HEALTH AND THE CITY

Mental-health issues can’t be solved by psychologists alone—city design can help, too

The world’s cities aren’t very mentally healthy.

People who reside in cities are more likely to develop depression, anxiety, and schizophrenia than those living in the countryside. No matter where you live, at least one in four people will have a mental illness in their lifetime, and everyone suffers from mental-health problems such as low mood, loneliness, stress, and anxiety at some time or another. These kinds of problems can affect everything from our relationships and housing to our social capital and resilience.

But mental health is not just an individual issue: It affects the whole city. According to the Organization for Economic Co-operation and Development (OECD), economic costs associated with mental illness amount to 4% of national GDP. Mental illness increases a city’s costs of health and social care and puts people at higher risk of physical-health problems. There are also indirect costs to the city: People with mental-health problems can become disadvantaged in education and employment, and their opportunities for economic and social participation may begin to decline.

In these ways, mental-health problems affect a city’s ability to remain thriving, resilient, and sustainable. But while many of the more physical aspects of health have been addressed using urban design—for example, some cities have created walking and biking infrastructure that encourages physical fitness to reduce obesity, while others have separated pedestrians from motor-vehicle emissions to reduce urban air pollution and prevent respiratory diseases—most cities have not taken the same intentional approach with their citizens’ mental health.

Many urban planners and public-health professionals are now starting to realize that if physical health is not solely the remit of physicians, mental health need not solely be the remit of psychiatrists. In order to improve the mental health of city-living populations, the public-health, mental-health, and urban-planning sectors need to start working together to find shared solutions instead of operating in silos.

Perhaps the best way to understand how we can improve this relationship in the future is to first look to the past.

The history of health-based urban planning

Modern urban planning was created in part to promote the health and wellbeing of city-dwellers in the late 19th century. And we needed it. As people from rural areas flocked to cities during the industrial revolution in pursuit of economic opportunities, so did outbreaks of infectious diseases. Doctors and nurses worked hard to treat patients, but it became clear that working at the individual level was only part of the solution. To successfully halt the outbreaks, the medical profession had to think bigger: They had had to identify and solve for the problems within the city that were supporting these outbreaks.

Urban-planning and health specialists combined forces to identify these factors and stop the spread of diseases like cholera and typhoid. They researched living conditions and found people residing in crowded buildings with poor air circulation and terrible sanitation—breeding grounds for infection. They then took action by improving city sewage systems, garbage collection, and rodent control. As a result, outbreaks of diseases declined and these principles of infection control became intrinsic to urban planning.

The current state of affairs for urban health

Since then, the disciplines of public health and urban planning have remained friendly, but they have developed and diverged on their own paths. However, they have recently joined forces once more to address a new type of population health threat: chronic diseases.

Chronic diseases like heart disease, stroke, cancer, diabetes, and chronic lung disease are a major worldwide challenge. Medical professionals address these chronic diseases at the individual level, but city-wide factors are also involved in the development of these diseases. For example, a combination of car use, poor pedestrian and biking infrastructure, poor public-transit links, sedentary office-based jobs, and a lack of access to parks and other exercise areas conspire to limit people’s physical activity, which is a risk factor for many chronic diseases.

Public-health specialists and urban planners are coming together in organizations like Plan4Health in the US and Active by Design in the UK to identify these factors and take action. A proliferation of “healthy cities” guidelines, recommendations, policies, and case studies has resulted, which recommend how architects and urban planners can increase physical activity. Some of these include the Active Design Guidelines and Environmental Protection UK’s proposals to improve air quality.

And yet, one category of chronic disease is often forgotten.

Mental health in the city

Mental health is the next big opportunity for the collaboration between urban-planning and public-health specialists—but it’s proving to be a slow journey.

When the question of mental health arose at the 2016 World Health Organization (WHO) Global Health Promotion conference in Shanghai, hundreds of public-health and city-planning professionals waxed lyrical about population-level physical-health projects. But when it came to mental health, they scratched their heads and mentioned programs run by mental-health professionals on an individual or small-group basis. Many of these professionals had not really considered how to address these challenges at the level of the population; mental health is often only given a cursory mention in healthy cities literature; sometimes it’s nowhere to be found.

It does not help that mental health has an image problem. Media headlines often conflate mental illness with violence, crime, and other negative implications. This creates and reinforces prejudice and stigma and makes it harder for people with mental-health problems to advocate for the topic. This in turn makes it even harder for urban planners to understand and engage in mental-health promotion.

The solution for mentally healthy cities

But urban planners can design the urban environment in ways that systematically address mental-health opportunities. For example:

  • Expanding access to green spaces—such as parks, street trees, or even office-window views of nature—has been proven to benefit mental health.
  • “Active design” is not simply a physical health effort: Because regular exercise can be an effective way to address some forms of mild depression (as well as reducing anxiety and some of the symptoms of dementia, ADHD, and even schizophrenia), interventions like creating walking circuits in a park or installing safe cycling infrastructure can have substantial mental-health benefits.
  • Positive social interaction increases self esteem and feelings of belonging as well as mitigating loneliness and anxiety. In order to encourage this, public spaces can install features like benches and chess tables to facilitate social interaction and provide settings for community activities.

When people are experiencing mental-health problems, individual and group interventions by mental health professionals are essential. But when it comes to promoting good mental health and preventing disorders, there are myriad untapped opportunities. When we shift the scale of innovation from the individual to the city, we can create long-lasting solutions that make our cities more enjoyable—and mentally healthy—for all.

You can follow Layla on Twitter at @laylamccay. Learn how to write for Quartz Ideas. We welcome your comments at ideas@qz.com.

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