Urban design as preventative medicine
The Healthy City By Julia Bürgi 2 months ago
Over the past year we've heard much about what we can do as individuals to benefit our collective health. Wear a mask, stay at home, get vaccinated. Doctors, public health officials, and governments have determined the rest of the collective measures on behalf of everyone.

Many of us have felt helpless or disconnected. However, as urban designers, planners, and urbanists the health of the city is directly in our hands. What would happen if we designed our cities as a form of preventative medicine?

What does design for infection prevention and control look like?

 

Over the last 200 years, we have come to understand how the spatial design of hospitals and healthcare spaces influences human health. In tandem with personal protective equipment and administrative measures, spatial design has proven to be a critical intervention in preventing and controlling infections in health spaces. 

Spatial pioneers have included health practitioners, such as nurse Florence Nightingale, who advocated for more hygienic hospital spaces after witnessing that many soldiers in the 1853-1856 Crimean War were dying in the hospital instead of on the battlefield. Nightingale developed hospital designs that included more space between beds, increased airflow, and surface disinfection regiments to remove human waste and bodily fluids that can lead to infections. These practices were adopted in wartime hospitals in Turkey, and later in her home country of England as well.

Around the very same time, mapmaker John Snow demonstrated the power of urban design to impact health by examining the relationship between cholera cases and water sources in London. His famous 1851 map revealed the waterborne nature of cholera – though this truth was only accepted by his peers and public health experts well into the 20th century.

The link between the built environment and health is clear. So how can we apply these lessons to urban design today?

How can we design for COVID-19?

The built environment needs to serve the same human needs regardless of its scale at the building or urban level: we all need clean air, water, and light. 

Image credit: @poolydrawnlines

Interventions to provide these necessities are en vogue at the moment and are being integrated into the designing of liveable, ecological cities.

Clean air means several things – it means providing both healthy ambient air quality, as well as the ability for people to take advantage of natural ventilation across climate types. Healthy ambient air is created by minimizing and/or reducing pollution – decreasing cars on the road (including through public transportation infrastructure), using renewable energy sources, preventing crop burning and forest fires, and developing a healthy, verdant urban ecosystem. These actions have auxiliary benefits – cities with greenery and rich biodiviersity, for example, can be better for walking, mental health, and offer better sound insulation. 

Airflow between and within spaces is also an important part of infection prevention and control. Urban designers should be conscious to orient spaces in order to maximize use of natural airflow, or at least avoid designing spaces that intensify urban heat island effects, therefore increasing reliance on mechanical ventilation year-round. 

Access to clean, infection-free water is also critical. This includes designing for adequate sewer systems and sanitation plants throughout a city, but also means conscientiously designing the urban environment to avoid water pollution. This means designing porous surfaces (and minimizing paved ones) so that water is absorbed through soil throughout the city, thereby minimizing runoff. Benefits beyond immediate human health include reduced threat of flooding and loss of habitat for plants and animals.

Like most living things, humans need light to thrive. While this may seem more appropriate for architects to take into account, urban designers can also have an impact on this by guaranteeing daylight availability in their plans.

Sunlight provides surface disinfection benefits and is critical for bone health, lowering blood pressure, mental health, and generating vitamin D. Urban environments, therefore, should be designed to provide every home with sufficient daylight, in addition to prioritizing parks and recreational green spaces with sun access in residential and commercial areas. (On the other side, of course, too much sun can pose hazards to health, so equitable access to shade is of equal importance!).

What are the benefits of designing our cities for infection prevention and control?

 

In addition to designing for preventative health, cities can also be designed to encourage better baseline health of its populations – people with poorer health to begin with are at higher risk of experiencing the most extreme effects of infectious disease. Trends such as designing walkable cities, providing spaces for people of all ages and physical abilities, and creating woman-friendly spaces  (across both wealthy and non-wealthy areas) therefore go hand-in-hand with preventing the spread of infectious disease. 

We have learned from COVID-19 that not everyone has access to homes and neighborhoods that  keep them healthy. To promote health and prevent disease through urban design is to minimize disruptions to the quality of life and financial operations of a city. I call on urban designers, planners, urbanists, and policy-makers to guarantee and expand access to clean air, water, and light throughout cities in response to COVID-19 and in anticipation of future potential pandemics.

About the author:

Julia Bürgi is a design thinking consultant based in Zurich with degrees in architecture and urbanism studies, as well as years of work in public health. In this nexus, Julia has specialized in infection control and the way our surroundings influence our health. Her work and passion for addressing social impact issues with a design-centric lens has taken her across the globe. Most recently, she has worked on “Guidelines for COVID-19 Quarantine and Treatment Centers in the Ethiopian Context” with the Association of Ethiopian Architects as well as “Guide to COVID-19 Prevention and Control in the Workplace” and “Guide to using germicidal GUV for tuberculosis” with Advance Access & Delivery.