Significant global health challenges are being confronted in the 21st century, including increases in unhealthy diets, physical inactivity, non-communicable diseases (NCDs), injuries from road trauma, and obesity, combined with population growth, rapid urbanisation, and climate change, prompting repeated calls to rethink approaches to prevention.1, 2, 3, 4, 5 Decisions about housing, food, water, energy, transport, social services, and health care6 will profoundly affect the health, wellbeing, and safety of growing and ageing urban populations.4, 6, 7 With the world's population estimated to reach 10 billion people by 2050, and 75% of this population living in cities,5 city planning is now recognised as part of a comprehensive solution to tackling adverse health outcomes.5
Associations between city planning and health are not new. In the 19th century, planning curbed infectious disease outbreaks in industrialising cities through improvements in sanitation and housing and separation of residential areas from industrial pollution.8, 9 In the 21st century, well planned cities have the potential to reduce NCDs and road trauma and to promote health and wellbeing more broadly. This could be achieved by reducing automobile dependency, traffic exposure, pollution, noise, and urban heat-island effects, while enhancing mental health, contributing to climate change mitigation, and promoting walking and cycling in ways that are safe, comfortable, and desirable.
Leading global agencies recognise that city planning and management decisions affect the liveability of cities6 and, ultimately, the health and wellbeing of residents. WHO recommends “placing health and health equity at the heart of [city] governance and planning”,10 highlighting the need for integrated urban planning, transport, and housing policy. This mirrors the Organisation for Economic Co-operation and Development's call for leadership from “transport, land use and health ministers” to create the “legal, administrative and technical frameworks” that promote walking.11 Similarly, the UN has endorsed integrated agendas to combat NCDs.12 The UN's Sustainable Development Goals include promoting healthy lives and wellbeing by making cities inclusive, safe, resilient, and sustainable.13 However, changing the way cities are planned, built, and managed will require bipartisan political leadership and community engagement.
Key messages
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Significant global health challenges are being confronted in the 21st century, and well planned cities that encourage walking, cycling, and public transport use have an important role to play in addressing these challenges
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Urban and transport planning and design can directly and indirectly affect non-communicable diseases, traffic injuries, and other adverse health and environmental outcomes
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Local and regional interventions can affect urban and transport planning and design, and these influence environmental, social, and behavioural risk exposures
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Integration of well implemented urban systems policies are needed to achieve healthy liveable cities
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Transport, planning and health ministers must develop appropriate legal, administrative, and technical frameworks contextualised to local conditions, to deliver compact pedestrian and cycling friendly cities that reduce private motor vehicle dependency
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City planning indicators are required to monitor progress within and between cities
In a rapidly urbanising world, understanding how urban and transport planning and design decisions affect health is important. City planners have traditionally focused on the physical, social, economic, and environmental aspects of where people live.14 However, rapid changes in motorised transport have increased the geographical size of urban areas. Combined with unprecedented urban population growth, this change has put transport mobility at the forefront of city planning. Early in the 20th century, engineers began addressing traffic congestion and road trauma in European and North American cities. Transport engineering soon emerged as a new field, gaining political and economic influence with the construction of national motorway networks after World War 2. Transport planning followed as an engineering subfield.15 City planning and transport planning are now typically run at all levels of government, but in separate agencies. Both are closely linked to political systems because they oversee major capital-intensive operations.16 However, these disciplines currently operate in separate academic settings with their research underpinned by different theoretical approaches.17
This Lancet Series focuses on the health impacts of city planning through transport mode choices. Drawing on evidence from multiple disciplines and using critical and systematic reviews where available, in this, the first paper we review the published work and propose pathways through which urban and transport planning and urban design (together referred to as city planning) directly and indirectly affect NCDs, traffic injuries, and other adverse health outcomes. We also identify eight urban and transport planning and design interventions and consider their influence on eight environmental, social, and behavioural health risk exposures. The second paper in this Series18 models some of the pathways through which city planning affects health. The third paper19 focuses on research translation by considering how science can be, and is already being, used to guide city planning policy and practice that create compact cities that promote health.