26 June 2013 – UPDATED 11 July 2013: Are our cities killing us? What are the health impacts of urban sprawl? These are significant questions with the evidence suggesting cities are creating health problems, from cancer to cardiovascular diseases.

A Massachusetts Institute of Technology study has revealed that more people die from air pollution than car accidents in Britain. And the Huffington Post reports that the United Nations now claims that air pollution kills more people than AIDS or malaria combined.

How do we solve this? Clearly, town planning will have to change to create healthier cities.

All this coincides with the United Nations telling us that, for the first time in history, more than half of the world’s population is now living in towns and cities. By 2030 this number will swell to almost five billion people, more than half the world’s population, with urban growth concentrated in Africa and Asia. In Australia, according to the UN, close to 90 per cent of Australia’s population now live in cities.

  • UPDATE: The Lancet Ocology reported on 10 July 2013 that long term exposure to particulate air pollution increases the risk of lung cancer after a study of 17 invetigations in Europe among more than 300,000 people. The risk was present at every level of exposure, the report said. “We found no threshold below there was no risk,” a spokesman from the Danish Cancer Society Research Centre in Copenhagen said. Read the whole story

There are many examples of these city-induced problems all over the world, the most notable in China.

Cancer is now the number one killer over there. The Xinhua newsagency reports that while the incidence rate of breast cancer is shrinking in western countries, it is on the rise in China as a result of changes in lifestyles, living conditions and diets. Breast cancer patients in China are on average 10 years younger than their counterparts in the west. The Chinese also have a higher risk of lung and colorectal cancer.

Rising vehicle emissions pose health hazards in large Chinese cities. According to Bloomberg BusinessWeek, levels of two major air pollutants — nitrogen dioxide and PM10 (particulate matter less than 10 micrometers in diameter) — have risen steeply in the last year. The average levels of those two pollutants were nearly 30 per cent higher in the first three months of 2013 than in the same months of 2012.

The result: rising levels of lung cancer. According to The Diplomat, only one per cent of China’s 560 million urban residents breathe air considered safe by the European Union. And indeed, the number of lung cancer-caused mortality in China has increased by a whopping 465 per cent in the past three decades.

The Chinese government is now admitting that decades of pollution have created pockets of cancer in the country, located in so-called “cancer villages”.

China’s environment ministry reports: “In recent years, toxic and hazardous chemical pollution has caused many environmental disasters, cutting off drinking water supplies, and even leading to severe health and social problems such as ‘cancer villages’.”

And it’s happening all over the world, wherever there are cities.

According to the Environmental Protection Agency in the US, levels of 80 cancer-causing substances released by automobiles, factories and other sources already exceed a 100 in 1 million cancer risk.

What does that mean? Let’s say one million people breathe air with these sorts of concentrations over their lifetime. The stats mean 100 of those people would be expected to develop cancer because of their exposure to the pollution.

And city living contributes to that. “Air toxic risks are local. They are a function of the sources nearest to you,” said Dave Guinnup, who leads the groups that perform the risk assessments for toxic air pollutants at EPA. “If you are out in the Rocky Mountains, you are going to be closer to 2 in a million. If you are in an industrial area with a lot of traffic, you are going to be closer to 1100 in 1 million.”

In Australia, the CSIRO says: “There is good evidence that ambient air pollution can trigger the acute symptoms of, and exacerbate, both cardiac and respiratory disease.

“Recent evidence has supported a causal link between the development of asthma in children and exposure to traffic air pollution as well as the exacerbation of established asthma. …. Young children, elderly people, those with chronic cardiac disease, and chronic respiratory disease such as asthma and chronic obstructive pulmonary disease, are generally more likely to be affected.”

The CSIRO cites a study of temperature, air pollution and total mortality in summers in Sydney which found that maximum temperature and sulphur dioxide air pollution had significant effects on mortality.

And of course, it’s not just cancer and respiratory disease.  In Australian cities today, there is insufficient physical activity, and there are sedentary lifestyles and poor diets, there’s car dependency, and there are suburbs that go on forever with no local shops and services, no public transport and long commuter trips. The result: more cardiovascular disease and type 2 diabetes.

Obviously urbanisation will continue. The challenge for planners and the industry is to create healthy and liveable cities, places that don’t make people sick.

The World Health Organisation says planning policies need to encourage healthy exercise, social cohesion, better housing quality, low impact food production and distribution, employment, community and road safety, equity and reduction of poverty, good air quality and protection from excessive noise, conservation and decontamination of land and climate stability.

Already moves to address this are being undertaken in places like Sandnes, Norway which has turned itself into a bike city and which contains urban sprawl, enhances urban density alongside local railway and light rail systems, has a high percentage of new residential units inside existing built-up areas and has a strong regional green belt connecting towns together and to main recreation areas.

One study cites other examples in places like Portland Oregon. It adopted a greenhouse gas reduction plan in 1993, the first local plan in the USA.

As part of that plan, it ensured that development away from the city centre is focused on public transport corridors. Then there is Salzburg in Austria which created a greenbelt around the city and created a traffic policy which gave first priority in all planning decisions to pedestrians, second to cyclists, third to public transport and last to the car.

And then of course, there is the state of Victoria in Australia, which took an early lead in healthy urban planning by introducing Municipal Public Health Plans (MPHPs) in 1988 in order to integrate Healthy Cities principles across the 210 Local Government areas that operated within the state at that time (today that has been reduced to 79).

The aim is to make public health a central focus for local government. In Victoria, councils have been given a role preventing ill health.

Rather than designing low density suburban sprawl with poor access to local shops, services, jobs or public transport and big box shopping centres, we need to rethink urban planning.

To create healthier cities, we should build compact pedestrian-friendly neighbourhoods, areas that have a mix of uses like shops, services, public open space and houses. And if the lessons from around the world are anything to by, there has to be better access to public transport and public open space.

Singapore aims for healthier cities

Planners could look to what was achieved in Singapore. The Urban Land Institute and Centre for Liveable Cites have explained how they do it in a piece of research titled 10 Principles for Liveable High Density Cities.

The first principle is to plan for long term growth and renewal. What sets town planning in Singapore apart is their long term horizons, something that just isn’t done here.

In Singapore, planners work with a 50 year time perspective, it’s the only way it can be done. City planning in Singapore is shaped by a long-term Concept Plan.

It’s a strategic land use and transportation plan that guides the overall land use strategy over a 40 to 50-year period, placing developments in a 10 to 15 year time frame. Under this plan, portions of land are identified and set aside for future development or redevelopment. The plan is constantly reviewed to make sure it fits in with conditions at the time. And there is constant change and renewal.


Housing is a good example. A Selective En Bloc Redevelopment Scheme identifies older blocks of public housing with good redevelopment potential. Affected residents are generally offered new homes nearby or given priority in relocation back to the new developments.


The next principle is to embrace diversity so that they are throwing together people with varied skills, knowledge, and entrepreneurial abilities. The multilingual workforce helped Singapore gain wider access to global markets and created new opportunities for the local economy.


Principle number three is blending nature into the city, softening the edges and reducing the exposure to harmful pollutants. In addition to the many parks scattered across neighbourhoods, water bodies course through the city, forming an important part of the landscape. Nearly half of Singapore, according to this report, is now under green cover. This is good for air quality and mitigates the harsh heat of the tropical sun.

Affordable mixed neighbourhoods

The report also recommends planners develop affordable mixed use neighbourhoods. Neighbourhoods in Singapore’s new towns come with a full range of amenities that are easy to access and generally affordable. They are also developed taking into account the hierarchical distribution of the population, land uses, open spaces, and infrastructure. Public housing buildings in Singapore’s neighbourhoods are usually a mix of nine to 13-storey slab blocks and 20 to 25-storey point blocks.

Co-located with them are various types of private residential developments which include landed properties and high-rise condominiums. They all share shops, clinics, eating establishments, and markets, all located within a 400-metre radius of the neighbourhood centre. It creates a healthier, less stressful environment.

Pubic spaces

Another principle is making better use of public space. In other cities, public spaces are treated as dead space but in Singapore, the land alongside canals and drains is fitted with walking and cycling tracks, as well as exercise equipment. Spaces under flyovers have been used for futsal, while large public car parks have been the venue for go-karting events. Parks which are generally dormant places at night have also been used as venues for large scale concerts.

Public transport

There is also a heavy focus on public transport, greener cars and more energy efficient buildings.

Green buildings

Greener buildings are promoted through schemes such as the Building and Construction Authority’s Green Mark Incentive Scheme, which includes cash incentives to retrofit and to conduct energy audits of existing buildings. The Land Transport Authority deploys tools such as the Electronic Road Pricing system, the Certificate of Entitlement bidding system for car ownership, the Off-Peak Car scheme, and the Park and Ride scheme to reduce overall car use.

Green boundaries

Another approach is to create green boundaries, and seamlessly integrating parks and water bodies into the city’s infrastructure.


Planners there also focus on creating spaces that are safe with more communal activities, greater visual access and encouraging more multiple use of sites.

Innovation…in water

There is more innovation in urban design to create a healthier, more sustainable city. Drains and canals have been developed to be part of the water catchment system. Planners have set a target of having 90 per cent of the land area serve as water catchments. Authorities there have also developed reclaimed water—under the brand name NEWater—to drinking and industrial standards

Public/private partnerships

And finally, there are more public private partnerships in town planning and urban design.

While Singapore has pollution issues, most of that comes from farmers in neighbouring Sumatra often burn forests as a cheap way to prepare the land for new plantings. And that pollution created in Indonesia will have an economic impact on Singapore and Malaysia.

Despite that, Singapore is a healthier place than other cities. Experts say its health system ranks among the best and most efficient in the world. Globally, Singapore ranks sixth in health care outcomes but it spends proportionally less on health care than any other high-income country, spending less than one-fourth the cost of health care in the United States and about half that of Western European countries.

Urban design has contributed to that.

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