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What Makes a Healthy City?

Jennah Ferrara, February 2012

Assessing a city's "health" has nothing to do with the impossibility of stuffing an entire metropolis into a primary care physician's waiting room. Defining a healthy city is a multi-layered and fluid process that involves the contributions of policies and practices to the quality of life of the city's inhabitants.

For decades the World Health Organization has attempted to gauge which factors influence metropolitan vigor. Online publications about city life like The New Colonist consider how certain characteristics add to urban vitality. Often the people who live in cities voice opinions that overlap those of the preceding pundits, and they also add their own experiences and needs into the mix.

When I asked over 15 people scattered throughout the United States, Cyprus, and Japan how they define a healthy city, many of their answers echoed the conclusions reached by nongovernmental organizations, universities and journalists who write about urban life. Most people I communicated with, though, also mentioned positions directly related to their own experiences and needs. "We're unofficial students of the city, but it is not our job" to research and write about it, said Raoul of San Diego. "We're the people who live in these cities and sometimes approach more specifically what a livable city is. And this is a subject dear to my heart."

Alisha of Grand Rapids is a returning student studying social work and interning at a local community health center, where she works with adolescents. She included the frequently mentioned qualities of public transportation, thriving parks and other green spaces as necessary for a healthy city, but she also emphasized multiple sexual health centers, sex education in schools and free/low-cost health clinics. These are needs she has observed in her field.

A steadfast Obama supporter and lifelong Democrat, corporate businessman Vincent of Wilmington, North Carolina, said his inclusion of the term "family values" on his list of "necessities for a healthy city" means "programs and institutions designed to keep families together, like the YMCA, parks, gyms, churches, movies, restaurants, etc., that will inherently encourage families to do positive things together in ways that will also do no harm to society. Not what the GOP and Newt had in mind!"

He continued, "I would consider a city "healthy" when it includes some of the following attributes:

Dismissing some of his ideas as "all pie-in-the sky," Darren of Pittsburgh was the only respondent to discuss the use of alternative energy sources, such as "solar-powered homes" and "cars, which would be much too expensive," within a healthy city. He supports active recycling programs and a more responsible destruction of garbage. (This prompted a conversation about the controversial hazardous waste incinerator in East Liverpool, OH.) Darren also emphasized the necessity for a vital public transportation system, as did many other respondents. Darren said the frequent use of carpool lanes among commuters who don't use the bus would decrease traffic snarls and aid the environment. "Oh, and fewer bars--I was just thinking of South Side," he continued, referring to a Pittsburgh neighborhood where many residents object to the profusion of watering holes that they say adds to crime, pollution and other problems.

Sustainability and Community

World traveler, cyclist, blogger and polyglot (six languages), Samuel Lucier is a Nevers, France, native living in Kagoshima, Japan. Influenced by the lessons learned in his journeys, he emphasized sustainability, community and global online communication as necessities for a healthy city. "The healthy city or village I'm dreaming of would organized, but still communicating with the world--maybe through the internet--to share ideas," he told me.

"For me a healthy city has to be sustainable, I think it's the main condition needed.... To me, being sustainable (and efficient) can be summarized in one sentence: Do local; think global. It means that food and all essential services should be done locally, no transportation needed, everything should be accessible by foot or bicycle. [My notation: This is much like the Slow Food philosophy] It implies smaller scales and lower densities. The city or village should look as an independent ecosystem from the outside. Same for energy, renewable for sure, managed locally, with an eventual interconnection with other villages, small networks to provide some reliability."

"After sustainability, I think sharing in the community is the second most important condition of a healthy city.... Information is power--money is not--and it's the only thing you still possess when you give it to somebody else. We have to share information, and for free. For example, I learned how to make a solar dryer from the internet, and all the emerging ecological movements--transition towns, permaculture, degrowth, Slow life, etc.--grow fast because of information sharing on internet. For that we need computers (let's say tablet PC that are smaller and less wasting energy to produce and use...)."

Student Comments

Noting that most of the people I'd spoken with so far were over age 25 (although the aforementioned CycleSam is only a couple years older than that) I decided to approach a somewhat captive group of University of Pittsburgh undergraduates to request more opinions. This time, I wanted to know how a group of future physical therapists, physician's assistants or nurses would describe a healthy city. These students were attending the Issues in Disability course at Pitt's School of Health and Rehabilitation Sciences, which I address once a semester about my experiences with multiple sclerosis. (As I think I had mentioned while writing about my 40th birthday, doing this is great fun: I compare myself to a combination teacher/social worker/visual aid/sit-down comedian.)

Rehab science student Mikaila cheerfully answered, "A healthy city is Pittsburgh! No, but I think it would include a city that is active, friendly and safe! Not a dirty city full of smokers and drug dealers, but where you see people exercising in the parks." Christa, who is planning a physical therapy career, listed low crime rates, no public smoking, clean streets, less driving, more walking or bike riding, an integrated community, friendly neighborhoods, limited fast food restaurants [another Slow Food-friendly answer!], sidewalks, accessibility to a gym.

Nursing student Alexis said, "I think a healthy city would be one that cared about the environment and themselves. I think of a city that values recycling and keeps parks and the city itself clean and has little crime, inhabitants that are friendly. I picture a healthy city with people walking, running, and riding bikes as their major mode of transportation. A healthy city would have many farmers markets and gardens." Rehab student Joelle described a "vivid urban environment with a multitude of options for entertainment and occupations. I would expect to see restaurants, theaters, shopping opportunities, and recreation outside. A city is healthy when the people are vibrant and involved."

Harrisburg resident and retired public-school teacher Ruan said, "A healthy city must have a strong educational system, thriving cultural centers, such as museums, an active library a great deal of community events and offerings--you can tell from the circulation of library how many people are accessing it--with programs, lectures and safe places for children to play," adding, "My red fox Labrador retriever wants free dog parks."

Frequent bus rider, San Diegan and wheelchair user Raoul listed the following characteristics as essential to a healthy city: "reliable, affordable, universally accessible public transit, walkable neighborhoods, with affordable grocery stores." And of course, disability-friendly "smooth sidewalks with plenty of curb cuts."

Freelance writer and editor Liz Capaldi currently lives in Cyprus and has dual citizenship in the U.S. and the U.K. She's lived in New York City and London and traveled extensively in Indonesia, about which she's written several books. She compiled a catalogue of her own descriptors of healthy cities with notes she accumulated during a life of international expeditions:

  1. Green spaces, parks, trees
  2. Well-preserved old quarter (I love the old part of Kyoto where you are stepping back several hundred years. I love Japanese architecture and am addicted to Japanese food. And there are three Imperial palaces you can visit free of charge.)
  3. Traditional architecture, preferably fairly low-rise, no ugly modern buildings. Attractive modern buildings are OK.
  4. Very little crime
  5. Local character (rather than another big, faceless modern city).
  6. Easy to get around on foot and by good, cheap local transport.
  7. A strong indigenous cultural tradition (Indonesia has gamelan and Wayan Kulit/Golek puppets. India also has classical music, Kathakali, architecture, curries, etc.)
  8. Free events (London has excellent free talks put on by many different groups including the likes of SOAS (School of Oriental and African Studies), museums, etc. Austin has free Shakespeare in the Park and the movement "Keep Austin Free."
  9. Cultural attractions (My brother lists Austin as his favorite American city for this reason.)
  10. Reasonably priced accommodations, food, etc.
  11. Small, personal cities with lots of attractive older buildings.
  12. Friendly, helpful locals
  13. Not too many tourists
  14. A University quarter
  15. Vibrant intellectual scene
  16. An ethnic mix. I love learning from people, and I learn something from every conversation I have with people from different countries and cultures.
  17. Libraries
  18. Good healthcare, social services, etc.
  19. Sense of community; neighborhoods that function more like villages, where people know each other
  20. Unpretentious, reasonably priced local restaurants. A minimal number of fast food joints (I've never eaten in any of the FF chains!) [There's that Slow Food sensibility again!]

Tourism and inauthentic additions to a city also discount a city's health, according to Kathleen, a performer and life coach who has lived in New York City for 26 years. Parts of New York have become "too Disneyland-ish," she said. "I miss the old industrial areas in the city that became shopping areas instead--some character is lacking."

But overall she views New York as a healthy city. Along with its internationally prominent arts and culture, the "parks have gotten nicer over the years and my building is more child- and pet-friendly," said Kathleen. "These are important qualities, like being able to walk a lot, farmer's markets and clean water--New York has some of the best tap water in the world. Good public transportation is important.... I like getting on the subway; I like the diversity. I like constantly being reminded you're with people who are different from you. I like a sense of community."

The many contributors to this article, the World Health Organization and New Colonist co-editor Eric Miller have discussed many factors to consider when defining urban wellness. A city's becoming aware of the changes it needs to make, making plans to enact these changes and following through with these plans are all necessary if a healthy city is to advance.

Healthy City Resources

Top Ten characteristics of a healthy city

According to the IHCF, the term Healthy Cities was coined in 1985. It was the title of a speech given at an international meeting in Canada.

Best Places

"The Alliance for Healthy Cities is an international network aiming at protecting and enhancing the health of city dwellers....The Healthy Cities approach is based on the concept that the social, economic and physical environment is the key to the health of city dwellers...."

A healthy cities blog

A World Health Organization website that details WHO's relationship to the healthy city philosophy

"California's information and action resource for service referrals and social change. Healthy City provides data and mapping tools to help you build a better community." This use of "service referrals" brings to mind a social worker who specializes in working with the entire city to fulfill its needs.

Jennah Ferrara