The Subtle Power of Persuasion - Charlotte Stuart

The Subtle Power of Persuasion Nurturing and sustaining positive health and wellbeing through architecture and urban design

Charlotte Stuart Pilot Thesis

The Subtle Power of Persuasion Nurturing and sustaining positive health and wellbeing through architecture and urban design

“A pilot thesis submitted in partial fulfilment of the requirements for the M.Phil. in Architectural and Urban Design 2019” Charlotte Stuart Queens’ College

With thanks to Dr. Victoria Lee, Dr. Ying Jin, Ingrid Schröder, Aram Mooradian, James Pockson

“This dissertation is the result of my own work and includes nothing which is the outcome of work done in collaboration except where specifically indicated in the text.”

Abstract This pilot thesis builds on the body of work which argues that the environment plays a role in determining our health by influencing our behaviours: either creating obstacles to, or encouraging, healthy choices. Such mechanisms are briefly outlined as we argue that a holistic approach, one which accepts complexity, is required to incentivise families, communities, private developers, local authorities, public bodies and central government to prioritize health-promoting environments. In addition, we examine how one-off healthy choices can be turned into a sustained, long-term change in behaviour and attitude by ensuring health-promoting resources are widespread, integral to everyday life and appealing in their quality. This work is set within, and contextualised by, Cambridge.

Word Count Main body with references: 5009 List of Illustrations: 351 Bibliography: 1029

Contents Part I - Setting the Scene

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1.1 Defining Health and Well-being 2 1.2 Choice and Context 3

1.3 Cambridge and Inclusive Growth 6 Part II - An Expanding Set of Scales

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2.1 The Home 10 2.2 The Neighbourhood 12 2.3 The City 16 2.4 The Nation 18 2.5 The Planet 20 Part III - Sustaining Healthy Behaviour

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3.1 Widespread and Pervasive 24

3.2 Convenient and Intrinsic 32 3.3 Welcoming and Enabling 40

Part IV - Conclusion 47

4.1 The Role of Architecture 48 4.2 Moving Forward 49

List of Illustrations 50

Bibliography 52

Part I

Setting the Scene

Figure 1 - Milton Road

1.1 Defining Health and Well-being To be in good health means more than to simply not be ill. An individual may not have a physical or mental illness, but that does not inherently imply their health and well-being is positive, or as good as it can be. This recognition is concisely summed up by the World Health Organization (1948, p. 1): Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being, without distinction of race, religion, political belief, economic or social condition.

Such a definition transcends conventional divides between different types of health and well-being and establishes their equal importance. For additional clarity, we understand well-being to mean feeling good and functioning well; it is not the absence of mental illness but a sense of social and emotional thriving (Huppert and So, 2013).

Along with this holistic understanding of what health is, we are developing a wider understanding of what affects health. The rise of preventable, noncommunicable illnesses, such as obesity and diabetes mean that access to medical services is not the only factor which affects health. A whole host of other determinants are at play: income, housing, environmental quality, transport, education and work (Buck et al., 2018). Similarly, certain behaviours are likely to worsen our health, behaviours which are inherently linked to the places we inhabit as they either makes healthy choices easier or create obstacles (Steemers, 2015). This presents an opportunity to reduce the mounting pressure on the National Health Service by staying healthy in our homes and communities (Steemers, 2015). We will now establish in more detail how the places we live in play a role in determining our health by limiting or encouraging health-promoting choices.

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1.2 Choice and Context Whilst there are a multitude of factors affecting health, it is in the environment that such determinants physically manifest and where we interact with their effects: from traffic accidents to poor air quality (Buck et al., 2018). This is reminiscent of the early public health movement of the nineteenth century, where the poor physical conditions of inner-city slums were addressed with improvements to sanitation, successfully tackling diseases such as cholera (Freestone and Wheeler, 2015). Non-communicable, preventable illnesses associated with ‘life-style’ choices such as smoking or physical inactivity do not weaken the relationship between the environment and our health. The blame for poor health arising from such choices cannot be put wholly onto the individual. Societal structures and inequities in the built environment may make it harder for healthy choices to be made (Fell, 2018).

The way that context can affect decisions is a key concept underlying ‘choice architecture’. Thaler and Sunstein argue that even arbitrary details which affect how different options are presented to individuals can have a big impact on their behaviour. Consequently if we, as designers of ‘contexts’, do not do so with a conscious intent to sway decisions, people’s behaviour will still be affected as ‘there is no such things as a “neutral” design’ (Thaler and Sunstein, 2009, p. 3). They argue for the pursuit of ‘libertarian paternalism’: preserving the freedom to choose, whilst ‘nudging’ people to make choices which are healthier. This ensures that no option is denied but healthier behaviours are made easier. This could take the form of making a bicycle easier to access from a garage so that using a car is not the default choice (Steemers, 2019).

How does a collection of one-off, healthier decisions translate into a long-term change in attitude? This is a fundamental question in determining the extent to which places can incite healthier life-styles. It is also central in examining the role of architecture in Maggie’s Cancer Care Centres, which provide practical and emotional support. Charles Jencks, architectural historian and co-founder of the charity, believes that their buildings amplify the messages and actions of the carers whilst uplifting the emotions of the visitors, as opposed to being the direct cause for heightened well-being (Figure 2) (2010). Jencks discusses

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Figure 2 - Maggie’s Oldham, dRMM 4

the debate between ‘strong architectural determinism’ and ‘weak architectural persuasion’, stipulating that Maggie’s Centres lie in the middle: architectural design cannot determine how people behave but it can be supportive (2010).

This essay extrapolates this argument, proposing that architectural and urban design can help to sustain healthy and happier life-styles by providing recurring, convenient and appealing environments which support such choices (Part III).

Additionally, we present the importance of promoting a long-term change in attitude towards the prioritization of health-promoting design within local authorities, central government, public bodies and private organizations.

We argue that this can be achieved by outlining the reciprocal, additional benefits of such strategies for city productivity, national prosperity and environmental sustainability. At the home and neighbourhood level, we argue that design which promotes good health for individuals also strengthens the ‘health’ of the family and the wider community. This holistic approach, which accepts complexity, is examined across a range of scales within the context of Cambridge (Part II).

Figure 3 - Location of Cambridge 5

1.3 Cambridge and Inclusive Growth Cambridge is undergoing rapid economic growth but is the least equal city in the United Kingdom (Figure 3) (Centre for Cities, 2018). Inequality is increasingly associated with exposure to circumstances that lead to poor health outcomes and reduced life-span (Allen and Allen, 2015). One of the most deprived wards in Cambridge, King’s Hedges, has a life-expectancy 10 years lower than that of the more affluent Newnham ward (Figures 4-5) (Jones and Weir, 2015). The Police and Crime Commissioner for the area outlines how: “increasing inequalities worsen crime and disorder, increasing economic burden and potentially impacting growth” (CPIER, 2018, p. 37). In this context, the Cambridgeshire and Peterborough Independent Economic Commission is arguing for inclusive growth.

Inequality does not just affect those at the bottom of the ladder, but negatively impacts the overall economic success and social cohesiveness of the city. For instance, unaffordable housing is synonymous with income inequality, and is an issue which Cambridge urgently needs to tackle. Otherwise, less well-paid workers will continue to move away and future businesses will be deterred from moving to the area if their employees cannot reasonably afford to live here (CPIER, 2018). Health inequalities can also directly hinder economic growth by reducing productivity. Those out of work due to poor health lead to lost taxes and higher welfare payments alongside additional National Health Service costs (Marmot et al., 2010). We are beginning to see the relationships between a person’s health, the physical and social environment and the flourishing of society. Enhancing the environment to improve one will likely benefit the other. This strengthens the argument for prioritizing healthpromoting environments, which are more likely to lead to sustained healthier life-styles if supported by governmental, public and private organizations alike.

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Arbury

King’s Hedges

West Chesteron

Castle

East Chesteron Abbey

Market

Newnham

Petersfield Romsey Coleridge Cherry Hinton Trumpington

Queen Edith’s

Figure 4 - Cambridge wards

78.2

89.5

Figure 5 - Life expectancy by ward, 2010-2014 7

Part II

An Expanding Set of Scales

Figure 6 - King’s Hedges Road & Busway

2.1 The Home There is a well-established body of work detailing how the physical conditions of the home affect physical health and well-being, partly because the symptoms and causes can be quantifiably measured. Therefore, we can readily understand how poor air quality worsens respiratory problems (Steemers, 2015), and how exposure to external noises, such as traffic, increases stress (Burton, 2015).

Furthermore, homes can ensure that one has sufficient privacy to study, a key constituent part of well-being, or simply recharge along with amble space for families to come together (Marco and Burgess, 2015). Without enough privacy tensions can rise weakening familial relationships whilst overcrowding can lead to depression, anxiety and ultimately social withdrawal (Burton, 2015).

This interplay between the individual’s health, the health of the family, and the home environment starts to be revealed. The extent of this relationship is quite significant, as 10% of an individual’s well-being is associated directly with their environment (Steemers, 2019). Another 40% of which is attributed to their up-bringing, which occurs within, and thus can be influenced by, the built environment – especially the home.

The home does not exist in isolation but interacts with adjacent dwellings and the street in ways which can either obstruct or foster a sense of wellbeing. Preliminary observations of homes in King’s Hedges, the most deprived ward in Cambridge, reveal numerous dwellings with back-gardens bordering pavements as homes are not orientated to the street (Figure 7) (Jones and Weir, 2015). This can erode the resident’s sense of privacy, with research indicating that they are more likely to withdraw socially as a result (Burton, 2015). Social connections are regarded as one of the foundations of personal well-being and have significant benefits for one’s physical health: increasing resilience to illness and extending life-span (Leyden, 2003). If a home has a transitional space between the public street and private home, such as a front garden, then privacy is maintained and space to engage with neighbours is provided: actively encouraging social interaction and thus improving the individual’s well-being (Burton, 2015). Such social engagement between individuals also contributes to the strength of the wider community.

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Figure 7 - Buchan Street, block morphology 11

2.2 The Neighbourhood There is a strong consensus that compact, mixed-use neighbourhoods provide the most health-promoting urban environment (NHS England, 2018).

Characterized by connective streets populated by proximate destinations and high-quality green spaces, they encourage walking and cycling as a means for transport and leisure (Giles-Corti et al., 2015). This boosts both levels of physical activity, associated with preventable illnesses such as obesity, and opportunities for social interaction, an established component of personal well-being (Burton, 2015). As such it is also important that individuals are not dissuaded from using such spaces due to fear of crime or traffic (Steemers, 2015). Pedestrian-orientated environments, connected by maintained cycle and pathways along with buildings overlooking the street can quell such fears (CABE, 2009). The casual encounters facilitated by such an environment also increase social capital, i.e. levels of trust and reciprocity between citizens, which is linked to reducing crime and enhancing economic development within the neighbourhood (Leyden, 2003).

The rise of ‘zoning’ in twentieth century planning was born out of a desire ‘to separate “unhealthy” spaces – such as industry – from residences’ (Corburn, 2015, p. 40). However, this is at odds with the compact, mixed-use neighbourhood model which reinforces healthier behaviours in daily life.

King’s Hedges is a predominantly residential area with two large employment ‘zones’ located next-door (Figures 8-9). The disorientating network of cul-desacs connects residents to the local schools but little else (Figure 10). Public open spaces suffer from a lack of over-sight and maintenance, whilst pervasive alley-ways further diminish perceptions of safety (Figures 11-12). This is one example of a suburban ‘neighbourhood’: typified by the inability to meet daily needs: work, food shopping or leisure (Leyden, 2003). Residents must travel elsewhere, usually by car or public-transport, to areas better resourced within the city, highlighting spatial inequities which we are about to examine further.

This limits the opportunities for healthy behaviours to be woven into daily life, as without convenience, the likelihood of such behaviours being sustained is compromised (NHS England, 2018), whilst reducing the individual’s exposure to the local community, hindering the formation of social and community ties.

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Green Belt

Gu

ide

dB

usw

A14

ay Science Park

Orchard Park

King’s Hedges Business Park

City Centre

Figure 8 - North-east Cambridge 13

Business

Park

Residential School Communal

Figure 9 - King’s Hedges, land use

Figure 10 - King’s Hedges, street layout 14

Figure 11 - Pulley-Play Area Park

Figure 12 - Alley-way, Ramsden Square 15

2.3 The City Cities, as concentrations of people and resources, create ample opportunities to improve health, but these opportunities are not equitably distributed (Naylor and Buck, 2018). As such, inequalities and deprivation manifest spatially in the urban environment, exposing many to poor health outcomes. One such resource is green space. Both the quality and quantity of green space have been linked to improved physical and mental health, largely due to being sites for physical activity and community convergence (CABE, 2010a). However: ‘people in deprived areas, wherever they live, receive a far worse provision of parks and green spaces than their affluent neighbours’ (CABE, 2010b, p. 41). Such disparities contribute to why those with different socio-economic backgrounds experience the built environment differently (CABE, 2008). If these experiences leave people discouraged then it is not enough to just rebalance the availability of opportunities: these spaces must be welcoming and convey a sense of ownership to be truly inclusive and thus sought out, otherwise healthpromoting assets will never reach their full potential (CABE, 2008).

Tackling health inequalities in cities will not only improve the health outcomes for individual residents but is fundamental for cities to thrive economically.

The Greater Manchester Board for Health and Social Care stipulates that the city cannot deliver on its independent economic potential if so many of its residents remain unfit for work as a consequence of poor health (Heppolette, 2018). Health inequalities can cause productivity losses, reduced tax revenue, higher welfare payments and increased treatment costs for the NHS (Marmot et al., 2010). Fortunately, the devolution agenda in the United Kingdom has led to the formation of autonomous city governments which can take a place-based approach to health. Their wide breadth of responsibilities increases their chances of successfully tackling these complex issues (Naylor and Buck, 2018). Cambridge is part of one such combined authority (Figure 13). Solutions to other issues, such as housing shortages, must not worsen health inequalities but be of benefit to current residents, as alluded to in the Cambridge Local Plan (2018). The North East Cambridge Area provides such an opportunity and current visions for this 166-hectare development emphasis a sustainable, healthy, mixed-use approach but there is little mention of its

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deprived neighbours (Figure 14) (Greater Cambridge Shared Planning, 2019).

The combined authority should heed the links between economic prosperity and health inequalities by pursuing an approach which benefits the health of existing and new residents alike.

Peterborough Fenland

Huntingdonshire

East Cambridgeshire

Cambridge South Cambridgeshire

Figure 13 - Cambridgeshire & Peterborough Combined Authority

Figure 14 - North East Cambridge Area 17

2.4 The Nation Not only must cities grow inclusively to the benefit of all residents, but nations must tackle widespread inequality to the benefit of all citizens. For instance, social and economic inequalities manifest as social position, which influences the wider determinants of health (Marmot et al., 2010). It is the role of social position which appears to worsen mental health when inequality widens: ‘greater inequality seems to heighten people’s social evaluation anxieties by increasing the importance of social status’ (Wilkinson and Pickett, 2010, p.

43). Additionally, those at the lower end of the spectrum are less likely to have control over where they live (Allen and Allen, 2015). This can lead to increased exposure to environmental stressors which worsen health and, when compounded, result in toxic stress (Corburn, 2015). Furthermore, if an area performs badly in one measure it will likely perform badly in others, resulting in an accumulation of poor health outcomes within a defined area (Wilkinson and Pickett, 2010). We can see this in Cambridge as north-eastern parts of the city consistently perform worse across different measures (Figures 15-18).

However, the power of such an accumulation indicates that even small benefits from health-promoting interventions can lead to long-term improvements if enough are compounded together.

We must also understand that health falls along a social gradient: regardless of our position our health is always likely to be worse than the person above us, and thus the health of many individuals can be improved, not just those who are most deprived (Marmot et al., 2010). Wilkinson and Pickett emphasize that ‘those in more unequal societies do worse than those on the same income in more equal societies’ (2010, p. 192), reinforcing their assertion that after a certain point it is the differences in income within that country that matter for the majority of citizens, not the absolute income of the country. Further benefits of more equal societies include better educational and economic performance, less violence and crime (Wilkinson and Pickett, 2010). Therefore, whilst important, economic growth should not be the sole measure of success for the United Kingdom. Quality of life (well-being) and sustainability must also be valued for prolonged prosperity and a sustained high quality of life (Marmot et al., 2010).

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17.4%

27.2

7.5%

6.1

Figure 15 - Multiple deprivation by ward, 2010

Figure 16 - Poor health by ward, 2011

22.1%

18%

7%

Figure 17 - Childhood obesity by ward, 2013-2016

1.7%

Figure 18 - No qualifications by ward, 2011

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2.5 The Planet We now turn to the numerous benefits that access to nature can have for our health. Corkery summarizes how nature can provide restorative settings whilst also improving social behaviour, academic performance and recovery times in hospitals (2015). But why does nature have this effect? Wilson and Kellert theorize that we possess: “a natural instinct to desire contact with nature that is evolutionary and inherited” (Corkery, 2015, p. 243). This desire is titled ‘biophilia’ and includes biophilic urban design (Bernheimer, 2017).

The inherent affinity that humans have for nature can be utilized to make healthy choices more appealing, say by lining streets with trees, enhancing the likelihood of such spaces being repeatedly used to the sustained benefit of the individual’s health. However, the importance of nature to human health and well-being also raises the dilemma of how to sustain the health of nature, the planet, in the face of climate change and diminishing biodiversity for our continued benefit? Especially as climate change has direct implications for human health, as seen by increases in fatal illnesses and death rates during short periods of extreme heat and extreme cold (CABE, 2009).

Fortuitously the relationships between health and environmental sustainability facilitate a ‘co-benefits’ approach, where a single strategy can have multiple benefits for both. The walkability of compact, mixed-used neighbourhoods reduces air pollution and fuel consumption as more people are walking instead of using cars, which benefit’s their health too due to increased physical activity (Thompson and Capon, 2015). Introducing greenspaces into our urban environment can also aid in mitigating climate change as they act as heat-sinks (Thompson and Capon, 2015). However, some argue that cities need to do more by being regenerative, as in: ‘proactively contribute to the replenishment of the run-down ecosystems – including farm soils, forests and marine ecosystems – from which they draw resources for their survival’ (Girardet, 2015, p. 71). This chimes with Clément, who argues that we depend on the diversity of the planet to survive, and we are at the point where that environmental diversity now depends on us (Skinner, 2011). Pursuing biodiversity can have immediate benefits for human well-being if such greenspaces are readily accessible in cities, forming environmental networks

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of wildlife movement (Kirby, 2015). Immediate health benefits coupled with the weight of climate change can help to prioritze both agendas in the minds of individuals and organizations (Thompson and Capon, 2015). Readily accessible, biodiverse, natural landscapes form a key part of Cambridge’s character with green-corridors penetrating the city from the Green Belt (Cambridge City Council Planning Services, 2018). However, north-east Cambridge has limited access to the expanses of the Green Belt and non-existent green corridors (Figure 19). The quality of life, and biodiversity, that such spaces provide means access must become universal.

Figure 19 - Green Belt & green-corridors 21

A series of design responses and provocations explore how architectural and urban design can help to sustain healthy choices in the long-term. These continue to set this pilot thesis within King’s Hedges, a north-eastern ward with the worst health outcomes in Cambridge.

Part III

Sustaining Healthy Behaviour

Figure 20 - Alley through Sackville Close flats

Figure 21 - Cambrige: current mono-centric form

Figure 22 - Cambridge: proposed local centres 24

3.1 Widespread and Pervasive The collective potential of accumulating beneficial outcomes from a multitude of health-promoting resources or interventions was posited in ‘Section 2.4 The Nation’, and is echoed by Steemers (2015, p. 12): A sufficient quantity and quality of diverse environmental, social and physical resources can influence human cognition, which, in turn, can increase the health behaviours of the wider population.

We must ensure that such choices are available in enough numbers.

Unfortunately, we also established that disparities in the quantity and accessibility of health-promoting environments often exist across a city (Section 2.3 The City). We question if the mono-centric form of Cambridge is an example of such a disparity, exploring whether dispersed local centres would better serve residents on their door-step (Figures 21-22) (Cambridge Design and Research Studio, 2017).

The Local Plan reiterates the vision for a hierarchy of ‘centres’, such as Arbury Court, a small complex of civic services and retail outlets (2018). This is on the edge of King’s Hedges, which is otherwise served by a scattering of community and religious buildings along with two small food stores. This is a far cry from the vision of Holford and Wright who proposed that: ‘a third of each Borough housing site should be set aside for schools, shops and other communal uses’ (1950, p. 39). King’s Hedges was built by the council from the 1960’s onwards, but this original goal was left unrealized. A design provocation questions what one third of communal land would look like spatially (Figures 23-24). This argues that a cohesive community needs a place to converge, otherwise it languishes and may lead to a rise in anti-social behaviour and diminished social capital (Fisher, 2017).

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Figure 23 - One-third as a consolidated centre or strip 26

Figure 24 - One-third as a dispersed grid or network 27

Figure 25 - Back-land sites

Figure 26 - Dispersed network 28

A subsequent design response examined how the numerous back-land sites within King’s Hedges could be utilized as sites for health-promoting, communal amenities (Figures 25-27). Conceptualized as a widespread network, these new facilities provide a range of services on the door-step of every resident and work alongside existing resources. We then explored how one such additional resource, introduced on a vacant site to meet an immediate need, could cause long-term change by catalysing adjacent re-development to house a multitude of other assets for the community (Figures 28-29). Interior views not only depict the types of programme being introduced, but also start to look at the quality of the indoor environment (Figure 30). NHS England emphasizes how the accumulation of time spent indoors is an additional opportunity for reinforcing healthy-choices (2018), and this is an avenue of research which we wish to explore in more detail in subsequent work.

Figure 27 - Maggie’s Centres collaged into King’s Hedges 29

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Figure 28 - Catalyse, external views through time

Figure 29 - Catalyse, ground plans through time

Figure 30 - Catalyse, internal views

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Figure 31 - Existing boundary to the Science Park

Figure 32 - Proposed ‘stitches’ to connect with the Science Park 32

3.2 Convenient and Intrinsic A further way to encourage sustained changes towards healthy behaviours is to make ‘the healthiest choice also the most affordable, easiest, and most accessible choice’ (World Health Organization Regional Office for Europe, 2018, p. 5).

Enacting healthy behaviours must become intrinsic to daily life, otherwise the extra time required becomes a barrier (Allen and Allen, 2015). We explore how this can be supported by embedding health-promoting resources into the urban fabric. This first design provocation is a selection of many experiments which sought to re-format the fabric of King’s Hedges by increasing pedestrian connectivity within the ward and with the surrounding area (Figures 31-34).

Figure 33 - Existing back-roads and hidden alleys

Figure 34 - Proposed widening of routes and greenspaces 33

Figure 35 - Blank-Slate Proposal: connective streets

Figure 36 - Patchwork Proposal: connective streets & original field boundaries 34

Further design propositions responded more boldly to the disconnecting labyrinth of cul-de-sacs (Figure 10). A blank-slate approach, which would demolish and re-build King’s Hedges, introduces a distorted grid of streets, a highly connective layout encouraging daily physical activity (Figure 35) (Burton, 2015). A more nuanced proposal, a patchwork of retention and replacement, forms a similar irregular grid of streets out of existing roads and new streets influenced by the original field-boundaries before the land was developed by the council (Figure 36). Both propositions also seek to inject a green-corridor into King’s Hedges, an amenity which the rest of Cambridge already enjoys (Figures 37-38) (Section 2.5 The Planet). This slice of wild fens, groomed parkland and community food production is traversed daily and provides short-cuts across the ward, becoming integral to local life.

Figure 37 - Blank-Slate Proposal: greenspace integral to daily movement 35

Figure 38 - Patchwork Proposal: injecting green-corridor into King’s Hedges 36

A separate design charrette explored how the layout and design of a middleschool could also encourage movement and nurture engagement with nature (Figures 39-42). Different types of educational space are separated out from one another, subversively inducing more physical movement (Steemers, 2015). The dining area is raised above the parkland, with a generous staircase celebrating the journey up to this room. The school consists of several courtyards and walled gardens, arranged so that each classroom has dual-access to nature which has been linked to improved educational performance (Corkery, 2015).

The school is conceived as one of many ‘departments’, a network of cultural, sports and other educational spaces set back from the busy high street of Peckham, London. This adds a further dimension of physical activity to the daily lives of students.

Figure 39 - View of elevated dining experience

Figure 40 - View of classroom book-ended by gardens 37

Classroom Garden Classroom Orchard

Classroom

Garden Classroom

Courtyard

L.R.C. Garden

Gatehouse

Shelter

Toilets

Teaching kitchen Greenhouse

Community food garden

Servery

Gatehouse

Hall

Garden Market Shelter

Teachers & staff Students Public & community Figure 41 - Peckham Middle School, ground floor plan & movement 38

‘Departments’ ‘Corridors’ Figure 42 - Peckham Middle School, network of dispersed ‘departments’ 39

3.3 Welcoming and Enabling Finally, we must ensure that individuals actively seek out health-promoting resources, that they are not deterred due to a lack of perceived safety or a sense that such a place does not belong to them (Section 2.2 The Neighbourhood, Section 2.3 The City). Addressing safety, an examination of King’s Hedges reveals alleyways, parking courts, streets and parks all lacking natural surveillance. One design response replaces a parking court with a new community amenity to oversee the street, the impact of which is enhanced by injecting a mixture of uses into this residential area (Figures 43-44) (Burton, 2015). Additionally, the neighbouring homes would be re-orientated so that their frontgardens face the street, not the current back-gardens, which can help to improve well-being for neighbours and passers-by alike (Burton, 2015) (Section 2.1 The Home).

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Figure 43 - Edit, ground plans through time

Figure 44 - Edit, external views through time

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Figure 45 - Edit, internal views

We now turn to a cornerstone of inclusive design: welcoming, delightful spaces where one can exert agency (CABE, 2008). Searching for inspiration we come across Maggie’s Centres (Section 1.2 Choice and Context). Often the effects of an individual’s context are more acutely visible in healthcare environments, as inhabitants are at their most vulnerable and stressed. A key way to mitigate stress is to provide users with a greater sense of control in their immediate surroundings (Ulrich, 1997). Maggie’s Centres break down the traditional passivity of patients in hospitals. With no reception and no signs, visitors are encouraged to ask questions and engage with others, with noticeable changes in attitude (Lee, 2010). The architecture also reacts against the sterile, whitewalled interiors of hospitals: With their striking forms and friendly atmosphere, and the contrast to the normal NHS hospital building, the architecture sends a very clear message to the vulnerable that they matter, that their illness is important to use and to society.

(Jencks, 2010, p. 41) The building communicates a sense of worth through its uplifting design, which is at once calming and stimulating: providing a positive distraction from the stress of illness (Ulrich, 1997). We argue that similar design characteristics can have a positive impact on well-being in buildings which serve a communal or civic function. Such buildings reflect their community; thus, their material qualities can be a source of pride or shame. This ambition has started to be explored in a series of internal views, but a more rigorous understanding of the specific aspects of design which provide comfort and delight is required (Figure 45). Additionally, our innate love of nature, established in ‘Section 2.5 The Planet’, indicates that if architecture engages with nature, we can persuade people to interact with other health-promoting resources. This last design response examines how a public swimming pool adjacent to a new slice of landscape can celebrate this connection (Figures 46-47). The building supports a neighbouring lido whilst a relaxation room provides views across the uninterrupted, wild fens (Figure 48). A more urban scale is introduced to suburbia: a civic presence which the community can call their own.

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Figure 46 - Restore, external views through time

Figure 47 - Restore, ground plans through time

Figure 48 - Restore, internal views

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Part IV

Conclusion

Figure 49 - Cyclist passing the Learner Pool

4.1 The Role of Architecture We have outlined the multitude of ways that places, context, social and physical environments can impact the health and well-being of individuals, communities, cities, societies and the planet. We have established the importance of not just making one healthier choice easier, but the need for cumulative, convenient, appealing choices which lead to sustained changes in behaviour towards healthier life-styles. However, the role of architecture and urban design should not be misinterpreted: Architecture cannot change society, the authors argue, but it can underwrite and enhance the basic activities of those who work in it.

(Jencks and Heathcote, 2010, p. 6) There are many determinants at play when it comes to our health, which interact with each other in complex ways, and our neighbourhoods and homes are just one such influence (Buck et al., 2018). What we have demonstrated is that context can influence, not determine, choice. However, in the pursuit of equitable good health we should use all methods at our disposal. Architectural and urban design is one piece of the puzzle, but a piece which is the backdrop to our lives – reinforcing social divides or breaking down barriers to communal resources. Architects should entwine health into their designs, just as health should be the purpose of planning (Barton, 2015). Ultimately: great design should be ‘making lives better by building happier, healthier and safer environments’ (Weir, 2018, p. 4).

Yet, with a large body of research pointing towards the social, economic and environmental benefits of this approach, The Design Council questions why healthy-placemaking has not been more widely utilized (Hunstone, Mesari and Pinchera, 2018). By surveying practioners, they found a large barrier is the perceived cost of healthy-design. However, there are a multitude of economic benefits for private developers, city councils, public bodies and central government. There is a tendency for clients, particularly when they are

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not the end-user, to focus on short-term economic benefits, thus architects should endeavour to educate clients on the long-term implications (2018). One other way that we can encourage the prioritization of health-promoting design is by championing meaningful community engagement. Once communities understand the benefits of health-promoting places they are more likely to demand their creation (2018). Whilst architects have a limited amount of power in the design process, they can be vocal advocates for healthyplacemaking, especially when framed as economically beneficial and socially desirable.

4.2 Moving Forward There are both tangible and intangible aspects to healthy design: whilst homes and streets are physical, the effect that their design has on us cannot always be observed or understood, as such impacts are often small, complex and diverse. More research needs to be done, and the right questions need to be asked. As architects and urban designers, we have a greater awareness of these nuanced relationships between the occupant and the environment.

There seems to be a lack of prioritization and a diminished perceived value for indoor environments (Hunstone, Mesari and Pinchera, 2018), even though we spend most of our time inside (NHS England, 2018). We argue that architects can contribute to the wider discourse of health-promoting environments by focusing on the internal, experiential and material qualities of space. It is the spaces where we gather, socialise, seek civic services and feel a sense of community pride that we wish to focus on moving forward. This will be aligned with an evolved understanding of community ‘health’-care, where ‘health services can be linked to other local assets’ to ensure that all aspects of health and well-being are cared for (NHS England, 2018, p. 6).

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List of Illustrations 1.

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Milton Road: author’s own Maggie’s Oldham, dRMM: dRMM Location of Cambridge: author’s own Cambridge wards: author’s own Life expectancy by ward, 2010-2014: authors own, Office for National Statistics King’s Hedges Road & Busway: author’s own Buchan Street, block morphology: author’s own North-east Cambridge: author’s own King’s Hedges, land use: author’s own King’s Hedges, street layout: author’s own Pulley-Play Area Park: author’s own Alley-way, Ramsden Square: author’s own Cambridgeshire & Peterborough Combined Authority: author’s own North East Cambridge Area: author’s own Multiple deprivation by ward, 2010: author’s own, Office for National Statistics Poor health by ward, 2011: author’s own, Office for National Statistics Childhood obesity by ward, 2013-2016: author’s own, Office for National Statistics No qualifications by ward, 2011: author’s own, Office for National Statistics Green Belt & green-corridors: author’s own Alley through Sackville Close flats: author’s own Cambridge: current mono-centric form: author’s own Cambridge: proposed local centres: author’s own One-third as a consolidated centre or strip: author’s own One-third as a dispersed grid or network: author’s own Back-land sites: author’s own Dispersed network: author’s own Maggie’s Centres collaged into King’s Hedges: author’s own Catalyse, external views through time: author’s own Catalyse, ground plans through time: author’s own Catalyse, internal views: author’s own Existing boundary to the Science Park: author’s own Proposed ‘stitches’ to connect with the Science Park: author’s own Existing back-roads and hidden alleys: author’s own Proposed widening of routes and greenspaces: author’s own Blank-Slate Proposal: connective streets: author’s own

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Patchwork Proposal: connective streets & original field boundaries: authors own Blank-Slate Proposal: greenspace integral to daily movement: author’s own Patchwork Proposal: injecting green-corridor into King’s Hedges: author’s own View of elevated dining experience: author’s own View of classroom book-ended by gardens: author’s own Peckham Middle School, ground floor plan & movement: author’s own Peckham Middle School, network of dispersed ‘departments’: author’s own Edit, ground plans through time: author’s own Edit, external views through time: author’s own Edit, internal views: author’s own Restore, external views through time: author’s own Restore, ground plans through time: author’s own Restore, internal views: author’s own Cyclist passing the Learner Pool: author’s own

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Bibliography Allen, M. and Allen, J. (2015) ‘Health inequalities and the role of the physical and social environment’, in Barton, H. et al. (eds) The Routledge Handbook of Planning for Health and Well-Being. Abingdon: Routledge, pp. 89–107.

Barton, H. (2015) ‘Planning for health and well-being: the time for action’, in Barton, H. et al. (eds) The Routledge Handbook of Planning for Health and Well-Being.

Abingdon: Routledge, pp. 3–16.

Bernheimer, L. (2017) The Shaping of Us: How Everyday Spaces Structure Our Lives, Behaviour, and Well-being. London: Robinson.

Buck, D. et al. (2018) A vision for population health: Towards a healthier future.

London: The King’s Fund.

Burton, L. (2015) ‘Mental well-being and the influence of place’, in Barton, H. et al. (eds) The Routledge Handbook of Planning for Health and Well-Being. Abingdon: Routledge, pp. 150–161.

Cambridge City Council Planning Services (2018) Cambridge Local Plan. Cambridge: Cambridge City Council Planning Services.

Cambridge Design and Research Studio (2017) Cambridge City Project. Cambridge: Department of Architecture, University of Cambridge.

Centre for Cities (2018) Cities Outlook. London: Centre for Cities.

Commission for Architecture and the Built Environment (2008) Inclusion by design: Equality, diversity and the built environment. London: Commission for Architecture and the Built Environment.

Commission for Architecture and the Built Environment (2009) Future health: Sustainable places for health and well-being. London: Commission for Architecture and the Built Environment.

Commission for Architecture and the Built Environment Space (2010a) Community green: using local spaces to tackle inequality and improve health. London: Commission for Architecture and the Built Environment.

52

Commission for Architecture and the Built Environment Space (2010b) Urban green nation: Building the evidence base. London: Commission for Architecture and the Built Environment.

Corburn, J. (2015) ‘Urban inequities, population health and spatial planning’, in Barton, H. et al. (eds) The Routledge Handbook of Planning for Health and Well-Being.

Abingdon: Routledge, pp. 37–47.

Corkery, L. (2015) ‘Beyond the park: linking urban greenspaces, human well-being and environmental health’, in Barton, H. et al. (eds) The Routledge Handbook of Planning for Health and Well-Being. Abingdon: Routledge, pp. 239–253.

Fell, G. (2018) Rethinking health inequalities in the context of a healthy city. Public Health, Sheffield.

Fisher, K. (2017) The Source of Stigma. University of Cambridge.

Freestone, R. and Wheeler, A. (2015) ‘Integrating health into town planning: a history’, in Barton, H. et al. (eds) The Routledge Handbook of Planning for Health and Well-Being. Abingdon: Routledge, pp. 17–36.

Giles-Corti, B. et al. (2015) ‘The influence of urban design and planning on physical activity’, in Barton, H. et al. (eds) The Routledge Handbook of Planning for Health and Well-Being. Abingdon: Routledge, pp. 121–135.

Girardet, H. (2015) ‘Healthy cities, healthy planet: towards the regenerative city’, in Barton, H. et al. (eds) The Routledge Handbook of Planning for Health and Well-Being.

Abingdon: Routledge, pp. 61–73.

Greater Cambridge Shared Planning (2019) North East Cambridge Area Action Plan: Issues and options 2019 consultation. Cambridge: Cambridge City Council.

Heppolette, W. (2018) The Greater Manchester Journey. Greater Manchester Health and Social Care Partnership.

Holford, W. and Wright, H. M. (1950) Cambridge Planning Proposals: A Report to the Town and Country Planning Committee of the Cambridgeshire County Council.

Cambridge: Cambridge University Press.

53

Hunstone, K., Mesari, A. and Pinchera, E. (2018) Healthy placemaking. London: Design Council and Social Change UK. Huppert, F. A. and So, T. T. C. (2013) ‘Flourishing Across Europe: Application of a New Conceptual Framework for Defining Well-Being’, Social Indicaors Research, 110(3), pp. 837–861.

Jencks, C. (2010) ‘The Architecture of Hope’, in Jencks, C. and Heathcote, E. (eds) The Architecture of Hope. London: Frances Lincoln, pp. 8–43.

Jencks, C. and Heathcote, E. (2010) ‘Introduction: A New Hybrid Architecture?’, in Jencks, C. and Heathcote, E. (eds) The Architecture of Hope. London: Frances Lincoln, pp. 6–7.

Jones, A. and Weir, S. (2015) The Cambridge Health Gap: Cambridge Fairness Review No. 5. Cambridge: The Cambridge Commons.

Kirby, V. (2015) ‘A strategic approach to green infrastructure planning’, in Barton, H. et al. (eds) The Routledge Handbook of Planning for Health and Well-Being.

Abingdon: Routledge, pp. 386–402.

Lee, L. (2010) ‘Building a Life Beyond Cancer: How Maggie’s Centres Work’, in Jencks, C. and Heathcote, E. (eds) The Architecture of Hope. London: Frances Lincoln, pp. 44–51.

Leyden, K. M. (2003) ‘Social Capital and the Built Environment: The Importance of Walkable Neighborhoods’, American Journal of Public Health, 93(9), pp. 1546–51.

Marco, E. and Burgess, S. (2015) ‘Healthy housing’, in Barton, H. et al. (eds) The Routledge Handbook of Planning for Health and Well-Being. Abingdon: Routledge, pp.

403–416.

Marmot, M. et al. (2010) Fair Society, Healthy Lives: The Marmot Review. London: The Marmot Review.

Naylor, C. and Buck, D. (2018) The role of cities in improving population health: International insights. London: The King’s Fund.

54

NHS England (2018) Putting Health into Place: Introducing NHS England’s Healthy New Towns programme. NHS England Publications.

Skinner, J. (2011) ‘Gardens of Resistance: Gilles Clement, New Poetics, and Future Landscapes’, Qui Parle, 19(2), pp. 259–274.

Steemers, K. (2015) ‘Architecture for Well-being and Health’, Daylight & Architecture Magazine by Velux Group, (23), pp. 6–19.

Steemers, K. (2019) Well-being and Health in Architecture. University of Cambridge.

Thaler, R. and Sunstein, C. (2009) Nudge: Improving Decisions About health, wealth and happiness. London: Penguin Books.

The Cambridgeshire and Peterborough Independent Economic Commission (2018) The Cambridgeshire and Peterborough Independent Economic Review. Cambridge.

Thompson, S. and Capon, A. (2015) ‘The co-benefits framework for understanding and action on climate change’, in Barton, H. et al. (eds) The Routledge Handbook of Planning for Health and Well-Being. Abingdon: Routledge, pp. 319–332.

Ulrich, R. S. (1997) ‘A theory of supportive design for healthcare facilities’, Journal of healthcare design: proceedings from the Symposium on Healthcare Design, 9(3–7), discussion 21-4.

Weir, S. (2018) ‘Foreword’, in Hunstone, K., Mesari, A., and Pinchera, E. (eds) Healthy placemaking. London: Design Council and Social Change UK, p. 4.

Wilkinson, R. and Pickett, K. (2010) The Spirit Level: Why Equality is Better for Everyone. 3rd edn. London: Penguin Books.

World Health Organization (1948) Constitution. Geneva: WHO. World Health Organization Regional Office for Europe (2018) Copenhagen Consensus of Mayors: Healthier and happier cities for all. Copenhagen: WHO Regional Office for Europe.

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