Healthy cities, technology and innovation

The Welsh socialist, writer and academic, Raymond Williams, once said: “To be truly radical is to make hope possible, rather than despair convincing.” It is a powerful quote, and one that really resonated at two conferences I attended recently: the Healthy City Design International Conference in Liverpool, and another at the University of Oxford’s Said Business School, which focused on sustainability, AI and innovation. One could be forgiven for feeling despair at the current state of the world. It was, unsurprisingly, a persistent theme at both events, with speakers painting a rather stark picture through the lenses of health & wellbeing, the economy and the environment. It is clear that we have sufficient evidence to make us confident that embracing rapid change is the only sensible direction of travel – as highlighted in the keynote presentations that I’ve summarised below. It’s also evident – from my LinkedIn feed for starters – that there are lots of people and organisations with all sorts of innovative ideas and practices that offer us the chance to make positive radical change immediately. So in the spirit of Williams, I want to use this article as an opportunity to make hope possible, and as a call for more meaningful innovation to support healthy places. We know that we must act now and not let opportunities for positive impact slide from one month to another. Professor Sir Michael Marmot set the scene at Healthy Cities with a contextual analysis of the poor health of UK citizens today. He presented a wealth of evidence that showed significant declines in both public sector expenditure and in public health since 2010. Data showed that increases in life expectancy at birth have stalled in England, with health for the poorest people getting worse. Amid a decade of the government’s austerity programme, public sector expenditure shrank from 42% of GDP in 2009-10 to 35% by 2018-19 – which is enormous. Marmot described austerity as an “economic choice, not an economic necessity”. Marmot’s work is concerned with the social determinants of health and he continued to paint a clear picture of the current situation in the UK. Real wages are lower today than 18 years ago and have fared much worse than our peer nations. Total government spending on healthcare per person, taking age into account, has been falling year-on-year since 2010 – we’re spending less than ever before. Austerity saw a decreasing amount of money being made available to local government; nearly one in five English Councils are at risk of bankruptcy according to the Financial Times. The tax burden in the UK (about 34% of GDP) makes us a low tax country in comparison to G7 and EU14, despite the political narrative claiming the contrary. Without London’s economic might, the national GDP of the UK drops by 14%, which means that we are as poor outside London as the poorest US state, Mississippi. We are, as Marmot pointed out, “a poor country with some rich people”. Professor Dieter Helm, meanwhile, used his keynote at Said Business School to focus on climate change, during which he said “anyone who thinks we are cracking climate change must come from Mars”. Indeed, 80% of the world’s fuel is still fossil fuel and sustainable innovations are not without their own issues. Electric vehicle supply chains, for example, still cause significant environmental damage and negatively impact biodiversity. The scientific evidence behind this is overwhelming, as explained in this article on MIT’s Climate Portal and this Guardian series examining EV myths. Helm also honed in on the poor state of Britain’s core infrastructure after 30 years of privatisation; energy networks, water utilities, natural ecosystems and a decent climate to name but a few. He argued that we need to look ahead to the next generation and ensure we can hand over working and viable infrastructure to them. If we can do that, which will involve creating more frameworks and increasing investment, then we have done all we can realistically do to enable resilience for future generations. I think we can all agree with Dieter Helm (and so many other experts worldwide) when he says that there is an urgent need to sort out the mess. I said this would be an article of hope over despair, so now that we have some shared high-level foundational context – admittedly bleak – let’s move on in a spritely fashion to some of those opportunities for radical change! Impact investing – investing with intentionality for people and the planet – is emerging as a major trend within the financial markets. Its global market value of over $1.1tr is firm proof that businesses are investing with more purpose. Kieron Boyle, chief executive of Impact Investing Institute, was speaking at Healthy Cities to explain why impact investing is becoming one of the world’s most credible tools for addressing cities’ key challenges – including achieving health equity. Considering the significant influence businesses have on our health and wellbeing, and are themselves affected by the decisions of investors, there is a compelling case for businesses to prioritise health and wellbeing. If commercial activities contribute to prevalent public health issues such as smoking, harmful gambling and poor diet, then it follows that there are direct adverse impacts on the workplace, such as increased sickness and absence, reduced productivity etc. It was encouraging to hear that investors are considering how to make healthcare more accessible and looking into the broader spectrum of social determinants of health – affordable housing, environmental health, food and nutrition, financial inclusion, community services, etc. Place-based impact investing, Boyle explained, which focuses on the strengths and needs of a place, is also gaining attention and paving the way for a brighter future for urban areas. Earlier this year, South Yorkshire Pension Authority announced the development of a new Place Based Impact Investment Portfolio with plans to invest £500m in the region over the next five-10 years. A key challenge for impact investing in urban health, however, is that it still lacks models for investment in urban health equity. Additionally, governments have been slow to take advantage of this capital so far and there are inherent risks in aligning public and private interests. While organisations like GRESB and The Good Economy are already providing data and benchmarks for measurement, if impact investment continues on its current trajectory more will be needed to support responsible decision-making in the long-term. Thought Thinking about place-based impact investment, the Digital Placemaking Experience Design Framework that I developed for NHS North East London, could easily be rapidly rolled out as a foundation for urban health and wellbeing. It has been designed specifically to support population health and built from the bottom up, informed by extensive stakeholder engagement. Building on this framework with data-driven insights would provide impact investors with all the evidence they need to justify their investments, measure their impact and, crucially, help to align environmental, economic and community outcomes. This is a question that often causes contention. Indeed, it was no different on a panel at Healthy Cities while discussing the Liverpool Green Lanes Provocation Project, which was awarded the ‘Most Innovative Idea’ at the conference. The challenge for many cities is to make existing, often outdated, urban neighbourhoods more liveable, resilient and healthy, which this project seeks to address. The overarching ambition is to catalyse large-scale greening, promote healthier living, active mobility, place activation and community engagement, among other interventions to deliver liveable city principles at scale. The outputs will ultimately be used to show how healthy city principles can be developed and applied in major urban regeneration projects, providing a benchmark for future initiatives. So while some did think it was ‘bold’, referencing all of the regulations, frameworks and stakeholders that had to work together to make it happen, others disagreed. Graham Marshall, director of Prosocial Place, called it an “ordinary” idea. While it is a great and important idea, I feel inclined to agree… This sort of urban innovation should be viewed as standard practice in 2023, not a risky and forward-thinking idea. Thought Since the conference, I have been thinking a great deal about what ‘bold design’ means in terms of reshaping an existing part of a city – and particularly the role of digital technologies. We’ve established that radical change needs to happen quickly, for which technology is a fundamental enabler, but it must be done in a way that avoids negative disruption and harm to members of the public. Just think about the process of rapidly imposing e-scooters across our major towns and cities, and the results. Then notice that you don’t actually know ‘the results’ and ask why? In Paris, its citizens recently voted to ban rental e-scooters due to their negative impact on the environment. FYI, I’m not anti-e-scooters at all. Much more thinking and discussion needs to happen to reach agreement on what constitutes a bold idea, bold design or a bold approach to place-based practice. But, we can address the question, “How can we be bold and innovative in a careful and responsible way?” For me, it all comes down to balancing the vision or the purpose with an ‘ethical by design’ approach and embedding that into projects from the get-go. Rather than seeing ethics as a limit to innovation, rather, we should all actively use ethics as part of a bold approach that considers the impact of our actions on people, place and the planet. We need to be bold by being aware of potential long-term as well as short-term effects of place-based innovation and acting accordingly – all of which swings back to impact investing, discussed earlier. As with the debate around what constitutes bold design, there was a lack of consensus regarding the most effective approach to projects: is it more effective to create a larger scale project or to start quickly with small interventions and scale them up? A key point of discussion was around maintenance and funding. It was argued that small-scale projects are often seen as quick wins but often lack the means to continue. The message being that whatever you’re doing in the city needs to be embedded in the vision, strategy and objectives if it’s going to be delivered within the city and for the long-term investment required. This links back to a point Dieter Helm made about maintenance and needing to sustain and improve existing infrastructures now, for the next generation. If there are no well functioning infrastructures in place, and no money for maintenance, then projects are much more likely to fall apart – whether it’s a community service or something physical such as water infrastructure or sewage systems. Ultimately, these things need to be running in tandem. A delegate also highlighted the critical role of undertaking public impact assessments, as well as social, strategic and economic impact assessments – for both short- and long-term projects/programmes. Just as important, in my opinion, is community engagement and valuing community wisdom to influence where the money goes. These are the people you are ultimately investing in, and listening to them will help to unearth insight that is often missed when taking a top-down approach. Thought The winner of the President’s Award at the 2023 Landscape Institute Awards and ‘Excellence in Public Health and Wellbeing’ category is a great model of practice and demonstrates the power and value of community wisdom and collaboration. Rooted in participatory and co-creation principles, the project from City of Bradford Municipal District Council was praised for challenging public health inequalities across the district, integrating blue and green infrastructures to highlight the role of the environment in health outcomes.  I see it as a useful model that shows a bridging approach; one that starts with small investment and leads to embedded long term investment. Carolin Göhler, President of the Landscape Institute called it a true exemplar of  “how landscape can benefit people, place and nature with good community health research, policy making, design, and implementation, with close community liaisons and management of green spaces.”  As one of the judges for this category, and who represented Bradford’s submission at the President’s Award deliberation, it was great to see first-hand some of the brilliant work taking place in Bradford. Let’s hope this one sets a precedent for other councils to follow! Parks are fundamental aspects of our towns and cities; they are places we walk, run, play and do sport; places that support biodiversity and promote air quality. They are intertwined with many social, economic, cultural and environmental factors that can have a positive impact on both people and place. Yet they are still so often overlooked, neglected, actively avoided or exclusive to certain groups – whether for safety concerns or through their design. It was great to have a whole session dedicated to parks at the Healthy Cities conference, where I was invited to speak about Calvium’s work to support investment in parks for the City of Edinburgh Council. The research project involved studying each of the city’s 149 parks to establish which could benefit from investment in sensitive lighting to support active travel. Geospatial and place-based data were analysed for each park in order to inform a ranked table of recommended parks. By lighting paths after dark, the aim is to enhance the perceived safety of parks and encourage their use as sites of connection. In doing so, it is expected more people will adopt active travel and the city will benefit from the associated health, economic and environmental benefits. This is just one example of how a simple change can make parks more hospitable places for people to move through. Fortunately, there are many global projects underway that showcase how inclusive, collaborative design can promote greater health and wellbeing – from supporting gender diversity and mental health, to boosting safety and biodiversity. Read about them here. Thought There is no end of literature linking parks and green spaces with improved health and wellbeing – the UN includes access to parks as part of its Sustainable Development Goals. There are many ways we can ensure they are safer, more welcoming and pleasant places to dwell or move through – more lighting, making them more physically accessible, keeping them clean and tidy. As seen in the Edinburgh Parks project, geospatial analytics (fusing spatial, demographic and statistical data) is a valuable tool for informing parks infrastructure investment and should be adopted for analysing the core infrastructures of our urban environments. Environmentally, parks and green spaces have a crucial role to play in promoting biodiversity and we are seeing great advancements in AI to better support biodiversity, such as tracking biodiversity on green rooftops. I would love to see more of this innovation implemented to benefit our parks and green spaces. From investing with purpose to ethical design and community wisdom and more, this article has shone a light on many innovative ways that we can create healthier and more resilient cities, today and in future. Ultimately, the onus is on us – the placemakers, digital innovators, local authorities and citizens – to spot the opportunities where innovation could benefit the health and wellbeing of citizens and nature. It is up to us to identify both the small, quick wins and the longer-term investments to enable better physical and mental health, to improve safety and access to green spaces, to futureproof urban infrastructures…These are not radical ideas, they are simply reasonable and achievable –  which is really great news ! Change is happening, and it is inspiring and reassuring to see. But time is of the essence and we need all hands on deck to ensure it happens sooner rather than later. As long as it is done with people, planet and place in mind, we have more than hope.