Using Your Legs in a City Designed for Cars

The new Sustainable Development Goal (SDG) 3 – ‘Ensure healthy lives and promote well-being for all at all ages’
– recognises that large unmet health needs are equally present in developing and developed nations.

Goal 11 – ‘Make cities and human settlements inclusive, safe, resilient and sustainable’ – seeks to also address rising unmet needs where they are concentrated, in cities in both low- and high income countries. Since 2014, more than half of the world’s population lives in a city and by 2050, urban populations are set to grow to two-thirds of the population globally.1 And there is a close link between urbanisation and health.

Urban health

Urbanisation is creating a wide range of new opportunities and challenges. On the one hand, people are drawn to the social and economic possibilities of urban life. On the other hand, urban development is putting strains on services and infrastructure. And the way that cities are designed and run influences how people live and can be both an enabler of – or a barrier to – good health.2

As urbanisation increase, so does the number of people with diabetes living in urban areas. Today 65% of people with diabetes live in urban areas which is equivalent to approx. 252 million urban dwellers and the number is set to increase.3 This poses a major threat to a sustainable city life. Drivers play out differently from city to city and they span infrastructural design and barriers to physical exercise4 to fast-paced working environments2 and unhealthy diet.5

Partnering up to change diabetes in cities

A programme – Cities Changing Diabetes – has set out to increase knowledge about the drivers of urban diabetes and how to tackle the issue. The global programme is a partnership between University College London (UCL), one of London’s leading universities, Steno Diabetes Center, a world leading institution in diabetes care and prevention, and Novo Nordisk, a global healthcare company with more than 90 years of leadership

in diabetes care. Together with local partners, the programme is mapping the problem in five ‘study cities’ across the world: Mexico City, Copenhagen, Houston, Tianjin and Shanghai.

During the past year, UCL and Novo Nordisk have conducted research training sessions in each study city. We asked Louise Hesseldal, Project Manager in the Cities Changing Diabetes programme, to share some of her reflections from Houston where one in 10 has diabetes.6

A city designed for people in cars

We must understand the challenges of diabetes in urban areas. One way to do so is by conducting so-called ‘Vulnerability Assessments’. It’s a qualitative research method developed by UCL which explores the social and cultural risk factors in regards to diabetes in urban areas – for example by exploring how people are exercising, or why they are not exercising at all.

In Houston, ten test-persons from the Houston area had been recruited to join this training session. The session allows the fieldworkers to practice interview techniques and test the questions on ‘real’ people. Interestingly enough, the majority of the people attending the training arrived by car. As one of them told me:

“Houstonians always go by car – we love cars.”

They told me that owning a car is crucial when living in Houston due to the long commute times. Even for short distances, they all preferred to take the car because it was simply too hot and humid to walk or bike anywhere. Their stories about the car-culture in Houston confirmed my first impression of the city as a town designed for people in cars.

Mall-walking the talk

Another interesting aspect of living life in Houston is that some people go to shopping malls to cool down – and even to exercise. It is called ‘mall-walking’, and apparently it is a well-established concept in Houston. Some malls open their doors early in the morning for walkers and provide formal mall-walking-programmes as part of their service offerings. And in some way I understand them: why power-walk in 80 degrees weather, when you can do it in a clean, safe and climate controlled mall?

The following day Anna Volkmann, my partner-in-crime and researcher at UCL, and I decided to go for a short afternoon-walk in the neighbourhood close to mid-town where we stayed.

We went by some nice green areas with playgrounds facilities for children and plenty of space for exercise and one observation was clear: there was no people walking, playing, jogging or bicycling.

We walked around in the area, trying not to block the road for the many cars driving there. A hard task, as there was almost no sidewalks or bike paths. We came by a mall and went inside to cool down – and we took the opportunity to go for a little mall-(power)-walk before we took a nice air-conditioning car back to the hotel.

Houston solutions

The solution to the challenges in Houston might not
be to establish more mall-walk-tours. Nevertheless, it illustrates the importance of looking into innovative ways of improving healthy living in Houston while taking into consideration the social, cultural and environmental factors of the equation.

The Cities Changing Diabetes programme in Houston has capable stakeholders involved from many different fields, and it is going to be interesting to see how the insights from the vulnerability assessment will be translated into new solutions to improve healthy living in Houston.

And when combined with insights from the other study cities, we hope the programme will help drive wider action around the world. It has been said that when the history of the 21st century is written, it will be the story of cities. Let’s make it a healthy one.