How to assess the effects of urban plans on environment and health

Introduction

A healthy city is one that is continually creating and improv-ing physical and social environment and expandimprov-ing community resources which enable people to mutually support each other in performing all the functions of life and in developing their maximum potential (Hancock and Duhl, 1986).

Urban health is a complex issue as the actions aimed at enhanc-ing the livenhanc-ing conditions of cities depend not only on the health sector but on decisions regarding other fields such as local gov-ernment, education, urban planning and on those profession-al engaged in providing sociprofession-al and heprofession-alth services (Lawrence, 2000; Galea, Vladov, 2005).

The Rio Conference first has highlighted the role of cities in ad-dressing healthy and sustainable development: health is consid-ered as an outcome of all the factors (environmental, economic and social) that affect both human beings and sustainable de-velopment (Capolongo, Baglioni, 2002). Actually, the European policy framework for health and well-being, Health 2020, reaf-firms the importance of urban development strategies grounded on a comprehensive acknowledgement of the determinants of health and it recognizes that mayors and local authorities play an ever more important role in promoting health and well-being. This view, focused on causal relationships between built envi-ronment and lives of individuals, families and communities, de-pends on a social model of health contrasting with the medical model that considers health the polar opposite of illness. The connections among environment and health can be described in terms of layers of influence (Whitehead, Dahlgren, 1991): in the centre there are individuals with a set of fixed characters. Then there are the determinants of health that can be modified: indi-vidual ways of living, patterns and norms of their community, structural and more general factors such as housing, working conditions, access to services and provision of essential facilities. Although how different factors affect health and how these in-formation can be used by policymaking still must be investigat-ed – because these relationships are complex and various – it is widely acknowledged that the quality of built environment is one of the principal causes of differences in people’s health (Ottawa Charter for Health Promotion, 1986 and The European Urban Charter II, 2008).

Urban planning should be considered as a form of primary pre-vention (Duhl, Sanchez 1999), as it could promote healthy be-haviors by a transport system that encourages pedestrian and cycle accessibility, a functional organization of the city that

en-How to assess the

effects of urban plans on

environment and health

* Politecnico di Milano, Dipartimento di Architettura, Ingegneria delle Costruzioni e Ambiente Costruito

** Politecnico di Milano, Dipartimento di Architettura e Studi Urbani (stefano.capolongo@polimi.it; maddalena.buffoli@polimi.it; alessandra.oppio@polimi.it)

sures autonomy to each of its part, a design of green and open areas responsive to all citizens’ needs and addressed to support recreation, well-being and social interaction (Barton, Tsourou, 2000; Barton et al., 2003, Frank et al., 2003; Edwards, Tsouros, 2006; Rao et al., 2007).

As urban plans can have both positive and negative influences on the conditions in which people live and work, their access to facilities and services, their lifestyles and their capability to build strong and long-term social networks (Capolongo et al., 2011), the paper shows how it is possible to address planning and design practice to sustainable development’s principles us-ing a bottom-up approach based on multicriteria evaluation. According to a long-term perspective, it is expected that a wide use of such an assessment tool will provide a better knowledge about the multidimensional nature of urban health, its all con-stituents and their combined effect over time, and that it will give a relevant contribution for better integrating urban health into public health policies and into land use planning and de-sign (Lawrence, Fudge, 2009).

Methodology

The evaluation of urban sustainability and quality of life plays an important role for supporting health policy-making since it establishes a basis for monitoring the progress of actions (Ca-polongo et al., 2013).

There are a lot of European initiatives aimed at measuring and monitoring the level of sustainability and quality of life of local communities by different set of criteria grounded on environ-mental, social and economic issues. Among these, the ‘Who’ Healthy city project has started the challenge of investigating the relationship among health gains and urban quality of life by rec-ognizing the existence of a strong nexus among urban planners and public health professionals.

Within this context, the paper explores the relationship between built environment, public health and quality of life and it dis-cusses the first results of a study carried out by an interdisci-plinary working group (researchers of Abc/Dastu Departments of Politecnico of Milano and technicians of the Prevention De-partment of Asl Milano) with the aim of: a) giving an overall picture of health and quality of life topics at urban level; b) pro-moting healthy community strategies; c) setting local priorities and goals according to ‘Who’ and EU vision; d) supporting the assessment task of technicians of the Asl Milano; e) monitoring advancements by evaluating changes over time; f) increasing public awareness about the link between quality of built envi-ronment and public health; g) burgeoning the opportunities for a more effective cross field of work and training among urban planners and public health professionals.

For the purpose of meeting all these targets, a multidimensional evaluation tool based on a set of performance criteria has been developed. Actually, it represents an innovative answer to the instances emerged in the field of public health over the past two decades, most of all the lack of a systematic and comprehensive approach (Barton et al., 2009). The criteria have been selected according to different experiences of Healthy city project (i.e. ‘Who’, Healthy cities 1994; Healthy City Project, City of Milan 2002; ‘Who’, Active city 2008) and existing sets of sustainability criteria (i.e. Urban Audit 1998-2000; Sister Project 2002;

Euro-pean Common Indicators 2003; Local Quality of Life Indicators 2005; Protocollo Itaca 2005; Ecosistema metropolitano 2008; GbTool 2002-2008).

Various brainstorming activities and focus groups with the tech-nicians of the Asl Milano have supported the definition of the fi-nal assessment framework (tab. 1). Six different thematic issues have been investigated: environmental quality and wellbeing, waste, energy and renewable resources, mobility and accessi-bility, land use and functional mix, quality of urban landscape. More specifically the criteria selected are: 1) air; 2) noise; 3) water; 4) ionizing radiations (environmental quality and wellbe-ing); 5) solid waste management; 6) liquid waste management (waste); 7) energy consumption and monitoring; 8) passive tech-nical systems for sustainability; 9) active techtech-nical systems for sustainability (energy and renewable resources); 10) distance to parks and local services; 11) public transport system; 12) availa-bility of pedestrian and bicycle paths; 13) links between existent mobility system and new settlements (mobility and accessibili-ty); 14) functional and social mix; 15) urban density; 16) filter-ing areas; 17) protection of sensitive users, 18) hazardous and nuisance activities (use of land and functional mix); 19) quality of outdoor areas; 20) urban furniture; 21) visual comfort; 22) system of urban green areas; 23) parking areas (quality of urban landscape).

In order to support the assessment of urban plans and projects with reference to their effects on public health and to address planning and design processes to the principles of sustainable development, each criterion has been described by an assess-ment card that specifies the goal it drives to achieve, its impact on health, a performance evaluation scale both at neighbour-hood level and at urban one, a selection of best practices sup-ported by pictures, notes and references. The performance val-ues are expressed by a qualitative score that goes from 0 (inade-quate performance) to 3 (good practice). Each score is explained by a reference judgement, that points out those requirements that are mandatory to meet for reaching the highest score. Such a performance evaluation scale can be considered the basis of the evaluation report delivered by the Asl Milano, as well as a companion guide for designers and planners, aimed at raising their awareness about the determinants that affect public health (tab. 2).

The overall score of each plan/project is given by the score achieved at the level of the 6 thematic issues, that is once more given by the score achieved at the lower level of each criteri-on. As the score achieved by each thematic issue is given by the average mean of the scores gained by each criterion, the performance values of plans/projects are defined according to the following three ranges: negative (0 ≤ performance value s ≤ 1,5); critical (1,5 < performance value ≤ 2,25); good (2,25 < performance value ≤ 3).

The final result is provided by different types of chart: a spider diagram, that shows the score achieved by each thematic issue (fig. 1), and three kind of histograms, the first that shows the overall score of the urban plan/project, the second that focuses on the scores of the thematic issues and the last that explains the score achieved by each criterion. The graphs are very useful as they highlight weaknesses and strengths of the urban develop-ment proposals under evaluation, in order to point out corrective actions and to effectively address health’s concerns.

Thematic issues Criteria 1 Environmental quality and wellbeing 1 Air 2 Noise 3 Water 4 Ionizing radiations 2 Waste 5 Solid waste management 6 Liquid waste management 3 Energy and renewable resources 7 Energy consumption and monitoring 8 Passive technical systems for sustainability 9 Active technical systems for sustainability 4 Mobility and accessibility 10 Distances to parks and local services 11 Public transport system 12 Availability of pedestrian and bicycle paths 13 Links between existent mobility system and new settlements 5 Land use and functional mix 14 Functional and social mix 15 Urban density 16 Filtering areas 17 Protection of sensitive users 18 Hazardous and nuisance activities 6 Quality of urban landscape 19 Quality of outdoors areas 20 Urban equipment 21 Visual comfort 22 System of urban green areas 23 Parkings for inhabitants

Tab. 1 – The evaluation framework (Source: author’s elaboration)

Issues Criteria Performance

values Presence of pollution sources, coexistence of the following strategies: ‐ location of sensitive users in protected areas and far from the pollution sources Good ‐ strategies for limiting emissions at source and/or reducing the diffusion of pullutants Presence of only one of the strategies listed above Critical Absence of the strategies listed above Not sufficient Presence of noise sources, introduction of the following strategies: ‐ location of sensitive users in protected areas and far from the noise sources Good ‐ strategies for limiting noise at source and/or reducing the noise transmission from fixed or mobile sources Presence of only one of the strategies listed above Critical Absence of the strategies listed above Not sufficient Coexistence of the following strategies: ‐ efficient water supply system Good ‐ reducing waste and saving drinking water Presence of an efficient water supply system Not sufficient Absence of the strategies listed above Critical Presence and/or absence of possible sources of ionizing/not ionizing radiations, coexistence of the following strategies: ‐ location of sensitive users and users with residence time higher than 4 hours away Good from ionizing/non ionizing radiations; absence of sensitive users close to power lines ‐ strategies aimed to remove or to mitigate ionizing/not ionizing radiations Presence of only one of the strategies listed above Critical Absence of the strategies listed above Not sufficient Air Noise Water Ionizing radiations/ non ionizing radiations

2 Waste

3 Energy and renewable resources

4 Mobility and accessibility 5 Land use

and functional mix

6 Quality of urban landscape

1 Environmental quality and wellbeing

Fig. 1 – The output of the evaluation at the thematic issues level Source: author’s elaboration

Developments and conclusions

The multidimensional evaluation tool has been tested with reference to the following requirements: the relevance, the ad-equacy and the applicability of the evaluation criteria outside of the city of Milan. For this purpose a survey has been carried out by a short questionnaire administered to a sample of 21 technicians of Local Health Agencies, who are regularly en-gaged in the evaluation of hygiene and health features of urban plans. The adequacy of each criterion has been assessed by a qualitative scale from ‘seriously insufficient’ to ‘optimum’ (seriously insufficient, insufficient; sufficient; good; optimum), while the importance and applicability from ‘low’ to ‘high’ (low; medium; medium-high; high).

The answers to the questionnaires confirm the validity of the evaluation tool. Regarding to the first question, 87% of the criteria has been considered as crucial for the assessment of urban plans, while only 3 criteria (urban furniture, visual

com-fort and parking areas), equivalent to 13% of the total, aren’t considered essential. The replies to the second question are very similar to the previous one: the adequacy of 74% of cri-teria has been judged as good, only two cricri-teria (urban furni-ture and visual comfort) has been considered as fully adequate, while four criteria (water, solid waste management, quality of outdoor areas, parking areas) has been deemed sufficient. The opinions concerning the degree of applicability of the evalua-tion framework outside of the city of Milan show a medium to high level of applicability for 52% of the criteria, an average level of applicability for 44% of the criteria and a low level of applicability for the criterion related to the public transport system.

These results highlight the need of rethinking some evaluation criteria according to different territorial features, moreover the ones that show a low level of applicability and a high degree of importance (fig. 2).

Fig. 2 – Comparison between level of importance and degree of applicability Source: author’s elaboration

Furthermore, the outcomes of the survey suggest to assigning to the criteria a different weight in relation to their potential effects on public health. The development of a weighting system would improve the responsiveness of the evaluation tool to the hygiene and health issues and strengthen the representativeness of the assessment. In order to test the evaluation tool, it has been ap-plied to 8 urban plans (Programmi Integrati di Intervento) and to 1 Strategic Environmental Assessment by the Department of Health and Environment of the city of Milan. The outcomes of this first application show the predominance of the judgment ‘good’ (76%), with only 19% of ‘critical’ and 5% of ‘negative’. The distribution of the ratings shows that the largest number of remarks with critical and inadequate judgment concerns quali-ty of air, pedestrian and cycle paths, functional and social mix, followed by noise, liquid waste management, distance to green areas and social services, public transport, hazardous and nui-sance activities, visual comfort (fig. 3).

Fig. 3 – Distribution of the ratings Source: Asl, Milan, adapted

Despite this first application should be considered as the be-ginning of a broader validation process, some useful insights have emerged: a) there is a broad agreement on the use of an assessment tool of the hygiene and health features of urban plans; b) the current framework of the assessment tool can pro-vide an overall picture of the nexus between urban health and planning; c) urban planning is a kind of primary prevention; d) the final scores and the performance judgments should be considered as a sound basis of common knowledge aimed at supporting the actors involved in urban planning; e) the study could be seen as a promising, interdisciplinary and experimen-tal kick-off for the sustainable development of healthy commu-nities; f) the results of this first step of the evaluation process are useful information for the monitoring of future interven-tions. Since stages and contents of the evaluation are planned under the perspective of a cyclic process (Faludi, Voogd, 1995; Oppio, 2007), the evidences emerging from each phase can be

used as input for the following steps. Thus, the communica-tion of the results is encouraged for public and private decision makers: the evaluation tool gives a synthesis of the strengths and weaknesses of the plans under assessment, enhancing the development of better design actions (short-term strategies) and addressing interventions towards the achievement of high-er levels of sustainability (long-thigh-erm strategies).

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