Series Urban design, transport, and health 1 City planning and population health: a global challenge Billie Giles-Corti, Anne Vernez-Moudon, Rodrigo Reis, Gavin Turrell, Andrew L Dannenberg, Hannah Badland, Sarah Foster, Melanie Lowe, James F Sallis, Mark Stevenson, Neville Owen Lancet 2016; 388: 2912–24 Signifi cant global health challenges are being confronted in the 21st century, prompting calls to rethink approaches Published Online to disease prevention. A key part of the solution is city planning that reduces non-communicable diseases and road September 23, 2016 trauma while also managing rapid urbanisation. This Series of papers considers the health impacts of city planning http://dx.doi.org/10.1016/ through transport mode choices. In this, the fi rst paper, we identify eight integrated regional and local interventions S0140-6736(16)30066-6 that, when combined, encourage walking, cycling, and public transport use, while reducing private motor vehicle This is the first in a Series of three papers about urban design, use. These interventions are destination accessibility, equitable distribution of employment across cities, managing transport, and health demand by reducing the availability and increasing the cost of parking, designing pedestrian-friendly and cycling- University of Melbourne, friendly movement networks, achieving optimum levels of residential density, reducing distance to public transport, Melbourne, VIC, Australia and enhancing the desirability of active travel modes (eg, creating safe attractive neighbourhoods and safe, aff ordable, (Prof B Giles-Corti PhD, and convenient public transport). Together, these interventions will create healthier and more sustainable compact H Badland PhD, M Lowe PhD, Prof M Stevenson PhD); cities that reduce the environmental, social, and behavioural risk factors that aff ect lifestyle choices, levels of traffi c, University of Washington, environmental pollution, noise, and crime. The health sector, including health ministers, must lead in advocating Seattle, WA, USA for integrated multisector city planning that prioritises health, sustainability, and liveability outcomes, particularly in (Prof A Vernez-Moudon Dr ès Sc, rapidly changing low-income and middle-income countries. We recommend establishing a set of indicators to Prof A L Dannenberg MD); Pontifical Catholic University benchmark and monitor progress towards achievement of more compact cities that promote health and reduce of Parana, Parana, Brazil health inequities. (Prof R Reis PhD); Washington University at St Louis, St Louis, Introduction care6 will profoundly aff ect the health, wellbeing, and MO, USA (Prof R S Reis); Federal 4,6,7 University of Parana, Curitiba, Signifi cant global health challenges are being confronted safety of growing and ageing urban populations. With Brazil (Prof R S Reis); Australian in the 21st century, including increases in unhealthy the world’s population estimated to reach 10 billion Catholic University, Melbourne, diets, physical inactivity, non-communicable diseases people by 2050, and 75% of this population living in VIC, Australia (NCDs), injuries from road trauma, and obesity, cities,5 city planning is now recognised as part of a (Prof G Turrell PhD); Queensland University of Technology, combined with population growth, rapid urbanisation, comprehensive solution to tackling adverse health Brisbane, QLD, Australia and climate change, prompting repeated calls to rethink outcomes.5 (Prof G Turrell); University of approaches to prevention.1–5 Decisions about housing, Associations between city planning and health are not Western Australia, Perth, WA, food, water, energy, transport, social services, and health new. In the 19th century, planning curbed infectious Australia (S Foster PhD); University of California, disease outbreaks in industrialising cities through San Diego, CA, USA improvements in sanitation and housing and separation (Prof J F Sallis PhD); Baker IDI Key messages of residential areas from industrial pollution.8,9 In the Heart and Diabetes Institute, 21st century, well planned cities have the potential to Melbourne, VIC, Australia • Signifi cant global health challenges are being confronted (Prof N Owen PhD); and in the 21st century, and well planned cities that encourage reduce NCDs and road trauma and to promote health Swinburne University of walking, cycling, and public transport use have an and wellbeing more broadly. This could be achieved by Technology Melbourne, VIC, reducing automobile dependency, traffi c exposure, Australia (Prof N Owen) important role to play in addressing these challenges • Urban and transport planning and design can directly and pollution, noise, and urban heat-island eff ects, while Correspondence to: enhancing mental health, contributing to climate change Prof Billie Giles-Corti, indirectly aff ect non-communicable diseases, traffi c injuries, University of Melbourne, and other adverse health and environmental outcomes mitigation, and promoting walking and cycling in ways Melbourne, VIC 3010, Australia • Local and regional interventions can aff ect urban and that are safe, comfortable, and desirable. [email protected] transport planning and design, and these infl uence Leading global agencies recognise that city planning 6 environmental, social, and behavioural risk exposures and management decisions aff ect the liveability of cities • Integration of well implemented urban systems policies and, ultimately, the health and wellbeing of residents. are needed to achieve healthy liveable cities WHO recommends “placing health and health equity at 10 • Transport, planning and health ministers must develop the heart of [city] governance and planning”, appropriate legal, administrative, and technical highlighting the need for integrated urban planning, frameworks contextualised to local conditions, to deliver transport, and housing policy. This mirrors the compact pedestrian and cycling friendly cities that reduce Organisation for Economic Co-operation and private motor vehicle dependency Development’s call for leadership from “transport, land • City planning indicators are required to monitor progress use and health ministers” to create the “legal, within and between cities administrative and technical frameworks” that promote walking.11 Similarly, the UN has endorsed integrated 2912 www.thelancet.com Vol 388 December 10, 2016 Series agendas to combat NCDs.12 The UN’s Sustainable that are referred to as the 6Ds.20 Building on this work, Development Goals include promoting healthy lives and we identify eight integrated interventions that are wellbeing by making cities inclusive, safe, resilient, and needed to create cities that promote health (table 1). We sustainable.13 However, changing the way cities are also diff erentiate between urban and transport planning planned, built, and managed will require bipartisan and design policies that determine regional and local political leadership and community engagement. outcomes. In a rapidly urbanising world, understanding how At the regional level, urban and transport planning urban and transport planning and design decisions infl uences the availability and accessibility of employment aff ect health is important. City planners have and key destinations required for daily living (eg, food traditionally focused on the physical, social, economic, outlets, educational facilities, and health and community and environmental aspects of where people live.14 services), particularly by public transport. Urban and However, rapid changes in motorised transport have transport planning also manages demand for driving (eg, increased the geographical size of urban areas. the ease and cost of driving and car parking) relative to Combined with unprecedented urban population active modes of transport. Local urban design and growth, this change has put transport mobility at the transport policies infl uence local neighbourhoods’ forefront of city planning. Early in the 20th century, structure, look, feel, and convenience (eg, street network engineers began addressing traffi c congestion and road design, availability of walking and cycling infrastructure, trauma in European and North American cities. residential densities, the diversity and mix of land-use, Transport engineering soon emerged as a new fi eld, and housing types); the desirability of neighbourhoods gaining political and economic infl uence with the (eg, levels of crime and traffi c safety); and public transport construction of national motorway networks after (eg, convenience, aff ordability, service frequency, safety, World War 2. Transport planning followed as an and comfort). Achievement of more compact sustainable engineering subfi eld.15 City planning and transport cities that promote health requires integrated regional planning are now typically run at all levels of and local planning and design. government, but in separate agencies. Both are closely linked to political systems because they oversee major Pathways to better health through urban planning capital-intensive operations.16 However, these and design disciplines currently operate in separate academic The fi gure shows potential pathways through which city settings with their research underpinned by diff erent planning decisions infl uence the health and wellbeing of theoretical approaches.17 residents. Moving from left to right, the fi gure shows how This Lancet Series focuses on the health impacts of city eight urban system policies work together to create urban planning through transport mode choices.