I rarely publish personal creative writing, not least because I have a strong suspicion that if it were classed as poetry it would really fall under stream of consciousness or rumination. Anyway, since finding myself largely immobile following a broken clavicle after a misplaced enthusiasm for a trial session of tag rugby (I know), words have been typically helpful in filling the vacuum from press work, painting and living as normal. ‘Road 1.0’, ‘Jonction’, ‘Pachinko’ and a final jottings that really wants to be called ‘cheese soufflé’ follow, written recently and in the past 12 months.
Abstract: 2016 is a critical year for sustainable development warranting this urban health proposal for Cambridge. With exponential population growth forecasts and some of the highest levels of homelessness, air pollution and house price rises across UK cities, interventions must be multi-sectoral. Evidence-based recommendations are to: 1) develop affordable housing prioritising settlement for the destitute identity group, and 2) reduce air pollution through improved safety and attractiveness of pedestrian areas. Review and target periods of 12- and 36-months will support and shape this vision for a modern, healthy city by 2030.
It was a dreary morning when the wheels / Rolled over a wide plain o’erhung with clouds, / And nothing cheered our way till first we saw / The long-roofed chapel of King’s College [Cambridge, William Wordsworth]
Wordsworth’s verbal mapping and visual transit into Cambridge is not so unlike our own. To know Cambridge is to come to it afresh, travelling into the urban nexus with the potential to offer recommendations that benefit from perspective: both academic and geographic. The city’s low lying above sea level and development height restrictions means that, as for Wordsworth, it remains visible to the unaided human eye across the surrounding lowlands. Unlike Wordsworth’s 18th-century movement across ‘wide plain’ into an urban nexus marked by King’s College Chapel, current comers register the place as a city – one which was conferred this status in 1951 in recognition of its history and continued behaviours as a productive space. Whether via East Anglian rail tracks on a 46-minute train journey from London’s King’s Cross station, or along the M11 or A14 roads, or rising through the system of locks and weirs as a bargerman, the city evidences the challenge of any modern urban hub: how to support the health of its users while ensuring sustainability for future peoples. By considering interactions within the urban system, forward-looking policy can be employed to change and benefit the health of Cambridge, noteworthy for its status as a magnet to people variously acting as ‘commuters’ of business, trade, travel and intellect. Cambridge’s citizens are a product of their city – and vice versa.
Through this overview of existent urban health policies and projects, the Cambridge polis has demonstrated its willingness to consider and customize initiatives from across the world to most effectively meet local needs. This wide-reaching outlook relates the local to global health, along a people-community-planet pathway (as employed by the Cambridge Sustainable Food Charter, 2014). This report offers renewed vision for Cambridge between 2016-2030 and negotiates recommendations in terms of amenability, costing, risk and feasibility. Cambridge has been lauded a pioneering city in terms of academia and more recently business, with the adoption of the ‘Silicon Fen’ appellation (referring to the regional aggregation of biotechnology based businesses) and one which is developing. In the Centre for Cities (2016) list, Cambridge was ranked sixth of the ten fastest-growing cities by population in the UK with an annual growth rate of 1.4%. Within this demographic swell, the Cambridge City Council’s Improving Health Plan (2008 p5) reported that ‘the number of people aged 65+ in Cambridgeshire is expected to rise by 60%’ by 2021. As a result of this context, this report focuses on the urban challenges of sustainable settlement and air pollution, recommended for their immediate relevance and demonstrable capacity to influence urban-related health outcomes for the major share of this population.
To date, sustainable settlement and affordable housing initiatives have frequently been included in urban health reports pertaining to the Cambridge city region in recognition of its considerable tourist capital and population growth. There is, however, room to improve. Such reviews have considered this demographic swell conceptually as a case of more people equating to a need for more houses, rather than recognizing the mobility and heterogeneity of population sub-groups. Indeed, Yvonne Rydin (2012 p1) highlights that average levels of health witnessed in Cambridge: ‘hide the effect of socioeconomic inequality within urban areas’. Urban poverty exists and persists in Cambridge. Last year, the main regional news outlet Cambridge News (2015) reported a 41% increase in homelessness associated with a range of factors: job losses, welfare reform and benefit sanctions. At present, there are some group-specific support services such as the University-based Streetbite society and Jimmy’s homeless shelter working on a short-term care model. For many of these individuals, their homelessness is a symptom of being out-priced from a depleting stock of affordable housing. Indeed, according to the Centre for Cities (2016) report, Cambridge came out top in terms of the highest rises in house price with a staggering 12.5% annual growth across 2014-2015 [Figure 1]. So too, it was ranked alongside Oxford and London as the least affordable cities in relation to the British average. Existent plans to increase the housing stock and to push through welfare reforms while demonstrative of sound regulatory structures and nurturing governance, overlook the need for new housing stock to be targeted to specific audiences within the overall population swell.
A similarly broad stroke, if simplistic, approach is witnessed in existent management and reduction of air pollution measures in the city. Mark Slade (ITV NEWS, 2016) remarked that: ‘air pollution is a problem for people’s health, we know that it is a problem for the environment’. Meanwhile, local think-tank Cambridge Past, Present & Future (2016) report that carbon dioxide emissions in Cambridge regularly breech UK and EU legal limits, contributing considerably to elevated air pollution and ‘must be tackled as a chronic public health issue’ directly associated with morbidity. Once again, this report advocates starting with the urban citizen and their unique, decentralized patterns of movement within – and use of – the city centre. I would invite you to imagine that you are rushing along King’s Parade to attend a choral service at King’s College Chapel on a Sunday morning [Figures 2, 3]. You are faced with a transit conundrum: cycle and plough through pedestrians who step onto the Parade for that all important Instagram snapshot; walk and risk being late for the service, or jump into a Hackney carriage for a horn-blaring drive. Scale-up this scenario to a weekly occurrence and this seemingly flippant narrative becomes one in which all three options have quantifiable urban, physical and psychological health impacts pertaining to air pollution. As an existent conundrum, the City Council has implemented traffic-centric actions such as guided bus routes and removal of Park & Ride charges so promoting public transport use and reconsidering personal vehicle use via the regional CamShare scheme. As a corollary, there has been effective promotion of walking habits. Certainly, the objective to reduce air pollution has the associated effect of protecting the local environment. As has commonly been attested, a healthy city is one which is pedestrian friendly. According to Clayton Lane of the Institute for Transportation and Development Policy, ‘the pedestrian is the indicator species for a sustainable transport system – and, it turns out, for a healthy one’ (DeWeerdt, 2015). Indeed, many thoroughfares in Cambridge’s centre are pedestrianized but what does this mean in practice? Too frequently this equates to narrow or poorly demarcated pedestrian areas such as the sidewalks of King’s Parade [Figures 1,2] that are regularly transgressed by pedestrians. So too, these zones are not always functional in terms of personal aesthetic or evaluations of security. In summary, current measures to reduce air pollution in Cambridge are a piecemeal effort that requires greater nuancing. As Executive Councillor for Planning and Climate Change Tim Ward identifies, ‘although the City Council has undertaken a significant amount of action in the past five years … climate change [and air pollution] still presents very significant risks’ (Cambridge City Council, 2012).
Many existent initiatives in the county and at a global health level reach their published expiry date in 2030, namely the Cambridge 2030 Vision project, and more latterly the Sustainable Development Goals. For ease of monitoring and comparison, this end-date has been chosen to achieve the proposed targets as below delineated to improve the health of persons living in Cambridge. The individual human user and consumer of the urban space must be the main beneficiary for the proposed set of initiatives, reaping complementary benefits, with many of the lower scale actions immediately delivering quantifiable changes and improvements in health. Furthermore, by appropriating the model of Cambridge University’s 2010-2020 Carbon Management Plan, there will be 12- and 36-month targets for policy development and management drafted in the Gantt Chart following:
This report recommends a 2030 target of affordable housing for all, a reassessment of council and social housing selling practices and prioritisation of settlement for the destitute population. This housing must be socially sustainable factoring in the projected rise in city house prices to ensure that residents are not out-priced, possibly for the second time. This will reduce the numbers of street-dwelling destitute so improving urban sanitation but will also augment the image of the city with attractiveness key to its magnetism for commerce and creativity. This intervention will require the appropriation of disused buildings, promotion of room-to-lets within personal properties for short-term provision and a reconsideration of brownfield sites ‘that might have development potential’ (Cambridge Past, Present & Future, 2014) within the urban green belt. This process will reap energy efficiency co-benefits by adopting the most advanced energy efficient repurposing build methods. Meanwhile, air pollution will be reduced through a comprehensive review and overhaul of pedestrian areas and walkways in the city to promote carbon efficient modes of movement and a transition from vehicle use. Indeed, the archaic limits of the city are marked by the green belt so improvements made in the present must be sustainable on-going in a city uniquely preserved from patterns of urban sprawl due to its compact nature and inherent walkability. The majority of pedestrian areas in the city are also cycle routes. The two can productively co-exist, but there must be clear zoning [Figure 5], introduction of pedestrian lanes in the wards furthest from the market epicenter and improvement of existent pavements. For instance, the walkways straddling Sidgwick Avenue [Figure 4] are inhospitable and represent a trip hazard as tree roots have surfaced. In this particular instance, an add-on benefit of resurfacing would be to consider the attractiveness of both walking routes and their value to users in terms of commodity and safety. Van Cauwenberg et al. (2012) support this imperative to make pedestrian lanes ‘pretty’ and recommend that tree planting becomes central – rather than ancillary – to road planning, possibly encouraging users to walk further. Many routes would benefit from a green lane, implemented through citywide planting of trees and maintenance of the existent stock. In addition to the beneficial carbon offsets of increased canopy coverage in the city and associated disruption of the urban heat island effect (Corburn, 2009), walking promotes health. Indeed, Cambridge City Council’s brochures promoting 1-3 mile walking tours and pedestrianized commuter routes would satisfy the UK government’s weekly physical activity recommendations of walking two 1-mile journeys daily (Walking for Health, 2013). The associated global health benefits of adequate physical activity acts prophylactically warding against non-communicable diseases and improving mental health and combating stress, (Klaperski et al., 2013) in turn reducing the local health system load.
These recommendations function across comprehensive plans projecting towards 2030, but are also characterized by meaningful, microcosmic behaviours and actions. Indeed, Cambridge will always be a city in flux; the nerveline of the River Cam symbolizes transition, arrival and departure; but the landed area will remain largely constant given planning restrictions and limited scope for urban sprawl. By adopting these initiatives that prioritise sustainable and cost-effective repurposing, by 2030, Cambridge will have secured its position as a self-supporting urban centre able to share its models of urban heath, affordable settlements, social progress and carbon efficiency to other cities.
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Footer panorama: The River Cam. KBJX6, 2015.
Header panorama: From King’s College Chapel. A. Bow-Bertrand.
Every month MdM recommends an anthology or monograph for readerly perusal. Inevitably, these suggestions spark discussion both on and off-screen, including a recent request for a showcase of the other global health blogs (and vlogs) that I return to again and again.
The below is a wild but wonderful selection of my most tried and tested reads as well as some more recent discoveries, to which I am always delighted to add. Please comment below if there are others we should know about.
Dr. Martin has achieved cult status amongst student global healthers for his brand of accessible, bitesize updates on careers, policy and research each week. While this is all published on his blog , his YouTube channel is really worth following. Offering a platform for entry-level professionals across NGOs and PPPs, his vlogs also feature charmingly dodgy web-cam use from his token resident global health elder, Terry Schmidt. Would recommend plugging in your sound and skipping the visuals or just heading straight to the podcast playlist.
Categorised by part of the world, this online journal showcases the writings of University of California (SD) students of international affairs. With a considered scientific angle, the editor’s blog explores contemporary issues making national news. Many of the blog titles err towards clickbait, but looking beyond the excessive use of the rhetorical question the content invariably represents a skilful distillation of complex issues such as climate change into academic yet accessible reads.
Admittedly, I spent a lot of my spare time at university as Press Officer and Blog Editor for this think tank, but the content is noteworthy for its breadth and tangible policy implications. Spanning topics and commissions as diverse as Action Against Hunger to leprosy missions with Lepra, the blogs track the progress of policy work for external organisations generally over 12-month periods, drawing on the most current comment and research in their respective focal sectors.
Less traditional blog, more broadcaster with accompanying transcripts, NPR’s ‘Goats and Soda’ publishes stories from a changing world with a prioritisation of health and development concerns. As a starting point, I would recommend reading their blog that details how the name ‘Goats and Soda’ came about. There is a lightness of touch in all of their work as well as great visuals and some outstanding interview pieces. Not always topical, but a constant source of inspiration.
Perhaps slightly biased given that I was fortunate enough to be commended for my suggestion of an untold global health story in their recent competition, for which the I wrote an article on the overlooked killer, Kala Azar (available here), but with due credit: Global Health NOW is an initiative from the John Hopkins Bloomberg School of Public Health. One of the most prolific of all these recommendations, GHN staff scour the daily news, reports and published research for the most interesting reads, compiling these into their e-newsletter which is disseminated along with social media coverage. A favourite for spotting new writing and noteworthy topics.
LinkedIn groups: Global Public Health
LinkedIn’s largest public health group, GPH is for those working professionally or studying areas of international public health importance, with a focus on health issues impacting low- and middle-income countries. One of the benefits of joining such a group is that discussion is often more lively and instantaneous than on blogging sites. Forums associated with these groups facilitate a blog conversation that extends beyond the confines of the written piece.
The Lancet Global Health journal is a comprehensive periodic read, but the tangential blog platform is worth dipping into. Guest and regular writers cover a host of topics from access to medicines, blood donations, urbanisation and collectively take a macro look at challenges within the field and consider possible answers to these.
Sadly this series finished last year, but thankfully the blogs have yet to be archived. Sarah Boseley is a magical writer, making the unfathomable feintly outlined and the tragic compelling rather than hopeless. Described as ‘The Guardian’s health editor on the politics, policies, philanthropy and progress being made in the fields of global health and aid‘, you can look back through titles that consider the policies and politics of Pharma, the hidden costs of healthcare in conflict zones and commentaries that consistently explore issues from every angle.
Comment below with your own must-reads.
Image Credit: A. Bow-Bertrand
On a grey February evening, the lure of complimentary wine and cheese, and a great track record of talks was enough to find me at the University of Westminster’s Fyvie Hall. There, James Wates, CEO and Chairman of the Princes’ Trust Built Environment Leadership Group and Vice Chair of the Queen Elizabeth’s Foundation for Disabled People was presenting ‘Why Professionalism is as important to the built environment as it is to medicine‘.
You may be wondering how there can be crossovers or comparisons drawn between the construction industry and the field of medicine. But both fundamentally prioritise quality of care and safeguarding of human welfare. Indeed, Wates drew on our immediate situation, highlighting that it was essential for us to have cover and warmth in order for the talk to proceed. So too, in order to survive, we need buildings in the form of schools and hospitals, shelter in the form of a roof on our homes and functional infrastructure to provide sustainable supplies of potable water.
Wates then cited the comparable need for teamwork between the two sectors using John Godfrey Saxe’s 1878 analogy (by way of Indian parable) of five blindfolded builders touching an elephant (one touched the trunk and thought he was dealing with a hosepipe; another a leg and thought it was a tree, another the tail and surmised it was a rope, yet another the body of the beast and thought it was a wall, and finally another touched the tusk and thought it was a sewer). Only through communication, cooperation and prioritisation of what Wates called ‘professionalism’ could the safety and suitability of the finished product (which he related to the medical ‘patient’ or bodily construct) be ensured.
Where mistakes are made on a construction project, they are, according to Wates, frequently irreversible as is the case in much of medicine in which: ‘good patient care turns into misery and despair; for the built environment projects that turn bad can damage so much. The advantage the built environment professional has is scale; we do big things that can last for generations’. To me, it is problematic to suggest that professionalism is of comparable importance to the building industry as to medicine. Or, rather not that it isn’t important but to question whether they are even synonymous.
Indeed, medicine, unlike construction, is a profession in the vocational sense. So to consider professionalism as a quality of it is to overlook the very composite quality of this field. The two are not comparable, and can only be contrasted to a certain extent. Certainly, I agree with Wates’ comment that ‘the built environment and medicine have a lot in common. Each have a number of different specialisms which seek to address particular issues. When it works it all goes well, when it doesn’t then there are major problems and we end up losing focus on what we are trying to achieve’.
However, in spite of the caveats, there is real interest in this field in terms of medicine and global health, most particularly in how the built environment can impact user and client wellbeing. We have all read reports of office workers who sit near to a window who sleep better at night and those who report greater work satisfaction if there is sufficient communal space within their workplace. This is one facet addressed by and in the area of urban health, but which demands a discourse of management rather than ‘professionalism’.
Image Credit: A. Bow-Bertrand