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In December 2018, the Royal Society of Medicine (RSM) held a day-long conference that brought senior decision-makers from the NHS, city government and the urban development community together with major research funders and academics leading some of the latest research in the field of healthy urban development.   The event was hosted by the Epidemiology and Public Health Section of the RSM, and chaired by its President, Dr Gabriel Scally. Dr Scally set out the headline challenges facing urban development decision-makers in terms of the growing burden of non-communicable disease and environmental costs, before introducing the first keynote speaker, Sir Malcolm Grant, Founding Chairman of NHS England.
Sir Malcolm provided delegates with a rare and valuable insight in to the history of the NHS, the critical and growing importance of prevention to the healthcare sector, and why the NHS has recently shifted some of its focus and considerable resource to a new Healthy New Towns programme, which explores new models of healthcare and digital futures, as well as the design of health-oriented developments. The second keynote was Professor Howie Frumkin, the new Head of Wellcome’s pioneering Our Planet Our Health programme. Professor Frumkin calmly presented a devastating picture of a planet and a people under existential threat from a multiplicity of environmental challenges, using the analogy used most recently by 16-year old environmental activist, Greta Thunberg - ‘our house is on fire’ - while also underlining the critical importance of research in enabling solutions. Dr Paul Pilkington and Janet Ige from UWE Bristol’s Department of Health and Social Sciences then described the state of the evidence: what we know, and don’t know, about the interaction of environment and health. This was based on a comprehensive review of the health literature in five areas - transport, buildings, natural environment, neighbourhood design and food – and where the gaps in evidence appear to be. Of a total of 26,428 publications retrieved, 209 were taken forward for review. Example key findings include:
Dr Alistair Hunt and Eleanor Eaton from the University of Bath’s Department of Economics presented their work on the economic cost of getting it wrong, and the bonus of getting it right. They had valued the potential change in human health between standard and optimal urban environments based on 26 characteristics of describing the built environment and 60 linked health outcomes. Their model includes cost of medical treatment, loss of productivity and a measure reflecting the pain and suffering associated with illness and mortality. Bearing in mind the varying evidence base as set out above, the top five characteristics that according to this valuation have the largest potential for impact on health were: green space, air quality, noise, overheating and proximity to a main road. After lunch Ruth Larbey of UWE Bristol’s Science Communication Unit spoke about her team’s experience in undertaking a range of public engagement activities, including: the design and exhibition of the sculpture ‘Inhale’, a diesel soot particle three million times larger than real life, made by renowned artist, Luke Jerram; the development of an interactive web-game tested with local communities and used in classrooms; and a wide range of community events using jigsaw games, wish trees and citizen-led walks. Andy Burnham, Mayor of Greater Manchester, then delivered a humorous, passionate and engaging talk (without any notes or props) on his experiences in Government and as Mayor of one of the fastest growing and vibrant cities in the country. He focused specifically on how cities can get development right for their future health and wellbeing. He highlighted both specific aspect such as the connections between transport and physical activity and the general principles of how we need to build communities not just houses. Daniel Black, Director of db+a, first set out four key challenges in achieving impact in this area:
Daniel presented the main barriers and opportunities for creating healthier urban development drawing on thirty interviews with senior decision-makers from the UK’s main delivery agencies: city council, volume house-builder, real estate developer, district council, development corporation, regeneration joint venture and a start-up social investment vehicle. Main findings include:
Richard Meier, former Partner at Argent, then spoke of his experiences in overseeing the £3 billion redevelopment of King’s Cross in central London, one of the largest and highest profile city centre developments in the country. Finally, Victoria Hills, former CEO of the Old Oak and Park Royal Development Corporation and incoming CEO of the Royal Town Planning Institute, spoke about her experience in leading one of the UK’s largest development corporations and her new role leading the largest planning institute in Europe, founded in 1913, with over 25,000 members. The RTPI has a long history of engaging with the health community, not least following the Public Health Acts of the 19th Century and the Housing and Town Planning Acts of the early 20th Century. More recent RTPI research has focused on promoting healthy cities and tackling climate change. Dr Scally brought the day to a close by reminding the audience of the critical need for research to have impact, citing the quote: “The philosophers have only interpreted the world, in various ways; the point is to change it". A description of the event and its full agenda can be found on the RSM website: https://www.rsm.ac.uk/events/epidemiology-and-public-health/2018-19/epm01/ Presentations from the day can be found on the UPSTREAM website.  A fascinating BBC Radio 4 Bottom Line programme on university businesses last month (9th Feb 2019). Headlines:
1. UK university expansion over recent years has been due mainly to cheap borrowing* (sometimes govt backed), not increase in fees, which was broadly like-for-like shift of burden from Govt to private individual 2. University income is mainly from fees (c.50%), but also top-up from govt (e.g. for science), research funding (15-25%), and other (events, accommodation, etc); commercialisation of IP rare and sporadic 3. UK universities face three main threats: fee reduction (possible 2/3 current), visas (students can’t stay on), and Brexit (European students in particular); implications for sciences, which are more expensive to run than arts, and follow on policy implications 4. Changes to university fees (e.g. down to c.£6-7k) would hit some universities much harder than others; possible outcomes: a) merging with other Unis, or b) govt bail out (made more challenging due to govt backed loans); insolvency questioned due to existing govt backing and potential impact internationally, though bail out also questioned due to recent bail out of banks *Over and above the Further and Higher Education Act 1992, which allowed ‘polytechnics' to be given university status  "We are creatures with faces. We face things. We're good at it. And when we can't, we panic. We always panic when we can't do what we're good at, which is why office workers, who are naturally good at running down wounded kudu, are stressed to hell, fearful and overmedicated." Below a graph from the OECD published in the Economist in 2013 in an article titled 'Get a Life' showing the negative correlation between GDP per hour against hours worked. See article here  Mr Foster is a Fellow of Green Templeton College, University of Oxford, holds a doctorate from the University of Cambridge in medical law and ethics, and is a qualified veterinary surgeon.
This blog was first published on December 10, 2016  UK fourth from bottom, beaten only by USA, Singapore and Portugal. Scandinavian countries notable at the top.  USA a clear demonstrator that income is unrelated to country-level health and social care issues. Inequality = ill health. Credit: The Equality Trust (https://www.equalitytrust.org.uk/)  This blog was first published on November 7, 2016
 Neighbour's haunting pumpkin a reminder of what Halloween is about: to remember the dead. Like Christmas, it's been hijacked by consumerism.
This blog was first published on November 1, 2016  The maps above show clearly how voting preferences in Bristol correlate closely with deprivation. What's interesting to me is the location of those who prioritise green issues: those who live in wealthy, central Bristol. That deprivation correlates with people's priorities is not new - Maslow famously illustrated this in his Hierarchy of Human Need - but it raises a fundamental challenge we face if we are to address the catastrophic impacts many are projecting will happen if we don't act on green issues. Deprivation is a fundamental challenge for the green agenda Bristol has just voted in a new Labour Mayor, Marvin Rees, and voted out Bristol's first elected Mayor, the Independent (and green) architect, developer and social entrepreneur, George Ferguson. Turnout was double what it was at the last election. It was still a two horse race, and the numbers who voted for George Ferguson appear about the same, but the substantially increased turnout, particularly from Labour voters, was what made the difference. In so doing the people of Bristol have sent a strong message not just about about equality, but also, perhaps unconsciously, about the environment. It's not possible to tell whether people were voting Mr Rees in or Mr Ferguson out - it's likely to be a bit of both - but what has been in evidence has been the level of dissatisfaction that some of Mr Ferguson's initiatives have prompted, and particularly on the most mundane and all-pervasive issue of them all: parking. What has been made resoundingly clear is that a majority of people in Bristol, European Green Capital 2015, appear not to prioritise green issues over reducing car use. A majority of people in Bristol - European Green Capital 2015 - appear not to prioritise green issues over reducing car use It was the "good people of Clifton", the wealthiest neighbourhood in Bristol, who made the loudest statement on parking by driving a tank around the city in protest - though a light-hearted gesture, the Tweet below gives you a flavour of the strength of feeling - but it was the quieter Labour majority who moved Mr Ferguson out of office.  This reaction against Mr Ferguson was not unexpected and it won't be to him either. He invited fellow architect and three times Mayor of Curitiba, Jaime Lerner, over to speak at Bristol's Academy of Urbanism Conference back in 2014. Mr Lerner cited the Mayor of Bogotá, Enrique Peñalosa, who was initially voted in on a landslide, but who then carried out a series of major initiatives to improve the environment, most famously perhaps the Transmilenio transport network, which radically reduced car traffic and pollution, but also prompted rioting due to issues such as bus fares and lack of facilities. He was voted out at the next election. Until the voting public is on side, leadership on longer term green issues appears to be political suicide.
Until the voting public is on side, leadership on longer term green issues appears to be political suicide As someone who has worked in the environmental field for over a decade I have been immersed in stories day in and day out about the growing ecological debt we are in and the increasingly worse perils that we are likely to face. Somewhat naively, it's only recently that I've realised others have not shared in that experience and therefore are unlikely to prioritise these issues as I do. The voting in of a Labour Mayor in London (against a Green Tory) suggests a broader shift in public mood in our nation's major wealthy cities. Many argue that we can't address ecological issues without addressing equality. The Green Party's slogan is "For the Common Good" for a reason. The question is whether the voting public and Bristol and London's new Labour Mayors will prioritise green issues alongside equality, or whether one will trump the other. Given our short-term political time horizons, the need for mainstream education to adopt ecological literacy as a core subject has never been greater. This blog was first published on May 26, 2016 IBM's Vision for the Future: Utopian, Accepting or Dystopian? - Published on January 25, 20153/26/2018
 IBM CEO Ginni Rometty's masterclass in Board-level sales offers a fascinating insight in to the world of tomorrow (if we keep on going as we are). 23 minutes is a bit long in these bite-size times, but well worth sticking out at least the first 15-20 mins:
http://www.ibm.com/smarterplanet/uk/en/overview/ideas/index.html Here are some headlines:
Encouragingly, she did mention one fleeting example of how digital tech had created genuine value: a farmer managing to reduce water consumption by 10% and maintain or improve plant growth. To me this type of innovation was the only genuinely sustainable value offering that she mentioned a "Smarter Planet" might bring. For the whole system to maximise this potential requires all senior decision-makers to school themselves in "eco-literacy" and make it central to their every discussion. Data may be a new resource, but it comes only indirectly from the natural world and it comes after water, food, security, shelter and community. Then again, she was addressing corporations, not people, and they do seem to be leading the way in areas like climate adaptation, so perhaps their innate survival instincts will provide for us all. Fingers crossed. (Image credit: Luc Legay) Equality, eco-literacy, and electionsThe maps above show clearly how voting preferences in Bristol correlate closely with deprivation. What's interesting to us is the location of those who prioritise green issues: in wealthy, central Bristol. That deprivation correlates with people's priorities is not new - Maslow famously illustrated this in his Hierarchy of Human Need - but it raises a fundamental challenge we face if we are to address the apparently catastrophic impacts many are projecting will happen if we don't act on green issues.
Bristol has just voted in a new Labour Mayor, Marvin Rees, and voted out Bristol's first elected Mayor, the Independent (and green) architect, developer and social entrepreneur, George Ferguson. Turnout was double what it was at the last election, but it was still a 'two horse' race. The numbers who voted for George Ferguson appear about the same. The substantially increased turnout, particularly from Labour voters, was what made the difference. In so doing the people of Bristol have sent a strong message not just about about equality, but also, perhaps unconsciously, about the environment. It's not possible to tell whether people were voting Mr Rees in or Mr Ferguson out - it's likely to be a bit of both - but what has been in evidence has been the level of dissatisfaction that some of Mr Ferguson's initiatives have prompted, and particularly on the most mundane and all-pervasive issue of them all: parking. What has been made resoundingly clear is that a majority of people in Bristol, European Green Capital 2015, do not prioritise green issues on reducing car use. It was the "good people of Clifton", the wealthiest neighbourhood in Bristol, who made the loudest statement on parking by driving a tank around the city in protest - see Tweet below to get a flavour - but it was the quieter Labour majority who moved Mr Ferguson out of office. This reaction against Mr Ferguson was not unexpected and it won't be to him either. He invited fellow architect and three times Mayor of Curitiba, Jaime Lerner, over to speak at Bristol's Academy of Urbanism Conference back in 2014. Mr Lerner cited the Mayor of Bogotá, Enrique Peñalosa, who was initially voted in on a landslide, but who then carried out a series of major initiatives to improve the environment, most famously perhaps the Transmilenio transport network, which radically reduced car traffic and pollution, but also prompted rioting due to issues such as bus fares and lack of facilities. He was voted out at the next election. As someone who has worked in the environmental field for over a decade I have been immersed in stories day in and day out about the growing ecological debt we are in and the increasingly worse perils that we are likely to face. It's only recently that I've realised others have not shared in that experience and therefore are unlikely to prioritise those issues as I do. The voting in of a Labour Mayor in London (against a Green Tory) suggests a broader shift in public mood in our nation's major wealthy cities. Many argue that we can't address ecological issues without addressing equality. The Green Party's slogan is "For the Common Good" for a reason. The question is whether the voting public and Bristol and London's new Labour Mayors will prioritise green issues alongside equality, or whether one will trump the other. Given our short-term political time horizons, the need for mainstream education to adopt ecological literacy as a core subject has never been greater. As the threshold for the use of EIA on residential schemes is about to be lifted, and the impetus to regulate the inclusion of health continues apace, focusing in particular on its integration with Environmental Impact Assessment (EIA), it's perhaps worth illustrating what EIA was created for in the first place...in order to highlight what it is not useful for. Which is the 'odd one out' below? The answer is the bottom right: the urban extension. All the others are single-use projects. There's no doubting that all will have either a significant or a very significant impact on the environment, but the urban extension is a complex mixed/multi-use proposal that involves lots of people making lots of decisions every minute of every day. Environmental Impact Assessment was created to mitigate negative impact (e.g. ostensibly by moving endangered species out of the way). It is not a design tool. It can not help plan a healthy sustainable and resilient neighbourhood. It certainly can't ensure that the landowners and developers take their responsibility seriously. Neither can SEA, and neither, I fear, will HIA.
Which is more important: scale or ownership? Bristol currently offers a perfect opportunity to ask that question.
Bristol City Council in late 2013 announced that it is planning on releasing 10 major(10+)/'super-major' (100+) sites, mainly in south Bristol, that will accommodate an estimated 1,500 homes around the periphery of the city; all of them in 'low value' areas. As the primary equity investor, landowners have the biggest hand in creating quality places, so this is a truly exciting opportunity given the experience of our Mayor (an architect and developer). This is tempered by the fact that Bristol, like so many local authorities, has had to go through substantial cuts and still needs to refill its coffers as a matter of urgency, with these 10 sites potentially offering major generators of income for the Council. Local Authorities are typically under-resourced in terms of staff expertise too, hence the Mayor's recent re-structuring; he's brought in specialist experience at senior level to lead in this area. The Cribbs-Patchway New Neighbourhood in north Bristol, which has been allocated 5,700 homes and 50 ha employment land, sits just outside Bristol City Council's administrational boundary in the urban fringe of South Gloucestershire Council (SGC). Given it is one very large site and next to substantial infrastructure (Parkway inter-city train station, 70,000 jobs, M4/M5 junctions, etc.), one can't help but get excited about the potential of this urban extension to transform the whole of the North Fringe of Bristol. This area is the economic powerhouse of the South West, yet quality of life and the public realm is very low: communities living around this area, like Patchway and Southmead, are some of the most deprived in the country. Yet, because of the scale of development proposed, there are things they should be able to do here (e.g. district energy network, public transport infrastructure, etc.) that will be out of the reach of Bristol's sites. On the other hand, the land in the Cribbs-Patchway New Neighbourhood is all in private hands, under the control of three major developers. I have tremendous faith in people in general, and developers are no different. I am sure they are all busting a gut to do their best, but there's no escaping the fact that they have a very different remit from a local authority: quite simply, they are not responsible for quality of life here over the long term. And on a purely practical level they are at three different stages of the planning process, which puts substantial pressure on those delivering on the ground and sadly limits their capacity to consider holistically. In 2012-13, db+a in partnership with the WHO Centre for Healthy Urban Environments at UWE were commissioned by SGC to run two large stakeholder workshops to help with the Cribbs-Patchway New Neighbourhood Masterplanning. SGC wanted us involved for two reasons:
As a resident of Bristol actively involved in the Bristol Green Capital (BGC) Built Environment and Land Use (BELU) Action Group, I have had the opportunity of comparing these two large initiatives in detail. Given the new drive from central government for a new wave of Garden Cities, one can't help but wonder whether Bristol or South Gloucestershire offers the greater opportunity. There has been some talk recently of a Metropolitan Area allowing clear administration over all the urban areas of Greater Bristol. This would certainly make sense in terms of planning infrastructure and service provision more effectively: the Cribbs-Patchway workshops highlighted the yawning gaps between the different administrations in terms of education, health and retail, for example. But given the land ownership of Cribbs-Patchway is in private hands, I can't help but think that would only be half the battle. [It's important to clarify here that the problem is not private ownership per se, but rather the intention, experience and/or mandate of the landowners. Some of the best developments in the country have been under private ownership (e.g. Cadbury's, Clarke's, etc.), while some of the worst have been under public ownership.] In answer to the question then: we evidently need both ownership and scale, and yet in Bristol's case we've no way of getting it without Compulsory Purchasing, which seems highly unlikely on sites like those in north Bristol. So on balance my hopes lie with Bristol City Council and their 10 lower value sites, though it's going to take some extraordinary collaborative planning to ensure the high quality we so desperately need. Let's hope the forthcoming Academy of Urbanism Congress 'Bristol: Towards a Greener Urbanism' can kick that all off in the right direction. I wonder if the decision-makers responsible for Cribbs-Patchway New Neighbourhood are coming. |
