You’re A Health Care Professional And You Just Don’t Know It

“Urban planning is health care.”

It’s a phrase that Araceli Camargo and Josh Artus come back to time and again. It is the guiding principle behind the new initiatives and research their Centric Lab consultancy is embarking on, trying to help developers and property professionals make the communities they build in more healthy and more equal. 

COVID-19 has made us all acutely aware of how fragile our health is and how where you live plays a big part in that. Living in a dense city made you more likely to catch the COVID, and being poor in those cities, and especially poor and from an ethnic minority background, made you more susceptible again. But even before the coronavirus pandemic, badly planned urban environments exacerbated health care issues, both physical and mental.

With that in mind, Centric Lab has launched a new Urban Health Council, bringing together academics, health professionals and activists, policymakers and companies active in the built environment to undertake and spread research and prompt new ways of thinking about how the places we build affect our health.

Several firms have already signed up to become members of the council, including big-name developers like Lendlease and HB Reavis. Other firms that have signed up to the council include PLP Architecture, Iceni Projects, TOWN Developments, Landsec, MAPP, Human Nature Partnership, McGregor Coxall, NOOMA, MAIA Group and BAME in Property. 

The new Urban Health Council and the research the Centric Lab is undertaking chimes with a moment in time when, prompted by the pandemic, the real estate industry is having to think more deeply about the places it builds. Wellness is a buzzword in property right now, but the focus on urban health goes beyond how you can look after the health of the tenants of one building and looks at how communities at large can be helped rather than harmed by development. 

“Over the last few years we’ve come to realise that as a society we don’t really understand health, what it is and what factors affect it,” Camargo said. “When we think about the neighbourhoods we create, we think about the aesthetics, but we have no idea about whether they are healthy or unhealthy.” 

“The development sector are health care professionals, but they don't know it yet,” Artus said.

Camargo lists myriad ways the urban environment influences people’s health. Noise pollution from poor windows impacts sleep, which in turn affects physical and mental health. Tarmac, concrete and the paint used on roads create heat islands in dense urban areas, which affects individuals as well as the climate more generally. And new research is uncovering the impact artificial light has on the bacteria in our guts.

Most strikingly, Camargo pointed to a case last year in which Ella Kissi-Debrah, a 9-year-old girl living in south London, was found to have died as a result of air pollution exacerbating her asthma. It was the first time air pollution had been officially cited as a cause of death anywhere in the world.

Health today is often seen as something for which the individual is responsible, Camargo said, but this is too simplistic and shifts the burden for public health away from governments and corporations like property developers.

Centric Lab, a not-for-profit firm, has conducted its own research for years into how the urban environment impacts us, using neuroscience, for example, to measure how buildings or places affect the way our brain functions.

Through its Urban Health Council, it is sourcing funding to undertake its own research into how the built environment affects public health, as well as disseminating research that has already been undertaken by other academics, bringing it together in one place so it is easy to access for the real estate industry, public bodies and the public itself. 

It will create a series of playbooks and hold seminars and workshops on specific topics, such as the effort to rehabilitate urban areas from the impact of COVID-19 and placemaking for public health. It offers advice on how to do this in an expressly anti-racist way, to try and avoid some of the flaws in development that have led to non-White communities in cities like London often having lower life expectancies than White counterparts. It has already created an urban health index, which scores different neighbourhoods of London according to how healthy they are.

“Through the use of biological research, environmental data and mapping tools we start to answer the question of 'is this area healthy' rather than 'are the people healthy here?’” Artus said. “This difference puts the emphasis on the place and not the people.”

The role of the real estate community, particularly developers, can’t be overstated in this: Real estate builds the world we live in, but often in a way that pays no attention to whether it allows people to live healthily. 

“People are coming to us and asking, how do we best take on board this information and use it to reduce the negative externalities we might create?” Artus said. “It’s about changing a mindset: How can a sector that has a lot of financial and political support become a driver of health?”

It can also offer specific advice.

“If you are building a BTR building or rented housing, can you put in double glazing to reduce the noise and help create better insulation?” Camargo said. “That helps people sleep better and improves their health.”

For one of the developers working with Centric Lab, the need to think about how its schemes impact urban health brings together parallel trends from the world of real estate and society more generally, trends that have been happening for years but which have been ramped up by COVID-19. 

“There’s a big shift that’s been going on in the development industry for some years, where across the globe companies like us have realised that we’re part of something wider, we’re going from building single buildings to creating communities and whole areas of cities," Lendlease Commercial Manager Jake Heitland told Bisnow. “And we are realising that issues like inequality and climate change are affected by our sector. We want to create places that are thriving, but we have to ask ourselves, what does thriving mean? One part of that means creating places that are healthy.”

Heitland points to a major scheme Lendlease will be developing around Euston station in central London, a 133-acre site where more than 3,800 homes and 3M SF of commercial space could be built.

Euston Road, which bounds part of the site, is one of the busiest roads in London, and though it is in the centre of one of the world’s richest cities, a combination of low income and poor urban environment means residents on some estates in the area have an average life expectancy up to 10 years less than the London average, government statistics show. 

Heitland said that while it couldn’t solve the problem on its own, Lendlease is looking at how the design and building of its scheme could improve health outcomes for people living in the area. 

Lendlease has been working with Centric Lab for the past few years and has utilised its research into the impact of buildings on the brain when designing new schemes. Lendlease plans to do the same thing as part of the Urban Health Council, he said. 

“Property is one of the last industries to focus on user experience — just look at how many people Zoom have working on the UX of their product, but property has never really thought about how people will actually use their product,” he said. “What Josh and Araceli are doing looks at how the places we create actually affect people.

“For a long time urban regeneration schemes just got away with planting a few trees, and placemaking was just about making pretty public realm, but today that isn’t going to be enough,” he said.

Public authorities are increasingly focused on picking development partners who are creating schemes that address issues like health and social inequality, Heitland said. Lendlease was picked to develop the site by HS2, the transport body building a new rail line between London, Birmingham and the north of England. 

“It isn’t just about attracting wealthy people; it is about creating places that are additive to the health of the whole community. COVID showed us that the wealthy can leave cities if they want to, but not everyone can afford to do that, so we need to make cities healthy for everyone.” 

Camargo and Artus are in the same camp, arguing that new, large-scale developments should think about “rehabilitation, not regeneration.”

They said that a lack of cohesive thinking between sectors like planning, development, health care and education has allowed avoidable bad health outcomes for city dwellers. As a society we are much better at fixing problems than preventing them, even if fixing them can be much more expensive. 

Artus pointed to examples where investors or local authorities are looking to stem health problems at the source rather than tackle them later on. For example, California insurance company Kaiser Permanente is investing in social housing because it helps reduce homelessness, which brings down the amount it has to pay out to hospitals in the form of medical bills. It is essentially cheaper to build a homeless person an apartment than pay the medical costs associated with long-term homelessness.

This kind of thinking has, in the past, been alien to the development industry and even local authorities. The property industry has started thinking about wellness, because it is something it can sell to corporate clients. But now it needs to think about health on a bigger scale.

“You can see a kind of correlation,” Artus said. “As the amount of LEED and BREEAM certificates has gone up, the number of cases of diseases associated with urban living has also risen. You have this almost Dickensian situation, where health is something that is only affordable to the wealthy. But if you focus on the urban environment, health is something you can deliver for everyone.”