Response by Melanie Lowe to “The oldest game in town”

In his essay ‘The Oldest Game in Town’ Senator Scott Ludlam eloquently describes cities as complex systems that are dependent on the natural environment. He argues for the need for systemic change to our cities, re-orienting them towards more environmentally sustainable forms of infrastructure and economic activity. Senator Ludlam points towards the benefits this could have for the liveability of urban environments and the lifestyles of residents.

He likens the flow and transportation of products, energy and waste in cities, to physiological processes in our bodies. However, the link between the human body and cities is closer than this analogy suggests. Many actions to increase the sustainability of our cities could improve human health and wellbeing.

Globally, chronic diseases such as cardiovascular disease, cancer, type 2 diabetes and mental illnesses have overtaken infectious diseases as the leading cause of death and disability amongst urban populations. Urban planning and design features such as levels of housing density, the layout of streets, and the location of employment and infrastructure directly and indirectly contribute to chronic diseases and their risk factors. These include levels of physical inactivity, unhealthy diets, social isolation and poor air quality. For example, low density residential developments on the urban fringe with poor access to jobs, shops and public transport discourage active modes of transport, such as walking and cycling. ((Lowe M, Boulange C, Giles-Corti B., “Urban design and health: progress to date and future challenges”, Health Promotion Journal of Australia, 2014; 25(1): 14-8)) Unfortunately, this type of urban form is a common characteristic of many cities around the world, including in Australia.

With over half the world’s population and 90 per cent of Australians living in urban environments, it is vital that we create cities that promote, rather than undermine, health and wellbeing. As Senator Ludlam writes, “Cities are where our species will probably stand or fall this century”. This certainly extends to protecting the natural environment as the underlying determinant of human health and wellbeing. Climate change is predicted to be the greatest health threat of the 21^st century. Among other health impacts, climate change is expected to increase the range of mosquito-borne infectious, and increase illnesses and deaths from extreme weather events, including heat waves exacerbated by the urban heat island effect. ((Costello A, Abbas M, Allen A, Ball S, Bellamy R, et al., “Managing the health effects of climate change”, Lance,. 2009; 373: 1693-733))

There is a growing understanding that health and environmental sustainability are closely connected, and nowhere more so than in our cities. ((Woodcock J, Edwards P, Tonne C, Armstrong B, Ashiru O, Banister D, et al, “Public health benefits of strategies to reduce greenhouse-gas emissions: Urban land transport”, Lancet, 2009; 374: 1930-43)) Land use and transport planning that prioritises walking, cycling and public transport over car use can have benefits for health through increased physical activity and reduced noise and air pollution. At the same time, reduced emissions from motor vehicles could help to mitigate climate change. We know that attractive green spaces encourage recreational physical activity in cities and promote mental health, with the potential to improve air quality and increase biodiversity. Food systems that encourage local urban and peri-urban agriculture could improve diets while reducing greenhouse gas emissions from industrial production, processing, packaging and distribution of food.

The public health evidence indicates that we need to create ‘complete’ communities, where services, jobs, shops, recreational facilities and education are accessible within a 20 minute walking, cycling or public transport journey from most homes. Senator Ludlam evokes this type of urban environment, but provides little guidance about how we are going to achieve it.

Policies that promote such environmentally sustainable, liveable and healthy urban environments cross many sectors, including infrastructure, planning, housing, transport, economics, health and environment. These sectors and all levels of government need to work together, and with the community, to create the types of cities where healthy and sustainable lifestyles are the easy choice.

Many cities around the world are taking positive steps, such as Portland, Oregon in the US and Vancouver, Canada which are prioritising walking, cycling and public transport in their metropolitan planning. There is still much to be understood about the complex processes that shape the health of urban populations. However, there is sufficient evidence of what works to guide decisions about transport, housing and urban planning. The fact that this would have co-benefits for human health and the environment strengthens the rationale for taking action.