Breaking Ground on Urban Health

Where we live matters for our health. And more and more of us are living in cities—an amazing 80% of the world in the near future, according to one estimate. Knowing this, how can we harness the urban environment to improve the health of those of us living there?    

This question is ground zero of a new Urban/Health program organized by Columbia’s Mailman School of Public Health and Graduate School of Architecture, Planning, and Preservation (GSAPP). On April 22, the two schools inaugurated the program with a daylong symposium at the GSAPP Studio X space downtown during which experts from both fields swapped healthy city strategies from bike paths to birthing rooms.  “If you’re really serious about cities,” said Mark Wigley, PhD, dean of GSAPP, “in the end, you’re going to be serious about health,” and vice versa.

Carlos Dora

The urban health conversation has been ongoing for more than hundred years.  Beginning in the middle of the 19th Century, well before the discovery of antibiotics, the battle against widespread urban infectious disease was won using the built environment of the city itself, observed panelist Karen Lee, MD, senior adviser on the built environment and healthy housing at the New York City Department of Health and Mental Hygiene. For instance, the construction of New York’s Croton reservoir in 1842 helped wipe out cholera. Today’s principal adversary is chronic disease stemming from a lack of access to healthy food; an environment that discourages walking and cycling; and air pollution from industrial development and automobiles.  Once again, the urban environment is being drafted into service.

New York is renowned for being ruled by pedestrians (think John Travolta in “Saturday Night Fever”). But just how much walking do New Yorkers do, and what makes them pound the pavement? Panelist Andrew Rundle, DrPH, associate professor of Epidemiology, explores these questions using GPS monitors to track how people move about their neighborhood block by block and matched it with the street’s “walkability”—a measure Rundle borrowed from urban planners that refers to how much a neighborhood’s built environment encourages walking and biking: two activities that have clear links to good health. It turned out that half of New Yorkers walk more than national recommendations. And surprisingly, the amount of crime in a neighborhood has little effect on pedestrian activity. Proximity to walk-up retail and subways matter more.

“Creating spaces for walking is a panacea,” said keynote speaker Carlos Dora, MD, coordinator of the Interventions for Healthy Environments unit at the World Health Organization. “No medicines can do this.” Over the last decade, New York City has taken up this philosophy, aggressively reshaping the five boroughs to promote physical activity, by adding bike lanes, bus lanes, and pedestrian plazas—interventions that have the advantage of being relatively modest investments.

While new technologies like self-driving taxis and buildings constructed using 3D printers are around the corner, low-tech solutions are needed. This is particularly urgent in the growing number of urban slums, said panelist Gina Lovasi, PhD, assistant professor of Epidemiology, who with colleagues at GSAPP recently spent time in the favelas in Rio de Janeiro. Lynn P. Freedman, MPH, JD, professor of Population and Family Health, gave a case study on her experience with a simple but highly effective intervention in the slums of Dhaka, Bangladesh, where following the introduction of clean birth rooms integrated into slums, the number of women giving birth at home plummeted.

Deans Linda P. Fried and Mark Wigley

While the successes are remarkable, there are some areas of the urban health project that are underdeveloped. According to Dora, too much attention has been paid to studies looking for the drivers of illness—the effects of air pollution, for example. “We focus on disease because it’s so dramatic,” he said. Instead more research is needed to weigh the effectiveness of various interventions. Unintended consequences like gentrification are another serious concern. Reshaping neighborhoods may exacerbate health disparities and shorten life expectancy. Inequality must be considered when planning interventions, noted Lovasi. New York City’s new bike share program does not extend to neighborhoods with the highest obesity rates, she added.

Designing healthy cities requires design: aesthetics matter. Even with the apparently simple task of getting people to take the stairs. Natural lighting in stairwells and other design elements make a big difference, said Karen Lee. This kind of insight is only possible when public health experts partner with designers, architects, and planners. The moment is ripe for collaboration, agreed Hilary Sample-Meredith, AIA, associate professor of Architecture, Planning and Preservation. 

“While the spark of ideas may come from someone’s imagination,” said Linda P. Fried, MD, MPH, dean of the Mailman School, “there are public goods [like healthy cities] that we can only accomplish together.”