Published in 2/2023 - Care


Towards a Pattern of a Healthy City

Emilia Rönkkö, Helka-Liisa Hentilä

Catharijnesingel, Utrecht. OKRA Landscape Architects 2020. Photo: Stijn Poelstra

Along with the Covid-19 pandemic, there has been a growing interest in the impact of the living environment on health and wellbeing. A research consortium led by the University of Oulu is trying to find out how future epidemics can be tackled by means of urban planning.

Over the past three years, medicine has, in an unforeseen manner, produced new information and solutions in order to tackle the Covid-19 pandemic, which is a global health hazard. At the same time, there has been a great need to study those indirect social, cultural and economic impacts that the lockdown of society may have in a long run. 

In the field of urban planning and design, too, new research information has been published at an accelerating pace regarding the impacts of the Covid-19 pandemic on urban environments, such as density and transport connections, quality of life and the socio-economic situation. Traditionally, the time perspective of urban planning and design has been long, but along with the pandemic, we have had to consider whether these kinds of crises also create pressure for a quicker publication of research results in the field of urban planning and design and for developing evidence-based planning and design solutions. 

In other words, the pandemic and the other crises taking place in the 2020s may result in an ever stronger paradigm shift towards evidence-based planning and design.1 The planning of so-called healthy cities has, for decades, been on the agenda of the World Health Organization (WHO). In their well-known Rainbow model2, Göran Dahlgren and Margaret Whitehead suggested, in the early 1990s, that the living environment constitutes an important part of health.

Generally speaking, subfactors of health may be health-promoting, protective (e.g., a vaccine) or they may tackle health hazards. It should be noted that, previously, the planning of and research on healthy cities almost entirely focussed on finding solutions for non-communicable deceases and particularly for the global problem that deals with a sedentary lifestyle. The Covid-19 pandemic put infectious diseases back onto the agenda of urban planning in the Western world, too, which has a high standard of living. 

In a project called Resistant Cities: Urban Planning as Means for Pandemic Prevention (RECIPE) led by the Oulu School of Architecture, University of Oulu, we are studying the role of urban environments and the opportunities of urban planning to prevent outbreaks of infectious disease epidemics. Our aim is to produce new knowledge and build systemic understanding of the mechanisms which are linked to the urban living environment and which increase wellbeing and improve resistance. We study, in particular, the connection of physical activity and diverse urban greenery to immunological health and resistance. In addition, we also study and develop multidisciplinary processes and evaluation tools in urban planning.

The proximity to forest areas is linked to a lower Covid-19 mortality rate.

Catharijnesingel, Utrecht. OKRA Landscape Architects 2020. In Utrecht, the city ring canal had been transformed into into a highway some 50 years ago. Lately, the road has been rewilded back into a canal and public space. The canal also serves as the basis for making the historic city centre climate adaptive. Photo: Stijn Poelstra

Contacts with Nature Increase Wellbeing

Currently available research evidence suggests that a living environment with rich biodiversity and contacts with nature strengthen our immune system.3 We also have extensive knowledge of the positive effects of nature on mood, blood pressure and stress levels. New evidence has been obtained regarding the connection of nature contacts with immunological health in a recent international study4, according to which the proximity to forest areas is linked to a lower Covid-19 mortality rate. However, the mechanisms of action are complex and further research is required. It would be especially interesting to see whether it is possible to produce evidence-based dose-response recommendations regarding an optimal amount of exposure to urban nature in the same way as has been done for health-enhancing and daily physical activity. Forest prescriptions written by doctors have already been tested in practice in Finland, too. Nevertheless, the evidence-based recommendations or target values for the promotion of nature contacts and physical activity should be more closely linked to the practice of urban planning and design. A good example of this is a recent study that has sought to define target values for the planning and design of urban environments that support physical activity.5

In other words, it is possible to plan – in a determined manner – urban environments that promote wellbeing. From the perspective of behavioural sciences, it is interesting to study how to increase positive exposure to good soil microbes. Wellbeing effects can be amplified by, for instance, aligning pedestrian and bicycle routes through green areas, but choices made by individuals do play a key role in how they manage to benefit from these aspects. Besides the accessibility of the green infrastructure, the frequency of visits and the exposure period are also important. 

Currently available research evidence suggests that a living environment with rich biodiversity and contacts with nature strengthen our immune system.

Hermanninranta master plan, Helsinki. Loci Maisema-arkkitehdit, City of Helsinki 2021. A key feature of the residential area planned in Hermanninranta is the wild waterfront park, which benefits from ecological solutions and aims to support urban biodiversity.

The quality of green areas significantly varies between and within cities, and, therefore, it is also necessary to study how active the use of green areas is and which preferences citizens have regarding their environment. Hence, the RECIPE project focusses – with the help of PPGIS questionnaires – on what kind of green environments are favoured by citizens and why. By analysing soil samples, we seek to produce new knowledge regarding whether certain types of urban green areas and their microbiological diversity are connected to the occurrence of infectious diseases.

Our preliminary results regarding the pull factors of green environments appear to be partly polarised: for some respondents, green areas are attractive when they are well taken care of and clean as well as provide supporting services. According to another group of respondents, green areas are attractive because they are natural, quiet and “have been left as they are”. It is also worth noting that contacts with nature and time spent in nature make people’s attitudes more positive towards nature itself. The Covid-19 pandemic may have temporarily strengthened citizens’ relationship with nature, which has caused busy peaks in recreational areas. Temporary changes may also lead to more permanent changes as to how and where people live, work and spend time. 

The results of the questionnaire will be utilised at co-creation workshops in which we discuss how the built environment can facilitate the making of choices that support wellbeing and guide people to act in ways that promote wellbeing. Our ultimate goal is to link urban planning solutions that promote health and wellbeing to a richer palette of methods for the promotion of public health. New trends in the development of promoting health and wellbeing include the utilisation of behavioural change theories as well as service design. New operating methods also challenge notions of silo mentality, according to which health promotion only concerns the health sector and not, for instance, the so-called technical sector.

Sporta pils community garden, Riga 2021. The Sporta pils community garden is the first urban gardening project in Riga, located on the plot of a demolished sports hall (sports pils). The project began on the initiative of one neighbourhood resident but ultimately more than 200 people participated. Its future success depends on continued commitment from the community.

Societal Security and Resilience

In the planning of healthy cities, this is a core question: how can an urban living environment support an active lifestyle and nature contacts in the best possible way and, how can exposure to, for instance, infectious diseases be reduced? Overlapping objectives and crises require that planning is synoptic, adopting a phenomenon-based and systemic approach that connects various views, as well as relationships between the phenomena and their mutual dependencies.6 This is why the planning of a resilient and healthy urban environment should more clearly be connected to comprehensive societal security, which is built on so-called “hard” security and “soft” safety. Key factors in strengthening both hard and soft societal security are ecological, economic and sociocultural diversity and resilience.

Societal security includes endurance of the built and digital infrastructure against direct threats. By means of urban planning and design, it transforms into physical buildings, a road network, bridges or green areas. Their functional and structural resilience is important in order to maintain societal functions in crisis situations. Crisis tolerance is increased by backup systems and by an opportunity to limit and disperse risks. 

Consequently, many metropolises have – sped up by the pandemic – advanced a policy that advocates 15-minute city districts and a new kind of hyperlocal urban planning, in which an adequate degree of self-sufficiency and autonomy of city districts allows physical contacts to be cut off in a crisis situation. The preconditions for this are short delivery chains, local services, as well as a small-scale production of energy and food. Due to digitalisation, it is possible to carry out more dispersed activities, but on the other hand, digitalisation makes societies more vulnerable than before to information network disruptions and power blackouts. Hence, the infectious disease pandemic has questioned the centralising urban development and spatial planning policy. 

Societal safety, in turn, means the feeling of being safe and socially engaged, as well as the citizens’ trust in the administration. In recent crises, its role has further increased. The Covid-19 pandemic has scanned spatial, social and economic inequality in society and an unequal division of duties. On the other hand, the pandemic has emphasised the role of informal, non-productised help and safety nets. At the same time, the welfare state’s formal, institutional forms of service supply have met the limits of their critical carrying capacity. Social resilience can be built indirectly – with the help of urban planning – by preventing, for instance, segregation through the placement of services in a certain manner.

South Harbor of Køge, Denmark. SLA 2023. Once an industrial harbor, the South Harbor of Køge is now a resilient, nature-based neighborhood. The network of lush commons handles all rainwater runoff and enhances biodiversity. Later on, the promenade will encircle the entire neighborhood, protecting it from future storm surges. Photo: SLA / Mikkel Eye

A Post-Pandemic Way to Perceive the City

Throughout history, cities have been centres for the spreading of epidemics, but also clusters of wealth and wellbeing. History has also shown that cities can manage and adapt to changes caused by illnesses, wars and economic collapses. Along with the climate change, new kinds of threats are formed by increasing floods, zoonoses and the thawing permafrost, making it increasingly probable that serious epidemics will become common.

What might the future cities that support health and wellbeing, in addition to ensuring the planet’s carrying capacity and crisis tolerance, look like? The environment, choices made by individuals, as well as equality relating to health and wellbeing, form a complex set of policies. Our research group has identified that the reality that is seen in the urban environment is often not included in political programmes that deal with the promotion of wellbeing.7 It would be important to closely link political measures to indicators that are based on scientific evidence. 

The pattern of a healthy city must be founded on a broad notion of environmental health. In other words, it must take into account traditional health hazards as well as positive environmental exposure factors and a perspective of the promotion of wellbeing. Multidisciplinary urban planning should be seen more clearly as a part of cross-administrative promotion of comprehensive security. At the same time, we could aim to close impact gap between scientific evidence and practical implementation and bring the tradition of public health promotion and the tradition of urban planning once again closer together. ↙

Docent. Currently works as research group leader in the RECIPE project at the Oulu School
of Architecture.

Professor of planning and urban design at the Oulu School of Architecture. Director of the RECIPE research consortium.

RECIPE project is funded by the Strategic Research Council (SRC), Academy of Finland.

1 Billie Giles-Corti et al.: ”What next? Expanding our view of city planning and global health, and implementing and monitoring evidence-informed policy”. The Lancet Global Health 10(6), 2022.

2 Göran Dahlgren  & Margaret Whitehead: ”The Dahlgren-Whitehead model of health determinants: 30 years on and still chas-ing rainbows”. Public Health 199, 2021.

3 Marja I. Roslund et al.: ”Biodiversity intervention enhances immune regulation and health-associated commensal microbiota among daycare children”. Science Advances 6(42), 2020; Parajuli Anirudra ym.: ”Yard vegetation is associated with gut microbiota composition”. Science of the Total Environment 713, 2020.

4 Yuwen Yang; Yi Lu & Bin Jiang: ”Population-weighted exposure to green spaces tied to lower COVID-19 mortality rates: A nationwide dose-response study in the USA”. Science of the Total Environment 851(2), 2022.

5 Ester Cerin et al.: ”Determining thresholds for spatial urban design and transport features that support walking to create healthy and sustainable cities: findings from the IPEN Adult study”. The Lancet Global Health 10(6) 2002.

6 Emilia Rönkkö; Eevamaria Juuti & Helka-Liisa Hentilä: ”Resistant, responsive, resilient cities: Urban planning as a means for pandemic prevention”. SBEfin. Emerging Concepts for Sustainable Built Environment. Virtuaalikonferenssi 23–25.11.2022. 

7 Mikko Kärmeniemi; Tiina Lankila; Emilia Rönkkö; Kari Nykänen; Heli Koivumaa-Honkanen & Raija Korpelainen: ”Do land use and active transportation policies change urban form and the transportation modal share? A longitudinal mixed methods study in the city of Oulu”. Journal of Transport and Land Use 15(1) 2002.