, pollution, noise, and urban heat-island effects, while enhancing mental health, contributing to climate change mitigation, and promoting walking and cycling in ways that are safe, comfortable, and desirable.

Leading global agencies recognise that city planning and management decisions affect the liveability of cities6 and, ultimately, the health and wellbeing of residents. WHO recommends “placing health and health equity at the heart of [city] governance and planning”,10 highlighting the need for integrated urban planning, transport, and housing policy. This mirrors the Organisation for Economic Co-operation and Development's call for leadership from “transport, land use and health ministers” to create the “legal, administrative and technical frameworks” that promote walking.11 Similarly, the UN has endorsed integrated agendas to combat NCDs.12 The UN's Sustainable Development Goals include promoting healthy lives and wellbeing by making cities inclusive, safe, resilient, and sustainable.13 However, changing the way cities are planned, built, and managed will require bipartisan political leadership and community engagement.

Key messages

  • Significant global health challenges are being confronted in the 21st century, and well planned cities that encourage walking, cycling, and public transport use have an important role to play in addressing these challenges

  • Urban and transport planning and design can directly and indirectly affect non-communicable diseases, traffic injuries, and other adverse health and environmental outcomes

  • Local and regional interventions can affect urban and transport planning and design, and these influence environmental, social, and behavioural risk exposures

  • Integration of well implemented urban systems policies are needed to achieve healthy liveable cities

  • Transport, planning and health ministers must develop appropriate legal, administrative, and technical frameworks contextualised to local conditions, to deliver compact pedestrian and cycling friendly cities that reduce private motor vehicle dependency

  • City planning indicators are required to monitor progress within and between cities

In a rapidly urbanising world, understanding how urban and transport planning and design decisions affect health is important. City planners have traditionally focused on the physical, social, economic, and environmental aspects of where people live.14 However, rapid changes in motorised transport have increased the geographical size of urban areas. Combined with unprecedented urban population growth, this change has put transport mobility at the forefront of city planning. Early in the 20th century, engineers began addressing traffic congestion and road trauma in European and North American cities. Transport engineering soon emerged as a new field, gaining political and economic influence with the construction of national motorway networks after World War 2. Transport planning followed as an engineering subfield.15 City planning and transport planning are now typically run at all levels of government, but in separate agencies. Both are closely linked to political systems because they oversee major capital-intensive operations.16 However, these disciplines currently operate in separate academic settings with their research underpinned by different theoretical approaches.17

This Lancet Series focuses on the health impacts of city planning through transport mode choices. Drawing on evidence from multiple disciplines and using critical and systematic reviews where available, in this, the first paper we review the published work and propose pathways through which urban and transport planning and urban design (together referred to as city planning) directly and indirectly affect NCDs, traffic injuries, and other adverse health outcomes. We also identify eight urban and transport planning and design interventions and consider their influence on eight environmental, social, and behavioural health risk exposures. The second paper in this Series18 models some of the pathways through which city planning affects health. The third paper19 focuses on research translation by considering how science can be, and is already being, used to guide city planning policy and practice that create compact cities that promote health.

Section snippets

Eight interventions to promote health

Urban planning and transport planning academics have long sought to understand ways to reduce motor vehicle kilometres travelled and encourage use of public transport and active transport modes such as walking and cycling.20 These academics have identified six key built-form characteristics and related policies that are referred to as the 6Ds.20 Building on this work, we identify eight integrated interventions that are needed to create cities that promote health (table 1). We also differentiate

Traffic exposure

Here we consider evidence for eight environmental, social, and behavioural risk exposures related to urban and transport planning and design decisions (figure 1), which in turn affect NCDs, injuries, and other adverse health outcomes.

Private motor vehicle sales are often used as an indicator of economic growth, development, and modernisation. However, a higher reliance on private motor vehicles increases traffic volumes and road trauma,25, 26 resulting in injury and early death.27 Road traffic

Implications of urban planning and design initiatives in LMICs

Translation of evidence from high-income countries into appropriate policies for LMICs, where urban environments often differ greatly, can be challenging. For example, in most middle-income countries, overall density patterns are considerably higher118 and cities tend to be more compact and monocentric (with jobs, cultural opportunities, and activities located mainly in the city centre).119 Urban residents in LMICs also depend heavily on informal and relatively inexpensive on-demand transport

Discussion

The escalating personal, social, and economic burden imposed by rapidly rising rates of NCDs and their risk factors,12 together with the health and societal impacts of climate change,4 will produce immense human and environmental harm that threatens to undermine global social and economic development and security.12 Between now and 2030, an estimated US$58 trillion is needed worldwide to upgrade, maintain, and develop urban infrastructure to meet growing demand and the challenges of the 21st

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