CREATING ENVIRONMENTS CONDUCIVE TO HEALTH AND WELL-BEING #8 Introduction
CREATING ENVIRONMENTS CONDUCIVE TO HEALTH AND WELL-BEING
“Health is a state of complete physical, Urban planning approaches tailored to health as well mental and social well-being and not merely as health impact studies supported by scientists the absence of disease or infirmity”. This is how have emerged to meet this need. Questions such as: the WHO has been defining health since 1946. How can we design “healthy” living environments that Yet health is still too often reduced to care. maximize the benefits of protective factors and minimize exposure to risks, both in their design and future use While care is essential during illness, the overall while taking into account the needs of all populations? health status of a population goes beyond this purely arise. curative approach and depends on the interlinking of a multitude of biological, behavioural, socio-cultural Designing regions, cities, neighbourhoods and and environmental factors. Action on these “health islands that are conducive to health also means determinants” is essential to prevent chronic illnesses supporting major transformations of the health and the loss of autonomy, which are major current system, by locally developing solutions that meet public health issues 1, but also to fight against growing current challenges: development of outpatient social and regional health inequalities 2. care, multi-professional grouping of practitioners, optimisation of medical time, development of prevention These determinants are strongly rooted in regions: approaches and a comprehensive approach to health they concern the quality of the air we breathe, promotion, emergence of e-health to combat the the water we drink, the social relationships we have, compartmentalisation of the health system, medical the food we eat and the opportunities we have desertification, the lack of private practices and the to be physically active and in contact with nature. saturation of the emergency services. The local scale therefore appears particularly well-suited to mobilising levers for action and promoting By identifying these current and emerging trends, a cross-cutting approach to health. This is the aim of this document explores the levers for action to meet the Healthy Cities programme developed by the WHO these challenges. New ideas are sourced from regional in 1987 and implemented via a worldwide network of organisations, the building industry, services associated Healthy Cities. with new medical practices and emerging literature on the “inclusive city”.
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1 Source: Responsible for 63% of deaths, chronic illnesses (heart disease, stroke, cancer, chronic respiratory diseases, diabetes, etc.) are the leading cause of death in the world. (WHO) 2 Source: In France, the life expectancy of the richest 5% of the population is thirteen years greater than that of the poorest 5% (INSEE, 2018) Contents
4 5 Editorial
Health and well-being are currently It is in this context that Bouygues Construction, CREATING a major concern of populations; as a player in the urban and regional ecosystem, it is estimated that 48,000 deaths has led this open and collaborative initiative with ENVIRONMENTS per year in France are due to air experts and players in the health and well-being pollution, according to the study by sector, property development and urban players, CONDUCIVE Santé Publique France published in start-ups, sociologists, architects, companies 2016. In a rapidly changing world, the and associations. The aim of this initiative was to TO HEALTH AND societal aspiration to live in a healthy share best practices and ideas, as well as come environment is a major challenge. up with proposals for the incorporation of these WELL-BEING Virginie Alonzi According to the second edition of new paradigms into property development and Bouygues Construction the ObSoCo-Chronos “Observatoire urban projects. Strategic Foresight Director des usages et représentations des territoires” (“Observatory of uses and In 30 years, two thirds of humanity will be living representations of regions”), published in cities, which presents a major challenge Today, the complexity of cities, their Health is influenced by many factors, first and in February 2020 and of which Bouygues for the years to come! Bouygues Construction growing importance, the increase foremost that of the living environment and Construction is a partner, more than is a responsible and committed player and, in needs, the pressure due to the emergence of new forms of community half of French people would like to “live through its subsidiaries, incorporates these diminishing resources and also the life in cities, linked to social, cultural and family elsewhere” if they had the opportunity issues of health and well-being via its eco- visible socio-economic fractures in interactions and changes, etc. (while more than three-quarters of design approach to designing, building or the social fabric highlight the need the French population live in towns renovating buildings that respect our people. to look at urban health in a different way. Urbanisation leads to problems such as noise, and cities), with a desire to live close At the city level, Linkcity develops property urban stress, natural and/or anthropogenic risks, to nature that remains very strong. development projects that take into account In a few decades’ time, our cities will be the a lack of road and food safety, the impacts of the sense of well-being of future residents, 6 Professor living environment for almost all of humanity climate change, pollution, etc. These make cities Today, various factors directly linked to while committing to the preservation of 7 Carlos Moreno in a world that is already predominantly vulnerable to the development of pathologies, our living environment and to the urban our shared assets, namely health and the Scientific director and urbanised. some of which are recent, such as high blood environment have an impact on our health environment. co-founder of the Chair ETI pressure, cardiovascular diseases, asthma, and well-being: the quality of air, of water, (Entrepreneurship Region Nowadays, all over the world, cities are where diabetes, allergies and obesity (generally due of soil, noise, biodiversity, buildings, changing Better understanding the changes that Innovation) Member the life cycle essentially develops. From birth to a sedentary lifestyle). Cities must take care of lifestyles, growing urbanisation, mobility, etc. of the Scientific Council of are in progress, anticipating future the health of their residents by providing solutions the Institut Mines-Télécom to death, the urban world is primarily the breakthroughs and accompanying change Chairman of the Scientific universe, space and time of human beings. that address the environmental, economic and Promoting quality of life is a real challenge for were at the heart of this open, multi-partner Committee of the “Live in Being born in a city means already belonging social elements of sustainable urban planning. regions and it is through a systemic approach approach to designing healthy, living and a Living City” Forum to a city culture, marked by the rhythm The aim is thus to propose a viable, liveable, that incorporates all health determinants inclusive cities! and way of life of cities, metropolises and equitable city, which, in its organisation and (individual, socio-economic, environmental mega-cities. From childhood to adolescence, operation, must incorporate the health dimension and those related to urban and regional from the transition to adulthood to ageing, into its primary objectives. policies) that we will be able to elaborate urban several urban life universes coexist. and regional development from the point of In this period of major change, it is view of uses and act to design inclusive living It is essential that all players in cities reflect essential to approach health from a spaces that are conducive to the health and upon the consequences of this phenomenon systemic, urban eco-health standpoint. well-being of individuals. with regard to human health and the impact By understanding the urban fabric, on our quality of life, which is the essential anticipating changes in lifestyle and So how is a city, neighbourhood or indicator of living together successfully. evolving relationships of residents with building that is conducive to our health their regions, we can move towards and well-being designed, built or The World Health Organisation has said a living city. renovated? How is a property development that,“(health) is not merely the absence of project or an urban project that maximises disease or infirmity but a state of complete the positive impact on our health while physical, mental and social well-being”. It has reducing risk factors designed? been clearly demonstrated that health and well-being, in their various physical, mental and social components, are closely interlinked and profoundly interdependent. Global developments with an impact on O1 health and society
8 9 Although France is among the top-ranking countries in terms of life expectancy at birth, it is fairly close to the European average A demographic for healthy life expectancy 4
More and more dependent people for longer and transition longer periods of time = supporting the loss of autonomy
In 2015, 2.5 million elderly people were living with diminished autonomy (requiring help to move around, dress themselves or groom themselves 5)
Among these people, 700,000 were considered Since 2015, in France, to be severely dependent there have been (situations of confinement to bed or chair and/or 78% 22% more people observation of impaired mental functions) lived at home in care facilities over 60 years old 10 than 11 1 The population under 20 years old is ageing
If recent demographic trends and the improvement in health status In 2018, continue, The estimated number life expectancy France could have at birth was of adults providing 4 million regular assistance to an elderly relative at home 7 The French are dependent is estimated at living longer but senior citizens their healthy 6 3.9 million life expectancy in 2050 remains stable 85.3 years 79.4 years for women for men 2
Healthy life expectancy Between 2006 and 2016, is 64.5 years for women it remained stable, while life expectancy at birth increased by 2.2 years for men 1 4 and for men 3 Source: French economy tables, INSEE, 2016 Source: Direction de la Recherche, des Etudes, de l’Evaluation et des Statistiques 63.4 years and 1.2 years for women 2 Source: Etudes & Résultats, no. 1127, October 2019, Direction de la Recherche, des Etudes, de (Directorate for Research, Studies, Evaluation and Statistics, DREES) l’Evaluation et des Statistiques (Directorate for Research, Studies, Evaluation and Statistics, DREES) 5 Source: Insee Première, July 2019 3 Source: Etudes & Résultats, no. 1046, January 2018, Direction de la Recherche, des Etudes, de 6 Source: Insee Première, July 2019 l’Evaluation et des Statistiques (Directorate for Research, Studies, Evaluation and Statistics, DREES) 7 Source: DREES, care-givers Care survey, 2015 Diabetes: Malignant Long-term In 2016, 2.6 million tumours: psychiatric Resurgence the most cases 2 million conditions, frequent LTIs victims excluding dementia such of infectious epidemics as Alzheimer’s disease: 1.3 million people
and development Glossary Chronic illness: a long-term, progressive disease with an impact on daily life. Significant increase: heart failure, of chronic diseases Chronic illness can lead to disability and heart rhythm disorders and heart disease: even serious complications 1
Long-Term Illness (LTI): a mechanism +18.6%, in other words, 1.1 million cases in place since the creation of the social security system to enable the management of patients with a chronic illness involving prolonged treatment and costly therapy 2
Emergence and re-emergence of infectious diseases in recent decades: 12 n Diseases resulting from animal-to-human transmission: Ecosystem Resistance to Stronger change treatments for promiscuity Ebola, H5N1, Marburg, MERS, infection between humans coronavirus, etc. and animals Risk n New diseases: HIV, BSE, meningitis W135, etc. factors persist
In 2017, The prevalence of chronic illnesses is 10.7 million people in France benefited from the increasing, in particular due to the ageing National Health Insurance body’s LTI population and longer life expectancy mechanism, in other words, 17% of insured persons. Compared with 8.3 million More than in other words, representing one third 20 million 35% of the The rate of obesity In 2014, only 25% In 2014, only 14.9% Decrease in alcohol 38% increase in 14.6% of the French people are population (BMI (Body Mass Index) of French people of French people over consumption tobacco-related mortality of insured persons, population has concerned* according to the >= 30 kg/m²) over the age of 15 the age of 15 complied but increase in heavy among women between in France is rising binge drinking 7 in 2008 3 a chronic illness National Health complied with the WHO with the dietary 2000 and 2013 Insurance body recommendation recommendations (HBD = 6 or more 10% in the to engage in at least of the National Health drinks consumed early 2000s two and a half hours and Nutrition Programme on one occasion) of sport and leisure (five or more portions 15% in 2014 4 activities per week 5 of fruit and vegetables * Expanding the scope to include all people who consume healthcare related to a chronic illness, with or without formal LTI recognition per day) 6 An epidemiological transition
Moderate “Social” and decrease in the non-biological consumption illnesses of medication for anxiety or linked to the lifestyles insomnia and consumption patterns of post-industrial societies 50% of French people feel very stressed or quite stressed 8
France ranks second in terms of 14 benzodiazepine* 15 consumption in Europe, behind Spain 9
Main Main causes consequences
Repercussions on sleep quality Professional life, and behaviour financial problems, (nervousness, etc.) personal life and on family and professional life * Molecules indicated in the treatment of anxiety, severe sleep disorders and epilepsy
but also 1 Source: Ministry of Solidarity and Health Health and Social Protection Survey, September 2017, IRDES 2 Source: National Health Insurance body 7 Source: L’état de santé de la population en France (Health status of the French population), 3 Source: National Health Insurance body, ameli.fr 2017 Report, DREES, Santé Publique France 4 Source: L’état de santé de la population en France 8 Source: “Les Français et le stress” (“The French and stress”), OpinionWay (Health status of the French population), 2017 Report, DREES, Santé Publique France survey conducted for the Ramsay Générale de Santé Foundation, October 2017. Heart problems, headaches, 5 Source: European Health Survey. 9 Source: Situational analysis of benzodiazepine consumption in France, April 2017, addictions, etc. Health and Social Protection Survey, September 2017, IRDES Agence du médicament (French National Medication Safety Agency, ANSM) 6 Source: European Health Survey. Phytosanitary The anxiety- scandals Scandals Recurrent food scandals that affect public (ready-made meals containing provoking confidence in figures horse meat (2013), infant milk contaminated with salmonella of authority and (2017), etc.) industrial players perception of a Health scandals (asbestos, breast implants, “multi-risk” society drug-related scandals, etc.)
Multiple crises A growing mistrust of an 16 occur one after intensive, global economic model, the other and make considered complex and the population lacking in transparency feel that they are living in a state of permanent threat a phenomenon accentuated by globalization
The French have more confidence in consumer associations and farmers Focus on 70% of French people than in scientific experts and NGOs to provide them feel that they lack confidence with information on the information on the quality in food quality of food products of the food products Significant increase in products they consume 1 emerging illnesses and diseases with epidemic tendencies: severe acute respiratory General climate disruption syndrome (SARS) in 2003, linked to global warming: Geopolitical Financial H5N1 avian influenza (2004), droughts, heat waves, H1N1 swine influenza in storms, etc. tensions crises 2009, Ebola (2014), Zika (2015), Coronavirus Covid-19 (2019) *
1 Source: Les Français et la confiance alimentaire (The French and confidence in food products), *A problem for all countries, including those with high standards of living and well-developed health systems. IPSOS for Respect In, November 2013. Health and Social Protection Survey, September 2017, IRDES Examples: SARS particularly affected affluent urban areas and spread easily in the most modern hospitals More diluted local sociability 25% of people living in cities with more A world under than 100,000 residents and 12% of people Between 2010 and 2013, Large 19.5% of the living in rural areas never isolation grew more cities concentrate population lives stop to chat while urban influence rapidly in urban inequalities. below the shopping or walking areas (+5%) than in In France, urban areas poverty line through their rural areas (+1%) are on average richer in city centres neighbourhood than rural areas, but (national average: the gap between rich 14.3%) 4 and poor is wider and disadvantaged populations are poorer compared to rural areas
2018: Mass 55% urbanisation of the world’s population lives 1 in urban areas is accelerating The increasing power of certain metropolises has been Forecast for 2050: accompanied by a feeling of increasing regional 18 68% inequalities and/or a feeling of disengagement 19 for many households living outside metropolises, Small and particularly in rural towns and small medium-sized and medium-sized towns 5
towns in search The feeling of a lack of local services of vitality and pessimism regarding the future of city centres
In 2018, 1 in 8 people Nearly half of the world’s In France, 95% of the in the world live in population lives population lives in an area a mega-city of more in a city of less than under the influence of cities 2 than 10 million 500,000 people (in terms of consumption residents practices, employment, etc.) Healthcare Public Commercial provision service Employment vitality The four elements 38% of the residents 40% of the residents provision of medium-sized 39% of the residents that have deteriorated the most of medium-sized of medium-sized An environment On average, 87% in medium-sized towns according 40% of the residents towns consider Attractive metropolises... a person who lives towns consider that of medium-sized towns that employment towns consider that with constraints: of the residents of the to their residents: commercial vitality Attractive from the point of view of in Ile-de-France loses healthcare provision consider that public opportunities have the example densely populated has deteriorated service provision deteriorated has deteriorated employment and access to diversified of noise from 10.7 months of Ile-de-France area live has deteriorated 3 resources ... but difficult to live in? transport healthy life due to the in housing exposed transport noise they to noise levels that are have been exposed to too high for a quality night’s sleep * 1 Source: United Nations, Department of Economic and Social Affairs, 4 Source: Observatoire des inégalités (Inequality Observatory), INSEE data, 2012 Population Division (2019). World Urbanisation Prospects 2018 5 Source: Les métropoles: apports et limites pour les territoires (Metropolises: 2 Source: Le nouveau zonage en aires urbaines (New zoning in urban areas), 2010, INSEE contributions and limits for regions), Conseil économique, social et environnemental * Threshold set by the WHO. Source: Impacts sanitaires du bruit des transports dans la zone dense de la région Ile-de-France 3 Source: survey by the Observatoire de la démocratie de proximité (Local Democracy (Economic, Social and Environmental Council), 2019 (Health impacts of transport noise in the densely populated Ile-de-France region), Bruitparif, February 2019 Observatory), AMF-CEVIPOF/SciencesPo, 2019 Connected health services: a strong development potential Emergence of societal In the medical field, the development A digital debates related of nano-technologies, biotechnologies, to the digital revolution: IT and cognitive sciences, grouped In France, • Democratisation under the acronym NBIC, is leading to of the access to knowledge the emergence of new fields: 14% society • Revitalised political space • Genetics of digital users have already tried • An unequal world • Molecular biology remote medical consultation, in other that is under surveillance? • Robotics words, 8 points more than in 2018 4 • Freedom of expression • IT modelling of biological reactions and remote medicine 3 reinforced or personal freedoms trampled upon?
Top three advantages related to the use of digital technologies:
Digital and 20 technological • Saving 21 innovation Facilitation Staying in contact time (Europe) is shaking up society of daily life with loved ones • Opening up to as a whole the world (Africa) In France, 66% 1.7 MB of digital users consider of data produced themselves dependent on digital tools, and per person per second worldwide 13% in 2020 1 Top three fears related very dependent to the use of digital technologies: In the United Kingdom, 74% of digital users consider themselves dependent Risk of on digital tools, and Protection of Unreliability dependency 20% personal data (Europe)/health very dependent 6 risks (Africa) 5
Ultra-dominant American Total stock market and Chinese digital giants (GAFAM, NATU, BATX), capitalization of France’s GDP who shape the global economy Google, Apple, in 2018: and whose sales and market Facebook, Amazon: $2,775 billion 2 capitalisation exceed the GDPs $3,490 billion 1 Source: IDC estimation 5 Source: According to digital users in nine countries (South Korea, Ivory Coast, of many nations 2 Source: Ycharts, Insee Egypt, Spain, the United States, France, Morocco, the United Kingdom, Senegal) 3 Source: Observatoire des usages du digital 6 Source: Observatoire des usages du digital (Digital technology usage observatory), (Digital technology usage observatory), 2019, OpinionWay/Orange 2019, OpinionWay/Orange 4 Source: La santé en 2030 (Health in 2030), Asteres, 2015 Development of health and O2 well-being practices
22 23 The French have a very favourable opinion New health and of their doctors well-being uses Health and well-being, major concerns of populations Public opinion is 88% 87% 84% 81% concerned about satisfied satisfied satisfied satisfied All around the world, health the future of the is one of the major concerns Healthcare Level of Time given Healthcare of populations. healthcare system provided information by general provided by by general provided practitioners specialist In 2019, the French made health and The opinion surveys carried out in practitioners by general during doctors well-being a priority ahead of employment, recent years on the medical system practitioners consultations education and the environment in the annual in cities found that the French have a national barometer of public services 1. This very favourable opinion of their doctors was a first since the creation of this opinion Health concerns but are concerned about the future Source : DREES Barometer, Qualité et accès aux soins: que pensent les Français de leurs médecins? (Quality of and access to healthcare: what do the French think of their doctors?), 2017 survey, which celebrated its fitteenth edition. of 18-30 year-olds of the national health system. This result was probably fuelled by concerns In particular, criticisms of the health system about the future of public hospitals, but also The themes that concern young by the conviction that good personal health focus on the issue of accessibility to Good personal people the most are as follows: and that of one’s loved ones is a prerequisite healthcare and medical deserts; these are 24 for a fulfilled and balanced life. health and the considered to be the major challenges facing A feeling of 25 the medical system of the future. The public good health of hospital crisis is also feeding the perception a lack of doctors In contrast to a purely physiological definition Mental of health, the French tend to equate “good one’s loved ones of a progressive decline in the quality of health” with being in good spirits and feeling 21% health hospital care. 29% of French people believe that there are not enough good mentally 2. This is a disposition they is a prerequisite general practitioners near their homes. This figure rises consider indispensable for developing a Endocrine The perception of the future of medicine is rather to 47% for specialized doctors. capacity for resilience in the face of life-related for a fulfilled 19% disruptors pessimistic: more than 90% believe that it will be more technological and more expensive problems (including possible physical health and balanced Source : DREES Barometer, Qualité et accès aux soins: que pensent les Français complications). and 75% fear that it will become less human. de leurs médecins? (Quality of and access to healthcare: what do the French think life Access This is a trend that they believe has already of their doctors?), 2017 18% to doctors begun, since nearly on in four French citizens feel that the human relationship between patients and health professionals is deteriorating 3. Interestingly, patients consider that relational criteria, such as empathy and the quality of listening, are as important as the The image of public thoroughness of the clinical examination and the The survey highlights a variety quality of the treatment prescribed, at least with hospitals is deteriorating of concerns related to societal regard to the choice of their attending doctor 4. well-being, environmental health Dissatisfaction following a hospital stay: and the quality of the healthcare system 2015 9% 20% 2017 1 Source: Barometer published by the Institut Paul Delouvrier, in partnership with the Inter-Ministerial Directorate of Public Transformation, as part of its mission to redefine and renew Three-quarters of French people think public action 2 Source: IFOP/Capital Image study, 2014 that hospital care will deteriorate in the future. Source : #MoiJeune survey, 20 Minutes/Opinion Way, 2019 3 Source: Survey by the Académie de Médecine on the perception and image of medicine and doctors, OpinionWay/ Académie Nationale de Médecine, 2020 Source : Baromètre santé 360°: Les Français et l’hôpital de demain (360° health 4 Source: Bénédicte Bleuse, Déterminants influençant le choix barometer: The French and the hospital of the future), Odoxa/Orange Healthcare, du médecin traitant par son patient (Determinants influencing MNH Group, FHF, Le Figaro Santé, France Inter, 2017. the patient’s choice of attending doctor), 2016 Everyone is becoming a player in their own health
Citizens are increasingly taking charge of their own health. Mistrust of healthcare facilities and industries linked to health scandals, and skepticism regarding vaccinitation is on the rise. A decrease in accessibility to healthcare, and an increase in the empowerment of individuals combined with the explosition of digital tools is giving rise to new practices that bypass conventional medicine and embody the ‘healthism’ movement in which everyone is responsible for their own health.
Self-measurement of health is growing The patient-expert, a new healthcare player Unconventional healthcare practices are popular among The practice of the quantified self emerged in 2007 The concept of the patient-expert, which appeared in citizens in Silicon Valley and aims to promote self-knowledge Anglo-Saxon countries in the 1970s, considers the patient through the autonomous measurement of data relating as a resource, both for medical teams and for other patients The WHO lists more than four hundred to one’s body and activities. suffering from the same pathologies. 26 of them, based on biological therapies 27 (herbal medicine, aromatherapy), “mind-body” In France, alternative Multiple physiological and cognitive parameters can be Their expertise, their knowledge of their illness and their approaches (hypnotherapy, sophrology), medicines are widely popular measured through wearables, which are connected objects experience of living with the illness on a daily basis justify techniques based on manipulation (osteopathy, amongst the population: that can be worn on one’s body (watches, bracelets, blood the involvement of the patient in therapeutic education chiropractics) or holistic approaches pressure monitors, clothing, activity trackers, etc.). Number programmes and in the improvement of the management based on their own theoretical foundations of steps, number of calories consumed, glycaemic index, of chronic illnesses. In France, the practice grew rapidly (homoeopathy, acupuncture). heart rate, blood pressure, sleep duration, etc.: data collection in 2009 with the Hospital, Patient, Health and Region Act, 68% of French people enables the production of a number of personal metrics, which defines the framework for this commitment, and the Their success is based on a feeling of surveyed are convinced of the benefits which are available to both clinical populations and healthy creation of a Patient University that trains and awards effectiveness, ease of access, a perception of alternative and complementary medicine. individuals. These mechanisms are based on the principles diplomas to patients, so that they may become trainers, of them being ‘more natural’ than conventional This figure rises to 85% for osteopathy of ranging and sharing, and even comparison between users, educators or facilitators. drugs, and on their range of applications. and 78% for acupuncture. which can be a source of motivation to improve one’s overall These fields of application include: lifestyle, eat a balanced diet or take up sport. In general, patients are increasingly well-informed and preventative medicine, treatment of mental involved in the management of their illness. They come disorders and their manifestations (anxiety, Beyond this personal use, connected objects can also have together in patient associations and organise themselves stress, insomnia, etc.) and relief of pain related a medical application and become real aids for caregivers online as communities, in order to seek medical information, to chronic pathologies. to monitor chronic pathologies, analyse effectiveness or share experiences and find support. Whether general in observe compliance with a treatment. The patient becomes nature or specialised in certain pathologies (particularly acute more autonomous through self-measurement practices or chronic illnesses), they enable patients and their families 1 in 3 people and the role of the doctor changes, focusing more on support to maintain a continuous link with patients suffering from regularly uses alternative medicine. and the patient’s quality of life. the same pathologies. Some provide access to relatively Homeopathy is a special case since it is firmly specialised information. This is the case, for example, of the rooted in the health practices of the French; smartpatients.com community, which provides information more than 3 out of 4 have previously used it. on the latest treatments available and lists searches for volunteers for clinical trials. This new patient status is not always favourably perceived by the medical profession, which is concerned about the associated risks (transmission of Source : Baromètre santé 360, Les médecines alternatives et complémentaires erroneous information, etc.). (360° health barometer, Alternative and complementary medicine), Odoxa/Orange, Nehs, Asip-Santé, SciencesPo, 2019 Healthy living encompasses habits and Preventive practices behaviours to be adopted in daily life, in order and attention to healthy to maintain a balance between good physical living are increasing and mental health. These factors include: quality of sleep, a balanced diet, physical activity, reduction of high-risk behaviours Prevention is becoming an increasingly (tobacco, alcohol, drug consumption, etc.), 57% important part of health practices, time allocated to relaxation and leisure, whether it involves using health services of French people believe that effective stress management and emotional as a preventive measure or changing it is more effective to improve and mental well-being. It is not always easy one’s behaviour and habits to improve prevention than it is to be able to find the right balance between our personal one’s lifestyle. to better treat people when preferences and desires, the constraints they are ill 2 and obligations related to our lifestyles, For example, 76% of French people have our personal and professional situations, already considered consulting a doctor or a our financial capacities and the ability to Prevention behaviours driven healthcare centre as a preventive measure, change our behaviour and habits. 63% of by awareness-raising and the without having any particular health problem French people say they frequently apply the well-being industry to treat1. Specific preventive check-ups recommendations they are aware of, while for certain cancers (colorectal, cervical, only 8% apply them systematically 1. The majority of French people consider breast, etc.), overall health check-ups and themselves well-informed regarding the lifestyle vaccinations are the most common preventive behaviours they need to adopt to preserve consultation procedures. their health in the long term1. They have been Is digital technology an made widely aware of these, most often by their attending doctor. opportunity to develop 76% health prevention? of French people The increase in these prevention practices is partly have already considered explained by the belief in the effectiveness of this 28 consulting a doctor type of approach, which is shared by healthcare 29 or a healthcare centre as professionals and the population alike. 57% of a preventive measure French people believe that it is more effective 51% Behaviours in to improve prevention than it is to be able to better of French people use at least one food 2 terms of physical treat people when they are ill . scan application (for example, flashing activity show a It is currently products to obtain information on their discrepancy between For some people, this conviction is nutritional quality) or physical activity what medical accompanied by a real interest in health fashionable measurement application (for example, professionals and well-being practices, to the point of to take care a pedometer) consider priority making them a daily pursuit. The «business» Behavioural changes related development areas of «wellness» is booming, as shown by the of oneself and However, few people to health and prevention and the level of proliferation of yoga and meditation centres, use them regularly change in actual corporate gyms, treatments, functional foods listen to one’s practices 1 and new food trends, etc., not to mention Preventive behaviours considered body and mind for food scan the numerous mobile applications that applications most important by doctors Behavioural changes enable people to develop and monitor their 11% sporting or nutrition programmes and share their achievements on social networks. It is for physical activity currently fashionable to take care of oneself measurement and listen to one’s body and mind, sometimes 15% applications to the point of becoming a moral imperative: Giving up Practising a the syndrome of a consumer society marked 79% 72% 48% by abundance, hyper-connection and chronic smoking sporting activity of French people of French smokers of French people stress? (77% of doctors check on a regular basis say they are changing say they are say they are changing this behaviour as one of their behaviour changing their their behaviour Technologies, applications and the two most important (at least one hour a day) to consume more behaviour to limit to practice a sporting connected objects exist but their from a list of 11 options) (36% of doctors check this fruit and vegetables, their consumption activity on 1 Source: Survey by the Académie de Médecine on the uses for prevention purposes have behaviour as one of the and 36% declare of tobacco, a regular basis, perception and image of medicine and doctors, OpinionWay/ two most important from that they do this and 58% declare and 18% declare Académie Nationale de Médecine, 2020 yet to be defined. a list of 11 proposals) systematically that they do this that they do this 2 Source: Health and prevention barometer, ODOXA/Nehs, Health systematically systematically Chair of Sciences Po, Le Figaro Santé, France Info, 2019 Contrasting health practices, Development of health reflecting social and regional inequalities in health systems towards new Available medical time is reduced
Beyond these major trends, health practices are highly modes of organisation Medical demographics alone do not explain this situation, although contrasted within the population, under the influence France is slightly below the average for OECD countries in terms of the of many factors: socio-economic characteristics (age, In France, the medical care of populations and care pathways density of doctors per resident (France: 3.2 doctors per 1,000 residents; gender, socio-professional category, income level, etc.), are organised around three main types of structures that form OECD: 3.5 doctors per 1,000 residents) 2 and could see its situation living and working conditions, access to healthcare, the basis of the national health system: deteriorate due to the ageing of the profession (almost one in three health and social policies, etc. doctors is over 60 years old) and the many retirements to come. • outpatient facilities for so-called “city” healthcare: Prevention practices are indicative of these disparities. private practice surgeries, paramedical professions, medical However, the explanation lies mainly in the organisation of working The health barometer on health and prevention in France biology laboratories, dispensing chemists; time. This is illustrated by the declaration of a general practitioner 3 carried out in 2019 for the Health Chair of Sciences Po and • healthcare facilities for hospital care: general hospitals practising in Paris, published in the Après-Demain journal , which Nehs notably illustrates two types of disparity: generational and psychiatric hospitals, public or private, for short or long- highlights the decrease in medical time and relates the daily obstacles and socio-economic. Among the limitations to good health stay care and follow-up or rehabilitation care; to the time devoted to his patients: more and more numerous and and daily prevention behaviours, some stood out as particularly time-consuming administrative tasks, involvement in teaching, significant: the lack of financial means for workers, the lack • medico-social care for so-called vulnerable, elderly increasingly long consultations, participation in interdisciplinary of motivation for those over 65 years of age, and the lack or disabled populations: EHPADs (Etablissements meetings. of time for privileged socio-professional categories. Similarly, d’Hébergement pour Personnes Âgées Dépendantes the level of knowledge in health and prevention and the The non- or nursing homes in English), etc. The sociology of medical professions also comes into play, with application of good health behaviours increases significantly seeking of care a feminisation of the profession and a partialisation of working time with age, level of education and belonging to privileged that mechanically reduces the provision of healthcare. socio-professional categories. is indicative 30 Young doctors “settle down” less 31 In terms of healthcare, the non-seeking of care is indicative of the social of the social and regional inequalities that weigh on health and regional A health system in crisis The constraints on available medical time, changing aspirations practices. The survey on access to healthcare carried out (preservation of family life and leisure time, etc.) and the discrepancies in 2019 for France Assos Santé shows the diversity of factors inequalities Today, this model is facing several problems between healthcare supply and demand in certain areas are fuelling that come into play. that require the organisation of the system to evolve. a growing lack of interest among young medical graduates in “settling that weigh on down”. health practices Medical deserts, a rural and urban phenomenon This loss of attractiveness in turn fuels the phenomenon of medical deserts. 63% of new doctors are salaried employees, a much higher Regional health development is unbalanced due to a significant proportion than among all practising doctors (43% ) 1. And two thirds dichotomy in the regulation of the provision of healthcare: of young private or mixed practice doctors work as replacements. while the hospital system is regulated, the State does not control 63% of French people the provision of healthcare in towns, where private practitioners are free to set up practice. In their current configuration, hospitals are not suitable for the management of chronic illnesses. have already given Reasons for giving up on or postponing care This specificity partly explains the current difficulty in combating up on or postponed medical deserts, which are areas where the medical services available While remarkable for treating acute episodes of a pathology or for are insufficient to meet the needs of the population. Almost the entire performing operations, hospitals are not organised to meet the long-term receiving healthcare Waiting time too long before French population (98%) lives less than 10 minutes away from a general needs of people who are ageing or suffering from chronic illnesses, getting an appointment 44% practitioner and only 0.1% of the population, in other words, around which are growing significantly. 52,000 people, have to travel more than 20 minutes by car to see a 77% 74% 72% Remaining cost too high (after general practitioner1. However, if, beyond access time alone, a more According to the National Health Insurance body, more than a third of the for people for the 25-34 for people reimbursement from the social security 41% comprehensive approach is adopted, which takes into account the French population is concerned, a figure that is set to rise as the population with age group whose body and health benefits) availability of medical services, the population’s healthcare needs and their ages. This major change in the health requirements of populations requires disabilities net monthly travel times, then nearly 5.7 million French people live in a community a major transformation of the health system. income Inability to pay fees up front that is “under-dense” in terms of general practitioners. The figures is less than 30% are even higher if specialists are taken into consideration (gynaecology, 1 Source: Etudes & Résultats, DREES, May 2018, no. 1061 €1,500 paediatrics, cardiology, etc.). All regions are affected, both urban and rural: 2 Source: Panorama de la santé 2019 (Health at a Glance 2019), OECD Indicators: Lack of doctors within a a quarter of the population living in an “under-dense” community in terms How does France compare? 25% 3 Source: “Temps de travail médical disponible: témoignage” reasonable distance of home of general practitioners lives in an urban centre. (Available medical working time: testimony), A. Scemama, Après-Demain, no. 42, 2017 Primary healthcare by our European neighbours Moving towards pathway medicine In 2018, orchestrated around patients • This shift has been taking place for several years in Catalonia, Finland and Sweden, where Today, new organisational modes are at work, the health system is organised around primary governed by national health policies and laws healthcare regulated by the State 2. In Catalonia, each that have come into force in recent years: 910 primary health area, with a population of between healthcare centres 5,000 and 25,000 people, has at least one primary 1 healthcare centre, which is the point of entry for • Hospital Reform Act These reforms tend towards patient in France patients and the basis of the health system 3. relative to Patients, pathway-centred medicine that Health and Regions (2009); combines prevention, healthcare • These primary healthcare centres are intended and medico-social monitoring. to play a pivotal and coordinating role, by • Health System The aim is to move from a system forging links with hospital, medico-social and social Modernisation Act (2016); centred on hospitals and based on establishments. • Law relating to the organisation a curative vision of health to a system and transformation of the health that decompartmentalises the “city”, 1 Source: Key healthcare provision figures, system (2019), which includes some hospital and medico-social sectors Direction Générale de l’Offre de Soins (DGOS - of the measures of “Ma santé 2022”, to organise the response to the General Healthcare Provision Division), 2018 a plan unveiled by the executive in health needs of patients, whether Hospital specialisation and Public hospitals: The inadequacy of the premises and the September 2018 to reform the French ill or healthy. The result is a development of outpatient care the way out of the crisis transfer on emergencies as the medical health system. profound transformation of the deserts develop partly explain the strong medical landscape. In this new organisation of the health system, These transformations, which are also part tensions that currently affect the public hospitals are refocusing on their healthcare of an economic rationalisation drive, are hospital. missions, with impacts on their organisation reconfiguring the hospital landscape, leading, and operation. in particular, to the closure of hospitals and Saturation of the emergency services, hospital beds. worsening working conditions (overload, 32 The two major changes concern the grouping feeling that the quality of healthcare is 33 of healthcare facilities with the concentration The DREES (Direction de la Recherche, des deteriorating) and inadequate remuneration of specialities within clusters, and the Etudes, de l’Evaluation et des Statistiques or are denounced by care providers. The development of outpatient care, which Directorate for Research, Studies, Evaluation attractiveness of public hospitals is marks the transition of the hospital from and Statistics of the Ministry of Solidarity and deteriorating, leading to recruitment difficulties a place of stay to a place of transition. Health) reports that 17,500 full hospitalisation for the majority of establishments and closures Primary healthcare centres public authorities, who see a solution The shift to outpatient care was initiated beds (with overnight stay) have been closed of departments. In January 2020, nearly 30% 6 of doctors’ positions were vacant in hospitals, for a coordinated local to medical deserts, to the need to by the development of outpatient surgery, in 6 years (between 2013 and 2018) . coordinate care pathways and to the which has seen significant growth in recent According to the body, this reduction is according to figures from the French Hospital response to citizens’ health Federation (which represents public hospitals). issues aspirations of professionals for shared Primary healthcare: “a years, with the outpatient rate during the day, offset by the creation of 5,300 “day” beds without overnight stay rising from (enabling greater patient turnover) and by the modes of practice. capacity to respond to a large 38% in 2008 to 54.1% in 20164. This development of outpatient and home care. The preferred response today is Private practice medicine is evolving majority of individual health development will continue in certain medical However, these overall figures mask organisational. It is based on the vision of with the growth of primary healthcare These local structures contribute needs” (World Organisation and psychiatric activities. According to disparities between the various types hospitals dedicated to technical and hyper- centres, including multi-professional to strengthening the medical fabric of General Practitioners) sociologist Pierre-André Juven, this change of establishments (public hospitals, private specialised healthcare, deferring those healthcare centres (MPHCs). in regions where the offer is fragile (for example, urban policy priority has its limits: “although outpatient care non-profit establishments, private for-profit treatments that would not fall within the scope neighbourhoods) and make it • All front-line health services: has many advantages, in particular not clinics): while public hospitals account for of public hospitalisation to city medicine and These groups of health professionals possible to reach patients as general medicine, primary care keeping patients overnight, it also has the 78% of the total number of full hospitalisation clinics. This transformation can only work if (medical professions, medical close as possible to where they medical specialities (for example, disadvantage of becoming a standard beds removed, the creation of “day” beds is it goes hand in hand with an increase in the auxiliaries, pharmacists) and live. They provide a coordinated city paediatrics), dental care, vision that is not suitable for certain populations mainly driven by for-profit clinics. resources allocated to public hospitals and other professions (psychologists, 5 and monitored response over time disorders, nursing care, physiotherapy, in particular elderly or isolated persons” . if the transfer of certain missions to the city nutritionists, etc.) provide healthcare to citizens’ health issues: checking medical and social workers, etc. is properly financed and organised. activities and participate in public that a pathology is not getting health, prevention and health worse, ensuring that a treatment • Missions: prevention, screening, education operations through a shared is appropriate, treating a wound, diagnosis, treatment and follow-up of 2 health project and real collaboration Source: Soins de santé primaires (Primary healthcare). Les pratiques professionnelles accompanying changes of habits patients, dispensing and administration between care providers. en France et à l’étranger (Professional practices in France and abroad), Thematic Bibliography, IRDES, 2018 that are conducive to health, etc. of medicines, pharmaceutical advice, 3 Source: Organisation des soins primaires en Catalogne (Organisation of primary healthcare in Catalonia), guidance in the healthcare system and Toni Dedeu, Revue française des affaires sociales (French review of social affairs), 2010 MPHCs have multiplied in recent 4 Source: Etat des lieux des pratiques de chirurgie ambulatoire en 2016 (Situational analysis of outpatient surgery practices in 2016), DREES, 2019 the medico-social sector and health 5 Source: Pierre-André Juven, Frédéric Pierru, Fanny Vincent, La casse du siècle. years and this trend is set to education. A propos des réformes de l’hôpital public (The hold-up of the century.Reforms of public hospitals), Raisons d’agir, 2019 continue, with the support of the 6 Source: Etudes et Résultats no. 1130, DREES, 2019 A regional organisation of the Digital health tools to support healthcare offer to benefit a gradation the transformation of the sector of patient management and the development of practices
The transformation of the medical landscape is accompanied In parallel with the reconfiguration of the medical landscape, by a new regional organisation of the healthcare offer, which practices are changing through medical but also technological is designed to be fluid and coordinated between cities and advances. hospitals and across all sectors: health, medico-social and social. It is based on three pillars: Regional Health Projects (RHPs), Numerous digital tools now exist for the remote implementation Regional Health Professional Communities (RHPCs) and the of activities, services and systems applied to the health, status of local hospitals. medico-social and social fields.E-health, since this is what is concerned, appears to be a lever for decompartmentalising The first two aim to develop a health project shared between sectors and developing prevention and primary healthcare. all players (local authorities, health establishments, medico- It applies to health information systems, by organising the social establishments, primary care players, users, education exchange of information between city medicine and hospitals, players, etc.) and the organisation of the day-to-day activities or between departments within the same hospital. Shared of health professionals around shared objectives. medical records (SMRs), for example, are based on this system; SMRs are digital health records that enable health As for the status of local hospitals, it reflects the intention professionals to access a patient’s health data to improve to move towards a gradation of patient care management. medical monitoring. E-health is also used in telemedicine, These establishments are focused on primary care and their through the remote exercise of certain medical practices. missions are refocused on the activities of multi-purpose medicine, healthcare for the elderly, follow-up and rehabilitation If e-health is to really take off, solutions will have to be found care, monitoring of chronic illnesses and advanced medical to the various issues it raises: confidentiality of personal data, and surgical speciality consultations (with the support social acceptability, management of the deployment of other establishments). Therefore, surgery and maternity of technical solutions to cover the entire population, switchover departments are closed, reserved for Groupements of current health services to digital technology, training, patient 34 Hospitaliers de Territoires (GHTs or Regional Hospital Groups). autonomy (when e-health solutions allow them to stay at home 35 This is development that worries certain mayors, who decry for their treatment), etc. the metropolisation of health.
Telemedicine acts E-health appears to be a lever for • Teleconsultation: remote consultation • Tele-imaging: medical imaging procedure decompartmentalising (radiology, scanner) carried out remotely sectors and • Tele-expertise: remote request by a doctor for advice from one or more colleagues developing prevention • Medical tele-monitoring: remote interpretation by a doctor of the data required for the medical monitoring of a patient • Remote medical assistance: a doctor remotely assists another health professional during the performance of a procedure Proposals for designing cities and neighbourhoods O3 that are conducive to health
36 37 Designing a supportive and welcoming living environment that facilitates the inclusion of people made vulnerable by illness, disability or loss of autonomy Limits to universal accessibility
In February 2005, France passed legislation The goal is to meet all of the population’s For a long time, the response took the making it mandatory for cities to create requirements and desires and to give them a form of equipment or developments a living environment adapted to residents central role in governance processes, regardless designed to eliminate disabling conditions, with disabilities, by making urban areas of any constraints they may have or of their according to a principle of universality accessible to everyone within 10 years. physical or cognitive abilities. In other words, or of “making everything accessible”. However, the additional time granted and the objective is to remove all urban and social the leniency shown due to the difficulties obstacles which could prevent some citizens However, this approach has shown its faced by cities in meeting the established from participating in the life of the community. limitations, as can be seen in housing deadlines have considerably diminished regulations. Accessibility standards (hallway the initial goal. This is a major challenge, as people with Enabling all and door width adjustments enabling people disabilities are affected by various forms of in wheelchairs to move freely and use the How is a welcoming city for people with exclusion. In 2015, according to the Human citizens to entire space of a home independently) require disabilities designed? Fifteen years later, the Rights Defender, disability was the second participate in an estimated 5 square meters of space per goal remains the same, but the approaches highest cause of employment discrimination. apartment1: while commendable, the original A city’s structure and organisation is likely to 38 have evolved. Methods focused solely on community life intention of adapting to everyone has proven 39 the technical compliance of buildings, public amplify some of the constraints and reduced to be inadequate for some users. Furthermore, spaces and public transport are no longer the capacities of people with disabilities. these standards themselves do not guarantee trend. The framework of the players is now accessibility for everyone and must often go that of an inclusive city: working to make urban hand-in-hand with developments to adapt spaces and services accessible to all, with no homes to the specific requirements of their restrictions. users (colour codes for people with visual impairments, bells for people with hearing impairments, walk-in showers and grab bars for people with reduced mobility, etc.). In this context, in 2018, the ELAN law confirmed the mandatory accessibility of 20% of new housing units for people with disabilities rather than 100%, while it must be possible to easily transform the remaining 80% through works, at a low cost. This legislative development was criticised by some organisations who defend the rights of people with disabilities, but encourages us to rethink our approaches. In 2018, the ELAN law confirmed the mandatory accessibility of
20% 1 Source: Le grand flou des logements “accessibles” of new housing units for people aux handicapés (The great uncertainty of “accessible” with disabilities rather than housing for people with disabilities), Anne-Aël Durand, 100% while the remaining 80% Le Monde, June 2018 must be transformable In France, an estimated 2.75 million adults present functional Inclusive solutions Giving people with limitations, including to benefit everyone disabilities the capacity 1.86 to act, design and million As far as possible, these solutions should with mobility problems benefit as many people as possible, in decide order to avoid further separation of people with disabilities from the rest of society. These approaches have the additional advantage of placing users in a legitimate The Wegoto application enables users to role that is all too often forgotten: that of search for the most well-suited itinerary experts in their own everyday lives. with no obstacles based on the user’s profile Changing perspective: Multiple disabilities Agile, service-oriented (cyclists, persons with reduced mobility, designing a city by They know better than anyone what solutions able to adapt persons with a visual or hearing impairment, putting oneself in the constraints, requirements or potential conflicts It is not uncommon to think of the word The different types etc.), making it a universal, non-discriminatory of use they face. The various players must “disability” as a one-size-fits-all term, of disability to various requirements and non-stigmatising tool that promotes shoes of all its users support these users, in order to jointly express forgetting that in fact, it covers a wide and contexts sustainable transport. and design the most appropriate responses. range of realities and situations. To move towards this ideal, players This is the aim of an experiment by the For all these people, cities are sometimes are using new methods to think outside InControl association in the United Kingdom In daily life in cities, the various types of Hearing: from minor hearing synonymous with constraints and the box with regard to the urban fabric. regarding allocations for senior citizens disability can result in difficulties in getting problems to complete deafness exclusion, when in actual fact they should, and people with disabilities. The association around in an unfamiliar environment, on the contrary, become sources of Among these methods is “inclusive design”, partnered with the authorities to create communicating, reading or climbing stairs. opportunities, in particular through their which entails learning from various disabilities a service enabling beneficiaries to decide In France, an estimated 2.75 million adults service-oriented capacity. or constraints, in order to improve the interface on the use of their allocations themselves, present functional limitations, including 1.86 Visual: from visual impairment of a service, piece of equipment or development by choosing the services to which they would million with mobility problems1. This data to complete blindness and including a maximum number of users. like to subscribe. The services chosen were 40 And if “accessibility was a service rather 41 includes neither children (over 350,000 than an array of equipment”, as Brice Dury There is no shortage of experiments, as quite different from those provided in the students with disabilities were reported in a considers it in his report for the Outlook and evidenced by an initiative in the city of Basel conventional offer and focused heavily on survey by the National Ministry of Education), Mental: consequence Public Dialogue Division of Greater Lyon 2, it in Switzerland, beautifully named “Les Yeux leisure activities that promote “well-being”. nor people who will be faced with a loss of of an intellectual disability would combine human assistance, equipment à 1.20 m” (“Eyes 1.20 m from the ground”). This was a successful example of autonomy, in particular senior citizens, whose and digital tools to provide the right solution at Its goal? To encourage the players involved in the empowerment. numbers are going to rise. the right time, through intelligent design that development to take children into account when combines the “for everyone” and tailor-made designing public spaces. Through a “Kinderbüro” Psychological: psychological aspects. For example, when going grocery (children’s office), children co-design development disorders such as schizophrenia, shopping, a person with a disability could projects (redevelopment of a street, design depressive disorders, etc., have access to a movable ramp system at the of a new school, etc.) and are involved in the which can be cured by means entrance to the building, an in-store pick-up democratic process. The results are summarised of appropriate therapy service to pre-order groceries, an application in a guide which takes the form of a measuring informing him or her of the products available stick perforated at a height of 1.20 m, in order in store, human assistance (to read labels, get to view the space from the physical position of a around the store, etc.) and a volunteer-based child. A similar principle could be applied to other Cognitive: consequence of home delivery service. profiles, in order to identify their usage challenges. dysfunctions in cognitive functions, The urban rhythm could be questioned, for such as attention and memory example, by taking into account the acceleration problems, etc. of our pace of life compared with the slower movements and flows of people who have difficulty getting around. Motor disabilities
1 Source: Enquête Handicap-Santé (Health and Disability Survey), DREES and Insee, 2008-2009 1 Source: Ville et handicap: en finir avec “l’accessibilité” (Cities and disability: an end to “accessibility”), 2011 Bouygues Construction Reference Inspiration
“Wizom For Life”, evolving housing that supports residents throughout their lives Functional fitted kitchen Adapted kitchen, free space under the work surface Connected This housing is transforming to meet the expectations of its Illuminated fall detector Secondary space, office, path bedroom, workshop, movable Adapted partitions, etc. occupants of all ages and in all life situations, through flexible bathroom architecture and an evolving construction technique. Designed by occupational therapists, its design serves the requirements of occupants for real quality of use. Equipment can be easily installed, Third Place Specialised Home City networks Search moved or removed to support changes in life or occupants. Services Bedroom for People With and activities led by our partners Unis-Cité and Hakisa help put for a first child Disabilities residents in touch with each other (for example, a common room Humanlab Age-Friendly dEMAND project within a residence). (Rennes) (Quebec, Vancouver) Connected Cities motion detector School of Safe non-slip floor In the Résidences Vertes project in Pulnoy (54), 65 private and social Grab bars Created by the My Human Independent Created in 2005 during the dEMAND is a participatory housing units are equipped with Pharmagest’s Carelib solution, Kit association, the Humanlab World Congress of Gerontology research project whose which uses new technologies and connected objects to make life opened its doors in Rennes Living and Geriatrics in Rio de Janeiro aim is to better understand at home easier for vulnerable senior citizens and their caregivers. in 2017. (Vandoeuvre-lès-Nancy) and supported by the World the realities of the mobility Health Organisation, the aim and social participation of The Ecole de la Vie Autonome This digital manufacturing pilot of the French-speaking Villes Canadians using mobility aids (EVA) was opened in 2012 by workshop (fablab) is dedicated Amies des Aînés programme (canes, crutches, wheelchairs, the Office d’Hygiène Sociale to health. In addition to the is to create a network of cities etc.): de Meurthe-et-Moselle, an development of projects such as committed to improving the association that manages several replicable electric wheelchairs, well-being of older residents Participants are users of establishments for people with Bouygues Construction Reference the aim is to enable people in their region. technical mobility aids. They are disabilities. with disabilities to “self-repair”. equipped with tools enabling Thanks to the involvement This was the goal of the project The approach is participatory them to identify their activities The EVA provides a form of “Handicap dans la ville” (“Disability in the City”), initiator, Nicolas Huchet, who had and is based on the experience and the location of the places of local players and also reception and accommodation that his forearm amputated in 2002 and personal history of residents. they go to using a GPS. They experts such as Bouygues prepares people with sometimes a Bouygues Construction/ISIT (University of following an accident at work and Cities joining the programme can take photos of the obstacles severe motor disabilities for Construction, our ISIT who could not afford a suitable ask residents about their needs or facilitators they encounter, Inter-cultural Management and Communication) autonomous living. At the end of students, who are not prosthesis. Nicolas designed and expectations before drawing comment on them using a programme that can last several hackathon to facilitate the daily life of people an inexpensive prototype bionic up an action plan. The Belgian, PhotoVoix technique and assess specialists in the issue of years, these people, who were hand that meets his needs in Swiss and French cities that the corresponding environment. disability, managed to with disabilities initially living with their parents or collaboration with a sculptor and are members of the network This information is decrypted and in an care facility, will be able to come up with ideas that go a fablab in Rennes. Humanlab exchange regularly to share their analysed by researchers, in order live independently in their own In 2018, Bouygues Construction’s Human well-being encourages collaboration between best practices. One example is the to better understand the issues well beyond the confines home in the city of their choice. department and the ISIT joined forces to organise the able-bodied people and people “À petits pas dans mon quartier” encountered and to come up with of the home in just a few They begin by staying in a studio “Disability in the City” hackathon. The goal was to with disabilities and promotes initiative set up by a senior solutions to address them. apartment within the EVA, which days, while at the same encourage students to get to grips with the diversity of the development of open source independence residential home is adapted to their disability, time remaining rooted types of disability and the specific needs of the affected solutions to help as many people in the 8th arrondissement of Lyon: alongside a team of professionals populations with respect to how they use the city on a as possible. a neighbourhood plan drawn up in the everyday reality of who support them as they learn daily basis. They also had to propose innovative solutions by residents and a psychomotor users’ lives. And they really how to carry out everyday actions through their ability to understand differences, which therapist that uses a scale... and obligations (eating, hygiene, enjoyed learning while is directly linked to their multilingual and inter-cultural expressed as a number of steps! shopping, administrative tasks, etc.) expertise. For one week, teams of Master’s level students This initiative restores residents’ feeling useful! and compensate for their motor thought up, designed and prototyped around ten solutions: confidence in themselves and deficiencies. They then live in an a geolocation-based application to connect French Sign promotes their independence, by EVA apartment located in the city, Language speakers (deaf, hearing or hard of hearing making them aware of the actual where they prepare for independent people) so that they can help each other in everyday distances between the residence living while benefiting from regular Marion Bedat situations, a touring bus for the early diagnosis of children and local services. Academic Director in charge of the with “dys” disorders (specific learning disorders such as monitoring. This approach enables Inter-Cultural Management specialisation dyslexia), etc. them to overcome any difficulties or apprehensions on their journey to independence at their own pace. Organising regions in a way that has a favourable Eight strategies impact on all the determinants for healthy of populations’ health urban planning Reduce emissions and exposure to pollutants and harmful factors Promote healthy lifestyles, including “Health as a compass physical activity and healthy eating Contribute to the development of the for regional development” social environment to promote social An increase schools to encourage physical cohesion and the well-being of residents Health is a lever for transforming our lifestyles. activity among students and Enable access to healthcare in the number of installing courtyard-side rather than and social services Our eating habits are changing, and through these, our environmental road-side vents in housing units for Identify and manage conflicts between agricultural production methods; our mobility practices are a healthier environment. various policies (environmental, development, shifting, and through these, the role of the car in cities. health approaches health, etc.) For Sandra Moatti, Director of the Institut des Hautes Etudes and tools In 1987, the WHO launched the Set up strategies that promote intersectorality d’Aménagement des Territoires (IHEDATE), “the local level seems Healthy Cities movement, an (particularly between urban planning and the most appropriate for promoting a cross-cutting approach international programme aimed healthcare professionals) and the involvement Tools and approaches are being of all stakeholders, including citizens to health, as promoted by the WHO: food projects, active mobility developed at various levels at implementing the health for all and sporting activities, air and water quality, mitigation of noise strategy and adapted at a local Design an adaptable project and take to support the consideration developments in lifestyles into account and heat, adaptation to disabilities” 1. level through a network of Healthy 44 of health in regional policies 45 and projects. Cities. This movement marked the Healthcare issues are therefore included in regional planning, birth of the Healthy Urban Planning through various regional plans, strategic planning documents These include regional Health (HUP) concept, developed in and urban planning documents, either implicitly or more overtly. and Environment Plans, Local 2000 in the work of Barton and 2 During the review of its local urbanisation plan, the City of Rennes health diagnoses to analyse the Tsourou . In 2014, in France, the made health a core value of its 2030 urban project. In the same health and social situation of a Ministry of Health and the EHESP vein, the Rennes Métropole inter-municipal local urbanisation geographical area, Local health (École des Hautes Etudes en Santé plan includes a strategic focus, namely “Building a metropolis contracts to reduce regional and Publique or French School of of well-being to serve its residents, incorporating health and risk social inequalities in health, etc. Public Health) published the “Agir management...”. pour un urbanisme favorable à la In particular, two development santé” (“Action for Healthy Urban project tools exist as a decision- Planning”) guide, a tool used to making aid. The Health Impact question every aspect of urban Assessment (HIA) identifies both organisation capable of interacting the favourable and unfavourable with populations, their environments IHEDATE population health effects of projects and lifestyle habits and thus or policies and proposes ways to determining their health status. The ISadOrA project (please see the IHEDATE, a partner of Bouygues maximize positive impacts while mitigating negative repercussions. interview on pages 46-47) provides 1987 Construction, chose to look at an operational adaptation of this An HIA implemented as part of a The WHO launches the regions from a health and well- tool, which aims to include issues being perspective in the 2018 cycle. new national urban renewal project Healthy Cities movement in the Maurepas neighbourhood relating to the health and well-being The 2018 “Regions, health and of populations throughout the well-being” annual report, which is in Rennes, for example, resulted in operational recommendations, definition and implementation of available on the IHEDATE website, development projects. describes the work carried out in such as extending the surface the 2018 cycle. area of school playgrounds within
1 Source: Territoires, santé, bien-être (Regions, health and well-being), Ihedate, SciencesPo, École des Ponts Paris Tech, 2018 2 Source: H. Baron, C. Tsourou, 2000, Healthy Urban Planning in practice, WHO Europe The operational keys of the ISadOrA guide What advice would you give to urban correspond to the major goals to be achieved, production players to help them take Over to... in order to ensure that development operations ownership of this guide and apply it The 15 are conducive to health. These major goals are to their projects? divided into two categories: operational keys First of all, players managing this type of 1. Process keys address how to successfully approach must acculturate themselves in carry out a development operation to ensure Healthy Urban Planning and the associated PROCESS that health issues are properly incorporated. principles (comprehensive, positive and KEYS They deal with the governance of the operation, dynamic approach to health, approach by the elaboration of a portrait of the health health determinants, integrated approach to • Health governance status and the environment concerned by the public health and environmental issues, links • Health/Environment Portrait operation, and finally the implementation of between development and health, etc.). For Participatory approaches Clément Deloly participatory approaches enabling residents to this, it is possible to turn to the increasingly • “Urban Planning and Health” exercise greater control over their environment abundant literature on the subject1, or to research officer,École des and its impact on their health. continuing education training courses (for Hautes Études en Santé DESIGN Publique (French School example, the “Diplôme d’Etablissement SPAT” KEYS of Public Health) methodological framework has been project. What were 2. Design keys deal with the programming (“Diploma in Public Health and Regional structured. Born of the desire to the methodological choices? and design choices to be made concerning Development”). Sharing a common culture • Exposure of populations to capitalise on this work, the goal of the the configuration of islands, public spaces and around these principles and advocating for pollutants and harmful factors ISadOrA project is to widely disseminate In addition to the development of a green spaces, in order to ensure that they are the implementation of Healthy Urban Planning • Quality of housing conducive to health. By incorporating several must unite as many governing players as ISadOrA Project knowledge and practices in the world culture common to all participants, a first Accessibility to employment, health determinants, they each deal with a possible around development operations • of operational development, in order to exploratory phase was organised around services and facilities Incorporating Health promote the dissemination and massive a summary of scientific knowledge in particular theme (exposure of populations to (elected representatives, developers, urban Active mobility and persons appropriation of these principles by all the field and the preparation of various pollutants and harmful factors, social cohesion, project managers, operators, public healthcare • into Development with reduced mobility players and thus make practices evolve theoretical frameworks. Questions such public spaces, urban agriculture, urban heat professionals, etc.). Operations towards Operational Healthy Urban as, “What are the links and mechanisms islands, rainwater management, etc.). • Social cohesion The implementation of the three process Planning (OHUP). between development choices, health Social function of interface keys is essential, to ensure that the approach • determinants and health?” and “How Each of these keys gives rise to a support spaces sheet that explains the “health” goals targeted works properly. In particular, the setting up of 46 The steering of the project, led by an are the links between health and Five senses and identity 47 by the key and lists best development practices a “health authority”, made up of development • interdisciplinary team committed to development taken into account and public health players and incorporated into of places Healthy Urban Planning driven by the at the different stages of a project?” and operational recommendations for their the governance of the operation, guarantees • Public spaces EHESP, the a’urba (Bordeaux Aquitaine were asked. implementation. the implementation of the approach. To do this, • Green spaces urban planning agency) and the FNAU development players must take a step sideways Health For example, with respect to active mobility, (National Federation of Urban Planning Health determinants were analysed from to get closer to public health players (those of a • Urban farming this may involve making facilities, offices, shops determinants Agencies), and its trilateral funding by the perspective of various components community or an RHA, for example), in order to Urban heat islands and public transit more accessible through • the Ministry of Solidarity and Health, of a development operation: functional ensure that the choices made in the operation Environments: specific developments such as bicycle parking. • Rainwater management the Ministry for Ecological and Inclusive diversity, public spaces, housing and are more concerned with the public health air, soil and water quality, biodiversity In terms of islands, it could involve limiting car Transition and ADEME (Agency for the green and blue islands and spaces. issues of a region. Living environment: electromagnetic fields, access, providing pedestrian paths between Environment and Energy Management), environmental noise, light, temperature, safety islands or designing a shared silo car park on attest to the desire to create synergies This guide provides a framework for the Socio-economic environment: social interactions, In parallel, the theoretical framework the outskirts of a neighbourhood. Operational incorporation of public health and environmental access to employment, services and facilities between sectors that are sometimes of a development operation was recommendations group approaches and issues into the process of elaborating a Lifestyle and individual capabilities: compartmentalised. dissected, in order to identify the time principles to promote the emergence of development operation. However, this physical activity, diet, individual skills, income. frames, governance and procedures for these types of practices. Identifying from the For more than two years, the project stakeholder involvement (community framework must be reworked by the players start sources of potentially harmful factors, involved in the operation according to its mobilised an interdisciplinary working services, future managers, populations, taking pedestrians into account, expanding group bringing together elected etc.) linked to each stage (decision context. The best development practices and infrastructure (ex. bike paths) with visual reference operational recommendations laid out in each representatives, developers, planners, to go ahead, initiation, design, points, is key. All of these action levers feed into a local government officials and several assembly, implementation, closure and of the sheets must provide the stakeholders guide intended for all stakeholders involved in the involved in the operation with information on the partners (observatories, resource management). development of a project. ways to proceed and the choices to be made, The goal of the ISadOrA project centres, regional health agencies, etc.). but these players must also take ownership of them. is to provide operational guidance This phase resulted in the for the incorporation of health into Federating players from all identification of 15 keys, which development operations. How did backgrounds and devising a constitute the core of the the project begin? method of synthesis that promote operational tool. How are they 1 Source: The following is a non-exhaustive list of structures to be consulted concerning Healthy Urban Planning: • Collectif FNAU, Santé et Territoires (FNAU Collective, Health and Regions), Paris Gallimard Alternatives, Points FNAU, 1st semester 2020 operational buy-in are key issues applied and which best practices • IAU, ORS IdF, Territoires, incubateurs de santé? (Development and Urban Planning Institute, Ile-de-France Regional Health Observatory, Regions - health incubators?), Les Cahiers, no. 170-171, Since the emergence of the concept for the success of this type of do they promote? September 2014 of healthy urban planning in the 1990s, • A. Roué Le Gall & MF. Thomas (2018). Healthy urban planning: from theory to practice. “Prendre soin des urbains” (“Taking care of urban dwellers”), Urbanisme magazine, October 2018, no. 410: 36-39. • “Agir pour un Urbanisme Favorable à la Santé, concept & outil” (“Acting for Urban Planning Conducive to Health, concept & tool”); EHESP/DGS Guide, Anne Roué-Le Gall, Judith Le Gall, Jean-Luc thinking on public health issues in urban Potelon and Ysaline Cuzin, 2014 ISBN: 978-2-9549609-0-6 environments has grown and the Mobilising all available levers Designing urban spaces of action for a regional fabric from the perspective that is conducive to health of human users to allow
The methods and practices of urban production include for connection and recreation many human uses and behaviours to act on health Design determinants, with a view to designing living spaces Urban production mobilises a wide range of players and expertise. Recent years have that are conducive to the health of populations: been particularly marked by the development of behavioural sciences (neuro-sciences, social psychology, etc.) that study the mechanisms governing our individual attitudes High quality design choices are made to and behaviour and decision-making processes. provide inclusive sporting facilities that are suitable for children, senior citizens, sedentary The economic approach to behaviour has notably theorised the nudge, presented by its instigators people, people with disabilities, and athletes. Cass Sunstein and Richard Thaler as a “soft method to inspire good decision-making”. This “nudge” The same is done for artistic street furniture and Regional Urban continuous bike paths, conducive to relaxation consists in making a slight modification to the context or the “architecture of choice”, in order planning development and movement. to influence behaviour in interest of individuals or the collective.
All over the world, nudged practices are taking over urban space: poems on public benches to encourage conversation and lounging, public fountains delivering fresh or sparkling water By controlling regional development and Through the process of collectively defining to promote water to quench one’s thirst, staircases that are painted or decorated with encouraging development choices that will give substance providing a framework for development projects, messages to encourage people to leave lifts or escalators, etc. There are many examples to promote through planning documents and the legislative to projects and design the urban form, through The issue of cohabitation between modes of and regulatory texts implemented by local the organisation of buildings, the layout of the transport is often a contentious one. In order to healthy actions. However, this approach can only have a real impact on user practices under certain authorities. road network, the general organisation of public open up public space to active modes as much as conditions. spaces, the design of islands and choices in possible, the City of Stockholm has devised two terms of density. scenarios, “slow” and “fast”, to support cycling and interaction with pedestrians: pavements are opened up to “slow” cycle traffic by means of road markings, and dedicated right-of-way reserved In 2018, London City Council took the decision 48 areas are set up in a structured network for “fast” 49 to ban fast-food outlets within 400 metres of cycle traffic. schools, in order to provide a healthier food In a metropolitan guide to public spaces and landscape for pupils when they exit schools. This roads, the Metropolis of Grenoble has defined cordon sanitaire aimed at combating obesity, several principles to be respected by all those which affects 40% of children leaving primary involved in the development of spaces and school in the United Kingdom. roads in the metropolitan area, notably in order to encourage active mobility, pleasant stays and the diversity of uses and users in public spaces, One of the fundamental Behaviour depends Incentives to change The scope of the message shaded areas and green open spaces. qualities of the nudge on individual choices but behaviour will only have and the result will be is its discretion is also determined by a real impact if they reinforced by combining social representations are accompanied by nudges with other types A model of “communal life”, the Superliken Behavioural changes should awareness-raising activities of actions (choice of park in the NØrrebro neighbourhood of be suggested without developments, urban Copenhagen is based on the idea of sharing The work of the Credoc, stigmatisation or coercion in the Credes and the SESI Explaining the bases configurations, etc.). Urban public space by and for residents. Its originality order to respect people’s free programming is based on a three-fold development and the carried out in the 2000s of desirable behaviour cohabitation of urban furniture from a multitude will. Indeed, the technique on the assessment of the (for example, what is the In Nantes, for example, the of countries (some of which were brought can be counter-productive for Evin law thus showed that advantage of using stairs Voyage à Nantes proposes by residents themselves), symbolising the some individuals, who find it measures concerning alcohol rather than escalators or lifts). a tour to get to know the cosmopolitan character of the neighbourhood. By translating project choices in terms of development, disparaging to feel influenced city, through a stroll including Stretching over a length of 750 metres, the park is had attracted a low level of housing, activities, public facilities and services into divided into three themed areas, each with its own and pressured to act in a adherence, due, in particular, artistic works or highlighting programme elements and thus defining restoration visual identity: a square devoted to sport and play, certain way. This is why the to the social representations regional structuring elements, goals for the urban space. predominantly red in colour and with a rubber- implementation of nudges related to alcohol, whose materialised by a coloured Urban programming covered floor; an area designed as an “urban must be subject to usage consumption is perceived line on the ground that living room”, encouraging people to meet up and tests, in order to verify their as convivial. Measures encourages people to walk can help simplify the play, with a predominantly black concrete floor relevance and effectiveness aimed at changing people’s around. marked by wavy white lines; a green, undulating Programming can contribute to simplifying the daily lives of users and park devoted to outdoor activities. and to test whether they behaviour to make it more daily life of users and to preserving their health have the expected impact virtuous have no effect if they and well-being by incorporating developments preserve their health on behaviour. that encourage the adoption of active mobility, do not act on what profoundly sports trails, a healthy local food supply, health determines it. and well-being third places, etc. Over to... Engaging citizens and enabling them to play an active role in their own health by co-designing and running positive health living spaces with them
The implementation of the concept of Healthy Urban Planning interactions with other individuals, what the Superliken Park in Copenhagen requires significant collaboration between various sectors and which will construct the meaning of provides, please see page 48). players and overcoming institutional and professional frameworks possible actions and the feeling of being in favour of participatory approaches with residents. able to implement certain behaviours It is also a question of supply. The or not. The basic idea is to understand presence of shared gardens in a that it is the context that is the essential neighbourhood, for example, affects determinant of behaviour, much more Xavier Brisbois representations related to diet as much than the values, wishes or other ideas as it does practices, by conveying Doctor of individuals. values such as local supply, sharing and Social psychology healthy food. This calls into question the Take the example of an environment relationship of residents with respect whose design structures flows in to their diet and can change perceived a way that tacitly prohibits prolonged orders with regard to their consumption stays. Imagine that the dominant social habits. Taking the social and representations associated cognitive functioning with mobility in this environment are In order to make cities spaces of speed of movement and optimisation freedom and fulfilment, let us keep of individuals into of distance-time. To minimise the in mind that spaces that are more risk of conflicting social interactions, account, in order to conducive to visibility restrict behaviour. individuals who do not fit into this pattern 50 The example of the metro is particularly 51 design contexts that are (for example, those who walk slowly) telling. In Paris, this is a place where will have to comply with a norm that speech is controlled due to proximity conducive to healthy generates stress or will develop with other passengers. The feeling of behaviours a sense of being pushed away from public spaces and adopt avoidance being listened to encourages self- behaviours by staying at home or looking censorship. This type of configuration for other areas to go to. can be reworked by designing a more private environment, in which sound does not carry so far (music, Participating in the life of the citizens in the governance of projects, Many citizen involvement initiatives What can the concrete city is a fundamental right throughout the process, is based on the can be identified during the design, applications for designing reverberant coverings, etc.). What contribution can behavioural and a vector of “good societal mobilisation of dedicated tools: participatory implementation and monitoring phases psychology make when dealing healthy living spaces be? diagnosis in the form of urban wandering of the project. Examples include: Finally, representations associated with health” with the urban fabric and its uses? to identify the issues, role-playing or Localised mechanisms to measure spaces or practices must be studied, The key question is that of the collaborative workshops to co-construct the population’s perceptions of a region, in order to anticipate the uses that The re-empowerment of citizens through the attractiveness of spaces, beyond their projects, etc. co-design and testing of services and In terms of the urban fabric, psychology, establishment of participatory mechanisms mere utility or functionality. Aesthetic, will take place in them and which are equipment conducive to healthy practices through the study of behaviour, can help and the subsequent rehabilitation of their lively spaces must be designed, not always those we expect or hope and running discussions on well-being to design the optimal context in which fundamental right to inhabit and manage Citizen involvement where events take place, and which for. During work on cleanliness, we issues in public areas. In order to be truly desirable behaviours, especially healthy the city can be, in itself, a source of personal throughout the process make people want to stay and spend were able to observe that tree roots in effective, these approaches must be fulfilment and well-being. behaviours, can take place. time there. Encouraging walking, for earth or grass generate more negative Taking health into account in projects implies long-term, have a representative sample It particularly takes into account the example, involves identifying places to interactions (cigarette butts, dog of the population and remain agile. Whether it concerns the evolution of their defining and prioritising the health issues functioning of cognitive and social go on foot, making paths conducive to excrement) related in a certain way living environment or the definition of specific to each social and regional context. processes, in other words, the way walking and also making them pleasant to the idea that nature will manage to development projects, the aim is to give in which individuals construct their to stroll around. eliminate these on its own. This implies citizens the opportunity to express their This is a stage at which it is essential to perception of their environment, via the the implementation of awareness- needs, to be heard and to contribute to involve residents, identify their health and processing of information received from Meaning can be created by staging raising programmes to support the collective reflection. This “empowerment” well-being issues and collect data related the environment and their certain behaviours (editor’s note: this is appropriation of new types of spaces. also serves collective well-being by to the perception of their health status or capitalising on the expertise of citizens to their habits and behaviours (diet, sleep, improve their living environment, in which physical activities, etc.). they are the leading experts. Involving Bouygues Construction Reference
An urban planning A diagnosis of approach conducive to environmental health and a “mental health” health at La Chocolaterie research protocol (Noisiel, Torcy - Seine-et-Marne)
While its name is evocative, the site of the former Menier chocolate factory is just as promising! Straddling the communes of Noisiel and Torcy in the Seine-et-Marne department, this historic site has a major heritage identity on a regional scale and a remarkable landscaped environment on the banks of the Marne river. In 1996, after ENVIRONMENTAL LIVING HEALTH AND MENTAL a period of abandonment, an initial rehabilitation project HEALTH HEALTH LIFESTYLES HEALTH restored the site to its former glory to accommodate the headquarters of Nestlé France, which moved to Issy-les- Moulineaux at the beginning of 2020. In this context, the redevelopment of these 14 hectares was entrusted to the Conflicts urban projects department of Linkcity France, in conjunction At the end of the diagnosis, these proposals are grouped erception and impacterception and impact with Bouygues Bâtiment Ile-de-France. Synergies Air quality and Health quality ofC omfortthe (ICU, ETC.)Inclusive and Healthy eating Social Access to equipmentPhysical activitiesLocal economic P P into five main themes that guide the design of the project: noise environmentbuilt environment evolving habitat Interactions and services development of the built environmentof the natural environment The challenge shared by the cities of Noisiel and Torcy, the urban community, the Ile-de-France Region and the State is • Combine the preservation of unspoilt natural areas and uses to transform this closed site into a genuine neighbourhood, Soil • Offer a micro-climate refuge Risk of Soil Educational Sport for all Perception open to its environment and offering a rich and diversified soil pollution fertilisation gardening versus soil (please see contact) with bio-waste conservation with naturalness programme comprised of: • Move around in one’s neighbourhood Climate • Raise awareness and make healthy eating accessible Bioclimatism for • The “Cité du Goût” (“City of Taste”), a tourist destination ventilation and natural “Climate refuge” Sporting activities Island of coolness (presence of lighting in homes for surrounding in cool environments water, shade, re-permeabilised populations surfaces) avoids the harmful with hotels and seminar areas, a cultural, event and • Pass on the history of the site through the project effects of heat on the brain experience-based site developed around chocolate; Water The approach is also based on a “mental health” research Role of natural View of and access • The “Cité Productive” (“Productive City”), where food ventilation corridor Underside of Green and blue grid to the Marne river protocol conducted by cognitive science researchers for the Marne buildings continuity versus and natural areas and Val Maubuée in flood-prone pedestrian crossings for all apartments processing and production activities will take place, creating and led by [S]CITY. Since our brain has evolved in natural areas and uses local employment; environments over millions of years, it is less suited to the Biodiversity Cool micro-climate thanks Conviviality Physical activities Porous façade Access to unspoilt Avoid allergenic to evapotranspiration for all versus natural highly urbanised environments that have recently appeared species around tb/tv that can nature and a variety • The Marne neighbourhood, a lively and attractive and islands of coolness versus sanctuaries development accommodate of species neighbourhood on the banks of the Marne river, with in the evolution of the human species and are modifying its biodiversity urban planning that fosters health and that will encourage functioning. The protocol established aims to understand Mobility carbon Better air Bicycle storage residential development. which natural and/or built elements of the Chocolaterie site quality rooms Support of Proximity Promotion Commercial Reduce noise and its without cars soft mobility and active of active ground floor harmful effect on the + carpooling modes modes + proximity of brain (the role of soft can be beneficial to mental health and restore cognitive home and work mobility) This healthy urban planning approach is based on a health and functioning, in order to preserve them as efficiently as environment diagnosis carried out by a multidisciplinary team Energy carbon possible. It includes workshops carried out with people Energy Support users in the Assistance Attachment promotes including Zefco (authorised representative), Urbapilot, [S]CITY performance adoption of good practices to improve the behaviours that protect familiar with the site to produce an experience-based and and IAQ (action - automation) surrounding built places, especially environment pro-environmental and Elan. In an analysis matrix, it combines elements relating emotional map of the area and a diagnosis carried out with (reduced consumption) to the environment (natural ecosystem and material and energy people unfamiliar with the site to assess the physical and Materials Organic and Constructive Support for Diversity and material flows) and those relating to health (environmental health, living sense-related qualities of the area, with particular attention geo-sourced materials framework that local consistency have an for better air quality enables housing construction impact on well-being health, health and lifestyles and mental health) to identify urban, paid to the natural setting (colour palette, presence of the to evolve sectors programmatic and usage proposals to be developed. sky, water, vegetation, noise) and the built environment Organic cycle (street width, height of buildings, geometry of buildings, Support for bio-waste Attachment fosters sorting through responsible behaviour, the design of housing such as waste sorting variety of façades, age of buildings). All of the qualitative and shared areas and quantitative data collected is used to formulate general recommendations for the future neighbourhood, in order to promote a favourable impact on well-being and mental health. These recommentations are the first step of the project, which is expected to be completed in 2024. • Diagnosis of the synergies and conflicts resulting from the intersection of environmental (Zefco, Elan) and health-related (Urbapilot, [S]City) themes Inspiration
Action-research Food project research project Metropolitan food project
“For health purposes, I move “Urban Oasis” “2030 model of around in my neighbourhood” (Annecy) a sustainable food system” (Saint-Denis) (Metropolis of Dijon) Conducted in Annecy by the Tribu design office in partnership with CAUE 74 and CASA Architectures and co- The action-research project “Pour la santé, je bouge dans financed by Ademe, the Urban Oasis research project aims Winner of the TIGA (Territoires d’Innovation - Grande Ambition mon quartier” (“For health purposes, I move around in my to provide methods and tools for the design of urban oases (Innovative Regions - Great Ambitions)) call for expression of neighbourhood”) began in Saint-Denis in 2013 in a priority in cities such as, “interludes that produce a feeling of calm interest, the Metropolis of Dijon project aims to make the Dijon neighbourhood of the policy of this city of around 7,000 that make people feel they have left a city where everything catchment area “the showcase of high-performance and sustainable residents. happens in a hurry”. agriculture in urban and suburban areas, based on viable economic models for local production that creates jobs”. Led by the City of Saint-Denis, the Saint-Denis Healthcare The research focused on what makes a place an urban oasis Centre, the Ile-de-France Regional Health Agency and the for its residents, based on their feelings and representations. The issues of urban and suburban agriculture, agri-ecology, biodiversity, Directorate General of Health, its dual objective was to increase The interviews, recordings and measurements carried out in five environment and food are explored through a wide range of projects. the practice of residents’ physical and sporting activities urban environments of the city of Annecy, which can be likened These projects include: market gardening, diversification production, by at least 20%, in order to limit the occurrence of chronic to urban oases, provided a basis for the implementation short circuits, replanting and development of Dijon vineyards, vegetable illnesses, and to identify efficient levers for developing of methods, diagnostic tools and the design of urban oases. production and the creation of a Dijon-agri-ecology label. The approach the practice of physical activity among a given population. This original “ambiance” approach proposed a new method is intended to be systemic, affecting all production, exchange, The programme began with a six-month research phase for the design and building of cities which differs from the processing, distribution and consumption activities in the region and (meeting with 300 residents and 80 professionals) to assess functionalist method that a accomodates spaces based mobilising the entire regional ecosystem: farmers, research and higher the level of physical activity of the population and to understand on their use (ex. parks, squares, gardens, etc.). The question education organisations (INRA, the Centre des Sciences du Goût et the obstacles to the practice of physical activity in the of senses is positioned at the heart of the reflection. de l’Alimentation (Centre for Taste and Food Sciences), the Agrosup neighbourhood. This diagnosis led to the implementation of Omnipresent plant life, a cut-off effect, a peaceful acoustic Engineering School, the University of Burgundy Franche-Comté), several actions which include the creation of a pedestrian plan atmosphere, cool spaces in summer, access to sunshine companies, the Food Tech innovation network, the Vitagora (agri-food) to increase the “walkability” of streets in the neighbourhood. in all seasons, a high-quality view, a plurality of uses and and AgrOnov (technology park dedicated to agri-technologies and agri- Other actions included the creation of weekly walking groups a close relationship with housing are the areas to be explored ecology) competitiveness clusters. The regional food system is being as an incentive for physical activity, as well as the installation in designing urban oases. redesigned to benefit “better and healthier eating” and by developing of sports facilities with local youth to create an environment local food chains. This approach echoes the major lessons learned from conducive to physical activity. the INRA’s recent multidisciplinary programme on the national dynamics 1 Source: Result of more than 200 interviews with national of the re-territorialisation of food, which highlighted the importance of and regional players and the collection of figures, presented food subsidiarity (substitution of one system, scale or production method at the “Re-territorialisation of food: contributions to the sustainability of food systems” symposium, coordinated by by another) and rebalancing actions, rather than the search for full food INRA, in November 2019. autonomy 1. Constructive methods Spaces designed in line • Encourage extended time slots to avoid Developing a network of places and to support development with the needs of the region the phenomenon of transfer to hospital objectives and users emergency services, which are already services based on the opportunities saturated; The support of the public authorities and In order to ensure that these structures • Design healthcare centres as living labs, provided by new medical practices the preference shown by young doctors for meet the needs of users in the regions which host innovations and health start-ups multi-professional and even salaried practice (practitioners, patients, local residents), in the region; to enable care to be provided as close favours the expansion of MPHCs. the development of MPHCs must be based on methods and prerequisites that cannot • Organise attractive working conditions for health professionals (management of to populations as possible France had 910 MPHCs at the beginning of be ignored: administrative tasks, salaried work, etc.); 2018 and these structures are set to multiply, The reorganisation of the health system is under way: called upon by the government to become • Conduct upstream socio-sanitary diagnoses • Design spaces that encourage collaboration it is based on the development of outpatient care and health the norm. Construction methods must adapt to identify health issues and needs and size between practitioners and facilitate dialogue networks, to benefit gradual and coordinated care of patients. to accompany this need for massive and medical programming accordingly; within health networks; rapid development. The innovative off-side • Co-construct property development and As a result, new regional organisation of • Those linked to demographic and wood-frame construction process is a means • Design healthcare centres to be friendly, medical projects with the authorities and major healthcare provision, hospital specialisation, epidemiological transitions: ageing of the to meet this challenge while remaining welcoming, open and lively places to live; the growth of primary healthcare centres and the population and increase in the number of health players in the region; environmentally friend by guaranteeing quality • Put prevention at the heart of healthcare development of telemedicine are reconfiguring dependent elderly people, explosion of chronic and energy performance. centre projects. the medical landscape. Regions see this as an diseases, etc. opportunity to meet current challenges: • Those related to the organisation of the health system: compartmentalised health system, regional inequalities in health, medical desertification, lack of young doctors setting up private practices, saturation of emergency Local authorities 56 57 services. are becoming Bouygues Construction Reference increasingly involved CO-DESIGNED Developing new local healthcare in the organisation Confluence Health Alliance with a scientific facilities, combining the provision of so-called “city” (Lyon 2nd) committee of care and the preventive aspect and local healthcare, in In the heart of the Confluence neighbourhood in Lyon, stakeholders the Alliance Santé Confluence medical project is part As a new player in so-called “city” healthcare, Multi-Professional of an urban innovation approach focused on the health Healthcare Centres (MPHCs) are becoming a pillar in the reorganisation order to attract and well-being of populations. Led by Linkcity, Bouygues of primary care provision in regions: professionals to their Construction’s property development subsidiary, it was region co-designed with a major scientific committee and local • They promote multi-professional healthcare These local structures make it possible to reach stakeholders. This innovative concept of a health space practices, by bringing together health players patients as close as possible to where they combines primary healthcare and prevention, in a spirit in a single location; live and contribute to the strengthening of the of proximity and openness to the neighbourhood: medical fabric in vulnerable areas (for example, • They contribute to smooth and coordinated priority neighbourhoods in urban policies). care pathways by forging links with other • Multi-professional healthcare centre including healthcare structures (hospital, medical and a sports-health space, managed by Office Santé; social establishments) and by developing • An occupational health centre operated services adapted to outpatient care by the Work and Health Action Centre; (for example, promoting home-based ageing well and returning home after a hospital stay); • An imaging centre operated by Safeguard Radiologists; • They are based on an overall approach to • A third place dedicated to prevention, hosting conferences and health, combining the provision of healthcare health promotion workshops led by local players and associative and the preventive aspect. partners; • An offer dedicated to healthy ageing, based on a Pharmagest actimetry programme. Opening up health areas to the city and neighbourhoods, in a comprehensive approach to promoting health among populations
Primary healthcare centres, first and foremost multi-professional healthcare Designing healthcare centres, are essentially local structures, located as close as possible to the populations. However, in order to reach citizens and to truly benefit health centres that are open in their region, they must be designed to be friendly, lively and open to all. to their neighbourhoods
1. Information on events Similar intentions are influencing and surrounding neighbourhoods, 2. A caregivers’ café conducive to discussions and meetings hospital establishments, driven by the accessibility, mobility, the quality of the 3. A reinvented reception terminal Hospital, Patients, Health and Regions health of spaces and the sustainable 4. Mapping of the health players in the neighbourhood Act of 2009. This law encouraged management of resources were central or RHPCs (Regional Health Professional Communities) hospitals to rethink their healthcare to these reflections. 5. Adapted and adaptable furniture for prevention workshops mission by extending their scope of 6. Spaces to host conferences for the general public action to include prevention and health Beyond this mission of health 7. Below we propose a usage plan with plausible scenarios promotion for populations. In this vein, promotion and from an urban the Ile-de-France RHA launched the standpoint, hospitals are increasingly Bouygues Construction Reference “Hospitals and regions that promote exploring their interface with cities, health” initiative in the “Petit Nanterre” by asserting themselves as living, open political sector of the city, which places to be passed through. This is includes the Nanterre Hospital Care evidenced by the numerous initiatives The healthcare centre Reception Centre (HCRC) (please to develop breathing spaces and to as a third place in the see interview on pages 60-61). The propose a cultural offer in the public aim was to design a hospital property spaces of these establishments. health and well-being 58 development project and an urban In Paris, the green spaces of the Pitié 59 development project in an integrated Salpêtrière hospital thus serve as a path of residents manner, by promoting architecture and park and picnic area for neighbouring Our vision of healthcare centres is that of places urban planning that is conducive to populations and the hospital chapel designed to shine in their neighbourhoods. the health of users. In particular, the hosts several art exhibitions throughout We propose that traditional waiting rooms be urban interfaces between hospitals the year. transformed into coordinated third places open to all, which become places of reference in the neighbourhood and in the daily life of populations:
• A warm architecture and universe, breaking with the codes of medical architecture to make it a generous place, where people enjoy spending time and recharging their batteries; • An event-based programme focused on health prevention to raise awareness of major health determinants (diet, ageing well, etc.); • Health-sports centres organising physical activities that are friendly and adapted to various profiles; Work carried out in collaboration with the Vraiment Vraiment ® office, • Green spaces, backed by therapeutic gardens, based on a study of use and questions put to care and prevention professionals. supports for therapeutic activities and spaces for contemplation and sensory stimulation; • Pathways to detect frailties (loss of sight, difficulties in walking, speaking, grasping objects, etc.) to encourage rapid treatment and limit the development of dependency. Over to... Urbapilot was involved in the the chronic and/or mental pathologies The results of the approach take the “Hospitals and regions that of elderly people on the HCRC site; form of project sheets that outline the promote health” experiment but also young children, single-parent main principles of development and launched by the Ile-de-France families and poor workers with specific programming. Could you give us some RHA1, with the support of the health problems (for example, the examples of content? City of Nanterre, on the “Petit prevalence of obesity) in the Petit Nanterre” sector of the city’s Nanterre neighbourhood. Based on health determinants conducive to policy, which includes the Hospital urban planning, project sheets explore the Care Reception Centre (HCRC) This territorial context presented a various aspects of a comprehensive health in Nanterre. What were the goals challenge for opening up the HCRC to project: support of transformation, places that and the main principles of this the city and highlighted the need to take promote community life, organisation of internal approach? into account the needs of the vulnerable movements, hospital garden frameworks, etc. groups in the choice of programming This approach is based on the and composition of public spaces. The hospital garden network, for example, Marie Chabrol opportunity to rethink hospitals beyond meets several objectives: Director and founder their healthcare missions and to extend How did this translate into their scope of action to make them • to make the hospital project participate Urbapilot the methodological approach? places that promote the health of in the green and blue network being set up on a regional scale and with a goal of urban populations in their extended region. The multidisciplinary team (urban resilience; shaded terrace The objective was to translate this planning, landscaping, hospital chat room overall approach to health into the site’s architecture, environment, sociology) • to reflect on biodiversity and its place games room Feedback on the urban and architectural project, taking took advantage of all available levers within the hospital site; local specificities into account. 2 ) (strategy, urban planning, architecture) • to incorporate hospital and neighbourhood “Hospitals and regions garden to build a comprehensive health project gardens into therapeutic approaches. that promote health” • The Petit Nanterre sector is an area based on four areas: of strong urban and demographic This question of the use and redeployment sport equipment dynamism but it also presents a • Economic development and inclusion approach in the Petit of physical and recreational activities and the healthcare trail contrasting environment in terms of of local populations; Active suburban garden (approx. 700 m 60 strengthening of social ties around green spaces 61 Nanterre sector and the Sports and outdoor activities services and amenities, with many local • Social practices and meeting places; have also emerged as fundamental. Hospital Care Reception resources (high density of associations, public services, green corridors) but • Promotion and prevention of health Suburban gardens are planned as a structuring Centre (HCRC) sector also multiple imbalances (poor diversity through outdoor spaces and nature in element of the hospital project and can be used of food shops, lack of sports facilities, the city; at the level of one or more hospital departments. difficult access to the river Seine). • Improvement of the urban environment They can be the subject of themes, depending on and reduction of harmful environmental the intended use and the hospital programming • The HCRC site suffers from a low factors. of the buildings that surround them. level of appropriation by staff members, users and local residents due to Reflections on the site transformation problems related to a lack of safety, project occured during a collaborative degradation, a lack of maintenance workshop with all users from hospital of open spaces and the gradual closure staff to end users. Initially, the groups of services and friendly areas. thought about how to position transformation within the overall urban • The population present in this sector fabric of the neighbourhood and how to includes a diversity of vulnerable include the site as an integral part of the hospitals are population groups, related to the history neighbourhood. Subsequently, on the and function of the site, which includes basis of inspirational elements prepared increasingly terrace on stilts (adaptation to raised social, medico-social and healthcare by the team, they designed concrete ground floors + preservation belvedere activities. Thus, we find people (some of actions and solutions to give substance exploring of permeable soil) them in very precarious situations) with to the project. links herbaceous layer with cities pioneer species 2 ) wet garden
Biodiversity suburban garden (approx. 700 m Green heart preserved 1 Source : Agence régionale de santé Developing places that address Inspiration the specific issues of loved ones and caregivers
Beyond care and prevention, new places and services are emerging to support the daily lives of caregivers, those people who provide assistance to loved ones who are ill, disabled or losing their independence.
In France, there are an estimated 11 million caregivers, the majority of whom are working women under the age of 50 1. The many difficulties they encounter (stress, fatigue, isolation, economic difficulties) often have repercussions on their personal and professional lives and multiply the risks of chronic illness. Nevertheless, the concept of caregivers has gained visibility in recent years and their status is now better recognised and managed. The latest advances to date are the law to promote the recognition of family caregivers, promulgated in May 2019, and the announcement of the introduction of paid leave for caregivers who are supporting elderly, ill or disabled relatives.
Numerous initiatives are being developed in regions, particularly in the Lyon conurbation. In addition to the opening of the first “respite home” (please see page 63), it is here that the first one-stop shop for aid to caregivers, named “Métropole Reception and respite centre Accommodation alongside hospitalised loved ones aidante” (Supportive metropolis), was created. Supported by 62 the Auvergne-Rhône-Alpes regional health agency, the Lyon Metropolis, the France Répit Foundation and a large group of associations, this approach aims to federate all the initiatives Maison de répit La Maison des familles and solutions provided in the region, in order to make them (Tassin la Demi-Lune) (Poitiers) easier to understand and to provide support. It takes the form of a website, a single telephone number and a site providing The first establishment of its kind in France, the Maison Located on the site of the Poitiers University Hospital reception services, information and guidance. de Répit (Respite Home) provides ill and disabled people Centre, La Maison des Familles (Family Home) enables and their caregivers with a place to rest and recharge their those who live far from Poitiers to stay with their child, batteries when caregivers are no longer able to care for spouse or friend hospitalised in the University Hospital their loved ones and to prevent exhaustion. Centre.
It is built in the heart of a one hectare wooded property 10 The structure was created in 1993, at the same time as the “Un minutes from Lyon, in a natural setting and with a “homely” hôpital pour les enfants” (“A hospital for children”) association, atmosphere conducive to care, well-being, tranquillity and whose aim was to design a place to accommodate the parents conviviality. Support is provided by trained professionals and of hospitalised children. In 1997, the “La Maison des familles” volunteers. It includes 30 days of reimbursed annual respite, association, which manages and operates the house on a daily medical supervision and continuous care for vulnerable people. basis, was created. The house is designed to be a real home, It also includes psychological and social support, opportunities with a friendly living room (board games, library, television, and time to talk and meet up, and well-being activities for billiards), a shared kitchen, a dining room, a landscaped 1Source: Caregiver barometer, BVA/Fondation April, 2019 caregivers who choose to remain on site. terrace and 29 bedrooms and studios. Each year, more than 1,500 families are accommodated, living there at their own pace and in complete independence, with no time limit (a third stay more than two months) and with a limited financial contribution from families (a modest financial contribution that decreases according to the length of the stay). In addition to accommodation, “housekeepers” and volunteers listen to and support occupants, in order to provide comfort and support in difficult and trying times. Over to... Designing and constructing buildings that respect people
Collective awareness Increase in the “Human beings are of the impacts of number of labels buildings on health relating to the health dependent on their and well-being of environment and this This role of accommodation is the primary function of buildings. This is occupants dependency makes Suzanne Déoux property and activities. The issues and comfort” or “acoustic discomfort”. one of the reasons why we spend an Doctor of medicine challenges of the relationship between However, the consequences go Since then, this collective awareness them vulnerable to the average of 80% of our time in enclosed Honorary Associate buildings and health are therefore beyond these subjective effects! It of the impact of buildings on health spaces today. characteristics of their Professor at the multiple. Keep in mind that the primary is the functioning of the body itself and the multiplication of scientific University of Angers, vocation of the building and civil works that is affected. It is estimated that However, this protective role was shaken studies have led to several labels various living spaces. Founder of Medieco, sector is to preserve and protect human the health expenditure generated in the 1990s by the asbestos scandal and and certifications to introduce goals President of Bâtiment health, from design to the operation by the consequences of the French Santé Plus and initiator the emergence of the problem of indoor air and monitoring indicators relating They have always sought of the built environment, in connection population’s exposure to noise, the first to health and well-being. of the conference Les pollution in buildings, which has since become to protect themselves Défis Bâtiment Santé, with its environment. Players are of which is sleep disorders, amount a real public health issue. According to studies, member of the Réflexion becoming increasingly aware of the to €57 billion per year1. The same the air inside our buildings is 5 to 10 times These labels are issued to any property against natural elements: Bâtiment Responsable need to put human beings and their reasoning applies to light. It helps to more polluted than the atmosphere outside. development buildings that comply with them. 2020-2050 work group health at the heart of their actions. synchronise all biological rhythms, but In 2013, this observation led to the first Indoor Although they now mainly concern office cold, heat, rain, wind, we limit ourselves to handling it from the Air Quality (IAQ) Action Plan in France, which buildings and focus on themes relating to sun, lightning, etc.” You defend a dynamic definition “visual comfort” standpoint. 64 was incorporated into the National Health physical health (healthy materials, air quality, of health, as a “successful eco- 65 and Environment Plan (NHEP). Legislation visual and acoustic comfort, etc.), some are The buildings This can be read on the website of the adaptation to our environment”. In addition to these five senses, there has also accelerated on this subject, making intended to apply to all types of buildings and Sustainable Building Plan, a network of of tomorrow, respectful Since the built environment is is also the general sensitivity through it compulsory to monitor indoor air quality increasingly incorporate criteria relating to building and property development players the primary environment of human which our bodies pick up a large in childcare facilities, nurseries and primary social health, well-being and quality of use. of human health working together to achieve energy and beings, the importance of the quantity of information related to our schools in 2018 and in leisure centres, middle environmental efficiency in buildings. link between health and buildings environment: perception of cold, heat, schools and high schools in 2020, with the aim is better understood. But how perception of the position of different of extending it to all other establishments open does the building industry make parts of the body in relation to space, to the public by 2023. demands on us? etc.
Launched in 2011 as part of the Through breathing, we are in permanent With the electromagnetic environment, Health and well-being labels in buildings Sustainable Building Plan, the contact with our environment. The interactions with the human body Réflexion Bâtiment Responsable quality of the 15,000 litres of air we take place without the intermediary 2020-2050 work group published inhale every day conditions the nature of any specific structures. However, • WELL • INTAIRIEUR • OSMOZ a document at the end of 2019 of the atmospheric compounds the electromagnetic radiation created Organisation: LEED Organisation: Immolab Organisation: Certivéa entitled “Responsible Building transferred to our blood and all our artificially by human beings today Launch: 2014 Launch: 2017 Launch: 2018 and Health”. What reasons led you organs. exceeds that which exists naturally on Theme: General (air, water, Theme: Specialised IAQ Theme: Workplace to include health in your forward- the surface of the Earth. The sensitivity food, light, physical activity, Target: new housing environment looking thinking on the buildings of children to this exposure is one of the comfort, spirit) Through our five senses, we perceive Target: offices of tomorrow? major questions concerning long-term Target: offices, the characteristics of our different living effects and requires the application of housing, commerce spaces. Our senses are closely linked Health is the most precious asset of to our vegetative nervous system, our the precautionary principle to limit it as human beings. It is omnipresent in “autopilot” that regulates the various much as possible, whether at extremely both individual and collective concerns, vital functions of our bodies (digestion, low frequencies in electrical installations from birth to the end of life. Whether breathing, blood pressure, etc.), without or at the microwave frequencies of The implementation of these types of qualification systems for the it accommodates life, organisations, our being aware of it. Take the example mobile phones. quality of the built environment and its surroundings helps to incorporate leisure activities or economic activity, of noise, whose impact on humans is well-being and public health into the heart of building construction or the building industry protects people, often discussed in terms of “auditory The opinion of the “Réflexion renovation operations. However, in order to be truly effective, even if this Bâtiment Responsable 2020-2050” is a utopian goal, particularly at the European level, we should aim for (“Responsible Building Reflection a convergence of certifications in the field of health, covering design, 1Source: Le coût social du bruit (The social cost of noise) - Bibliographical analysis of French and European works. CNB/ADEME 2016 report 2020-2050”) work group construction, operation and maintenance. As essential to life as air, water is subject to School of Speech Therapy and Audiology at Finally, health must be dealt with in a continuous monitoring. It is the most controlled the University of Montreal, current noise levels comprehensive manner, including physical, food product. Its quality must be impeccable, by in childcare facilities significantly reduce speech mental and societal health, and extended A building that Limiting exposure to pathogens ensuring that its transfer into pipes or equipment intelligibility and verbal learning in children. 70% to city and regional development: these does not disperse pollutants and bacteria. of older children consider themselves disturbed approaches must go beyond buildings alone contributes to A building that is conducive to health limits by noise when reading and more than 60% to extend to urban planning and, more broadly, health prevention the exposure of its occupants to pathogens, For you, a responsible building is first and consider that they have difficulty concentrating to the environment. The themes raised in this whether physical (particles, electromagnetic foremost a way of meeting the essential in a noisy environment, according to acoustic document include: mobility, inclusiveness, social Buildings interact with many health radiation, fibres, etc.), chemical (volatile organic needs of occupants. What are these needs measurements and the survey conducted in links, circular economy and culture. Exploring determinants: water quality, air quality, compounds, etc.) or biological (mould, pollen, and how do they change depending on Lyon by Acoucité among 300 children aged 9 to the therapeutic function of buildings and the city electromagnetic fields, sound environment, etc.). the people the building accomodates and 11. Good acoustics in a school are not a “plus”. as well as promoting art in all its forms, while light, temperature, safety, social the activities it hosts? They are a criterion that is intrinsic to the very respecting the quality of life of the occupants, interactions, physical activity, food, access In France, construction and decoration products function of schools as places of communication are also raised. to services and equipment, etc. have been subject to mandatory labelling since The building must take into account different and knowledge acquisition. 2012 with respect to their volatile pollutant types of needs (physiological, sensory, These are all levers to be explored and operated emissions. A classification from A+ to C provides sense-related, psychological and societal). You conclude the document with several to positively impact the physical, mental and information on the level of emissions of ten Recommendations concerning “housing” recommendations for buildings that social health of their occupants. Buildings have pollutants, with the A+ label assigned when all buildings, “training” buildings and “corporate” respect human health. What are these a particularly important role to play in health values are below health thresholds. buildings are adapted to the functional goals and recommendations? prevention, by minimising exposure to risk factors requirements of the profiles of their occupants. Typology of (for example, pathogens) and maximising the In addition to building-specific sources, the outdoor Similarly, changes in the use of buildings and The first concerns construction materials in the impact of protective factors (for example, active environment, equipment and its maintenance their reversibility must take into account the building industry (traditional, low carbon, circular human needs design, integration of living things). and the behaviour of occupants can also be responsible for the presence of contaminants in fundamental human requirements of their economy, etc.) and notably includes Physiological needs: breathing, sleeping, indoor air. Significant transfers of pollution from future use if health, in its overall sense, is to be the implementation of a health assessment drinking, eating, eliminating, resting, moving preserved. of these materials, installation products and around outdoor air to indoor air are particularly likely to occur in areas that are repeatedly exposed to equipment for builders and manufacturers. Sensory and sense-related needs: seeing, Take the example of young children. Their hearing, smelling, touching, tasting, feeling specific sources of pollution (road traffic, industrial vulnerability to the built environment is greater The next question is the consideration of the (temperature, humidity, space) sites, urban heating, agricultural phytosanitary treatments, etc.). Moreover, they were the subject 66 than that of adults. It is therefore essential impact of the daily environment on human well- Psycho-social needs: privacy, aesthetics, 67 that all their needs be properly addressed in being, notably through models used to measure care, safety, conviviality, local services, of a study published by the Anses (National the living spaces that accommodate them. the impact of buildings on uses (performance of biophilia, peace. Agency for Food, Environmental and Occupational 1 According to the work of Michel Picard of the education, business, etc.). Health Safety) in 2019 .
The reduction of the exposure of occupants to these agents is based on the combined activation of various types of levers: use of low-emission or labelled materials, increase in ventilation flow rates, maintenance of equipment such as ventilation Exteroceptive (dermal) through regular servicing, measurement of air - Exploration: vibro-tactile - Protection: temperature and pain quality inside the building and awareness-raising, - Perception: cold, hot, wet, dry filtration treatment of the air brought into buildings and support for users in everyday actions, such as Electromagnetic the ventilation of housing units. Environment - Non-ionising radiation Proprioceptive - Lonising radiation General (spatial sense) sensitivity - Conscious including kinethesis - Unconscious
Water Touch Since Sensoriality 2012 Vision construction and decoration products have been subject to mandatory labelling Breathing Hearing
Smell 1 Neuro-vegetative Source: Caractérisation des transferts de pollution de l’air system extérieur vers l’intérieur des bâtiments (Characterisation of outdoor air pollution transfers inside buildings), ANSES, 2019 Active design to encourage movement
Created in Canada, the concept of active design, which identifies urban and architectural principles to promote a physically active lifestyle, is part of the movement towards environments that are conducive to Social design Buildings that Bouygues Construction Reference healthy lifestyles. of buildings reflect the living world
This approach, which stems from urban As urban microcosms, buildings are Living in a place where it is possible development, can be applied to the world of places where the diversity of social to be in contact with nature is a deep The Ecotone project construction to combat sedentary lifestyles and configurations specific to human life desire of the French who consider it (Arcueil, Val-de-Marne) related illnesses and to free up movement, which are expressed, whether they relate to to be the most important element when is a natural principle of life. In tertiary property intimacy, social relations or forms of asked to characterise their ideal place Winner of the innovative call for projects entitled “Inventons development, this is reflected by a fast-growing sociability. to live 1. la Métropole du Grand Paris (Inventing the Greater interest in developments, equipment and uses that Paris Metropolis), the Ecotone project is a symbol of the promote a mobile and active stature: movements The design of buildings must integrate This result is hardly surprising if we biomimicry approach and one of the first of its kind in the between complementary spaces (conventional this social dimension and support this consider the notion of biophilia, which world of property development. services, creative spaces, meeting rooms, capacity to forge links, within the building supports the innate affinity of human relaxation areas), standing offices, meetings but also in its relationship with the block, beings with the natural world. This desire This project (led by the Compagnie de Phalsbourg) showcases while walking. The approach is also beginning to the neighbourhood, the city or its external to surround oneself with the living world is what the implementation of the biomimicry approach in spread to the world of housing, as in apartment environment. reflected in the building sector through the property development can look like. Designed as an urban buildings, and certain concepts, such as KuBe in incorporation of natural elements (fountains, rock of glass and vegetation, the future building will open onto Copenhagen, are pushing experimentation to the The design of flows inside buildings and waterfalls, plant walls, gardens, etc.), in the city and the environment and end the isolation of an area limits (please see page 71). order to benefit the physical, mental and which, today, is divided due to its proximity to two motorways. 68 the programming of spaces promote 69 meet-ups between users and sharing, emotional well-being of occupants. This multi-storey building with terraces and patios providing while preserving spaces for personal homes and workplaces with natural light features 65,000 m² breathing. This is the direction of several Staying connected with nature. Biomimicry, dedicated to the tertiary sector, a layout designed to promote current projects. Apartment buildings, for an approach consisting of drawing intergenerational links (residences for young professionals, example, accommodate an increasing inspiration from the principles of living temporary apartments for researchers, childcare facilities, number of shared spaces on roofs, on things (forms of living things, materials home care for the elderly, etc.), a health and fitness centre, The multidisciplinary team applied the principles of biomimicry ground floors or in the heart of buildings, and manufacturing processes that responsible restaurant services. to its way of operating; cooperation and ecosystem logic fed by which encourage users to come together operate in living beings, interactions that mutual interactions. With this in mind, the four project architects around common activities or projects. species develop among themselves, the worked together using shared specifications. All of this work is The hybrid building concept, which overall functioning of natural ecosystems) supported by a scientific committee that works on biodiversity promotes a mix of uses and a diversity of also advocate this, in order to respond and biomimicry, comprising the Museum National d’Histoire user profiles, aims to intensify porosities sustainably and at a lower energy and Naturelle, the CEEBIOS (European Centre of Excellence for between buildings and their environment. environmental cost to the issues facing Biomimicry in Senlis), ELAN (property development consulting our human societies. This took shape subsidiary of Bouygues Bâtiment France Europe) and Engie Lab in the building sector in 1996 with the Crigen. construction of the Eastgate Building in Harare, Zimbabwe, for which architect Other experts may join this committee, such as professor Mick Pearce drew inspiration from a termite and architect Achim Menges from the University of Stuttgart, 1 Source : Penser les territoires autrement. mound to design natural, economical who designed the “Hygroskin”. This concept is part of the Observatoire des usages et représentations des ventilation. Today, the subject is taking on territoires, 2020, L’Obsoco, Chronos / Ademe, architectural experiments that shall be tested in the project; Banque des Territoires, Bouygues Construction, a real dimension in the world of property a wooden envelope, modelled on the behaviour pine cones, Groupe La Poste development, as shown by the emergence which will open or closed based on the relative humidity without of projects that incorporate the principles of any outside intervention or energy, for improved user comfort. biomimicry (please see the Ecotone project, page 69) and the launch, in October 2019, of the Biomim’ City Lab, a work group that brings together property development players, whose aim is to develop the biomimetics approach in this sector. Inspiration
Building concept that mobilises Active design in Designing a building the spatial sense (proprioception) residential buildings to serve culinary education of users
Via Verde Buckingham KuBe (United States) (Virginia, United States) (Copenhagen)
Located in the Bronx neighbourhood of New York City, this In Buckingham, Virginia, USA, architects, doctors, In the Frederiksberg neighbourhood of Copenhagen, the 222-unit social housing complex consists of three types of researchers and educational teams thought up the design KuBe is a centre for exploring culture through movement. buildings: a 20-storey tower, 6-storey and 13-storey duplex of the new kindergarten and primary school building, apartment buildings, and town houses. with health and well-being as their primary concern. Designed by the MVRDV agency, it is adapted into six volumes over a total surface area of 3,200 m², including a theatre, The architectural concept is based on the integration of a As a health determinant, food had a prominent role in the exhibition spaces and a circular room dedicated to the practice suspended park that takes the form of successive terraced reflections and design of buildings in order to promote learning of yoga. Alternative movement areas are equipped with climbing gardens that spiral upwards towards the planted roofs of the about the principles of healthy eating and the development slopes with holds, slides, nets and poles to encourage users to buildings. This public garden, a real living space, encourages of a culinary culture. The school thus includes a kitchen for walk, run, crawl, jump, climb or slide, in order to involve them residents to walk, rest, do sport, ... and to walk up the stairs to educational purposes and culinary laboratories, making cooking in various experiences related to movement. Floor coverings their homes rather than using lifts. The stairwells of the buildings a subject of study. vary depending on practices: elastic for running, concrete for are wide, lit by natural light and brightly coloured to encourage climbing, epoxy resin and parquet for quiet activities. people to use them. By fostering the mouvement of bodies in space, this place challenges the spatial senses of its users — something that is often forgotten when assessing the environmental quality of buildings. The body senses and understands space through its position, its movement and the situation of the various segments of limbs in relation to each other. Nerve information transmitted to the brain by receptors in muscles and joints enables the adjustment, control and regulation of posture, balance and body movement. Inspiration book
O4 Multi-generational and inclusive spaces designed around movement Network of biodiversity areas Free play and streets rebalanced and freshness islands in favour of soft modes Schools interacting with the neighbourhood and sharing Museums and nature parks their establishments Multidisciplinary Educational urban farm and health spaces direct distribution sales points open to the city
Community café and incubator of citizen projects
This inspiration book is the result of the open and collaborative reflection (the list of participants is available at the end of the document) that Bouygues Construction carried out on healthy neighbourhoods. Which urban organisations seem to hinder or, on the contrary, encourage virtuous behaviour in terms of health? Collective composter To what extent and how do the “living environments” constituted by our neighbourhoods and housing units play a role in our health status?
Sociologists, social psychologists, public health researchers, architects, doctors, pharmacists, experts in healthy urban planning, property development players, start-ups and companies in the fields of sport, food, air quality and services to healthcare facilities and many others contributed to this reflection, by sharing their Sensory gardens Participatory artistic performances and shared gardens in public spaces visions and solutions. They compared their ideas through an approach combining design thinking and foresight and fed by expert interventions.
Respite home for vulnerable people and their caregivers Eco-designed buildings inspired by the principles of biomimicry
Self-service orchards Redesigned uses with fast and slow pavements
Local health and well-being currency
De-waterproofed soil Citizens who A dedicated health and co-design their well-being body, which living spaces supports each development project throughout the process
Ideas Ideas A methodology Shared governance Rehabilitation of the for identifying and that brings together all fundamental right to live prioritising health regional players (local and manage the city, issues, defining authorities, healthcare with a focus on personal appropriate action facilities and players, fulfilment and the need Usage expertise levers to be researchers, companies, to live together of residents for the implemented within associations, common good the framework of the citizens, educational project and measuring establishments, social and monitoring the housing providers, impact of the project etc.) and a restricted Inspiration on the health of scientific committee populations (health and well- Best practice Solution Solution being professionals, researchers) that orients choices Atelier des capucins CityPlay PotLoc (Brest, France) LinkCity
A participatory artistic approach to An urban co-design tool used to group An on-line platform to directly survey equipping public spaces as part of the all stakeholders of an urban project (local city residents about the local shops and project to develop an eco-neighbourhood: authorities, residents, shopkeepers, services they would like to see established 5,000 residents mobilised in 3 years to architects) around a role-playing game, in their neighbourhood create wooden furniture with multiple in order to jointly define the goals of the forms and uses with the support of cultural future project, share their fears and design associations and architect collectives concrete solutions to meet these challenges An approach to urban design A healthy living which places the five senses environment that at the heart of the reflection regulates environmental pollution and the health effects of global warming
Ideas
A network of urban Buildings and Ideas oases based on environments that the principles of reflect the living world omnipresent vegetation, and are inspired by the a break and respite principles of biophilia Islands of coolness A rebalancing An environment Buildings effect with other urban and biomimicry and vegetation of traffic that provides and urban atmospheres, a soothing to combat urban in favour of information on organisations acoustic environment, heat island phenomena soft modes to harmful factors that limit cool spaces in summer, and their effects reduce sources and advice on exposure to access to sunshine and Inspiration of pollution how to behave pathogens light in all seasons, quality views and a Solution variety of uses O Ubi Campi Inspiration
Gardens designed to accompany the Best practice Best practice Best practice experience of the five senses: structuring of spaces for rich visual perception (distribution of light and shade, shades of Carbon sink Meeting area “Oasis” playground colour, textures), introduction of foliage and (Poissy, France) (All over France) (Paris, France) materials (smooth and rough stones, wood, metal), organisation of opportunities for In addition to tree planting, an experiment Shared streets for calmer roads: halfway School playgrounds transformed into urban spontaneous gathering, amplification to combat urban pollution: a two-metre high between a 30 km/h zone and a pedestrian cold islands thanks to the substitution of certain noises (the hammering of rain, cylindrical device that captures polluting area, a concept of a pedestrian priority area of asphalt by materials that are permeable the rustling of the wind in foliage) particles through the photosynthesis open to all modes of traffic, with a speed and suitable to heatwaves, zones of open mechanism of micro-algae. An experiment limit of 20 km/h for vehicles and two-way ground, increase of green spaces (trees, conducted over several months roads for cyclists gardens, green walls and roofs), creation demonstrated an absorption capacity of shady zones, setting-up of fountains, etc. equivalent to that of fifty trees A living environment that A living environment that stimulates and accompanies produces and promotes a people in movement healthy and balanced diet
Ideas Ideas
The use of active An environment “Walkability” and Rebalanced regional A food supply landscape design to promote conducive to the “cyclability” of the food systems, based that promotes “good urban and architectural practice of physical environment, both on the development of eating” principles that and sporting activities, for utilitarian purposes urban agriculture and encourage a physically which is lively and and for strolling local supply chains active lifestyle adapted to the diversity Spaces for education of needs (children, and culinary and taste sedentary people, men culture and women practising sport, seniors, etc.) Inspiration Inspiration
Best practice Solution Best practice Best practice Best practice Best practice
KuBe Airfit Bike City Agropôle Halles Castermant Paniers solidaires (Copenhagen, Denmark) (Vienna, Austria) (Molondin, Switzerland) (Chelles, France) (Loone-Plage, France)
A building that integrates alternative and Multi-generational and multi-level outdoor Residential housing optimised and A centre for experimentation and innovation As part of a large-scale urban project, Vegetable baskets from short circuits playful areas (climbing slopes, slides, nets, fitness areas (students, senior citizens, equipped for the use of bicycles (storage to invent the healthy food of the future: redevelopment of halls through the provided at a low cost in the social centres ladders) to encourage movement: walking, sedentary people, seasoned sportsmen and at the entrance of the apartments, adapted mobilising and supporting the entire agri- integration of a third place, whose of the city’s “priority” neighbourhoods, running, crawling, jumping, climbing, women) connected to a sports coaching lifts, free maintenance station, bicycle food ecosystem to develop solutions for all programming aims to enhance the combined with workshops and educational sliding, etc. solution to democratise sport in free access areas, connection to urban bicycle paths) regions local food and agricultural ecosystem events that create links around cooking (winegrowers, brewers, market gardeners, associations): processing workshop, short circuit sales outlet, educational areas, etc. A living environment that A supportive and welcoming promotes social interaction living environment that and a rich local life facilitates the inclusion of people made vulnerable by illness, disability or dependency and that supports their loved ones
Ideas
A public space Places and services A city with local Ideas appropriated by the that are welcoming and services that promotes collective, which attentive to the needs an urban experience becomes a living of people who are rich in activities and The use of inclusive Places that meet the space in its own right vulnerable or isolated sociability design to design specific needs of family places and services members and caregivers that benefit as many Inspiration people as possible
Best practice Solution Best practice Inspiration Saint-Bruno Les Escales Solidaires Les Grains de Sel (Saint-Bruno, Quebec) Habitat et Humanisme (Paris, France) Best practice Solution
Free play areas created in several street Open to all, “Bistrots des amis” bistros are A cooperative participatory supermarket sections and governed by road markings, anchors in neighbourhoods and provide where members, who are the only Maison de répit Bistro Mémoire signs at the entrance and exit of the residents with activities to combat customers, make decisions together with (Tassin-la-Demi-Lune, France) area and certain rules (time slots and isolation by using meals as a vector respect to the management and activity clearance of the roadway to allow vehicles of social integration of their store according to principles of A temporary home for people suffering from Happy moments led by a team of to pass) to encourage the adoption of a solidarity, neighbourhood cohesion, support illness, disability or dependency at home psychologists and volunteers with people healthy and active lifestyle: developing for small producers and the local economy and a respite and support solution for the living with Alzheimer’s disease and their friendships, fostering social cohesion and caregivers who accompany them on a daily caregivers, organised in friendly public neighbourhood life, encouraging physical basis places (café, tea room, restaurant, media activity and creative play for children library) to facilitate their social integration and change society’s view of the illness Actions implemented Path by players
Evolution of Regions that organise Yvette’s home underwent various people’s habits developments to make her daily life healthcare facilities and easier: shower seat, handrails, non-slip services as close to the surface, etc. As part of the rehabilitation of Yvette’s population as possible and residence carried out a few years ago, the social housing provider had worked with that aim for health equity various players in the social and medico- social fields to adapt certain housing units.
Ideas
Local healthcare Healthcare facilities facilities combining open to their region, care provision and in a comprehensive Yvette preventive aspects approach to Lacroix 75 year old and designed promoting health Retired to meet the needs among populations of the region’s users Place of residence: Collective social housing 83 in the suburbs of a medium-sized city Family status: Widow. Her children and grandchildren regularly visit her during A community canteen has just the school holidays Health status: Since a minor fall a few months ago, opened in Yvette’s neighbourhood. Yvette feels less comfortable going out Through the social housing provider, Yvette Created to tackle social isolation, Inspiration Main health issues: To maintain her independence and her relatives became aware of regular the goal of the canteen is to with respect to daily living and going out home visit programmes for elderly enable residents to meet up and people. take part in the organisation of Best practice meals: cooking, setting the table, clearing away place settings, washing up, etc. Alliance Santé Confluence (Lyon, France)
Yvette is visited twice a week by the In healthcare centres, transformation of the postman, who makes sure she is well. traditional waiting room into a lively third place open Initially sceptical and reluctant to have a to everyone, which becomes a reference area in the stranger visit her home, Yvette now enjoys neighbourhood and in the health and well-being path this ritual and her family is reassured. of residents, with a strong focus on prevention
Yvette plans to try out the concept soon. Passionate about cooking, she hopes to learn new recipes and share her own tips, especially with the younger generation. Xavier’s neighbourhood has Xavier visited the café to a community café. This social and meet the volunteers and solidarity-based economy company residents. He liked the friendly Since then, Lola’s father has decided to notably works with hospitals to help atmosphere. He plans stop dropping her off by car. He and Lola people in difficulty return to a normal to return to take part in now use their bicycles and are trying out the social life. activities and resume a new cycle path made of ecological plant- more normal social life. based asphalt.
Xavier has made this place his safe haven and goes there when he feels stressed. He has recently tried to incorporate certain plants The city recently prohibited car parking recommended for their soothing or melancholy in front of Lola’s school to limit noise and dissipation properties into his diet. pollution.
Xavier Lola Gaillard The City has implemented a vast Moreau 40 years old 9 years old Executive on programme to encourage walking in the Schoolgirl long-term sick leave city. Dedicated signage, pedestrian strolls with visual and sound environments, development that 84 takes natural paths into account, etc. 85 Place of residence: Private individual housing in the centre of a medium-sized city An adventure playground Place of residence: Private collective Family status: Divorced has just been inaugurated housing in the centre of a major metropolis Lola’s school has Health status: Following his divorce and difficulties in the neighbourhood. Health status: Lola is in good health but is being undergone work to at work, François experienced an episode of severe With their dizzying wooden treated for her dust mite allergies remove concrete and depression. After full-time hospitalisation, he is now slopes, their foam blocks Main health issues: To maintain good health by green the playground: under outpatient care acting on health determinants (environmental and evapotranspiration surfaces, Main health issues: To recover from to constantly reinvent new psycho-social factors, etc.) depression and resume a normal life settings, and their hammers, green walls, plant tubs, shade saws, nails and paint available houses, etc. to build wooden towers, these bold playgrounds encourage children to test their limits and make up stories.
During heat waves in summer, the A therapeutic garden has just been space is transformed into an oasis opened near Xavier’s home. Made up of urban coolness that is open to of several theme-based planting areas (calm everyone. Lola’s entire family spends and sleep, immune system, digestion, blood time here and particularly enjoys the circulation, etc.), it also includes information misters and water fountains turned on panels explaining how to recognise the different for the occasion. plants and their medicinal properties.
Lola and her friends have taken to this new Encouraged by his therapist to resume a playground, which is poles apart from traditional physical activity and appreciative of the City’s standardised squares. Initially worried about the pedestrianisation work, Xavier plans to walk safety of their children and the risk of accidents, more to take care of his daily needs parents have been won over too: Lola now (medical appointments, shopping, etc.) spends more time outside, playing and exercising. Laura is delighted with this initiative, When Ousmane was Ousmane sees a general especially as she is an activist for raising discharged from hospital practitioner there every public awareness of the difficulties linked after his myocardial three months and a to disabilities in cities. In addition to her infarction, he was referred cardiologist once a year. involvement in community-based groups, to his city’s healthcare centre As part of the therapeutic she regularly takes part in consultation and for long term post-infarction education programme provided participation programmes organised by the monitoring. by the healthcare centre, city. She has already submitted disability- he has participated in group related projects within the framework of the sessions on various themes participatory budget. (cardiovascular risk factors, nutrition, physical activity, The City has just published a self-monitoring, etc.) “Disability, inclusion and universal accessibility” strategy, which sets Ousmane and his family have become out a series of actions to be carried members, which is a way for them out to benefit citizens with disabilities. to improve the balance of their diet, an element that is essential to Ousmane’s A traffic calming area has just been health. Ousmane regularly participates in developed near Laura’s home in response to the distribution of baskets to other members. various conflicts over the use of roads. In this area, which gives priority to pedestrians, vehicle Ousmane Laura speed is limited to 10 km/h, pedestrians are Mwana The City has set up a prescription- Nguyen allowed to use the roads and have priority, and 55 yeras 33 years old based sport and fitness programme cyclists are authorised to travel in both directions Tradesman Employee on the roads. to encourage the practice of regular, moderate physical activity adapted to the 86 health status of chronically ill patients. 87 Place of residence: Collective social housing Place of residence: Collective in a priority neighbourhood in a metropolis social housing in a small town Family status: Divorced Family status: Married with two children Health status: Laura became a paraplegic 10 years Health status: Ousmane suffered a myocardial Laura trains there daily to maintain ago following a climbing accident. She regularly goes infarction two years ago. His condition is now her physical and muscular fitness to hospital for medical examinations stabilised in preparation for her upcoming sitting Main health issues: To reconcile life in the city and Main health issues: To adapt his lifestyle her disability and to continue her high-level sporting volleyball matches. and care pathways to prevent the risk of heart activity failure related to his medical history
In conjunction with a farmer converting to organic practices, an AMAP (Association for the Preservation of Peasant Agriculture) has just been created in the city. A one-year contract has been signed with the producer for the weekly delivery of fresh fruit and vegetables The neighbourhood has a sport and fitness to members. As part of this programme, Ousmane’s trail developed for visually impaired doctor prescribed regular moderate people, people with reduced mobility and Laura appreciates this new development, physical activity. During an initial appointment, able-bodied people: raised-dot information which enables her to easily use her wheelchair a sports educator guided him towards a physical panels for tactile reading, wheelchair- on bicycle sections. She would like to see activity adapted to his pathology. Since then, accessible surfaces and apparatus, etc. this type of programme extended to other Ousmane has been meeting him regularly to areas. inform him of his progress. Conclusion Acknowledgements
CREATING Management of the approach ENVIRONMENTS Clémence Chastan, Positive Impact Innovation Project Manager, Linkcity CONDUCIVE Elsa Favreau, Strategic Foresight Project Manager, Bouygues Construction TO HEALTH AND Sophie Piechaud, Strategic Marketing Project Manager, Bouygues Construction WELL-BEING Co-organisers of workshops
As we have just seen, our neighbourhoods we deliver. I-Care cluster, Rhône-Alpes Cluster serving innovative care population is changing. There For construction, we have long since Ideas Laboratory, Multi-partner open innovation platform (Grenoble) are more elderly people, but reduced the inconveniences caused chronic illnesses, mobility by construction sites and favoured Tubà, Place of innovation and experimentation for the city of tomorrow (Lyon) difficulties and even disabilities non-polluting materials and we are Ville & Aménagement Durable (Cities & Sustainable Development), Centre for exchanges can affect all of us. now developing the use of wood and and resources for buildings & sustainable development in Auvergne‑Rhône‑Alpes low carbon concrete in our projects. Long-term illnesses (LTIs) affect 20% However, above all, we wish to develop of our population but account for 75% projects where nature resumes its of our health expenditure. Since the rightful role, where services are close Speakers during workshops 88 Claude Rolland treatment and monitoring of these at hand and where people want to walk 89 LTIs rarely require a technical hospital Healthcare department around, connect with their neighbours Xavier Brisbois, Doctor in Social Psychology director of Bouygues platform but always require local and participate in neighbourhood Construction multidisciplinary care with doctors, meetings on health prevention or Mathis Cacheux, Psychologist and Ergonomist, Tubà nurses and paramedics, we must mutual assistance to benefit people reinvent our health model to enable Marie Chabrol, Founding Director, Urbapilot in difficulty. easier access to care and develop Claire-Sophie Coeudevez, Associate Director, Medieco proper prevention. Medicine has made great strides to provide more and Because our needs evolve over Gérald Comtet, Director, I-Care Cluster better care, but today, poor lifestyle, the years, we are developing projects Fanny Coulombie, Project Manager, Cities & Sustainable Development pollution and lack of physical activity where flexibility and scalability are are increasing the number of LTIs and incorporated from the outset. Nicolas David, Project Manager, Bebel Court preventing an increase in healthy life Clément Deloly, “Urban Planning and Health” research officer, expectancy. Better living means learning to École des Hautes Études en Santé Publique (French School of Public Health) enjoy the air, water and land that As a builder and property developer, surrounds us. It means talking Suzanne Deoux, Founder, Medieco, President, Bâtiment Santé Plus we have a responsibility to provide new to each other, and helping those Marine Gouezel, Consultant, Novascopia and innovative solutions to improve around us. We are working to the quality of life of the people who create such places where life will Fleur Leplat, Coordinator, Métropole aidante will live or work in the buildings and be better.
Publication and editorial division
Virginie ALONZI Elsa FAVREAU Participants in the approach
Adrien Amalricht, OÏKOS Benjamin GUINOT, CNRS Adamantia Batistatou, SCALAB (University of Lille) Aura HERNANDEZ, Psykolab Anissia Benzekhroufa, Medieco Carole HORLAVILLE, Delta Dore Alice Bonidan, Linkcity Léonore JOERG, TENERRDIS Lorraine Bosvet, Entrepreneurs du Monde Anne JOSSE, ESQUISSE Etienne Bourdon, Laboratoire Education Marie JOYEUX-FAURE, HP2 Laboratory et Pratiques de Santé (Paris 13 University)/O Ubi Campi Béryl LATRASSE, OZ’IRIS Santé Karine Bouty, Savoie-Mont-Blanc University Sylvie LE BAUT, Pharmacist Olga Braoudakis, Grenoble Urban Planning Agency François LEROUX, OÏKOS Antoine Burgaud, M2care Christophe MARTINSONS, CSTB Manon Capitan, Amstein + Walthert Claire MASSA, Meersens Virginie Chasles, Lyon 3 University Mireille MASSON, Algoé Lucie Combaz, OZ’IRIS Santé Sandra PAHIN-MOUROT, Savoie-Mont-Blanc University Foundation Laurent Combes, SERM SA3M Thierry PERNEY, Red Cross Floriane Combray, Linkcity Fanny POINSSOT, City of Grenoble Constance De Alexandris, Ecoceaty Marion POLLIER, Labo cités Tiphaine Detoudeville, M2 CARE 90 Isabelle RANGER, Habitat et Humanisme 91 Capucine Diancourt, Playful City project Claude ROLLAND, Bouygues Construction Emmanuel Dujardin, Tangram Architectes Health Division Director Marie-Christine Eudes, APICIL Group Timothée ROSSET, Linkcity Céline Fauquembergue, Vous êtes ici Anne-Sophie SAFFRE, Aria Technology François Ferry, Esprit Tiny Fanny SCHNUR, Axes Majeurs Julie Fessy, Meersens Daniel SCHOEN, AA Lyon Sandra Frey, Lyon Metropolis Gaëlle SIX, La vie en roses François Gallix, Linkcity Paul STEPHAN, Modes de villes Cesaltina Gama, La Poste Marion THARREY, INRA Lyon Cédric Geeraert, Tangram Architectes Martin THEBAULT, Savoie-Mont-Blanc University Pauline Gignet, CROQ’ACTI, D-marche Claire TUMELIN, Docteur House Sébastien Guerendel, Accsis Santé Frédérique VIANNES, Robin des Villes
Workshop facilitators
Virginie ALONZI Elsa FAVREAU Design and production: www.agence-heidi.fr Photo credits: Bouygues Construction, Thinkstock, Lucie ALBON (illustration) Laetitia FLOURENT Patrizia Di Fiore Nicolas BOUBY Mathieu JAY Illustration credits: Lucie Albon Printing: FSC-certified offset paper Clémence CHASTAN Laurent MICHELIN Justine DENFER Sophie PIECHAUD March 2020 THE TERRITORIES DEALING WITH THE HEALTH CRISIS
COVID-19 Supplement July 2020 #8
COVID-19 Supplement july 2020 Introduction Vulnerabilities
The emergence of this virus validates the The global imbalance new approach of the health policies created of ecosystems increases in the 2000s by the OIE (Word Organisation WHAT ARE our vulnerabilities to the for Animal Health) and taken up by the FAO (Food and Agriculture Organization of the THE IMPACTS risk of animal pandemics United Nations) and the WHO (World Health and, in the future, the Organization), which takes into account the OF COVID-19 links and interdependencies between decline of biodiversity human health, animal health and ecosystem ON CITIES AND health : «One Health». Appearing in China at the end of 2019 in TERRITORIES? circumstances that are still unknown (but Our current models of growth and development probably linked to an animal vector), the SARS- are fuelling our own vulnerabilities and this Cov-2 coronavirus joins a long line of viruses that crisis reminds us of the urgent need to return Sudden economic shutdown, cities come into contact with humans as a result of to a global balance of ecosystems. Today, we providing a minimum service reduced to pressures on the environment. Global warming, are affected by the risks associated with animal vital functions, large scale quarantine to deforestation, agricultural expansion and the components, but tomorrow we will face the the home: the crisis due to the COVID-19 increase of urbanisation accentuate the human- even greater threat of the decline in biodiversity, epidemic revealed both the resources animal interface. The distribution ranges of which directly affects our food security. More and the vulnerabilities of the cities four pathogen-carrying mosquitoes are expanding than ever before, our regional development billion people worldwide found themselves and contact with natural reservoirs of pathogens models must control urban sprawl and fight soil confined in April 2020. This forced pause is increasing, multiplying the risk artificialisation. of animal pandemic. 94 caused a re-examination of our urban 95 lifestyles in terms of our relationship with time, space and the essential.
For many elected representatives, philosophers, sociologists, geographers, town planners and architects, the crisis appears to have been a tremendous opportunity to reinvent the model of the city that is more favourable to the environment and human beings. What lessons can be taken from this crisis if we are faced with a situation that could recur in the decades to come, where the coronavirus served as a “dress rehearsal, a crash test for human societies”, according to Edouard Bard, a professor at the Collège de France.
This essay will first analyse thevulnerabilities and resources revealed by the crisis, from a regional point of view. New uses linked to the crisis will then be explored, including incorporation in development projects and real estate products, before concluding with the impact on urban models and how urban environments operate. A global approach through the determining factors of health, and its regional interpretation, are necessary to reduce vulnerabilities to the virus These initial analyses confirm the importance of a There are other, more latent inequalities in addition to those comprehensive approach to health and the related related to the virus itself, linked to quarantine measures, determining factors in addition to individual biological whose effects will become apparent in the longer term. Worrying epidemiological assessments characteristics, many behavioural, environmental and The experience of the two months of distance learning risks carried out daily by the national public socio-cultural factors intertwine to determine our health deepening educational inequalities, especially for students health agencies reveal profiles vulnerable status. The case of Seine-Saint-Denis, a department who didn’t have access to computer equipment to follow to the virus. 77 % heavily affected by the COVID-19 epidemic, is particularly online courses, who did not have a large or quiet enough striking. space to concentrate and children whose parents were not of patients admitted to intensive care units had at able to assist them. At the end of May 2020, according to least one comorbidity According to a computer graphic produced by Le Monde figures from Santé Publique France,77% of based on data from INSEE and the Ile-de-France regional health More than ever, the epidemic is confirming the need patients admitted to intensive care units Santé Publique France observatory, excess mortality jumped by nearly 130% between to combine a comprehensive approach to health via had at least one comorbidity. Among the May 2020 1 March and 27 April 2020, compared to the same period in determining factors and a health system capable aggravating pathologies of patients in intensive 2019, an increase twice as high as in other departments in the of preventing and managing the development of chronic care, obesity, diabetes, cardiac pathologies greater Paris region (+67% in Yvelines and +65% in Seine- diseases on the one hand and, on the other, of responding and pulmonary pathologies were the most et-Marne). This is due to the economic, health and social rapidly and proportionately to an infectious epidemic. common. inequalities in the department: job insecurity and poverty, 96 We have not paid 97 medical deserts, co-morbidities and overcrowding in the home. This established link between chronic diseases attention to antibiotic and vulnerability to infectious epidemics resistance, nor to confirms the need to address the risk factors the links between largely rooted in our lifestyles and consumption environment and patterns (alcohol or tabacco consumption, COVID-19 and pollution intense pace of life, diet and the quality of our health, still less to the living environments). Urban concentration, in inequalities in access A study by Yaron Ogen, a researcher particular, isa source of high exposure to risk to healthcare and at Martin Luther University Economic, social and health factors due to settings that may favour seden- life expectancy that Halle-Wittenberg, conducted across tary lifestyles and intense paces of life as well 66 regions in Italy, France and inequalities in Seine-Saint-Denis as continuous exposure to pollution. persist and are even Germany, showed increasing. We must Housing conditions: Althouth a causal link has not yet been scienti- now both accelerate the that 78% of COVID-19 related fically demonstrated, several studies question deaths were in regions with the the correlation between air pollution and morta- adaptation of the health Average Percentage of highest concentrations of NO2 lity related to COVID-19. system to the treat surface area households containing (nitrogen dioxide), combined with a per person three or more persons • Seine-Saint-Denis is the department with and monitor chronic downwards airflow that prevented the highest number of people over 65 years diseases and create effective dispersion of air pollution. the conditions to deal 18 sqm 42 % old suffering from pathologies such as diabetes and chronic respiratory diseases. Long-term exposure to this pollutant with the significant and in a quarter of in could thus be a factor in mortality due deadly epidemics that homes in Seine- Seine-Saint-Denis • The department has a large number to COVID-19 in these regions. are likely to recur Saint-Denis of key workers working in the essential sectors that are most exposed to contact with the public: hospital workers, cashiers, Gaby Bonnant and Etienne Caniard, 25 sqm 22 % salespeople, delivery personnel, care Health specialists Gaby Bonnant and Etienne Caniard (respectively, former president of Unedic and assistants. member of the High Council for the Future of Health Insurance, and former president of Mutualité in Paris in Paris Française and a member of the National Authority for Health) in an opinion column in “Le Monde” globalised economy have moved production sites Strategic relocations and consumption locations apart and multiplied Urban density: are needed to reduce logistics requirements. Individual behaviours an aggravating force dependence on and national policy decisions such as restaurant or resilience in the face closures or restrictive trade or supply chain globalised supply chains measures to ensure national food security have of the epidemic? global implications. The food The abrupt deceleration of the economy The notion of density has largely fuelled due to quarantine and border closures has In 2017, a report by Utopies on the food autonomy of debates during the crisis: does a dense highlighted the limits of, and vulnerabilities autonomy of cities warned of the low food cities warned city encourage transmission of the virus? to, widespread global interconnectedness. resilience of the regions in France. Intuitively, it would be tempting to answer of the low food yes to this question because of the higher likelihood of interpersonal contact. Shortages of protective equipment, in Movements to re-regionalise food were under resilience of the particular, have revealed the drawbacks way before the COVID-19 crisis, of deindustrialisation and the levels of as demonstrated, for example, regions in France However, the positive correlation between density overdependence on globalised supply chains by the City of Albi aiming to improve and infection rate is far from obvious. An analysis (surgical masks, respirators, gowns, etc.), its food autonomy by 2014 and the Dijon conducted by the World Bank on 284 Chinese Of the 100 urban 1 leaving healthcare workers and front-line workers metropolitan food project (see p.55 Trendbook #8). cities even shows the opposite. The correlation areas studied, only between the number of confirmed coronavirus dangerously ill-equipped during peak periods of By accelerating awareness of the fragilities 8 exceeded the 5% the epidemic. of a globalised system, the COVID-19 crisis cases per 10,000 inhabitants and population should amplify movements of food autonomy threshold. density in each of the regions revealed higher relative infection rates in lower-density regions Likewise, uncertainties over food availability, re-regionalisation. 98 than in Shanghai, Beijing or Shenzhen. Rather 99 which have triggered panic and mobbing in This is due to the than population density, distance and economic supermarkets, have highlighted the fragilities More generally, movements to reconfigure inconsistency of a system that links to the epicentres of the epidemic (Wuhan) caused by a globalised food market. While there real economies are expected, with a return is not very regionalised, where would appear to explain the highest rates. is “enough food in the world to feed everyone”, to regional value chains and relocation 98% of food is “imported” according to Qu Dongyu, Director-General of of strategic industries (pharmaceuticals, agricultural products, while The ability to enforce quarantine and physical the Food and Agriculture Organization of the electronics, telecoms, etc.). Following the end of at the same time distancing measures therefore appear to United Nations (FAO) in an opinion column in quarantine in June 2020, the French government 97% of local agricultural be more decisive than population density in “Le Monde”. “we still need to ensure that food announced its intention to control the entire products are exported. the spread of the virus. However, large and is available where it is needed.” And that’s paracetamol production chain on national soil dense cities benefit from advantages linked to exactly the problem. The long value chains of the within three years. economies of scale and an increased capacity to react: high level services facilitating stay-at- home orders (broadband connections, home deliveries), quality and size of care infrastructure, capacity to maintain and reorganise essential urban services (water, sanitation, energy, waste, transport), capacity to organise local community networks. Could one go so far as to say that a dense city would be more resilient in the face of the epidemic? However, once again we are confronted with the notion of inequalities: although the risks linked to density can be controlled, overcrowding within the home and the concentration of front-line workers exposed to the virus in an area (cf. Seine-Saint-Denis p.5) are, in fact, factors that encourage transmission.
1 Source : https://blogs.worldbank.org/sustainablecities/ urban-density-not-enemy-coronavirus-fight-evidence-china The regional response also relies on social agility and the capacity of stakeholders to initiate Resources new collective dynamics
Local authorities have shown According to Stéphane Cordobes, an on their perceptions and proposals, associate researcher at École Urbaine the Agency intends to identify the resilience in their management of de Lyon (interviewed on this subject), networks and often unprecedented the crisis aside from greater involvement forms of cooperation that were by local authorities and elected created at the height of the crisis The crisis was a test of resilience for the regions and an representatives in the management in order to support these initiatives opportunity to test their ability to respond to the impact. of the crisis, the intelligence of and make them sustainable. While regions also relies on the horizontal the period of quarantine was not Although the latter was brutal, the response was reactive and involvement of civil society, local very conducive to “living together”, it the evolution of the crisis eventually defused initial fears and elected representatives and was, on the other hand, a breeding even panic caused by the risk of overrunning hospital structures experts, as well as local economic ground for “doing together”, which is The collectives and and disruptions in the supply of food and basic necessities. The stakeholders, supported by State aid. promising for the future. networks that are created or crisis even brought to light a number of assets that regions, unveiled when dealing with particularly urban regions, have been able to bring to bear in Examples The response to this extraordinary managing the crisis. time in history came from the ability emergencies are in effect of regional of cities to manage and reorganise processes of regionalisation The regions were key players in the management of the crisis, responses in crisis essential functions and services, of in their own right. They both during the period of quarantine and at the time of the end all stakeholders to work together with will be beneficial not just of quarantine. In many cities, operational crisis units have been management social agility on a common objective set up to manage the current crisis and to anticipate a potential and to continue to “function as a to deal with the current overlap of crises (e.g.: power supply disruptions, exercise of society” (socialising via windows or crisis, but also to influence the right of withdrawal of truck drivers), as Célia Blauel, Deputy balconies, for example). 100 how we build the future, 101 Mayor of Paris in charge of Paris 2030 outlook and resilience, if we manage to maintain told us1. During quarantine: One of the challenges ahead will be • provided essential services to the ability to enhance and consolidate or even intensify these the population (water, sanitation, the solidarity unveiled by the crisis. dynamics. This involvement energy, waste, municipal police) This is one of the objectives of could also play a role in the • organised solidarity networks Mission Résonance, initiated by 1 Source : https://www.bouygues-construction.com/blog/fr/dossier-special/ (food aid for certain families, help the Tours Urban Planning Agency future, which is a far more COVID-19-impacts-confinement/#que-nous-a-appris-la-crise-du-COVID-19-sur- la-resilience-des-territoires for the homeless, childcare for care following the crisis. By questioning promising prospect than the workers, social links with isolated local stakeholders from all walks of life other, more worrying trend vulnerable people, various re-housing needs) that has also manifested • provided the population with during the crisis, that of protective equipment (mask withdrawal, in the forms of making). borders, video-surveillance and control, to name a few. Example of an initiative In my opinion, the real intelligence of the regions At the end of quarantine: Many initiatives have emerged during the health crisis, • helped shopkeepers and artisans demonstrating the responsiveness of civil society and its ability lies more in these collective who were particularly hard hit by to initiate transformations to support resilience. dynamics than in the the crisis (temporary occupation influence of techno-powers. of terraces on public walkways for This is the case of the call for the creation of a Metropolitan After all, that is basically cafés and restaurants, structuring Interest Market (MIM) launched by stakeholders from Lyon’s civil of short circuit local economy) society. This market would take the form of a cooperative society what ‘creating regions’ is all • implemented measures for social of collective interest in which local authorities, sustainable food about. distancing in public spaces (creation stakeholders, producers and consumers would join forces to temporary of bicycle paths) increase Greater Lyon’s food autonomy and support the emergence • ensured the resumption of school. of a sustainable territorial food system. Stéphane Cordobes, Associate researcher at École Urbaine de Lyon The fate of the tertiary sector is more uncertain. The experience of While it is likely that the health crisis will change movement patterns widespread remote working (for professions suitable for this type of (towards more remote activities, active modes of transport and work) will likely have a profound effect on future patterns of use of perhaps more private cars) rather than revolutionise them, the tertiary real estate. The spread of remote working and the adoption experience of quarantine has above all argued in favour of a decrease Usage of new collaborative technologies that have proven effective could in mobility: made possible by the maturity of remote practices and reduce office occupancy rates and at the same time reinforce the more free time, it is one of the responses to the growing aspiration for The quarantine measures taken in the face of the pandemic These needs are expected to continue and increase, particularly those need for head offices that “showcase” the company’s values and are a slower pace of life. may have varied in severity by country, but they have undeniably related to the growth of “remote” activities, which is undoubtedly one capable of uniting employees: the office will have to demonstrate added changed our habits and lifestyles as never before. Will this impact of the major trends associated with the period of quarantine. A key value in terms of image, performance and attractiveness. Companies The rise of remote practices has also favoured another major trend result in the emergence, spread or revolutionisation of certain factor in maintaining work activities, digital tools have passed the test could opt for more flexibility, adapting to the workplace as a service and observed during quarantine: a massive urban exodus where uses? of the crisis and proved effective for different uses (work, learning, diversifying their real estate positions in favour of coworking. 1.2 million Ile-de-France residents left for the other regions of France. consumption, healthcare). A change of scale has taken place thanks While this may have been seen as the beginning of a demographic Improving the experience of essential to new converts and accelerated appropriation of these tools. Beyond rebalancing of the regions, the realities observed at the end of the period of the crisis, these tools should continue to be attractive Slowing down quarantine are less clear-cut. According to initial figures from estate uses and simplifying everyday life because of the alternative they represent in the face of commuting and agencies, intentions to buy second homes or pursue “lifestyle The period of quarantine meant a significant restriction the option they offer to bring together a community. changes” as observed by the increase in visitors have so far not been of freedoms due to limitations on travel, consumption Mobility reduced to local and essential travel, 23/24 hours a day at translated into action, and residents of large conurbations are more and meetups. While part of the population found this home: the period of quarantine has changed the relationship to time How can the growth of these new remote working practices be likely to look in smaller towns than in the countryside or the coast. and space for a large part of the population. This reduced space embodied in development projects and real estate products? extremely difficult, some saw this period where time seemed we have been forced to live in is contrary to our nature as beings of It has already been noted that certain sectors will grow, such “suspended” as an opportunity to take a break, to focus on movement and has encouraged a great level of introspection into our as logistics (whose role has exploded during the crisis), to the themselves and to slow down the pace of our modern lives. ways of living. extent that operators are now advocating classification of the The leisure or everyday activities that marked this period food supply chain as a vital operator. (cooking, DIY, gardening, sorting, tidying up, cleaning, reading, The rise of “remote” activities In this context, dissatisfaction related to cramped or inadequate watching videos, checking in with family and friends, etc.) have housing, limited access to nature or lack of outdoor space has The environmental issues related to the development of logistics nourished a form of psychological resilience in the face of the Virtual consultations billed to Assurance Maladie been exacerbated. It has made the need for quality housing and the systems will be all the more crucial. Efforts will focus on bringing crisis, and have even been a source of well-being for some. • 486, 000 during the first week of quarantine resolution of tensions between density and quality of life glaring. logistics platforms closer to consumption locations, which should • 10, 000 per week prior to quarantine strengthen the real estate offer provided by new urban logistics spaces According to the “COVID-19: Le Jour d’après” (The next day) survey 102 Aside from comfort and the living environment, the use value of (urban distribution spaces, urban delivery spaces, urban distribution carried out by Obsoco during quarantine, 56% of the French people 103 74 % of GPs expect to continue using virtual housing has fuelled debate in the context of increased hybridisation of platforms). surveyed believed that their habits would change once the pandemic consultations after the epidemic 1 uses of the home: remote working, distance learning, remote medical passed. While the long-term impact on usage is difficult to predict, consultations, exercise, home-production (food, energy, crafts) or reactions during the crisis and the changes in practice point to possible 19 % of French people have bought a new category transformation (cooking, DIY), etc. Good connectivity, the ability to directions. This is the case for commuting, which underwent numerous of products online during quarantine 2 modulate or reorganize spaces for these different uses, and even the upheavals and reversals during the different period of the crisis:
option to achieve a degree of autonomy played a crucial role in the • During the period of quarantine: car traffic reduced to vital In Chine, 89 % of consumers now want to make more frequent experience of this period. 3 functions, public transport “reserved” for front-line workers and online purchases of fresh and basic necessities exercise reduced to a one-hour walk a day for most of the population.
4 • At the end of quarantine: wide-scale continuation of remote Intentions to work remotely in the future : practices (due to remote working in particular), distrust of public “Experienced” New remote transport, fear of an increase in the use of private cars for health and remote workers workers safety reasons, development of active modes of transport (walking, Criteria for assessing a dwelling cycling, scooters, etc.) supported by the development of dedicated temporary infrastructures and bicycle purchase subsidies from local On an 39 % 52 % deemed more important as authorities and the government. ad hoc basis 1 a result of quarantine On a regular basis 59 % 28 % Balconies, terraces, gardens, criterion no.1 for No remote 2 % 20 % 66 % of respondents work
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81 % of respondents 1 Source: Doctolib 4 Source : Source: Anact (National 2 Source: YouGov for Keley Consulting Agency for the Improvement of Working 1 Source : BNP Paribas survey, April 2020 3 Source: Nielsen Conditions), June 2020 Models Producing and The cities we know today were partly forged by the fight Nature in the city, the development of soft mobility and the consuming locally against infectious disease epidemics. After the cholera reduction of the role of cars, the development of agriculture epidemic of 1832, which claimed 19,000 victims in a few and urban agro-ecology (integration of all environmentally- Local workshops for fabric masks, local months in Paris, the 1850 law on substandard housing friendly production techniques into the urban landscape), purchases, purchases of short chain introduced new systems (wider windows) to let in light solidarity and local uses: these ingredients in the liveable, products encouraging small producers: and allow better air circulation. This crossover between peaceful city were already at the heart of urban policies during the period of quarantine, the local medical hygiene advice and town planning reached its before the health crisis. They will remain the driving force of economy was centre-stage in production apogee with the great Haussmann project: future urban transformations, but could benefit from a new and consumption. approach based on the concept of health-friendly urban • Wide avenues and city blocks with courtyards for ventilation planning: how can these factors respond to the health issues and air circulation in the city The “Manger au temps du of the population of a given region and form part of planning a coronavirus” (“Eating patterns in the period of • Parks and green spaces to provide oxygen neighbourhood, block or building? coronavirus”) survey conducted by Terralim and the research units of Agrocampus Ouest • Water supply and sewerage networks to clean up the city. showed that demand was up to ten times higher than supply, particularly for fresh Far from this hygienic vision, the health crisis linked to produce. According to Yuna Chiffoleau, a COVID-19 is an opportunity to re-examine our urban models, researcher at the national research institute for our objectives and the tools we have at our disposal to agriculture, food and the environment (INRAE) implement them. in Montpellier, interviewed by Ouest France, the success of short chains was down to A resilient and liveable city several factors: 104 • Consumers need transparency and The key concept of resilience emerged during this period. 105 reassurance about the origin of products and Already present in the thinking of certain cities before the the supply chain crisis (e.g. Paris), it now concerns all regions. The city must be resilient, capable of reacting to any type of crisis or shock and • Solidarity with local producers affected by to overcome them in a sustainable way by restoring a balance. the closure of restaurants, school canteens Re-examining the city from the point of view of resilience and markets leads to new modes of governance and action: cross- • A desire to use fresh and varied produce functional strategies to adapt to the challenges of our era (in with a view to healthy eating. particular adapting the city to climate change), exploitation of collective intelligence and inhabitants as stakeholders for According to a survey carried out for Engie resilience Improved regional cooperation and re-regionalisation Solutions on the end of the crisis, 60% of French (to secure water, energy and food supplies), a culture of people want to change their consumption habits crisis management with particular attention to sensitive and by favouring local purchases and short chains. vulnerable people, etc. While sales fell after the end of quarantine, initial feedback from producers shows higher overall The massive urban exodus during the period of quarantine levels than before the crisis, indicating that short was an undeniable reminder of the disadvantages of the dense circuits were not just a simple fallback solution city, as Célia Blauel put it: “It was not a feeling of insecurity to avoid the large supermarkets. Community- that drove some residents to leave Paris, but the closure of supported agriculture, farmer shops, farmer terraces, restaurants, cinemas, theatres, etc. Once these “Drives”, online ordering and food markets have places are closed, the capital’s weak points are obvious: a bright future ahead. We still have to find a too much concrete, lack of green spaces, solution for a short-chain logistics model to keep lack of communal spaces.” pace with growing demand while controlling the carbon impact. The advent of a temporal approach to Is the smart city town planning to ensure local balances emerging stronger from the health crisis? How can dense cities be adapted and make physical distancing possible at the end of quarantine? To overcome this challenge, cities While the crisis has generally reinforced have used agile urban actions that have proven effective existing or emerging urban models, it also in managing the crisis: seems to be fuelling existing divisions on certain concepts.
Action Example This is the case for the “smart city”, in its technological sense, related more broadly to the use of data. While some praise the advantage of the smart city in crisis Tactical urban planning: • Temporary bicycle paths management (e.g. Dijon Métropole, which has temporary structures with • Removal of parking spaces to widen added an additional toll-free number service easy-to-install parts to signpost footpaths for café and restaurant terraces available 24/7 to its centralised control centre. changes in the layout of a street, or store entrances Residents can call about various issues, intersection or public space and excluding medical emergencies. According • Temporary lowering of the speed to direct user behaviour to the service, the scheme facilitated limit for traffic and sharing of the roadway coordination and reduced the need for staff to in places with a high concentration of be sent out, reducing exposure to the virus). pedestrians and cyclists However, others point to mass surveillance and data management as an infringement of civil liberties and an invasion of privacy and 106 107 are concerned about the spread of these • Imposition of time slots limiting the schemes in the context of the health crisis. duration of outings and sports practice In France, volumetric analysis of data through Time-based urban planning: • Closure of streets to traffic at certain cooperation between Orange and Inserm times to allow the extension of restaurant Modulation of the city’s busy (French National Institute for Health and terraces periods for decongestion Medical Research) to analyse population movements and the Stop COVID contact • Flattening of peak hours to avoid rush tracing app sparked the debate: the revelation hours on public transport by cryptography researchers that a much wider set of data was being collected than initially announced would appear to confirm the fears of detractors. Although we are still a long way from the mass-scale monitoring of The crisis brings a temporal approach to urban planning to the infected people or those likely to be infected, forefront. This approach was already seen to flourish in the past in the as in South Korea or China, the health crisis form of the “Bureaux des temps” or “Temps urbains” projects. could increase the appetite for tracking and video surveillance systems and bolster the Whatever the concept (tactical, temporary, reversible, transitory, temporary, dynamic of safe cities, which has already time-based), the objective is to observe uses in order to identify potential for prevailed in some cities (Nice, Marseille, intensification, deintensification or adaptation and to organise uses while paying Saint-Etienne). attention to local balances. This approach has proved effective in times of crisis to support a rapid change in uses over a short period of time and is also Regardless of the role of technology, the smart relevant for longer time frames in urban or property-development projects. This city will rely above all on the involvement of approach will likely be essential to overcome the challenges ahead, particularly stakeholders and citizens, who demonstrated in reconciling density and quality of life. To be viable, this approach needs to their ability to organise, provide care and show be used to balance the habits of users and ensure local balances, rather than solidarity to tackle COVID-19 during the crisis. hyper-optimizing buildings and infrastructures. Trend books
#1 Leisure and urban dynamics #2 Move towards mutualisation in social housing #3 Digital cities, human design #4 Ageing well at home #5 New campus models for a learning society #6 Housing in the future #7 Cities and Mobility, reinventing proximity #8 Creating environments conducive to health and well-being
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