Urban Blue Spaces

Planning and Design for Water, Health and Well-Being

Simon Bell, Lora E. Fleming, James Grellier, Friedrich Kuhlmann, Mark J. Nieuwenhuijsen, Mathew P. White, Simon Bell, Lora E. Fleming, James Grellier, Friedrich Kuhlmann, Mark J. Nieuwenhuijsen, Mathew P. White

• Éditeur: Routledge
• Année: 2021
• ISBN:
  9780429509100
• Édition: 1
• Sujet: Architettura
• Sous-sujet: Pianificazione urbana e paesaggistica

This book presents an evidence-based approach to landscape planning and design for urban blue spaces that maximises the benefits to human health and well-being while minimising the risks. Based on applied research and evidence from primary and secondary data sources stemming from the EU-funded BlueHealth project, the book presents nature-based solutions to promote sustainable and resilient cities.

Numerous cities around the world are located alongside bodies of water in the form of coastlines, lakes, rivers and canals, but the relationship between city inhabitants and these water sources has often been ambivalent. In many cities, water has been polluted, engineered or ignored completely. But, due to an increasing awareness of the strong connections between city, people, nature and water and health, this paradigm is shifting.

The international editorial team, consisting of researchers and professionals across several disciplines, leads the reader through theoretical aspects, evidence, illustrated case studies, risk assessment and a series of validated tools to aid planning and design before finishing with overarching planning and design principles for a range of blue-space types.

Over 200 full-colour illustrations accompany the case-study examples from geographic locations all over the world, including Portugal, the United Kingdom, China, Canada, the US, South Korea, Singapore, Norway and Estonia. With green and blue infrastructure now at the forefront of current policies and trends to promote healthy, sustainable cities, Urban Blue Spaces is a must-have for professionals and students in landscape planning, urban design and environmental design.

Open Access for the book was funded by the European Union's Horizon 2020 research and innovation programme under grant agreement No 666773

The Open Access version of this book, available at

www.taylorfrancis.com/books/oa-edit/10.4324/9780429056161, has been made available under a Creative Commons Attribution-Non Commercial-No Derivatives 4.0 license

Part I
Water, blue space and health and well-being

The evidence base and how to use it

Chapter 1: Blue space as an essential factor in environment and health

George P. Morris, Himansu S. Mishra and Lora E. Fleming

DOI: 10.4324/9780429056161-3

Introduction

In this chapter, we attempt to locate the growing knowledge about the public health importance of urban blue spaces within a much longer evolution and history of understanding about the environment and human health. To begin with, we will briefly review the interest in physical environment as a determinant of human health, which dates back several millennia. Within an environmental frame of reference, we then present a more detailed analysis of the changing perspectives on human health and its determinants, from the beginning of modern public health to the present day – a period of approximately 200 years. With the subject matter of this book in mind, our review concludes that the provision and maintenance of urban blue and green spaces, aligned to the needs of the surrounding community, are wholly consistent with the most modern perspectives on public health. Specifically, the topic of blue space speaks to 21st-century public health aspirations going beyond health protection and promotion. These can be summarised as embracing prevention, equity and the urgent need to reduce damage to the Earth’s biophysical systems.

In his ‘grand narrative’ on the progress of public health from pre-Socratic times to the immediate post-Second World War era, George Rosen observed that humanity’s major health problems have always “been concerned with community life”, especially the control of transmissible disease, the management and improvement of the physical environment, the provision and safety of the food supply, medical care and the relief of disability and destitution (Rosen, 1958/ 1993). While noting the ever-shifting emphasis among these activities over time, for Rosen, they formed the basis of public health as it was understood in the 1950s.

From a 21st-century perspective, Rosen’s and other post-Second World War narratives (e.g. Sands, 1952) sound a rather triumphalist note, tracing progress in ‘taming’ epidemic and endemic diseases over nearly two centuries powered by science, medicine and improvements to the physical environment (Porter, 1999). Later, Thomas McKeown (1976), in an equally celebrated text, courted some controversy by attributing only a very limited role to clinical medicine in improving health outcomes and related population growth. Instead, he identified improved nutrition and environmental reforms as the major contributors.

Events since the 1980s have demonstrated mid-20th-century optimism over the containment of infectious disease to be misplaced, serving to emphasise the dynamic nature of public health. As Rayner and Lang have observed, “public health is wrapped around the reality of change” (Rayner and Lang, 2012). Rosen, Sands, and even McKeown, wrote at a time before the emergence of HIV, Ebola, SARs and, more recently, COVID 19; before widespread concern over the catastrophic potential of antimicrobial resistance; and, of course, well in advance of today’s understanding about the grave health implications of human impact on the natural world in terms of climate and other environmental change. Yet their observations concerning the centrality of environmental factors and implicitly the importance of towns and cities as crucibles for public health action are enduring. Indeed, these insights have, if anything, been reinforced by the socioecological and planetary perspectives which now dominate the public health discourse.

The classical perspective

Rosen’s definitive textbook, A History of Public Health, offers conclusive evidence of sanitary/environmental provision in ancient towns and cities, plausibly driven by a concern for community health (Rosen, 1958/ 1993). By drawing on the archaeological record, Rosen cites evidence from excavations covering different civilisations and multiple places dating back over 4000 years. Sites in India, Southern Europe, the Middle East and North America variously reveal evidence of sewer lines; water supply arrangements; and, within buildings themselves, bathrooms, drains and even water-flushing arrangements for toilets. Moreover, the layout of many ancient cities indicates a measure of conscious planning and, putatively, a form of building regulation.

However, the key common early point of reference for commentators on public health and its environmental dimension is the so-called Hippocratic Corpus (Adams, 1891). Set out in 62 books, the Hippocratic Corpus emanated from Greece between 430 and 330 BC. In their original content and their selective assimilation of ideas from others, the books of the Corpus are now considered the bedrock of western medicine. Importantly, they depart from ancient notions of diseases as products of evil spirits and the curative potential of magical incantation and potions (Frumkin, 2005). Of particular relevance to this narrative, these books were the first example of a systematic attempt to present a causal relationship between human disease and the environment.

The Hippocratic treatise, Airs, Waters and Places (Adams, 1891) introduced several ideas foreshadowing much later thinking on the environment and health. The book recognises, as we do today, the potential of food, water and wider environmental conditions to be sources of disease and, more generally, that health is unlikely to thrive in poor environmental conditions. By alluding to the health relevance of perturbations in discrete environmental compartments, the text presages a ‘compartmentalised’ way of thinking about the environment that many would recognise in conventional approaches to environmental management and indeed in environment and health activity (Morris and Saunders, 2017).

The Greek writers inevitably lacked a ‘planetary perspective’, as we would understand it based on 21st-century knowledge of the Earth’s systems, their connectivity and their fragility, yet, in parts, the texts convey acceptance that humans have capacity to damage the natural environment in health-relevant ways. Also consistent with current thinking, they saw humanity as situated in nature, subject to its rules and composed of natural substances – the body, within its environment, as a composite whole. This perspective lies at the core of 21st-century concepts such as ecological public health (Rayner and Lang, 2012), planetary health (Whitmee et al., 2015) and one health (www.onehealthcommission.org/en/why_one_health/what_is_one_health/).

It would be wrong, though, to imply a continuum of enlightened ecological thought stretching from Hippocrates over two millennia to the present day. In his book, Ecological Transition, published in the 1970s, the celebrated American anthropologist John Bennett observed that the history of the human species is marked by increasing denial of nature in, and by, humankind. Bennett believed this denial to be strongly stimulated by the Western Renaissance (with its anthropocentric orientation) and subsequently accelerated by later processes of industrialisation (Bennett, 1976; Rayner and Lang, 2012). Nash (2006) goes still further in asserting that the dichotomy that separates human beings from nature “underwrites the very discipline of history”.

Modern public health: from miasma to ecological public health

We will now direct an environmental focus on the more recent history of public health and to a period sometimes termed the ‘modern public health era’ – an interval starting from the early 19th century to the present day. We deliver our narrative in two parts. The first part takes its structure from a chronological framework created by South African-born, American epidemiologists Susser and Susser to analyse and predict developments in epidemiology (1996). Epidemiology is public health’s underpinning science and is the study of the distribution of disease in the population and the determinants of this distribution (Baker and Nieuwenhuijsen, 2008). Given our more specific focus on the environment, in the second part of our narrative, we uncouple and review the mix of ideas, principles, shifting cultural norms and so on which profoundly shape today’s perspectives on the environment in public health. We support this where appropriate by the use of conceptual models.

In the Sussers’ conceptualisation, the period from the early 19th until the closing decades of the 20th century can be seen as a succession of three ‘eras in epidemiology’. They identified, within each era, an underpinning paradigm concerning disease and its causation in which those seeking to understand and control disease adopted particular analytical and preventive approaches. We draw on this conceptualisation to reflect on how the role of environment in health was perceived within each era and whether there is a contemporary legacy.

From the 1990s onwards, conceptual models increasingly featured in the public health literature, including the subdiscipline of environment and health (Morris et al. in Nieuwenhuijsen and Khreis, 2019). Conceptual models are, in essence, simple representations of complex real-world situations. In public health, they are invariably schematic diagrams showing relationships among the broad domains whose interactions generate health, disease and inequity. In an interdisciplinary area like public health, conceptual models can become common points of reference, offering a common language (and visualisation) for discussion and collaboration among different constituencies of policy and practice. Some generic models may be ‘populated’ to analyse quite specific challenges or outcomes. Equally, they may support health impact assessment, gap analysis or the configuration of information or surveillance systems. However, in their simplest terms, conceptual models might best be understood as tools with which to think and communicate (McIntosh et al., 2007; Reis et al., 2015).

The environment in an Era of Sanitary Statistics

Most accounts of modern public health choose as their starting point the Industrial Revolution, first in Britain and then mirrored closely thereafter in mainland Europe and the United States. In Britain, at least, rapid industrialisation was spawned in the late 18th and early 19th centuries by a convergence of technological innovation, abundant coal supplies and a supportive economic and political context. Notably, industrialisation initiated and accelerated several major societal-level transitions (Morris and Saunders, 2017). The subsequent interactions of urban, energy, nutritional, economic, cultural and other major transitions have shaped the conditions for the pursuit of population health and equity ever since, defining and redefining the public health challenge (Rayner and Lang, 2012).

Industrialisation was famously the source of prosperity for some, but for others (notably the urban poor), life in towns and cities was characterised by poverty, squalor, severe overcrowding and an absence of wholesome water or sanitation. These conditions supported endemic diseases (such as typhus and tuberculosis) and sustained successive waves of epidemic disease (notably cholera) with attendant mortality. Also contributing greatly to chronic diseases and reduced life expectancy, and otherwise compounding the misery of urban life, were appalling working conditions and polluted air.

By choosing the term ‘Era of Sanitary Statistics’ for a period which endured for much of the 19th century, the Sussers discerned that the launch, and the early success, of the new public health movement was not founded on an intimate understanding of disease processes and causation (Susser and Susser, 1996). Rather, progress came through linking statistics on morbidity and mortality to a developing range of district-level social and environmental data, notably on overcrowding, housing and working conditions. The finding that the worst health was co-located with the most squalid insanitary and overcrowded conditions fuelled a sanitary revolution, which, over a period of several decades, would transform the living conditions of city dwellers, improving health and extending life expectancy. The promotion of sanitary measures – largely a mix of slum clearance and the provision of water-borne sewerage and piped water supplies – was entirely consonant with the prevailing ‘miasmic paradigm’ which postulated that diseases were spread through noxious vapours in air (Baker and Nieuwenhuijsen, 2008).

Several observa...