Places of care Articles

Healthcare spaces and the city

Health-conscious urban planning and health impact assessment

Giacomo Toffol, Laura Reali

Paediatricians working for a better world, Cultural Association of Paediatricians

By May 2020July 17th, 2020No Comments
Photo by Lorenzo De Simone

Due to the profound architectural and social structure changes of the last decades, roads, cars and parking lots have been occupying more and more the urban space of our cities, which are mainly designed to meet work needs. The spaces meant for children, pedestrians and cyclists instead have been increasingly limited by the progressive reduction of green areas. Urban traffic, with the resulting air pollution, is one of the primary risk factors in our living environments; it also limits children from moving around independently, thus adding the risk of obesity, which affects more than a third of the population aged 8-9 [1]. Home-based and sedentary lifestyles are associated to the progressive increase of non-communicable conditions, such as obesity and asthma, and also mental health conditions, the most frequent in Europe being depression [2]. Chaotic urban traffic is also responsible for car accidents, which in 2016 alone caused more than 10,000 injuries and 44 deaths among children younger than 14 years old [3].

The current urban environment, the parents’ work schedule, the insufficient measures to balance work and family life, the misbelief that air pollution only affects the outdoor air, and the fear- whether founded or not- of traffic and strangers, force children to spend most of their time indoors. Their resulting isolation and the virtual world that they’re increasingly immersed in negatively impact their physical and mental development as well as their main activities – games, imagination, creativity and social interactions – thus also limiting their natural need for independence [4]. Richard Louv defined the “nature-deficit disorder” as the progressively poorer familiarity with nature and the outdoors [5].

Cities then – despite seemingly richer and more stimulating than rural areas – can damage the brain development and wellbeing of children by causing a state of chronic stress [6]. The only facilities where children and teenagers can fight chronic stress and nature-deficit are the public parks and the green and wooded spaces. It’s fundamental to have these areas in the vicinity of homes to promote the wellbeing of children and a better weight control and mental balance, thanks to the opportunity to practice outdoor activities and sports that they offer [7].

Green spaces are just like true “lungs” for our urban spaces. They can halve the concentration of PM10 and reduce the ozone levels in the atmosphere as well as the degree of noise and temperature of the environments, through the surface and movement of leaves [8-10]. Therefore, the simple presence of green and wooded areas represents the simplest and most cost-effective mitigation strategy to fight the increasingly frequent heat waves resulting from climate change. Overall, the availability of public green areas in our country is not that disappointing, with an average of 32,8 m² per inhabitant. Nevertheless, there is a great variability among Italian regions and these areas are often mismanaged and actually inaccessible [11]. They should allow free access to the public, and in particular free physical activities that do not depend on pre-existing sports facilities, in order to both reduce social inequality and favour under-privileged social classes, and to guarantee all children the freedom of movement and the right to play. It was demonstrated that well-equipped parks with organised playgrounds meeting the needs of different age groups tend to be utilised more [12]. It wouldn’t be that difficult to create more of these, given the benefits they bring.

References
[1] Il sistema di sorveglianza OKkio alla SALUTE: risultati 2016.
[2] Wolfe I, Thompson M, Gill P, et al. Health services for children in western Europe. The Lancet 2013;38:1224-34.
[3] Istat. Incidenti stradali anno 2018. Pubblicato il 25 luglio 2019.
[4] McCormick R. Does access to green space impact the mental well-being of children: a systematic review. J Pediatr Nurs 2017;37:3-7.
[5] Louv R. Last child in the wood. Chapel Hill: Algonquin Books, 2005
[6] Tost H, Champagne  FA, Meyer-Lindenberg A. Environmental influence in the brain, human welfare and mental health. Nat Neurosci 2015;18:1421-43.
[7] Uga E, Toffol G. Ambienti naturali e salute mentale. Quaderni ACP 2019;26:a&s.
[8] Nowak DJ, Hirabayashi S, Bodine A, Greenfield E. Tree and forest effects on air quality and human health in the United States. Environ Pollut 2014;193:119-29.
[9] Cohen P, Potchter O, Schnell I. The impact of an urban park on air pollution and noise levels in the Mediterranean city of Tel-Aviv, Israel. Environ Pollut 2014;195:73-83.
[10] Sanusi R, Johnstone D, May P, Livesley SJ. Street orientation and side of the street greatly influence the microclimatic benefits street trees can provide in summer. J Environ Qual 2016;45:167-74.
[11] Istat. Il benessere equo e sostenibile in Italia, 2019. Roma: Istat, 2019.
[12] Cohen DA, Han B, Isacoff J, et al. Renovations of neighbourhood parks: long-term outcomes on physical activity. J Epidemiol Community Health 2019;73:214-8.

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