Commentary

Urban health: a new discipline

This paper presents a novel model of an elementary autonomous housing complex called Bio-Morpheme, intended to be an element of a Bio-City's structure. Its novelty manifests from the idea of urban form integration with the form of the water transformation cycle in the building and its immediate surroundings. Key factors include the retention and utilisation of rainwater in the Bio-Morpheme. Another feature of the proposal is the potential to use Bio-Morpheme-like complexes as autonomous units or combine them into larger structures based on integrated water management in typologically diverse city zones. Define the urban and architectural features of a Bio-Morpheme complex allowed using the proposed theoretical model to verify the potential for comprehensive water management featuring the utilisation of rainwater and stormwater harvested from roofs, pavements, bicycle paths, and roads. The study assumed climate and hydrological conditions for Krakow, Poland, predicting the potential for application. The authors observed that a Bio-Morpheme's structure allows for incorporating 41% of the collected runoff into its water supply infrastructure and using this water for domestic purposes when the remaining water can be direct to a surface reservoir. The reservoir provides the Bio-Morpheme's residents with direct contact with a water surface and enhances the microclimate. The Bio-Morpheme model is a solution that allows for rationalizing processes in elementary urban structure cells, which has a beneficial effect on lowering the demand for grid-sourced water and the amount of sewage produced. It also allows for introducing a surface reservoir into an urban interior and guarantees the highest quality of the environment and the health of residents.

Cities are home to over half the global population; that proportion is expected to rise to 70% by mid-century. The urban environment differs greatly from that in which humans evolved, with potentially important consequences for health. Rates for allergic, inflammatory and auto-immune diseases appear to rise with urbanization and be higher in the more urbanized nations of the world which has led some to suggest that cities promote the occurrence of these diseases. However, there are no syntheses outlining what urban-associated diseases are and what characteristics of cities promote their occurrence.

To synthesize the current understanding of “urban-associated diseases”, and discover the common, potentially modifiable features of cities that may be driving these associations.

We focus on any diseases that have been associated with cities or are particularly prominent in today’s urban societies. We draw on expertise across diverse health fields to examine the evidence for urban connections and drivers.

We found evidence for urban associations across allergic, auto-immune, inflammatory, lifestyle and infectious disease categories. Some conditions (e.g. obesity and diabetes) have complex relationships with cities that have been insufficiently explored. Other conditions (e.g. allergies and asthma) have more evidence demonstrating their relationship with cities and the mechanisms driving that association. Unsurprisingly, air pollution was the characteristic of cities most frequently associated with disease. Other identified urban risk factors are not as widely known: altered microbial exposure and a disconnect from environmental microbiomes, vitamin D deficiency, noise and light pollution, and a transient, over-crowded, impoverished population. However, many complexities and caveats to these relationships beg clarification; we highlight the current knowledge gaps and outline ways to fill those gaps. Identifying urban-associated diseases and their drivers will allow us to prepare for the urban-disease burden of the future and create healthy cities that mitigate that disease burden.

To determine if urban residence is associated with an increased risk of anxiety/depression independent of psychosocial stressors, concentrated disadvantage or selective migration between urban and rural areas, this population wide record-linkage study utilised data on receipt of prescription medication linked to area level indicators of conurbation and disadvantage. An urban/rural gradient in anxiolytic and antidepressant use was evident that was independent of variation in population composition. This gradient was most pronounced amongst disadvantaged areas. Migration into increasingly urban areas increased the likelihood of medication. These results suggest increasing conurbation is deleterious to mental health, especially amongst residents of deprived areas

Water is one of the most important landscape elements. In settled areas, planners rediscovered urban blue in the form of rivers as a soft location factor in post-industrial times. Although the recognition of the need for recreational or ‘healthy’ places like urban green or urban blue in cities is increasing, current urban planning is mostly conducted without taking beneficial health issues into account. In this paper an extended concept of therapeutic landscapes is used to analyse two promenades on the river Rhine in the centres of two German cities (Cologne and Düsseldorf). A complex of qualitative and quantitative methods from diverse disciplines is applied to obtain a multi-dimensional image of salutogenic health processes. The results show that the promenades are favourite places to spend leisure time and to engage in recreational activities, in addition to providing restoration from everyday stresses. Water is a strong predictor of preference and positive perceptive experiences in urban environments. Users of the promenades also report strong emotional attachments to the place. Urban blue space may be interpreted as a therapeutic landscape in various ways. The study forms a contribution to planning issues, particularly considering benefits for human health, and enhances current research concerning therapeutic landscapes.

Water is one of the most important landscape elements. In settled areas, planners rediscovered urban blue in the form of rivers as a soft location factor in post-industrial times. Although the recognition of the need for recreational or ‘healthy’ places like urban green or urban blue in cities is increasing, current urban planning is mostly conducted without taking beneficial health issues into account. In this paper an extended concept of therapeutic landscapes is used to analyse two promenades on the river Rhine in the centres of two German cities (Cologne and Düsseldorf). A complex of qualitative and quantitative methods from diverse disciplines is applied to obtain a multi-dimensional image of salutogenic health processes. The results show that the promenades are favourite places to spend leisure time and to engage in recreational activities, in addition to providing restoration from everyday stresses. Water is a strong predictor of preference and positive perceptive experiences in urban environments. Users of the promenades also report strong emotional attachments to the place. Urban blue space may be interpreted as a therapeutic landscape in various ways. The study forms a contribution to planning issues, particularly considering benefits for human health, and enhances current research concerning therapeutic landscapes.

With rapid global urbanization, the importance of understanding relationships between the changing urban environment and human health and wellbeing is being increasingly recognized. However, the science underlying the complexity of linkages is poorly developed. In this paper, we explore the different types of health and wellbeing risks in the urban environment, their dynamic, ever evolving nature, and define both their spatial and socioeconomic dimensions. We also present the new innovative program on Health and Wellbeing in the Changing Urban Environment that was launched recently by the International Council for Science (ICSU) wherein an integrated systems approach is recommended to address this complexity. We conclude by identifying key elements needed for the success of the new science initiative.