Principle 4: Facilitate positive behaviour and health

State of health 

Diets inextricably link human health with environmental conditions and sustainability. To feed a future population of ten billion people a healthy, sustainable diet whilst also operating within planetary boundaries requires the transformation of eating habits, improving food production and reducing food waste¹.

Human relationships with food, and the impact on our collective and individual health must also be examined. Obesity is the most prevalent major public health crisis relating to food consumption; in 2016, 1.9 billion adults were overweight² of whom approximately one third were obese. The incidences of obesity close to tripled between 1975 and 2016², and now equates to around 13% of the world’s adult population and continues to rise.

Physical inactivity and sedentary behaviours are risk factors for other non-communicable diseases such as cardiovascular diseases, diabetes, musculoskeletal disorders and some cancers. Physical inactivity is estimated to cause more than 5 million premature deaths annually across the globe, representing 9% of all deaths³. The built environment is one of the many complex factors that influence peoples’ activity levels and lifestyles, and consequently physical health. Research has found that low levels of neighbourhood walkability were positively associated with more sedentary lifestyles⁴.

Outcome:

Buildings and local community play a supportive role in the healthy lifestyle of occupants, including the reduction of obesity, by designing the space to encourage regular physical activity, reducing barriers to accessibility, availability and affordability.

Strategies across the lifecycle

Design:

• Centrally located, visible and aesthetically pleasing stairwells within buildings and indoor public areas

• Access to end of trip facilities to promote physical activity before, during and after work (including walking/riding to work, e.g. bicycle parking, changing facilities)

• Access to public transport to reduce personal car use

• Urban master-planning prioritising safer street design to encourage heightened personal activity and exercise levels, e.g. connected neighbourhoods with pedestrian footpaths, access to public exercise grounds such as sports fields, outdoor gyms, cycle paths, central cycle parking, etc

Operation:

• Active services during work in office buildings (e.g. staircases, standing or treadmill desks in the office)

• Access to transportation and end of trip facilities to promote physical activity to and from work (including walking/riding to work, e.g. bicycle parking, changing facilities)

Benchmarks:

• The WHO recommends that adults should do at least 150 minutes of moderate-intensity aerobic physical activity per week⁵

• Urban planners should consider the principles of the Bloomberg Partnership for Healthy Cities and WHO’s Healthy Cities Network

State of health 

Nourishment:

Nourishment is essential to good health. A growing body of population-based epidemiological evidence has shown the importance of nourishment in preventing and controlling noncommunicable diseases as well as preventable chronic diseases⁶. At the same time, changes in the production and distribution of food have meant that highly processed and sugar rich foods are in greater supply. The WHO estimates that globally, most people do not consume the recommended daily amount of fruits and vegetables, and this is leading to over 1.7 million deaths each year⁷.

‘Food Deserts’ are regions that have lessened access to healthy food, broadly due to socio-economic factors such as income or location. People who live in regions categorised as ‘food deserts’ are recognised as being at a higher risk of diet-related conditions, such as obesity, diabetes and cardiovascular disease⁸. Sustainable urban planning and operational building policies, to support local communities, can be helpful factors in addressing this socio-economic health issue.

Hydration:

Hydration is of fundamental importance to health and wellbeing as without water humans can survive only for days⁹. Water comprises of 75% body weight in infants to 55% in elderly people and is essential for cellular homeostasis and life¹⁰. Within the built environment, our priority must be to maintain a safe and sustainable supply of clean water, as outlined in Principle 1.2, consumed in necessary quantities to maintain human health and maximise wellbeing. The Institute of Medicine recommends a daily water consumption of approximately 2.7 L for women and 3.7 L for men¹¹.

Social connectivity:

The WHO has demonstrated the link between social interaction and health¹². Social connection improves physical health and psychological wellbeing, whereas loneliness is associated with a 26% increase in the risk of premature mortality¹³. Studies have suggested that strong social connections lead to a 50% increased chance of longevity and people who feel more connected to others have lower rates of anxiety and depression¹⁴. Our buildings and communities can be designed in a way that fosters social interaction¹⁵.

Outcome:

The built environment actively contributes to the improvement of nutrition, hydration and social connectivity of building occupants and people in the local community, where possible, by supporting healthy food choices and hydration practices, and providing infrastructure for positive social engagement.

Strategies across the lifecycle

Design:

• Communal dining facilities and scheduled meal breaks in workplaces to foster interaction

• Urban planning to foster inclusiveness and social engagement with central shared areas

• Infrastructure to ensure clean water provision (see Principle 1.2)

Operation:

• The promotion and provision of healthy food options (fruits, vegetables, whole grains)

• Provision of food preparation areas (refrigeration, heating, storage and utensils)

• Onsite production of food

• Buildings operating in less developed communities must strive to address food deserts by increase the availability of healthy food to low-income population

• Provision of fresh clean water and encouraging hydration

Benchmarks:

Universal benchmarks for building and urban design specialists to encourage nutrition, hydration and social connectivity on site are not widely available. Practitioners are encouraged to incorporate strategies into projects on a bespoke basis, following local examples where possible.

The wider lifestyle factors that can contribute to reducing the risk of non-communicable diseases and can be implemented at regional policy level are outlined through the Partnership for Healthy Cities principles: https://partnershipforhealthycities.bloomberg.org/.