Urban Planning and Disease Spread
Redundancy, Resiliency, and the Integration of Health Policy in Urban Planning Efforts in the Era of SARS-CoV-2 and COVID-19
Author: Ryan C. Miller
(Photo by Matthew Henry on Unsplash)“If the purpose of urban planning is not for human health, then what is it for?”
-- Dr. Maria Neira
WHO Director, Department of Environment, Climate Change and Health
Discussion Overview
The video to the right (4:57m) provides an overview of the project discussed below.
A script of the video can be found in the expandable field titled Discussion Overview Script.
Discussion Overview Script
Slide 1: Urban Planning and Disease Spread
Slide 2: “If the purpose of urban planning is not for human health, then what is it for?” -- Dr. Maria Neira
WHO Director, Department of Environment, Climate Change and Health
Slide 3 Project Scope & Overview
Welcome to this overview of how the field of urban planning can be integrated in the field of public health, with the goal of curtailing the spread of infectious diseases in the future. It will provide a basic overview of planning and its potential applications relevant to the world of public health.
Slide 4: What is planning?
So, first off, what is planning? Urban planning is a science-based, technical process that incorporates the expertise from a variety of science, social science, engineering, and social advocacy disciplines with the goal of crafting policy that guides the equitable development of our urban and rural landscapes. In other words, you can attribute the functionality and nature of where you live based on the policies laid out in your community’s comprehensive plan.
Slide 5: Why Planning for the Future? Cities are Growing!
Bearing this in mind, why is planning important for the future and the realm of public health? Well, since the 1950s urban population has surged from 746 million to 3.9 billion, and the World Health Organization has been forecasting a 50% increase in global population from 1990 to 2040 with populations set to become less rural and more urban with global urban population forecasts calling for an increase from its current 4 billion to over 6 billion by 2050.
Slide 6 & 7: Urban and Rural Populations: 1950 and 2050
Here is a graph detailing the projected global population growth over the coming decades broken down by high vs low-income countries and urban vs rural populations.
In short, with global urban populations forecast to surge over the coming decades noted by the light blue growth curve, the use of planning to guide development will be crucial.
Slide 8: How can Planning help? Theory
One the most effective ways planning can help is through the application of two of its core tenets, the application of sustainable development practices and dense urban forms.
Sustainability practices will ensure that development occurs in a manner that address the needs of the present economy, the environment, and is supportive of social equity without adversely affecting the needs of future generations.
Meanwhile, encouraging dense urban development promotes accessible environments that provide adequate services (e.g. healthcare facilities) and maintains concurrency standards (e.g. utilities) to meet the needs of the area population.
How can Planning help? Policy Implementation – slide two
So, what can planning do to achieve this end.
First off, before any policies are created, it is imperative that any planning document is context appropriate and remains relevant to an ever-changing landscape; therefore, it should be understood that any policies include a pre-disaster anticipatory phase, active response phase, and post-response phase/evaluation period.
In a sustainably planned, densely development environment, considerations for spatial diversity must be made. Access to greenspaces and other open-space environments that facilitate social interaction are crucial to promoting overall well-being as well as the opportunity to observe social distancing mandates during disease outbreaks and pandemics. It sounds counterintuitive to promote dense urban form to fight the spread of disease, but the data indicate the contrary, it is, in fact, protective against the spread.
Policy provisions must be made to ensure concurrency and resource access remains available and equitable as communities develop. A great summary of basic policies outlined by the World Health Organization to address disease spread is detailed on the next slide and in the information below.
Given that health care crises often disproportionately affect lower-income and racially diverse communities, it is critical that the equitable access to social infrastructure resources is assured (e.g. schools, daycare facilities, and health care facilities).
Another interesting policy recommendation to address disease spread is to sustain and promote the spread of urban vegetation. These policies have been shown to not only foster improved well-being for urban residents, but also mitigate the spread of SARS-CoV-2 virus. The report below provides a more in-depth exploration of the data findings.
Communicable Diseases and Planning Policies: Examples
Access to sanitation and basic concurrency standards are powerful tools to stem and prevent the spread of disease. Here are some examples of applied policies and how they have been used to address disease spread in the past. As you can see many of these policy measures outline address freshwater access, waste management, waste water management, agriculture practices, and housing. In short, the role of planning and community development is a powerful tool for public health in addressing disease spread.
Conclusions
So as global population increases and becomes more urbanized, expanding cities have the potential to emerge as future flashpoints for local and global health issues, if adequate planning policy frameworks are not implemented. Future disease spread can be addressed within the built environment through adoption of policies that promote equity, economic resiliency, and environmental preservation; the core underpinnings of sustainable development along with dense urban form.
If you would like to learn more, please continue to the report below for a more in-depth examination of these data.
Thank you!
Project Scope
This project will be to examine how urban planning and the implementation of growth policies can be used to address the spread of infectious diseases.
Given the wide-ranging nature of the urban planning discipline, it will provide only a basic overview of urban planning, its core tenets, justification for its use, how it integrates within the field of public health, and how it can be used to impact health outcomes, with emphasis on communicable diseases and the advent of SARS-CoV-2 and the global COVID-19 pandemic.
Basic policy recommendations will also be provided to promote disease mitigation and disaster resiliency.
What is Urban Planning?
Urban planning is a technical and highly-politicized process that that provides structure for how communities grow and interact within the built and non-built environments (Kelly & Becker, 2000). It is a multi-faceted discipline that incorporates geography, demography, human behavior, economics, and the life sciences to provide analytical framework for policy creation to guide development. It is also an umbrella category that involves other sub planning fields (e.g. land use, health, transportation, environmental, open-space, infrastructure, neighborhood, historic preservation, housing, social, equity, etc.).
Planning's Theoretical Foundation, Legal Authority, and the Global Health Map
Sustainability
One of the main tenets of Urban planning, especially within the urban context, is to guide development with the goal of maintaining balance between economic concerns, environmental preservation and management, and social equity; the three pillars of sustainable development.
The goal of sustainable development strategies is to satisfy the needs of current generations without compromising the needs of those of future generations (Godschalk et al, 1998).
Sustainability finds many of its roots in biology and ecology with the concept of ecological carrying capacity, or that notion that a given ecological system can only sustain a certain population before experiencing a system correction (aka a population collapse). In other words, growth of urban areas must remain in balance with respect to these three vertices in order to promote social, environmental, and economic equality.
Density
Modern planners follow the maxim of ‘density is king’ to ensure the success and sustainability of a planned urban environment.
Promoting denser, compatible development patterns, with equitable distribution of resources (e.g. public services, healthcare, utilities, food, etc.) within a given physical footprint decreases urban metabolism, the flow of materials and energy within a city, which, in turn, helps to mitigate the effects of climate change and, key to this discussion, lower rates of disease transmission (Samuelsson et al, 2020; Kelly & Becker, 2000).
Planning's Legal Authority
With the advent of the landmark Supreme Court case of Euclid v Ambler (1926), planners were granted the legal grounds to use their regulatory powers to restrict incompatible land uses within a community (i.e. zoning) so long as it provides a public benefit. To this day, Euclid remains unchallenged and serves as the foundation of the planning profession to guide the growth and development of a community or urban area.
Figure 1.0. How the Built Environment and Planning Fall within the Global Health Map
Figure 1.0 provides context for how the built environment falls within the global ecosystem and anthropogenic development continuum (Baron & Grant, 2006). This figure is commonly used in planning to provide context for the collaborative planning process and how it integrates experts from other fields such as: public health, utility and service providers, ecologists, urban designers, transportation engineers, environmental scientists, community development, and economic development (Baron & Grant, 2006).
Each sphere segment influences adjacent spheres and any significant perturbations can elicit downstream or upstream effects that can directly affect human health (Baron & Grant, 2006). For example, changes in a few blocks in an urban may result in changes in traffic circulation patterns or movement flow of people, which, in turn, would affect activity patterns and the local environment. A single change along any part of this continuum can set off ripple effects, affecting other spheres of social, economic, and environmental variables. The greater the change the further the ripples can extend through the continuum. The focus of this discussion is on how the urban planning, which directly influences urban form, which, in turn directly affects human health.
Why is Urban Planning Necessary for the Future? Cities are Growing!
Not only is global population growing, forecasting data from the World Health Organization point to a 50% increase in global population from 1990 and 2030, but there is also an ongoing shift in growth patterns based on location rural vs urban, see Figures 1.1 and 1.2 below (Prüss-Ustün et al., 2016).
According to the United Nations Department of Economic and Social Affairs [UN] (2014), since 1950, global urban population has increased from 746 million to 3.9 billion. Population projections indicate total urbanized population will increase from its current 4 billion to over 6 billion by 2050, an increase of 66%, with the majority of this anticipated growth expected to occur in informal settings of small and mid-sized cities among lower to middle income countries (UN, 2014).
Meanwhile, global rural population has grown only modestly since 1950 and is forecast to peak at 3.4 billion in 2020 and decline to 3.1 billion by 2050, see Figure 1.1 below (UN, 2014).
Figure 1.1. Evolution of Urban and Rural Populations Between 1950 and 2050
Figure 1.2. Urban and Rural Fraction of the Population, 2012
Note: Organisation (sic) for Economic Co-operation and Development (OECD) is an intergovernmental economic organization founded in 1961 with the goal of stimulating economic progress and world trade. It is comprised of 36 member states that generally possess high-income economies, accounting for 62.2% of global nominal GDP, very high Human Development Indices (HDI), and are regarded as “developed countries” (http://www.oecd.org/about/history/#d.en.194377).
Growth Implications and Planning
This influx growth in urban areas, coupled with growth associated with natural population growth (i.e. births vs deaths) has significant implications for the transmission of infectious diseases and the progress of current and future pandemics (Alirol et al., 2011).
Hauge et al (2020) point out how the characteristics of urban areas can play a role in the spread of emergent pathogens and vectored diseases, (e.g. crowding and systemic inequality).
Planning and Future Disease Outbreaks: Anticipation, Mitigation, and What Can be Done?
Evidentiary Justification
It seems counter intuitive to continue forward with policies that foster dense urban settings in light of current social distancing guidelines for COVID-19, and that policies promoting a less-dense form of growth (i.e. sprawl) would be preferable.
Not only has past research pointed to the socio-economic and public health drawbacks of promoting low-density growth but recent research by Hamidi et al. (2020) examining SARS-CoV-2 transmission and mortality rates in 913 metropolitan counties in the Untied States found that no link exists when controlling for population, socioeconomics, and health care infrastructure (Procter, 2020). These findings were also corroborated by a separate study that showed a non-linear relationship between cumulative COVID‐19 cases and population density, see Figures 1.3 and 1.4 below for their findings (You & Pan, 2020).
In fact, Hamidi et al (2020) went a step further and found that dense counties had significantly lower death rates, most likely due to access to better health care and ease of management of social distancing interventions. What is more, their research also points out that low-density development forms are not immune to pandemics or experience lower death rates; rather pandemics are more deadly due to lack of accessible healthcare.
In terms of the built environment, research has found that urban linkages (i.e. how well-connected an urban area is linked to surrounding communities through economic, social, and transit circulation) play a significant role the transmission of SARS-CoV-2 (Hamidi et al, 2020).
Figure 1.3. Exposure Response Curve between the log Cumulative COVID‐19 Cases and the Percentage of Urban Vegetation
Figure 1.4. Exposure Response Curve between the log Cumulative COVID‐19 and Population Density
Informed Policy Recommendations
Implementation of context appropriate, preventative, anticipatory strategies allow for the establishing of an actionable policy foundation or baseline, which, to ensure continued effectiveness, should be reevaluated post-event to ensure challenges and opportunities are addressed to ensure any prior missteps are not repeated (Godschalk et al, 1998). To plan in a dynamic world requires policies to be reevaluated for efficacy and applicability.
In a sustainably planned environment, considerations for spatial diversity must also be made. Provisions for access to greenspaces and other open-space environments that facilitate social interaction are crucial to promote overall well-being as well as provide the opportunity for social distancing during disease outbreaks and pandemics (Samuelsson et al, 2020). This recommendation gains even greater significance when considering populations of most large cities in Africa and Asia are forecast to double in the next 10-20 years (Prüss-Ustün et al., 2016).
Provisions must be made to ensure concurrency and resource access remains available and equitable as communities develop, see Figure 1.5 below (Grant, 2020).
Given that health care crises often disproportionately affect lower-income and racially diverse communities, it is critical that the equitable access to social infrastructure resources is assured (e.g. schools, daycare facilities, and health care facilities (Morello-Frosch & Pastor, 2016; Procter, 2020).
Policies that sustain and promote the spread of urban vegetation has been shown to not only foster improved well-being for urban residents, but also mitigate the spread of SARS-CoV-2. According to research by You and Pan (2020), each 1% increase in foliar coverage in urban settings will lead to a 2.6% decrease in cumulative COVID-19 cases. It stands to reason that incorporating vegetation coverage into future urban comprehensive plans would promote resilience of cities to possible public health emergencies.
Figure 1.5. Communicable Diseases and Planning-Based Mitigation Approaches
According to Hauge et al (2020), historical policies created specifically to address disease spread in urban areas have been limited, until the advent of SARS-CoV-2 and COVID-19, however, despite the application, they are no less efficacious.
The spread of communicable diseases can be mitigated through multi-scale planning efforts to address urban form, concurrency, resource access, and the human scale environment. Figure 1.5 to the left details how effective, actionable policy measures can address the spread of the most common communicable or vectored diseases (Grant, 2020). In most examples detailed, access to sanitation and basic concurrency standards are powerful tools to stem and prevent the spread of disease. The role of planning and community development is significant.
Limitations, Practical Considerations, and Further Study
Many studies examined in this discussion were based in wealthy nations, where planning and development practices are able to keep pace with the rate of growth. What is more, the populations are relatively more homogenous compared to the wider socio-economic disparities seen in lower-income countries where the majority of growth is forecast to occur in the coming decades (Hauge et al, 2020). In many of these areas, growth is outpacing the capacity of planned city development, which increases the risk of disease spread.
It is presumptuous to assume that any set of policy measures or recommendations would be applicable to every scenario, regardless of location or context-specific characteristics. Therefore, further studies should be focused on exploring how planning can adapt to current and future growth scenarios that exceed the regulatory capacity of planning policies in their current forms.
Conclusions
As global population increases and becomes more urbanized, expanding cities have the potential to emerge as future flashpoints for local and global health issues if adequate planning policy frameworks are not implemented.
Cities and urban areas represent the future of rethinking organized approaches to addressing disease prevention and fostering health through the implementation of policies that promote equity, economic resiliency, and environmental preservation; the core underpinnings of sustainable development (Grant et al, 2017).
The role of planners in addressing future pandemics and infectious disease outbreaks is significant.
The role of planners and local governments in addressing pandemic outbreaks is crucial to advocate against a reactionary push to pursue low density and suburban types of development and maintain density and compatible land use initiatives.
Robust planning practices can be key in addressing communicable disease reduction and management responses (Grant et al., 2020).
Dense urban development is unrelated to confirmed virus infection rates and inversely related to confirmed death rates shows that modern compact, sustainable urban design is a powerful tool to guard against disease transmission (Hamidi et al, 2020).
Works Cited
Barton, H. & Grant, M. (2006). A health map for the local human habitat. Journal of the Royal Society for the Promotion of Public Health, 126(6), 252-261
Godscahlk, D. R., Kaiser, E. J. Berke, P.R. (1998). Integrating Hazard Mitigation and Local Land Use Planning. In J. Burby, Cooperating with Nature: Confronting Natural Hazards with Land-Use Planning for Sustainable Communities (pp. 85-118). Joseph Henry Press. Grant, M., Brown, C., Caiaffa, W.T., Capon, A., Corburn, J., Coutts, C., Crespo, C. J., Ellis, G., Ferguson, G., Fudge, C., Hancock, T., Lawrence, R. J., Nieuwenhuijsen, M. J., Oni, T., Thompson, S., Wagenaar, C., Thompson, C. W. (2017). Cities and health: an evolving global conversation. Cities & Health, 1(1), 1-9, https://doi.org/10.1080/23748834.2017.1316025
Grant, M., Carbajal, P., Oyuela, A., Herick de Sa, T., Roebbel, N., Sietchiping, R., Andersson, C., Arnold, V. C., Bozzi, A., Braucach, M.F.W., Caiaffa, W., Chong, J., Claeson, A., Coburn, J., Crispi, G., Grande, R., Hinsch, M., Howden-Chapman, P., Kim, R. H., Korc, M., … Wang, L. (2020). Integrating health in urban and territorial planning: A sourcebook for urban leaders, health and planning professionals. https://unhabitat.org/integrating-health-in-urban-and-territorial-planning-a-sourcebook-for-urban-leaders-health-and
Hauge, S.H., Meijerink, H., Alveberg, B., Berg, A. S., Bergh, A., Bragstad, K., De Blasio, B. H., Eriksen-Volle, H.M., Feruglio, S. L., Forland, F., Grøneng, G. M., Holme, J. A., Hungnes, O., Iversen, B. G., Whittle Johansen, J. D., Jønsrud, K., Macdonald, E. A., Nøkleby, H. M., … Wolden, B. (2020). Urbanization and preparedness for outbreaks with high-impact respiratory pathogens. Norwegian Institute of Public Health. https://apps.who.int/gpmb/assets/thematic_papers_2020/tp_2020_4.pdf
Hamidi, S., Sabouri, S., Ewing, R. (2020). Does Density Aggravate the COVID-19 Pandemic? Early Findings and Lessons for Planners. Journal of the American Planning Association, 86(4), 495-509, https://doi.org/10.1080/01944363.2020.1777891
Kelly, E.D. & Becker, B. (2000). Community Planning: An introduction to the comprehensive plan. Island Press.
Morello-Frosch, R. & Pastor, M (2016). Environmental Justice and Vulnerable Populations. In H. Frumkin (Ed.), Environmental Health: From Global to Local (pp. 252-272). Jossey-Bass.
Procter, D., (2020, April 23). Public health experts should be at the urban design table: Consultant. Daily Commercial News. https://canada.constructconnect.com/dcn/news/infrastructure/2020/04/public-health-experts-should-be-at-the-urban-design-table-consultant
Prüss-Ustün, A., Wolf, J., Corvalán, C., Bos, R., Neira, M. (2016) Preventing disease throughhealthy environments: A global assessment of the burden of disease from environmental risks. World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/204585/9789241565196_eng.pdf?sequence=1&isAllowed=y
Samuelsson, K., Barthel, S., Colding, J., Macassa, G., & Giusti, M. (2020). Urban nature as a source of resilience during social distancing amidst the coronavirus pandemic. https://doi.org/10.31219/osf.io/3wx5a
United Nations Department of Economic and Social Affairs. (2014). 2014 revision of the World Urbanization Prospects. https://www.un.org/en/development/desa/publications/2014-revision-world-urbanization-prospects.html
You, Y. & Pan, S. (2020). Urban Vegetation Slows Down the Spread of Coronavirus Disease (COVID‐19) in the United States. Geophysical Letters, 47(8), https://doi.org/10.1029/2020GL089286