27 November 2020
The Urban Health approach on guard of urban residents longevity and wellbeing
Sergey Levkin, Head of the Moscow Department for Urban Planning Policy

The Urban Health approach (health-oriented urban development, healthy urban environment) is a new vision and ideology for the development of modern cities. This approach studies the relationship between health and the surrounding urban environment and answers a key question for the future of any city: "How can we ensure that the urban environment promotes an active and healthy life?"

The aim of the Urban Health approach is to prioritize public health and well-being in the development of an urban environment. In recent decades, there has been a significant increase in life expectancy around the world, particularly in cities. However, these positive changes have created new challenges. Chronic diseases caused by the negative effects of the urban environment, a sedentary lifestyle, unhealthy diets, overexertion and stress are the main issues on the current agenda for the development of megacities.

The Urban Health approach is based on three important principles:

The first is the implementation of health priorities in all aspects of urban administration, which will ensure that urban administration is oriented towards improving the quality of life and health of citizens.

Secondly, environmental change and spatial development should be the drivers of public health. Urban planning decisions and strategic plans should all be based on an assessment of health risks, socio-economic indicators and data regarding the quality of the environment. 

The third important component of the Urban Health approach is a comprehensive economic assessment to link current investments with the future benefits of implementing "healthy" principles in the existing principles of city administration.

Urban Health principles implemented in Moscow over the past several years

Over the past several years, numerous projects have been implemented in Moscow that have positively impacted the health of citizens. Moscow Standard: Renovation is one of these projects. The program was launched in 2017 with an aim to improve the living conditions of city residents residing in old buildings, as well as renovate the urban environment and create comfortable public spaces. The renovation of dilapidated buildings (old houses built in the 1950s – 1960s) will not only improve the living conditions of over a million residents in Moscow, but it will also greatly stimulate the development of the city's infrastructure as a whole.

Living conditions account for roughly 80% of a city's combined impact on the health and well-being of its residents. It is also becoming the basis for increasing life expectancy. The renovation program involves both the demolition of dilapidated residential buildings and the rehousing of residents in comfortable apartment buildings. An important aspect of the program is the creation of a comfortable urban environment that meets modern standards for the development of megacities. The renovation of the housing stock will significantly impact the health of the population by substantially improving the quality of housing in the city and implementing construction and planning standards aimed at creating "healthy neighborhoods". This will reduce all categories of environmental pollution (noise, light and air), further involve residents in the life of their city and encourage a healthy and active lifestyle. A study of neighborhood planning projects that have already been approved has revealed significant improvements in relation to the factors that influence citizen health as compared to current conditions. On average, the quality of the environment has doubled.

In Moscow, a number of projects are currently being implemented for the development of transport infrastructure. One of these projects is Moscow Central Diameters. This project is designed to integrate suburban railway traffic into the city's unified transport network. The first two lines were officially opened on November 21, 2019,  connecting the Smolensk and Sverdlovsk directions (Odintsovo — Lobnya), as well as the Kursk and Riga directions (Nakhabino — Podolsk). These lines account for about 30% of the program's entire passenger flow. Once completed, the Moscow Central Diameters project will reduce traffic in the capital's transport infrastructure by 10 to 12%. The impact of the project will have a significant effect on the general well-being of those living in Moscow. Enhancing the attractiveness and diversity of a public transport system increases the popularity of that system and motivates travelers to switch from private vehicles to public transport, thereby reducing the level of harmful emissions into the atmosphere and increasing the activity level of residents.

With regard to the general development of transport infrastructure, road traffic has decreased by an average of 23% since 2013 and average vehicle speed has increased by 13%. Public transport has increased in popularity and is now the preference of up to 70% of Muscovites during peak hours. A reduction in commute time is a critical aspect of mental health for city residents. In addition, the development of transport infrastructure that prioritizes public transport can reduce the emission of harmful pollutants into the atmosphere. Modernizing a city's transport infrastructure reduces the risk of road accidents and is an essential part of the process to achieving zero road deaths.

In developed countries, the general population is aging, with the median age of residents gradually increasing over the years. This trend is also evident in Moscow. The Moscow Longevity project aims at boosting employment and comprehensive development for the older generations. The project gathers doctors, nutritionists and other specialists to conduct lectures on living a healthy lifestyle, proper nutrition, giving up bad habits, taking care of oneself, recognizing symptoms and knowing when to call a doctor. Moreover, the Moscow Longevity addresses the problem of loneliness among the older generations. The project improves the mental health of residents and decreases the risk of accidental deaths among the elderly population. In the absence of chronic cardiovascular diseases and diabetes mellitus, for example, physical activity can ultimately increase the average life expectancy of retired people.

London's Healthy Streets program provides useful experience in this area. The key goal of the program is to increase activity levels among citizens by improving the quality of the environment in the most-used areas around the city. The Healthy Streets program may not seem to differ significantly from ordinary community improvement programs but it is, in fact, fundamentally different in nature. The program is based on an assessment and projection of the effects associated with the health of citizens. An intuitive system is used to assess city streets based on ten indicators, including noise level, cleanliness of the air, amount of green space, available sunshade, difficulty of crossing, busyness, etc.

New York developed the Active Design approach along a similar path, based on the idea that the environment affects people and their behavior. By changing certain factors of the human environment, a person's everyday behavior can be organized in such a way that they will be more inclined to make healthy choices. The creators of the approach explain "healthy choice" to mean all everyday situations in which citizens are confronted with two alternative options, with all other aspects being equal, and choose the option that is more beneficial for maintaining a high quality of life and minimizing health risks. For example, they may choose healthy food, active types of mobility and sports, community involvement and greater exposure to nature. In this way, the Active Design approach creates an architecture of choice through planning and a wide range of tools for spatial improvement, altogether nudging people towards a healthier lifestyle and thereby significantly reducing risks to human health.

The top international standards, WELL, BREEAM and Active Design, are particularly emphasized in Moscow during the implementation of programs to develop the urban environment, including the renovation program. It should be noted that many aspects of the renovation program, as well as other urban development projects in Moscow, comply with the standards for the design and construction of a healthy environment. However, any new editions of these standards should always be consulted and tweaked.

Scientific and analytical activities in Moscow that promote ideas of a healthy city among the population

Research into Urban Health is progressing alongside the direct implementation of these principles. In 2019, the Moscow Urban Forum analytical center and the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor) conducted a study, the results of which were included in the Urban Health analytical publication. As part of the study, analysts selected 5 cities with the most advanced projects and practices for implementing the principles of developing a health-oriented urban environment. The methodology for selecting the best practices was based on the ability to compare the development agenda of certain cities with Moscow and experience in implementing Urban Health principles both at the strategic and implementation levels.

The book "Standards for construction and design of cities" was published this year. It analyzes six leading world standards for construction and design (BREEAM, LEED, WELL, FITWEL, HEALTHY STREETS, ACTIVE DESIGN). The description of each standard provides an overview of the methodology for the approach and the developing organization; it examines the characteristics of the assessment and certification procedure for each standard and analyzes the entire product line of each developer for all types of buildings and then provides samples of the best cases in Russia and around the world.

The results of this research are incorporated into the implementation of projects in Moscow. The principles of Urban Health, as well as the standards for the design and construction of a healthy urban environment, are being gradually introduced into urban programs, especially those related to construction and transportation. The approaches being implemented for key megaprojects in Moscow (Moscow Standard: Renovation, development of the city transport infrastructure, etc.) draw upon these principles, although this may not always be explicitly stated.

Today, Moscow is sharing its positive experience regarding the implementation of the Urban Health agenda at the international level

The First International Congress of Urban Health was held in 2019 as part of Moscow Urban Forum, bringing together 64 experts from 14 countries around the world. During the 12 sessions of the Congress, international experts, government representatives, members of the medical community, entrepreneurs and architects discussed approaches to designing a healthy urban environment, the standards for healthy construction, city medical services and 21st-century lifestyle diseases and epidemics.

Speakers at the Congress included Jo Ivey Boufford, President of the International Society for Urban Health; Niels Lund, Vice President of Novo Nordisk and sponsor of the Cities Changing Diabetes program; Joanna Frank, President of the Center for Active Design; and Mazda Adli, Director of the Fliedner Klinik Berlin, psychiatrist and author of the book Stress and the City.

In February 2020, Moscow participated in the World Urban Forum in Abu Dhabi (UAE), where the best city projects were presented, including a variety of projects aimed at improving the health of citizens.

In 2021, the 10th Moscow Urban Forum will host the Second International Congress of Urban Health, bringing together an even larger number of experts to share their experience.

In addition to the efforts of these forums and congresses, the related field of research is also continuing to develop. The MUF Analytical Center has already published two analytical publications, one of which offers a detailed description of the concept of Urban Health, while the other focuses on standards used in cities around the world, including Moscow, for the design and construction of healthy urban environments. To share the experience of Moscow with international audiences, the book Urban Health has been translated into English.

In addition to the books that have already been published, a new book is currently being prepared for release. This book will compare the implementation of Urban Health principles in the administration of 15 of the world's largest megacities.

Public educational events are also being held at an international level. In October, specialists from the MUF Analytical Center conducted a lecture on Urban Health concepts in Spanish to students from the University of Buenos Aires.

When planning the layout of city space, the Urban Health approach reduces the risk of spreading noncommunicable diseases.

The implementation of the Active Design principles mentioned earlier increases the physical activity level of the urban population. This, in turn, helps reduce the risk of cardiovascular and musculoskeletal disorders, obesity and diabetes.

The number of citizens suffering from obesity and associated diseases can be significantly decreased when a city promotes a healthy lifestyle and proper diet through the enhancement of cycling infrastructure, develops comfortable public spaces, implements special labels for food products and increases the popularity of farmers markets and weekend markets. As a result, average life expectancy can be dramatically increased.

The guarantee of equal and easy access to green infrastructure, such as parks, forests and bodies of water, as well as the general availability of high-quality medical services, is a basic condition for the comprehensive reduction of risks to human health, disease rate and mortality in a city.