Health and the City


Public health concerns played an important role in the way in which our modern cities were originally built. The desire to improve public health and safety compelled cities to establish safe water supplies and sewerage infrastructures.

However, for at least half a century, health concerns have taken a backseat to a focus on mobility as planners have sought to optimize the city for drivers. In recent years, the relevance of urban design to health has reemerged, with a growing awareness that urban design is contributing to lifestyle diseases that diminish the health of World 1 and, increasingly, World 2.


  • Public health interventions using urban design and planning will increasingly be used to help curb lifestyle diseases.
  • Cities will shape urban physical environments to facilitate healthier lifestyle choices by residents.
  • Urban environments impose a wide variety of cognitive burdens on urban residents, negatively affecting mood, decision-making, and attention span. Even brief exposure to nature and greenery has beneficial physical and mental effects.

3 Drivers for the Rebirth of Urban Public Health

One of the primary motivations for health researchers to examine the connection between cities and health is the growing disease burden posed by diseases of affluence. Many people in World 1 and developing economies in World 2 are getting caught in a vicious cycle: higher incomes lead to higher-calorie diets, sedentary lifestyles, and higher rates of car usage that further reduces physical activity.

  • Growing obesity. Obesity is a global problem. There are 1 billion overweight people worldwide, and 300 million of those pass the threshold of obesity. One of the primary causes of expanding obesity is growing adoption of World 1 diets, and increased availability of foods with high levels of fat, sugar, and calories.1 Around the world, calorie intake is rising, but modern lifestyles make it a challenge to engage in enough activity to compensate.
  • Sedentary lifestyles. Modern lifestyles tend to be sedentary lifestyles, with work, travel, and entertainment all commonly performed in a sitting position. In the US, the vast majority of adults engage in few vigorous activities. According to a study in the American Journal of Preventive Medicine, only 5% of Americans engage in any form of intensive exercise on an average day.2 Sedentary lifestyles are common in the EU as well, where Portugal is the most sedentary with 85% of men and 90% of women leading sedentary lifestyles. In general across the EU, Scandinavian countries are most active, while Mediterranean countries are the most sedentary.
  • Auto-dependence. Car-centric mobility systems—especially in the US—make the car the default mode of travel even for short trips. For trips under one mile, cars and trucks are used 60% of the time in the US.4 This fact is reinforced by sprawling development patterns that design roads around the needs of motorists, and neglect the mobility needs of pedestrians or bikers.

3 Supporting Trends

  1. Green urban infrastructure: Preserving and expanding greenspace and planting trees can directly improve quality of life for city residents.
  2. Food demand and supply rising: World 2 countries are developing a taste for fast food and World 1 diets. Early action in growing World 2 cities could preemptively limit the spread of fast food restaurants and convenience stores.
  3. Urban middle classes will sprawl: Emerging World 2 middle classes will spread into suburban areas. World 2 cities can still ensure that these new communities preserve mobility options for residents.

3 Business Implications, Opportunities, and Threats

  • Companies can make relatively inexpensive upgrades to their retail or commercial properties that can boost their appeal for both workers and customers. Parking lots could be dotted with trees; high-maintenance lawn can be converted into biodiverse and low-impact meadow. Appropriate and appealing landscaping can help elevate the brand and provide differentiation from competing retailers. It may also help create a more healthy and productive workspace for employees.
  • Companies could expand their “green” marketing initiatives by sponsoring and subsidizing tree-planting programs or the maintenance of local parks. Conversion of unused public spaces into small pocket parks can tangibly improve consumers’ daily lives and help build community good will for low levels of investment.
  • Fast food is increasingly being perceived by regulators as an unhealthy vice. Banning fast food from areas around schools and restricting the sale of promotional toys with fast food meals are early stages of the application of a vice model to fast food. Future campaigns against fast food could come in the forms of restrictions on TV and print media advertising, prominent product warning labels, and high sin taxes to curb demand. While some societies will embrace these approaches, others will consider it too much government meddling, and still others will take a “wait and see” attitude; but in at least some places, cities will implement programs that promote citizen health through healthy diet.