Accessible design for vulnerable populations in Thailand: An analysis of accessibility for cognition

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Background: For the first time in 16 years, Thailand has recently modified its accessible design to better accommodate vulnerable populations. Being able to safely utilise public services, buildings, and spaces is a prerequisite to participating in social activities for vulnerable people, particularly individuals with cognitive challenges whose needs have often been neglected.

Purpose: This qualitative study aims to examine accessibility for cognition by focusing on public uses based on Thailand’s ministerial regulation on accessible facilities for the elderly and people with disabilities.

Methods: The recent version of the ministerial regulation, covering the first (2005) and second (2021) issues, was summarised. The accessibility was compared between cognitive (60 years and older with mild cognitive impairment or dementia) and normal ageing groups, as well as cognitive (i.e., intellectual and learning impairments) and non-cognitive (i.e., visual, hearing, physical/mobility, autism, and emotional/behavioural impairments) disability groups.

Results: Cognitive ageing and disability groups had the least accessibility in public facilities and places when compared to their non-cognitive counterparts. The disability group was considered to have more limits in terms of accessibility due to their dysfunctions and severities than the ageing group. Only four locations contained related concepts of accessibility for cognition: Clause 6 in Chapter 1 (Accessible Facility Sign), Clauses 8.8 and 10.8 in Chapter 2 (Ramp and Lift), and Clause 11.5 in Chapter 3 (Stairs). The scopes were restricted to signage and emergency alarm system contents, which were linked to language and visuospatial cognitive functions, but none were directly relevant to specific cognitive domains. Unsurprisingly, normal ageing and wheelchair users were more likely to achieve a better degree of accessibility, followed by people with visual and hearing disabilities.

Conclusions: Although accessible design for vulnerable populations took over a decade to develop, Thailand has yet to effectively address accessibility for people experiencing cognitive ageing and disabilities. These challenges will be more pronounced when dealing with people who are advanced in age or suffer from severe cognitive conditions, and even worse when both occur together. This study suggests that Thailand needs to pay greater attention and incorporate a more significant cognitive approach into each chapter in order to expand its accessibility. Public amenities and areas where difficult decisions must be made, multiple perceptions must be balanced, and motor skills must be performed under time constraints should all be provided with safe and sustainable solutions.

Learning Objectives

• Accessibility for cognition is necessary for public design guidelines as a national accessible standard, particularly in undeveloped nations, including Thailand.
• Cognitive performances, functions, and domains should all be taken into account when considering accessible design and requirements.
• A cognitive approach for vulnerable populations should not only provide an accessible design for first- or one-time use, but also address their recurring and long-term use, as well as potential consequences.

Promoting equity through universally accessible, barrier-free civic architecture

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The new Ontario Court of Justice is in Toronto’s central civic precinct, completing a campus of three judicial buildings dating back to the early 19th century. The design of this LEED Gold building balances an expression of the identity and values of a modern justice institution without supplanting the prominence of the adjacent, Modernist Toronto City Hall. The facility contains 63 specialty courtrooms, ten conference settlement rooms, and associated judicial, prisoner handling, crown attorney, and court services facilities – serving 1,800 Canadians, daily. The design features a refined, compact mass, expressed via two primary components: a transparent 4-level atrium, which includes the building entrance, public services, and access to high-volume courts; and a 14-level tower containing the main courts and associated functions.

To support its civic duty, the facility embodies holistic universal design strategies, reinforcing an ethos that all Canadians should have equal access to justice – an important aspect of civic architecture in the 21st century. This is expressed, internally and externally, by balancing security and welcoming design, starting from the approach via multiple public transportation options and accessible parking, through the public realm, lobby, and to each floor and major functional space – all designed to be barrier-free and informed via Crime Prevention Through Environmental Design principles.

The project was awarded the Gold Accessibility Certification from the Rick Hansen Foundation, which measures holistic barrier-free design by requiring the following measures on projects: accessible entries, pathways, and key functional areas; onsite accessible parking and service by available public transit; wayfinding strategies/signage for both site navigation and safety; accessible lifts to all levels, and at least one universal washroom; emergency systems with visual/audible alarms; and assistive communication enhancement technologies – and more.

Members of the design team will showcase these state-of-the-art features, as well as address how accessibility links to greater goals of social justice, sustainability, indigenous design principles, and the inclusion of archeological finds. It will explore the drivers for accessibility, from larger planning initiatives, to the materiality of individual spaces and technologies used. This case study will showcase how placing people at the heart projects elevates all through the power of aspirational design.

Learning Objectives

• 1) Participants will learn how to design accessible, barrier-free public spaces.
• 2) Participants will learn about applicable reference standards for accessibility and safety, both of public realm and private spaces.
• 3) Participants will learn how aspects of community, indigeneity, sustainability, and accessibility assemble to promote equity across the built environment.

The causal relationship between green and blue space (GBS) and maternal health: a systematic review

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Research into the impact of green and blue space (GBS) exposure on maternal and neonatal health has mainly used cross-sectional methods that do not allow for causal inference. Additionally, the latest review omitted blue space exposure effects and maternal health considerations. That review was also limited to papers published up to 2022. Thus, our review aims to analyse study results to answer the question: What is the causal evidence of an association between GBS and maternal and neonatal health?

Methods: We synthesised evidence from GBS studies and maternal and neonatal health outcomes, following PRISMA guidelines. Searches were conducted across seven online databases (Medline , Scopus, Web of Science, PsycInfo, Embase, Environment Complete, and Maternity & Infant Care Database) in April 2024. Cross-sectional studies were excluded. Risk of bias assessment was carried out using the ROBINS-E framework. The evidence was synthesised narratively and quantitatively, where relevant. We conducted a meta-analysis when the exposures and outcomes were comparable. Subgroup analysis based on similar residential buffer sizes of Normalized Difference Vegetation Index (NDVI) readings were conducted. Meta-analysed studies were required to be low risk of bias or have only some concern of bias.

Results: Fifty-seven (57) studies were included following the screening of 1094 articles. Only seven studies investigated blue space. Most studies were carried out in either Europe (n=20) or North America (n=18). Narrative synthesis results indicated that increased greenness (as denoted by NDVI readings) was protective against maternal mental health disorders and gestational diabetes mellitus. Furthermore, greater distance to blue space was associated with increased incidence of small for gestational age (SGA). Meta-analysis results suggested a 10% increase in NDVI readings was associated with lower incidence of low birthweight (LBW) (odds ratio = 0.94 (95% CI 0.91,0.98), p<0.01) at buffer size 500m and increased birthweight (coefficient = 10.15g (95% CI 5.67,14.62), p<0.0001) at buffer size 200-300m. A 10% increase in NDVI was also associated with a 6% decrease in odds of SGA (odds ratio = 0.94 (95% CI 0.77, 1.16), p<0.01) across all buffer sizes.

Conclusion: These preliminary results indicate causal evidence to suggest the protective effects of GBS exposure against LBW and SGA, conditions that could hamper long-term child development in the first 1000 days of life. Analysis is ongoing. In future, more GBS research is needed to inform policy on urban planning for healthier communities.

Learning Objectives

• Understand the effects of green space exposure on neonatal health outcomes.
• Understand the effects of green space exposure on maternal health outcomes.
• Understand the effects of blue space exposure on maternal and neonatal health..

Healthy Happy Places – Garden at the Hub project

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Healthy Happy Places acts as a bridge between sectors and the community, to come together to turn unloved spaces into healthier, happier places. The aim is to use the designed environment to create positive mental health and wellbeing in areas of inequalities in the North East of England. It rests on principles from different disciplines, including health creation, and strengths based approaches such as Asset Based Community Development (ABCD), creative placemaking, participatory action research, and tactical urbanism. The practice of Healthy Happy Places uses a set of ingredients and a creative approach to develop places that are more joyful, calming, and nurturing places to be.

Practical application: The Garden At The Hub was formed through a collective (including community), to activate an underutilised space outside a Primary Care Network Hub to benefit the community, patients attending, and the workforce in the surrounding buildings. The collective included North Shields Primary Care Network, NHS Property Services, NHS Northumbria Healthcare Foundation Trust, VODA, North Tyneside Art Studio, North Tyneside Council, Health Innovation North East North Cumbria (HI NENC), and the North East North Cumbria Integrated Care Board (ICB).

Outcomes: Darius, citizen and garden volunteer: “It's got a nice feeling to it, like you know it's a safe space. I can't thank you enough for making me feel welcome… you are all lovely people and I feel blessed I have found and joined in. It was a breath of fresh air.”

Jo Beynon, specialist psychological therapist: “Green spaces are hugely important to our wellbeing. Having access to a green space for staff and patients creates an implicit and explicit understanding of this. I have spent time in the garden with clients as a means of experiencing the feeling of calm. We have used the smells of the herbs and the tastes of strawberries to connect with sensory experiences.”

Challenges and learning points centred around how to progress a project such as this when there are often several parties involved with ownership, management, and leasing of the land and property.

Implications: There is potential for the concept and practice to be spread to other sites in the ICB footprint. There is also an opportunity to reimagine the possibilities of healthcare and mental healthcare community sites to use the buildings and the exterior spaces to create more holistic creative spaces that aid recovery and healing and address the wider determinants of health.

Learning Objectives

• Reflecting on the ingredients for a healthy, happy place in the context of a street-scale project
• In practice - how can this be achieved
• Learnings - what are the successes and challenges of creating healthy, happy places

Photovoice for understanding loneliness and mental health in spaces and places in a ‘thriving city’

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They say a picture paints a thousand words. Photovoice is a participatory, qualitative method in which research power is shared with the participants. It empowers participants to share their story through creative means and take charge of the narrative of their own experiences.

Photovoice is being used in a project exploring Thriving City Initiatives – a novel public mental health initiative in various cities across the world aiming to improve the mental health and wellbeing at a population level. The method is being utilised to further understand how the populations of cities that adopt the Thriving City model experience their urban environments. It explores where people feel isolated and lonely in cities – an increasingly potent public health hazard – and where they feel least lonely. It further asks participants to examine their barriers to feeling included, integrated, and connected. The project is sure to provide insight into what public mental health and wellbeing initiatives in different contexts, with varying healthcare (infra)structures, can do to improve population’s experiences with socio-spatial connections in cities. Learning where people feel connection and, more importantly, where they do not, enables knowledge to be obtained about where leaders, communities, policymakers, and others at all levels of urban systems can work to support the public’s health.

People and space are intrinsically interconnected. People influence places and spaces and places and spaces influence people. The Photovoice project will be combined with Geographic Information Systems to further explore connections and experiences with urban space in a novel, mixed-methods manner.

Learning Objectives

• Learn how photovoice can be used as a tool to understand experiences of mental health and wellbeing in places with Thriving City Initiatives
• Learn how qualitative data such as photovoice can be combined with GIS in novel ways to create a mixed method study
• Learn more about the types of spaces and places which impact people's mental health in cities

Towards climate-ready cities: Nature-based solutions in Peruvian urban drainage reconstruction

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Nature-based Solutions (NbS) offer vital benefits and services amid escalating biodiversity loss, closely tied to worsening climate emergency and extreme weather events. Emerging evidence underscores NbS as potent tools in addressing the global climate crisis and providing environmental, social and financial benefits.

Globally, countries grapple with escalating environmental threats affecting economies and livelihoods, and Peru is no exception. Despite being one of the world's most biodiverse countries, Peru faces heightened vulnerability to climate change impacts, including natural disasters like earthquakes, floods, landslides, and droughts. The El Niño Phenomenon exacerbates these events, with climate change intensifying their frequency and severity. Compounded by existing challenges such as deforestation, water pollution, and poor land use management, these climate risks imperil Peru's future development.

Following the devastating 2017 El Niño climate cycle, the UK Department for International Trade collaborated with the Government of Peru in June 2020 to reconstruct urban drainage systems, schools, health facilities, and flood protection. In partnership with Mace and Gleeds, Arup worked with the client, local designers, and contractors to reconstruct resilient and climate-ready sustainable urban drainage systems.

Arup facilitated technical assurance through design workshops, engagement with local experts, site visits, and the formulation of design guidelines. A comprehensive document outlining design guidelines was created to offer practical technical guidance, emphasising design principles, benefits, and crucial coordination for the effective implementation of NbS in an arid urban drainage design.

The purpose of the guidelines is twofold:

1. To deliver comprehensive, valuable, and practical guidance for the client to support the design process and technical delivery of the NbS projects within the Urban Drainage Reconstruction programme.
2. To provide the client and local designers with tools and processes to increase strategic delivery of NbS, their benefits and opportunities, and to make steady progress in turning Peru’s climate change goals into reality.

Learning Objectives

• Nature-based solutions
• Climate resilience
• Biodiversity

South Bristol – case for change for parity of investment into the primary care estate

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The establishment of Integrated Care Boards (ICBs) introduced a 'single budget' for commissioners, aiming to elevate primary care's influence in capital bids and ensure a steady revenue stream for improving estates. Unlike NHS trusts, which have streamlined governance and clear decision-making structures, Primary care in England consists of approximately 5,500 independent practices responsible for their own estates. NHS commissioners may reimburse certain costs but lack direct control over the 8,000 practice buildings and cannot mandate co-located services to support care closer to home and integration with local authorities and the third sector. This fragmentation makes it challenging to reach consensus and develop a prioritised capital project pipeline for rapid capital spending.

NHSBNSSG ICB aimed to address these issues by commissioning a 'Case for Change' report to:

• Secure 'parity of voice' for primary care within BNSSG ICB, building a case for increased investment from the 'single budget';
• Explore the benefits of commissioner-owned/controlled estates to enhance integration with non-NHS services;
• Develop a methodology for building consensus across primary care and community organisations;
• Identify a strategic capital pipeline for primary care and engage local housing and planning teams to support delivery;
• Establish a strategic direction for primary care, providing assurance to NHS and partners.

Methodology: Before commissioning the 'Case for Change' report, the ICB conducted a detailed prioritisation of their entire primary care estate focusing on condition, capacity, and functional capability. They found that four of the top six priorities were located in the economically deprived area of South Bristol and parts of the city centre. Recognising this pattern, the ICB developed a capital prioritisation plan emphasising colocation, integration, and site identification to ensure impactful investment. The findings from the 'Case for Change' report will enable primary care teams to lobby for increased capital funds with solid evidence of deliverability and affordability. This proactive approach addresses common pitfalls in primary care estate schemes and strengthens engagement with local planning authorities. The aim is to facilitate discussions on housing growth, regeneration opportunities, and developer contributions

Results and conclusions: Although ongoing, the project will realise collective benefits to the local health economy through effective partnership working. By promoting co-location and flexible occupation arrangements, place-based investment in the One Public Estate (OPE) can foster diverse, inclusive, and prosperous communities. This, in turn, enhances community resilience, improves population health outcomes, and contributes to a more sustainable NHS.

Learning Objectives

• To develop a methodology for building consensus across Primary Care and community organisations;
• To identify a strategic capital pipeline for Primary Care and engage local housing and planning teams to support its delivery;
• To establish a strategic direction for Primary Care, providing assurance to NHS and wider partners.

Conjecture mapping framework development for evidence-based atrium design in contemporary workplaces

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Atria serve as central hubs that connect people and places, facilitate navigation, and introduce natural light (Hills et al., 2024). As contemporary offices and higher education workplaces become catalysts for in-person interaction in an increasingly digitalised world (Davis et al., 2022), the integration of research and practice for evidence-based atrium design remains underexplored. Existing studies focus on isolated aspects of environmental performance (Holford & Hunt, 2003), lacking a holistic approach to enhancing human experience and health. This paper presents the development of a framework for designing and evaluating atria in commercial and educational settings, using a conjecture mapping approach (Sandoval, 2013) to strengthen design research methodology.

A literature review of 150 relevant papers, case studies and design standards (BREEAM, WELL, Fitwel, LEED) was conducted to identify current research findings. An exploratory dimension reduction technique based on custom dimension definitions was then employed to aid the development of a conjecture map derived from relevant factors in the literature. This approach helps synthesise qualitative and quantitative research to identify relationships between design decisions and health outcomes and provide a holistic understanding of important considerations for atrium performance in relation to human health and wellbeing.

The resulting framework outlines a three-part system for conjecture testing: “Design embodiment”, focusing on design elements, including environmental, spatial, contextual, economic and sustainability factors (e.g. air quality, lighting, biophilic design, place-based connections), that contribute to the creation of an effective atrium space; “Observable mediators”, involving environmental, end-user experience and activity, economic and sustainability metrics (e.g. CO2 levels, user satisfaction, space utilisation, energy efficiency) that can be used to evaluate atrium performance, linking design factors to health outcomes; “Health outcomes”, covering physical, behavioural, and cognitive dimensions, (e.g. physical activity, collaboration, attention restoration) to assess the atrium's impact on health.

This framework approaches design as a trajectory for conjecture testing and serves as a tool for the creation of an evidence base for atrium spaces that enhance human experience in educational and professional environments. While some implementation challenges, such as contextual variability and resource constraints, are present, the framework represents an advancement in fostering health and wellbeing outcomes through science-driven design, by acting as a hypothesis-generator for post-occupancy evaluation. Next steps in testing and application include pilot studies with designers to develop assessment tools, and case studies to evaluate the effectiveness of atria in creating inside-outside connections between building interiors and the urban realm (Zingoni, 2024).

Learning Objectives

• Explore a holistic framework for atrium design based on a conjecture-mapping approach that synthesises design elements and performance metrics to establish relationships between design decisions and health outcomes in atrium spaces.
• Understand the role of atrium spaces as central hubs in contemporary offices and higher education settings.
• Evaluate health outcomes associated with atrium design, such as physical, behavioural, and cognitive benefits, through relevant metrics.

Systems workshops: Delivering a ‘whole-health’ approach to enable healthy environments

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OURI Labs and Quality of Life Foundation have co-created collaborative workshops for local authorities with the aim to provide independent, external facilitation, and provide a space for local authorities to discuss the opportunities in promoting and delivering healthy environments.

The pilot workshop was delivered to East Sussex County Council, a two-tier local authority, which wanted to focus on a "Hot Food Takeaway Approach". The main objective was to help East Sussex feel more informed and confident in creating healthier food environments through a systems approach. This holistic view across different geographies, departments, and roles can lead to more efficient resource utilisation and joined-up thinking.

The workshop achieved this aim through three core components:

• Providing background on the obesity crisis, elements of takeaway food policies/approaches, criteria, public health evidence, and links to guides/resources.
• Presenting current evidence on obesity and deprivation patterns at national, county, and local levels to highlight trends.
• Facilitating identification of shared priorities and ways of working collaboratively.

For East Sussex specifically, the external facilitation created a valuable opportunity for the system to come together, be guided by subject matter expertise, and work towards enablement, support and change. The dedicated space and time allowed partners to listen, collaborate, identify gaps/opportunities, map actions, and appreciate the "whole systems" impacts. Tangible outcomes included greater confidence in the subject area, appreciation for different partner perspectives/priorities, identification of links and opportunities for partnership working, and clear next steps.

East Sussex aims to champion healthy food environments, reflect learnings in planning groups, continue the conversation, and feed insights into policy development. The power of external, independent facilitation was invaluable in helping East Sussex navigate this complex issue. It provided guidance on improving system dynamics, joining up efforts, and driving positive change aligned with shared priorities and policy objectives around obesity prevention and healthy food access, particularly for children and young people.

Overall, the workshops demonstrated the benefits of an external, systems-focused approach to supporting local authorities in tackling multifaceted public health challenges through cross-sector consensus building and action planning. We continue to look at scaling this as an opportunity nationally for other local authorities.

Learning Objectives

• A greater confidence in the subject area
• A greater appreciation for different system partner perspectives, priorities, powers and limitations
• Identified links and opportunities across partnership working and identified further actions for our system to take to help create healthy food environments.

Shaping environments to shape us: The case for longevity cities

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Longevity Cities are an emerging platform to tackle the challenges of global population ageing.

This discussion explores a recent report that presents a five-pillar framework, urging action to optimise environmental exposures, promote brain health, enhance urban liveability, leverage emerging technologies, and prioritise equality. The presenters will explore the intricate link between climate change, health, and longevity, emphasising the need for innovative cross-sector solutions.

The framework underscores the economic impact of brain health, the role of technology in personalised healthcare, and the significance of community engagement. The call for Longevity Cities extends beyond policy to include cultural richness, community involvement, and innovative financing models. The panel provides a blueprint for a future where cities prioritise health and longevity on a global scale.

Learning Objectives

• Recognize the interconnections between and economics and health
• Identify cross-sector and community engagement strategies
• Learn strategies to optimize environmental exposures

Destinations, density and democracy: Are council policies supporting active living?

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This study examines council policies within Australian regional cities, shedding light on their alignment with evidence-based recommendations for promoting active living.

Methodology: This study is part of a larger research project exploring Australian council's active living, transport, and recreation policies. A validated survey was distributed to Australian councils (n=250) with cities or towns exceeding 10,000 residents, resulting in 57 responses from 52 councils. Survey questions exploring active living covered governance, destination accessibility and diversity, density, desirability and democratic policy domains.

Two regional Queensland councils were selected as case studies based on demographic similarities. Councils’ websites were searched to verify survey responses and to collect policy data. The analysis compared survey responses and policy data collected to evidence-based recommendations to determine policy alignment with the evidence-base.

Results: While both councils’ policies promote destination accessibility, diversity, and higher residential densities by developing ‘compact and complete’ walkable neighbourhoods, they often lack comprehensive policy measures for achieving these outcomes. Policies requiring walkable distances to activity centres and small parks better align with evidence-based recommendations than those for other daily destinations. Despite permitting mixed land-use, mixed-use zoning, and opportunities for mixed-use buildings were limited.

Housing equity and diversity policies focus on higher residential densities around activity centres and transport hubs. However, neither council have citywide minimum targets aligning with evidence-based recommendations, and one restricts proportions of dual occupancy dwellings. Additional strategies include infill development, mixed allotment sizes, and waivers or discounts on infrastructure charges for multi-dwelling developments. Positively, one council's urban form framework also supports new housing choices for ageing in place, adaptive and multi-generational housing designs.

Both councils adopt community participatory approaches in place planning through co-design and similar engagement strategies when developing their growth plans. Both councils also offer regular, free or low-cost programmes for promoting physical activity and social inclusion, with one council incentivising commercial activity providers by waiving park hire fees and providing promotional support.

Conclusions: These case studies confirm that regional Queensland councils are adopting policies to promote active living. These policies broadly align with evidence-based recommendations or show progress towards them. However, there are critical policy deficits regarding walkable access to daily destinations and housing diversity/densities. These policies can be improved by introducing explicitly defined, evidence-based standards and targets to strengthen equitable access to destinations and housing in their cities.

Learning Objectives

• Understand the extent to which regional Queensland councils' policies align with evidence-based recommendations for promoting active living.
• Identify the key areas where regional Queensland councils' policies need improvement to enhance active living.
• Explore strategies for improving active living policies within local government.

Liverpool as a healthy city: Living the dream

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Taking an ecological, whole systems approach to cities, towns and villages, as the places where people ‘Live, Love, Work and Play, Healthy Cities has gone on to become a global movement involving over 1500 cities. In its most recent phase, it has re-emphasised local leadership as the key to delivering on the United Nations Sustainability Goals For 2030.

Carl Jung had a dream about Liverpool (1927). He said, “Liverpool is the pool of life”. Artist and poet Adrian Henri created a mural ‘Esmedune’ which shows Liverpool as a verdant, futuristic city. Professor John Ashton wrote ‘Esmedune, Vision of Dream’. In the 1970’s/80’s grass roots movements created a new force for the city’s regeneration. (Morphology; MacDonald, Humphreys)

Case Study 1: Use of healthy cities modelling tool in masterplanning Seacombe
HLP worked with Bax & Co, Barcelona using the ‘Healthy Cities Generator’, to model various design options as part of the masterplan process. Twenty urban determinants of health are appraised using the ‘Healthy Cities Generator’ tool. The model is evidence-based enabling comparisons between various iterations and the development of the best possible plan from a health perspective. The workshop will explore methodologies for developing ‘healthy cities’ and projects.

Case Study 2: Rotunda Community College ‘live-learn’ project, Liverpool
Rotunda is a community-led education college carrying out a project to tackle homeless issues – single parents needing secure living environment and learning/ training opportunities to enable them to ‘get back on the ladder’ to employment and housing and older people, tackling issues of loneliness, isolation and vulnerability. The project is intergenerational co-housing, creating a new connected community with local roots and support. The project is in every way pioneering and the workshop will explore how such projects can fulfil the ‘dreams’ of a healthy city.

Key themes to be explored in the workshop are:
• ‘Healthy cities’ agendas, policy context;
• Working with communities;
• Tackling health inequalities between some parts of our cities;
• Building sustainable neighbourhoods. What role can the concept of ‘15 minute’ cities play;
• A city for all, design for all forms of disability, physical and cognitive;
• Promoting bio-diversity while providing space for enjoyment by communities; and
• Reducing the need for cars, routes for cycling and walking. Safe, secure convivial environments.

Learning Objectives

• To use sound action words, poetry, music and visual imagery to explore and investigate the Knowledge, Cultural and innovatory Healthy connections and disconnections between Manchester and Liverpool
• To present a multi co authored show of Past, Present and Futurist Speculative projects in the Northwest Metropolitan City Region
• To speculate and discuss innovative new ways of designing future Healthy, Cultural and Knowledge connections in and between two major Northern Metropolitan Cities

The role of built and natural environmental indicators in informing data-driven design and planning

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As non-communicable diseases become a growing public health concern, this study suggests that incorporating detailed environmental exposure assessments into urban design can improve health outcomes. We explore how precise environmental measurements can guide healthier city planning. We assess environmental exposures across 11 domains, including air quality, green space, public transport, indoor characteristics, and walkability for every residential address in Bradford and link these to individual-level health information.

Using geographic information systems and precise residential locations, we model probable routes from home addresses to key urban destinations. We demonstrate the application of this approach through research examples, including a study examining the proximity of fast-food outlets in relation to child health metrics. In addition to primary research, we demonstrate how this dataset can be developed as a unified environmental inequality indicator to identify areas needing urban improvements and to evaluate the impact of urban design interventions.

Our research reveals that current urban design often lacks adequate evidence for considering the varied dimensions of environmental exposure at a meaningful scale for everyday life, leading to suboptimal health outcomes. By systematically measuring exposures across multiple domains, we identified critical areas where urban environments can be optimised to support health. The results underscore the need for urban planners and policymakers to adopt a holistic approach to environmental exposure in city design to mitigate health risks associated with non-communicable diseases. This study highlights the potential of detailed environmental exposure data to inform more resilient, inclusive, and health-oriented urban design, aligning with the conference’s emphasis on health equity, diversity, and sustainable city planning.

Learning Objectives

• Evaluating Urban Design through Environmental Exposure Assessments
• Interpreting Data on Health Impacts of Built Environments
• Identifying Areas for Urban Improvement Using Environmental Indicators

The health impacts of cumulative construction: Marsh Wall, London

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London has 32 local authority districts (boroughs) that make up Greater London. This abstract will focus on the London Borough of Tower Hamlets (LBTH) in east London. 

 Since 2021, a newly formed Development Coordination team have focused on developing strategic solutions for improving construction coordination through a variety of evidenced interventions.  

Thesis statement: Identify the health and wellbeing impacts that long term cumulative construction activity has had on the amenity and people who live, work and visit Marsh Wall, and to outline how current measures that address health impacts of construction could be altered to improve health outcomes in the future.  

Marsh Wall was selected because of the area’s continuous development over the past 20-30 years since the establishment of Canary Wharf in the late 80s and early 90s.  

Methodology: The research does not follow the standard structure for a health impact assessment (HIA). Instead, this research focuses on the impacts of construction phase activities on human health rather than the impact on health of a completed development project. To the best of our knowledge, this has not been previously undertaken. 

The research focused on:
A review of existing literature, policy and guidance;
Planning data gathered, available site information, scale and timeframe for development delivery over a period of 15 years;
A baseline assessment of publicly available data on health outcomes and determinants;
Identification of health impacts relative to developments; and
Stakeholder engagement focused on identifying recommendations for mitigation methods.

Results: 
A summary of how construction impacts health;
A review of the evolving landscape of development in the study area and subsequent impacts identified on residents living and working within the study area; and
Identification of recommended mitigation practices relative to thematic areas of work (environment, transport, employment, crime, health and safety).

Conclusions: 
Provide consistent and centralised access to construction information for residents;
Site monitoring of impacts is important to residents and results should be shared with residents;
Mitigation measures varies widely between different sites; best practice needs adoption across all sites;
Lack of oversight of contractors needs addressing to reassure residents policy and guidance are being enforced;
Not all negative impacts can be avoided or mitigated; further appraisal, monitoring and review are required. 

The implications of these findings have been fed into local policy and guidance, as well as forming the platform from which regular council-led coordination meetings and additional support services have been established.

Learning Objectives

• Understand the health impacts of cumulative construction activity and related concerns of resident communities around the borough
• Understand the scale of impact of development around Marsh Wall
• Practical insight into where the Development Coordination team need to focus with respect to protecting residents in both policy and practical action

Mitigating air pollution in compact built environment through design optimisation for healthier city

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Compact urban development strategies can promote vibrant and resilient cities. The better amenity promotes the usage of public transport and facilities, which could facilitate sustainable urban development and foster community resilience. However, a compact built environment strategy also introduces environmental problems, such as urban heat islands and poor air quality. In particular, air pollution has been a major problem in compact cities, imposing threats to residents’ health.

There are two ways to mitigate urban air pollution: control pollution emissions or enhance pollution dispersion. There has been a fairly large amount of attention being paid to the former, but many studies overlooked the fact that a well-designed city form helps with the dispersion of pollutants. Actually, optimising city planning and design is an effective way to enhance pollution dispersion, but recent studies by the author have proved that the densely built urban form in many cities is not optimised for pollution dispersion, and there is a lack of studies that can directly help urban planners and city designers to optimise the planning scheme and design proposal at early stages efficiently. Practitioners need straightforward information of reasonable accuracy and intuitive and transferable guidance for healthy city design.

Using PM2.5, a commonly used proxy to investigate pollution dispersion, this study focuses on optimising urban planning for better pollution dispersion in compact urban environments. Utilising mobile monitoring, geospatial data analysis, and city design metrics, this study aims to develop scientifically correct and straightforward optimisation strategies for urban air quality improvement through city design. This will allow considerations of pollution dispersion to be incorporated into real-world city planning and design practices. The study output has been applied by local authorities in a large city to inform planning decision-making.

Learning Objectives

• Interdisciplinary Conversation
• Healthier City Design
• Connecting Research with Practice

Healthy urbanism rehab

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Good health is a human right and is intrinsically linked to planetary health (One Health). Healthy urbanism is identified in literature as a domain of research, policy, and practice that addresses health through principles of inclusion, sustainability, and equity, plus inclusion of diverse knowledges. This type of transdisciplinary and translational activity requires skilled integrators operating across systems that are often siloed. From our pilot, these integrators face particular challenges in at least two broad groups: i) capacity/delivery problems: through a lack of clear and valued role within wider systems; and ii) health risks: including due to stress, burnout, moral injury, solastalgia, and loneliness – these also interact in complex ways with structural discrimination such as racism and misogyny. If the full potential of healthy urbanism practice is to be realised then there is a need to investigate these challenges, develop understanding of them, and provide restorative/rehab spaces for this group of integrators. This is needed as foundational to delivering One Health.

Methodology: Healthy Urbanism Rehab is a transdisciplinary space that seeks to include diverse knowledges across and between disciplines and research/policy/practice. It is a professional peer-support space. Methods are based on reflective learning and draw on aspects of participatory research, and action learning set approaches. Values are formative. Ethics are addressed, including through agreed boundaries between participants.

Between Healthy City Design 2023 and 2024, a group of such boundary spanners (n=5) piloted Healthy Urbanism Rehab through a series of online workshops (f=4). A workshop is proposed as a method to provide further reflective space and open out discussion with a diverse range of attendees at HCD 2024, with potential to identify future directions and co-learning with workshop participants. Methods will comprise a facilitated panel discussion and small group learning.

Workshop aim: Bringing Healthy Urbanism Rehab to a wider audience, to share our reflective learning; to provide a space for participants to reflect in small groups; and for co-learning as a whole group. The process matters: findings partial, emergent, and contextual. We are interested to identify future potentials and whether/how this topic connects with a wider audience.

Conclusion: Healthy urbanism rehab is offered as a scaleable methodology for peer-support for practitioners addressing the particular challenges faced when addressing One Health in the face of global poly-crises. Learning from a pilot suggests future need to develop understanding and increase investment to supporting practitioners in this space.

Learning Objectives

• Reflective co-learning on healthy urbanism practice.
• Approaches to integrating rehabilitation and peer-support into everyday practice.
• Reflective learning / key topics from a pilot with an expert panel: e.g. value proposition for healthy urbanism practice; practitioner wellbeing.

Made for me

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Imagine a city that allowed blind people to navigate their way around just by touch? Where older people can travel around safely without fear of falling. Where people who have hidden disabilities can easily find spaces designed for their needs. A city that allows everyone to move seamlessly from one area to another, from paths, to roads, to parks, and to public transport. We have created a toolkit encompassed in an accessibility hub called a ‘Made for me’ hub.

‘Made for me’ hubs take mobility, sensory and daily living aids, and house them in pre-existing spaces, retrofitting them to become hubs, containing accessible toilets, water fountains, seating, quiet rooms, and lockers to support people in their daily lives and their journeys across the city. Once implemented, these hubs would be an amazing way of making all cities much more accessible to everyone – to the people who need assistance. London already hires out electric scooters and bikes, so why can’t we hire out mobility, sensory and other aids, such as wheelchairs or noise reducing headphones, in the same way, from the same hubs?

A ‘Made for me’ accessibility hub app would be produced so everyone could locate the hubs that best suits their own requirements and provide information on accessible places and routes in the local area. Each ‘Made for me’ hub will be situated at transport interchanges, wherever the city locals and visitors start or end a journey. ‘Made for Me’ hubs would be interconnected, so you could easily borrow an item from one hub and drop it off at another.

In staffing ‘Made for Me’ hubs, there is a great opportunity to hire and train a diverse workforce, one that includes neurodivergent and disabled people. Their experiences would also further help and inform how the accessibility hub moves forward, best serving the people it assists.

This is a massively ambitious idea, but one that we think can grow and grow, making a huge difference to the day-to-day lives of many people, eventually nationwide.

The prize is huge – we could lead the world in inclusive, accessible city making. The people prize is even bigger, with the opportunity to enhance access to economic, social and cultural opportunities, to create fairer, more empathetic places and combat the risks of loneliness. Let’s make our places ‘Made for me’.

Learning Objectives

• Promoting placemaking for the disabled and chronically ill
• Creating empathetic cities
• Creating equality for communities

The intersection of public space design and emotions: A critical review

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Public spaces significantly contribute to the liveability of the cities and the wellbeing of the citizens. Providing people with better emotional experiences through urban design and planning has thus become a pivotal aspect for built environment professionals, due to the rapid urbanisation and declining mental health in the cities. Urban public spaces provide a place for people to relax, socialise, rejuvenate, and be a part of urban life, which makes it important to understand the relationship between public spaces and citizens’ emotions. Additionally, research suggests that specific physical characteristics or elements of a public space influence the emotional responses of people.

The significance of the design of urban public spaces in the lives of citizens leads to the need of comprehending the association between the design elements of public spaces and citizens’ emotional responses. To investigate this association, this study conducts a systematic literature review of relevant studies conducted over the past decade.

Key findings highlight that most studies have focussed on understanding the impact of design elements on positive emotions, especially happiness, and relaxation. On the other hand, negative emotions were mostly found to be associated with the absence of particular elements, rather than the elements themselves. The studies emphasised that the characteristics of the design elements play a vital role in the emotional responses of people, resulting in the idea of ‘quality over quantity’.

Additionally, the reviewed literature also sheds light on the disparity in the number of research studies conducted on parks/green spaces relative to other public spaces. Even the studies investigating the different typologies of public spaces tend to concentrate on the green elements of these spaces. Based on the critical review, this study develops a conceptual framework to comprehend the interrelationship between public spaces, design elements, human activity, and emotions, which may aid in understanding the citizens’ emotional experiences with regard to the design of public spaces. This may further contribute to enhancing the quality of public spaces by emphasising on creating emotionally positive public spaces.

Learning Objectives

• Understand the association between design elements in urban public spaces and the emotional responses of citizens
• Recognise the disparity in the existing public space-emotion association studies.
• Learn about the developed conceptual framework to comprehend the interrelationship between public spaces, design elements, human activity, and emotions

Urban regeneration of sustainable social housing and the impact on health and wellbeing

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Urban regeneration initiatives focusing on sustainable social housing have garnered increasing attention due to their potential to significantly impact residents' health and wellbeing. Poor housing conditions, such as dampness and insecure tenure, exacerbate mental health issues, while access to good quality, affordable housing is essential for overall health. Despite recognising these challenges, interventions by housing providers and policymakers are often limited, highlighting the need for holistic support. Estate regeneration aims to address declining housing conditions and socioeconomic marginalisation but frequently lacks sustainability. This research emphasises social sustainability and aims to investigate how urban regeneration of social housing can enhance residents' health and wellbeing, using a single case study approach.

The study will be conducted in a major metropolitan city known for its significant urban regeneration efforts and diverse population. Employing a mixed-methods methodology, this research explores sustainability measures and their impact, offering insights for future urban planning and public health interventions. Quantitative measures include comprehensive surveys to assess health outcomes, perceptions of housing quality, and overall wellbeing, alongside the analysis of anonymised health records to monitor changes in health indicators before and after regeneration. Environmental assessments were conducted using inspections and sensors to evaluate improvements in housing conditions, such as dampness and air quality. Qualitative measures involve in-depth interviews and focus groups with residents, local authorities, and stakeholders to gain detailed insights into personal experiences and the perceived impact of the regeneration efforts. A comprehensive case study narrative are developed to detail the regeneration process, challenges encountered, and strategies employed.

The assessment of successes and shortcomings are conducted through a robust evaluation framework, analysing health and wellbeing indicators, housing quality improvements, social and economic outcomes, and sustainability metrics. By focusing on a single, in-depth case study, this research aims to provide a detailed and nuanced understanding of how urban regeneration initiatives can be effectively designed and implemented to enhance the health and wellbeing of residents in social housing. The findings will offer valuable insights for policymakers, urban planners, and housing providers, highlighting successful strategies and potential pitfalls to avoid. This approach ensures that the study remains robust and its insights applicable to broader contexts, contributing meaningfully to discussions on urban planning, public health, and social sustainability.

Learning Objectives

• Investigate the relationship between urban regeneration of social housing and the enhancement of residents' health and wellbeing.
• Identify and analyse the sustainability measures integrated into social housing and their impact on health and wellbeing.
• Explore potential strategies through which sustainable social housing could effectively address future health and wellbeing challenges.

Ecourbanism: A whole-systems regenerative approach to healthier, more equitable cities

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The climate and biodiversity emergencies are inextricably linked; their combined effects exacerbate a public health equity crisis. The urgency to achieve key environmental and equality goals by 2030 is intensified by the concurrent phenomenon of rapid urbanisation, rising ageing populations in developed countries plus major health and equity challenges in developing nations. The scale of the challenge is illustrated by 60% of the global population forecast to reside in urban centres by 2030, rising to around 70% by 2050.

Achieving transformational resilience to address this in a short timeframe requires amended planning laws and regulations to promote design for health and resilience now, in addition to carbon and biodiversity targets. Space in streets and squares is needed to locate new or retrofitted nature-based solutions. An investment in natural assets (including urban soils and vegetation) enables delivery a flow of benefits to people – ecosystems services (ESS). These aims are consistent with many of the 17 UN Sustainable Development Goals that are to be achieved by 2030.

In April 2024, 2400 Swiss women aged over 64 successfully sued their own government at the European Court of Human Rights, over climate change inaction that threatens their future health. In a landmark case, the court ruled this failure violated the European Human Rights Convention. Over 61,000 deaths were attributed to European heat waves in 2023, primarily among elderly women. The Marmot Review on Health Equity (2020) noted that climate change exacerbates existing inequalities, with older people and low-income groups bearing the brunt of extreme weather events. The IUCN states biodiversity plays a critical role in human health and wellbeing, yet biodiversity is adversely affected by climate change.
In England, there are requirements to reduce carbon emissions and increase biodiversity in all new developments, but not for environmental net gain or salutogenic design. Australia's Strategy for Nature 2019-2030, takes a more comprehensive approach, aiming for healthier environments for both people and wildlife. Prioritising both human and environmental health is crucial, these issues need alignment to achieve improvements to both housing and health services.

Drawing on the authors’ experience in designing, implementing, and teaching the regenerative whole-systems ecourbanism approach, this paper presents international case studies of healthier and more equitable urban neighbourhooods, and discusses the potential to adopt ecourbanism in planning legislation as a means of promoting positive change that addresses the environmental emergencies, promotes public health and reduces urban inequalities.

Learning Objectives

• Ecourbanism - a whole-systems regenerative approach to design
• Using Ecosystems Services approach to urban health & equity
• Employing Nature-Based Solutions for transformational resilience

Community as client toolkit: Mindsets and behaviours for healthier project experiences and outcomes

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Local people are experts on their places. There is a wealth of latent expertise and knowledge in every community that is often squandered. We need to maximise this precious placemaking resource, and this means elevating people’s role in decision-making about place. Going beyond merely providing engagement platforms, we need to treat the community as a client.

This means recognising the community as the ultimate custodian of a place. It challenges us to redefine who we build for and why. The word ‘client’ is framed in a development sense as decision-maker, budget-holder, owner. These terms – wrapped in power, access, and control – are external to the community, and stimulated by a development’s delivery timescales and objectives, not necessarily a place’s.

‘Client’ becomes an episodic event, closing on project delivery. That is why the place itself needs a client – to advocate for its own future, beyond the delivery of a project. And that client is its community. We see community-led development projects with the client organised from the community around a place, with a focus on collective ownership and long-term stewardship. The impetus and precedent for communities taking the role as client is there and works. Development projects and communities can have uncomfortable experiences of the planning process. But we need to go through the process together. Maybe our focus is too much on changing the process when what we really need to change is our behaviours in the process. Community as client moves us away from unhealthy adversarial ‘us vs them’ tropes, with behaviour and mindset change on all sides to be more empathetic of the challenges faced on all sides.

The 'Community as Client' toolkit empowers communities to take an active role in development processes, for enhanced project outcomes, elevated social and economic value, increased community satisfaction, and healthier places. Adopting this toolkit, professionals can foster a more inclusive engaged approach, prioritising long-term community needs.

Learning Objectives

• Explore practical methods, purpose and benefits of truly engaging and respecting communities as a peer and equal, and supporting them to behave as client.
• Recognising the impacts of urban change on people's mental health, wellbeing, psychological safety, sense of security and belonging
• Exploring behaviours and mindsets within the development process that can lead to conflict, disengagement, poor engagement practice, lack of participation, and the impact on project delivery, team performance and satisfaction, and benefits realisation.

Evaluating school streets in Bradford

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A city’s built and natural environment influences child health through exposure to health hazards or hindering physical activity. Active travel to and from school (ATS) can substantially contribute to children’s physical activity levels. Neighbourhood and street design that supports active travel to school is crucial. Recent increases in ATS have been linked to the growth of programmes, such as School Streets, promoting ATS and road safety. School Streets protect children’s health by temporarily restricting vehicle access to road(s) surrounding schools during drop-off and pick-up. This study presents a combined outcome and process evaluation of School Streets interventions in Bradford, which aims to strengthen evidence in two areas: the impact of built environment changes on child health and wellbeing; and the best methods for delivering and increasing the acceptability of school streets.

Methodology: The School Streets evaluation uses a quasi-experimental design: three schools with School Streets and four size, ethnicity, deprivation-level matched control schools. Children told us how they travel to school, feel about their journey and perceive various built environment features using the C-HaPIE survey at three time points (baseline May 2023, 4-6 weeks post-intervention (T1), 1-year post-intervention (T2)). At T1, we asked children their views on the School Streets intervention. Air quality was measured with diffusion tubes and/or Zephyr monitors. Manual traffic counts were recorded. Preliminary results are presented from the baseline and T1 surveys.

Results: A total of 997 children (age 8-11 years) across seven schools completed surveys at baseline and 665 (age 9-11 years) atT1. At baseline, children who actively travel 3+ days/week (57%) liked their school journey more than those who did not. At T1, 266 children in School Streets schools took part; children liked School Streets a little (47%) or a lot (30%). The main reasons cited for children liking School Streets were feeling safer (36%), having a more peaceful, pleasant and quiet street (22%), and feeling cared for (17%), whereas when asked what they did not like, the top responses were nothing (24%), parking further (18%) and the road being closed to vehicles (11%).

Conclusion: School Streets shows high levels of acceptability among children. Children report feeling safer, having a more pleasant environment and feeling cared for. Following completion of T2 surveys, a difference-in-difference analysis will be used to determine whether School Streets affects children’s self-reported wellbeing, active travel, and perceptions of the built environment on their journey to school.

Learning Objectives

• Active travel to and from school can substantially contribute to children’s physical activity levels and street design that supports active travel to school is crucial.
• Children who use active travel modes 3+ days/week like their school journey more than those who do not travel actively.
• School Streets shows high levels of acceptability amongst children who report feeling safer, having a more pleasant environment and feeling cared for.

Reimagining urban setting via a spatial lens: Exploring the relationship between walking and stress

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There is growing research on the health benefits of walking in the prevention of chronic physical and mental health disorders. The development of many of these long-term diseases is linked to chronic stress. A common patient-led or practitioner-led intervention to reduce stress is walking. Although research suggests the setting of walking impacts patient adherence and the strength of its health benefits, the current literature exploring this is limited and somewhat restrictive, focusing on the benefits of rural or green spaces. This dissertation aimed to examine setting through a cultural geography lens, guided by Doreen Massey’s re-conceptualisation of space. It explored how aspects of urban space can exacerbate and alleviate stress while walking.

A mixed methodology was employed. Ten interviewer-led, semi-structured walking interviews (WIs) were conducted in Southwest Birmingham, UK, each consisting of sections focussed on aspects of space explored by the literature review. Change in quantitative, self-reported, perceived stress after WIs was also measured. Five supplementary walking interviews with members of walking groups were conducted to include their perspectives. Similarly, a virtual interview was conducted with a social prescriber, which is a role in UK primary care settings designated to support patients in lifestyle interventions. Thematic analysis was conducted on the interview transcripts.

The findings showed walking interviews may alleviate stress, and that several dimensions of space may impact stress while walking. Participants highlighted stressful physical and sensory aspects of the built environment like boundaries, monotonous surroundings, and traffic crossings. Participants' digital spaces both facilitated escapism from these or exacerbated stress. They also expressed how open spaces can facilitate connections with people and subjective triggers enhancing the comfort associated with belonging. Finally, participants commented on the stresses associated with the influence of politics and the media on their spatial perceptions.

It was concluded that a balance of sensory stimulation in spaces facilitating freedom, intrapersonal, and interpersonal connection alleviate stress the most while walking, which is dependent on the heterogeneity, openness, and temporal dynamism of interactions of Massey's space. Future research should explore the relationship between comfort and stress and examine how and to what extent space affects other aspects of health. It should also translate this into practical recommendations for walkers, healthcare professionals, and planners globally. This could allow optimisation of a free, relatively accessible lifestyle intervention to alleviate stress on a personal and population level, to reduce long-term stress and chronic disease.

Learning Objectives

• Chronic physical and mental health disorders are linked to long-term stress, which is impacted by regular walking
• Walking may exacerbate stress through sensory stimulation and facilitating the continuation of digital and political spaces
• Open, heterogenous, and temporally dynamic spaces facilitate social and intrapersonal connection which creates a sense of comfort, limiting stress.

The Old Kent Road Family Zone – a new approach to improving community wellbeing

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The Old Kent Road Family Zone (OKRFZ) in Southwark, London, works to improve children’s wellbeing in one of the most deprived boroughs in the UK, by bringing together local partners to provide early help for the community to address social challenges and better access to physical and mental health services.

Building on the rich, community-based practices of Surrey Square Primary School, OKRFZ is different from many other place-based approaches. Instead of seeing the community as “vulnerable”, focusing on their needs and deficits, and imposing solutions by those who don’t live or work within the community, the OKRFZ model is premised on the belief that the answers lie within the community itself. Our experience so far has given us the insight that the community is capable of leading change if they're given the tools and resources to do so including developing strong partnerships with other sectors.

OKRFZ works to create the right conditions for local people to bring solutions to life, in two ways:
• Deep community engagement and listening. The Community Board, comprising local residents and organisations, is at the heart of OKRFZ. Board members are tasked with listening to others within their community. This powerful process of deep listening helps us all to understand the issues as the community sees them, as well as building and deepening relationships. Together, we then work to ascertain the root causes of issues, co-design solutions, bring them to life, experience them together, and reflect/learn from the experience.
• Support for incubating, launching and running community-led projects, such as the Saturday Marketplace, Youth Club and Community Restaurant for 450+ local people monthly. These are often done in partnership with local government, businesses, charities, or the healthcare sector. We think this is key and puts emphasis on effective partnership.

We’ve seen improvements in community connection, mental health, and financial security for individuals who have engaged with the Zone. Significant impact has been seen for some mothers who report now feeling part of a wider community, gaining financial stability for the first time, and being able to see a brighter future for themselves. Projects are also offering employment, training and development opportunities.

We are working to scale this model by training other community leaders to develop Family Zones to create safer and stronger communities, initially in South East London, and then more widely across the country.

Learning Objectives

• Describe some of the key characteristics and ways of working of a Community Board that effectively engages and sparks locally-led action, based on deep listening and relationship building.
• Describe some of the key elements of effective partnerships between community members and local government, businesses, charities, or the healthcare sector.
• Identify opportunities to apply some of the OKRFZ lessons to other neighbourhoods.

Promoting healthy communities in Italian marginal territories

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Marginal areas, distant from the main urban centres where essential services are concentrated, play a fundamental role in promoting the sustainable development of the countries and preserving cultural and economic identity, traditions, natural resources, and cultural heritage. For these reasons, it’s vital to slow down the continuous and constant abandonment that these places are experiencing by enhancing the inhabitants' opportunities and quality of life. In line with these objectives, the REACT research project, funded by the European programme NextGenerationEu and the Italian National Research Programme, aims to regenerate marginal areas' cultural landscapes from a people-centred perspective. A strongly interdisciplinary approach is used to develop a theoretical-practical model to revitalise a valley in the Tuscany region called Casentino.

The REACT research group, comprising researchers from four Departments of the University of Florence (Architecture, Economics, Education, and Industrial Engineering), actively engages with public administrations and local communities. Through diverse methods, activities, and approaches, the group strives to enhance its work's impact on regenerating the territory and fostering health equity.

To do so, the research addresses the theme, focusing on cultural landscape as the tangible and intangible manifestations of human interaction with the environment. It encompasses various elements, such as built environments, cultural heritage sites, landscapes and natural systems, community practices, and experiences. Part of the research is focused on defining strategic intervention with the collaboration of various stakeholders (residents, associations, public institutions) who are involved in the discussion of four different themes, which are considered crucial for the comprehension of the dynamic: 1. Agro-food and forestry heritage and crafts; 2. Social traditions and practices; 3. Landscape and territory; 4. Settlements and buildings.

This paper will unveil the intermediate results of our research, geared towards defining strategies to analyse the cultural, economic, and social dynamics. The aim is to create vibrant, inclusive, healthy, and sustainable environments and communities in Casentino, with the potential to be generalised to other similar areas.

Learning Objectives

• People-centered perspective
• Interdisciplinary approach
• Co-design

Economies for healthier lives: Improving employment and health outcomes in Liverpool City Region

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Liverpool City Region has some of the highest rates of economic inactivity owing to poor health, which has major economic costs. Labour market interventions that help people – particularly those with health issues – to enter or remain in good quality jobs are central to delivering economic prosperity and can enhance people’s health. Too often these initiatives are delivered in isolation, across different administrative tiers, complex systems and different geographies, which can limit our understanding of how specific interventions affect health outcomes. Moreover, the knowledge base regarding which services ‘meet people’s health and economic needs together’ is sparse, which hinders programme accountability, has implications for the efficient use of resources, and impacts on learning across networks.

Purpose: One of five Health Foundation funded projects across the UK, this collaborative project will enable health and wellbeing to be incorporated across Liverpool City Region’s economic strategies. It will develop an integrated approach to labour market programmes by bringing together health services and a wider social offer (welfare, housing, debt) with employment programmes, informed by the lived experience of residents at a city-regional scale.

Methodology: Four interlinked workstreams to provide evidence and insight to improve the service offer and better meet population needs:
• Context mapping with stakeholders.
• Evidence benchmarking via a systematic review of peer-reviewed and grey literature and rapid evidence reviews of local programmes.
• Data linkage, local area health profiles and equity audit linking employment support and outcomes, with health data for individuals
• Stakeholder engagement with employers, residents, and public services to shape project activities and sense-check findings.

Findings: Learning from all four workstreams will be used to inform the development of an options appraisal to identify what activities are possible to improve, and redesign, for an integrated service ‘offer’ to improve people’s health, wellbeing, and economic prosperity. A toolkit has been developed to support dissemination and inform future policy design.

Implications: The development of an Economy and Health Integration Toolkit to collate these activities will allow other areas to replicate our work.

Learning Objectives

• To build capacity and capability within existing systems to integrate health and employment outcomes in programme design
• To raise the visibility and where appropriate, encourage the development of arrangements for collaboration between the hierarchies of organisations, which directly or indirectly aim to improve people’s health, wellbeing and economic prosperity
• To identify how data can be used in novel ways to inform the relationship between health and employment support, and how this can be used in collaboration with stakeholders

Heat and health: Unlocking neighbourhood climate resilience

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Resilience has been a rapidly developing concept supporting local authorities, planners and designers in preparing for urban shocks and stresses, including overheating. However, it remains relatively abstract and rarely merges climate and health resilience. With climate and health vulnerability inextricably linked, this project addresses the need for tools that bridge urban development and urban health challenges, proposing an integrated resilience framework for neighbourhood development. This research-driven and practice-relevant heat and health framework identifies pathways to enhance local resilience. It provides a structured and actionable approach to embedding inclusive and health-driven decision-making in strategic planning and design.

In the context of increasing temperature extremes and hazards, cities face systemic challenges managing heat stress and its growing negative impacts on people’s health and wellbeing. Extreme heat poses risks for everyone, however its impacts aren’t felt or experienced equally. People living with chronic and underlying health conditions are especially vulnerable, as are children and the elderly. Heat exacerbates air pollution and disproportionately affects people with respiratory and heart conditions. Meanwhile, different housing and environmental conditions create uneven exposure to thermal stress and are likely to entrench new and existing inequalities.

Drawing on an existing resilient urban water framework (de Graaf & Ovink, 2021), and evolutionary resilience approaches, this initiative structures resilience through five distinct neighbourhood capacities. The capacity lens unlocks a taxonomy of feasible resilience definitions and incremental steps to reduce climate vulnerability. Designed for the neighbourhood level, it relates to the growing trend of planning sustainable proximities, or 15-minute cities, to foster place-based wellbeing and climate action. Its scale offers a unique entry point to reconcile strategic objectives with local needs, accelerating change on the ground to increase adaptive capacities while creatively responding to the environmental and social fabric.

During this talk, the project team will discuss the framework’s theoretical roots and practical case studies to demonstrate applicability and explore its potential. Speakers will present the project case study neighbourhood in London, where the team simulated seasonal ranges of thermal stress and comfort, engaged with local communities and studied possible avenues to bridge between health and built environment considerations. This project is a collaborative research initiative between Ramboll, a multidisciplinary design and engineering consultancy, and Impact on Urban Health, an urban health foundation that addresses health inequalities by focusing on issues that disproportionately impact people in cities.

Learning Objectives

• 1. Gain a deeper understanding of climate vulnerability, particularly from overheating
• 2. Examine a new 5-capacity heat and health resilience framework for neighbourhood development
• 3. Conceive how the framework can support holistic and structured responses to multiple climate health vulnerabilities through case studies

Designing healthy cities: Interactive healing environments for wellbeing and community engagement

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This paper explores integrating interactive healing environments (IHEs) within urban settings, building on the smart cities trend. IHEs enhance wellbeing through multisensory experiences and community engagement, offering a transformative approach to urban planning by incorporating ancient knowledge to enhance well-being and cultural intelligence.

Purpose: The research aims to provide a framework for incorporating IHEs into healthy cities. It examines how IHEs serve as adaptive spaces that respond to urban dwellers' needs, promoting wellbeing. IHEs act as platforms for community feedback on urban initiatives and facilitate engagement among government bodies, industry, and community organisations, fostering cultural integration and enhancing cultural intelligence and belonging. This approach underpins health equity, diversity, and inclusion, ensuring a healthier and more productive population.

Methods: A multidisciplinary approach, combining insights from urban planning, technology, healthcare, community development. Key elements:
1. Literature review: Analysis of studies on smart cities, IHEs, and their impact on wellbeing.
2. Case studies: Examination of successful IHE implementations in urban settings.
3. Framework development: Strategic roadmap integrating IHEs, focusing on accessibility, sustainability, and inclusivity. Roadmap integrates ancient knowledge to enhance wellbeing and cultural intelligence.

Results: The findings highlight the benefits of IHEs:
• Stress reduction: Calming environments through ambient lighting, therapeutic sounds, and tactile elements.
• Mental rejuvenation: Immersive experiences that promote relaxation and mental health.
• Social cohesion: Interactive spaces for community engagement/connection.
• Community feedback: Platform to receive feedback on urban initiatives, aligning planning with community needs.
• Cultural integration: Engagement government bodies, industry, and community organisations with diverse communities, promoting cultural integration, enhancing cultural intelligence and belonging.
• Ancient knowledge utilisation: Incorporation of traditional practices and wisdom to enhance overall well-being and cultural understanding.

Conclusion: Integrating IHEs into Healthy Cities represents pioneering approach to urban design, where technology and human-centric principles converge to enhance wellbeing and community engagement. This research provides a strategic roadmap for cities to adopt IHEs, emphasising accessibility, sustainability, and inclusivity. By fostering collaborative partnerships and leveraging innovative design principles, cities can create environments that enhance individual health and nurture a vibrant community. IHEs' role as platforms for community feedback ensures that urban initiatives align with residents' needs and aspirations. They promote cultural integration, enhancing cultural intelligence and fostering a sense of belonging among diverse communities. Utilising ancient knowledge, IHEs blend traditional wisdom with modern innovation to create healthier, more inclusive cities. This vision for healthy cities holds potential to transform urban landscapes, making them more responsive to inhabitants wellbeing.

Learning Objectives

• Engaging and interactive wellbeing solutions using creative technologies, ancient knowledge, storytelling and interaction design.
• Authentic community and stakeholder engagement to encourage feedback, co-creation and a sense of belonging.
• Cultural integration and intelligence – enhancing multicultural understanding and connections.

Corner shops for lively and resilient communities

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By designing the built environment for people instead of cars, a contribution can be made to a softer city, which improves the quality of life for residents as well as their health. Important aspects of such an environment are social infrastructure stimulating encounters, as well as shops and other daily facilities at walking or cycling distance.

Shops and other facilities established in corner buildings are supposed to contribute to a soft city. Because of their location they can attract clients from different directions and display their products on two sides of the shop. In many old neighbourhoods, the corner buildings used to be destined for amenities, but nowadays they are often used for housing. Meanwhile, loneliness is increasing and in many places there is a need for meeting places. To find out whether it would be worthwhile to invest more in the preservation of these corner facilities, we investigated their added value for the neighbourhood in the Groningen Korrewegwijk, where there are still about 40 such amenities. We conducted a case study consisting of observations and conversations with owners, staff and passers-by.

It turned out that corner properties provide liveliness to the Korrewegwijk in several ways. The bike store also has a package service and a seating area. Local residents are sharing their joys and sorrows here. The owners provided informal care for a neighbour who suffered from dementia. A neighbourhood hotel offers a laundry service staffed by volunteers for people who cannot do their own laundry. The sidewalks can be seen as a flexible extension, where the bike store placed its bike pump (for everybody’s use), the florist its plants, and the grocery store its fruits and vegetables. However, there are also empty corner properties, which create less lively street scenes. The baker’s shop has closed because of staff shortage and the bike store will also close soon.

Hence, it can be concluded that the (up and running) corner properties in the Korrewegwijk are more than just amenities. They are places to meet, where feelings are shared, and even customised care is provided. However, this might not always be the case. Further research should generate more insight, which can be used by space makers willing to contribute to lively neighbourhoods fostering community resilience.

Learning Objectives

• Urban design
• Resilient communities
• Social infrastructure

The importance of accessibility engagement within active travel infrastructure design

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Framework:
Wheels for Wellbeing highlight access barriers within public realm that make spaces impassable for many cycles, mobility scooters, wheelchairs and Disabled pedestrians. Although the Equality Act 2010 outlines legal duties to ensure the needs of all individuals are considered, with government guidance in place to offer sector implementation advice, more can be done to ensure that accessible spaces are implemented in practice. The Chartered Institution of Highways & Transportation (CIHT) suggests continued co-design to be essential for ensuring accessible spaces for all.

Description of practice application:
Over the past 12 months, MP Smarter Travel (MPST) has partnered with Lambeth Council to deliver the Accessibility Working Group (AWG). MPST has facilitated monthly AWG meetings with seven community members with diverse impairments to discuss the accessibility of current and proposed physical infrastructure across the borough. Member impairments include visual impairments, neurodivergence, and mobility impairments. A mixture of office meetings and site visits are used to aid discussions. Through lived experience, the AWG provide valuable insights into a range of accessibility challenges. Member feedback is reviewed through a highway engineer lens, to ensure that all recommendations are in line with design policy. In turn, accessible design alterations are recommended to Lambeth Council. Designs include colourful crossings, continuous footways, LTN review, walking routes.

Outcomes:
14 public realm designs have been reviewed and tweaked using the AWG. Often, different impairments have different accessibility needs. Open discussions with members with different accessibility needs is crucial to ensure designs are accessible for all.
Through this project, Lambeth Council has addressed common accessibility barriers, ensuring that roads, parks, and transport facilities are designed with inclusivity in mind. Internal Lambeth Council staff have also been upskilled in inclusivity, providing long-term benefits to internal and sub-contractor practice.

By designing infrastructure that is inclusive for Disabled people, we are designing infrastructure that is inclusive for all within the community. In the long-term, increased accessibility within infrastructure and public realm will enable more community access to active travel modes and experience the associated health, wellbeing and economic benefits.

“People with disabilities often don't feel like they're involved. It is nice to feel useful, included and involved in decision making” - AWG member.

Implications:
Based on the success of year one, we are looking forward to the continuation of this project for another year. We hope this case study demonstrates best practice, promoting the need for the delivery of similar projects countrywide.

Learning Objectives

• Understand current accessibility barriers on current and proposed infrastructure design
• Discuss a range accessibility changes for a variety of different impairments
• Identify recommendations for inclusive improvements to infrastructure design