Human Cities: increasing urban wellbeing

Continuing the Conversation

Our aim in publishing this green paper is to stimulate discussion. To bring together people who are thinking innovatively about what makes cities fit for humans, to foster discussion and debate, and to promote fresh thinking in the quest for solutions.

We will be running a number of events exploring the themes in the green paper. To register your interest in participating, please visit www.thermegroup.com/humancities.

We are always extending our global network of stakeholders and partner organisations. For enquiries regarding opportunities for collaboration, based on the themes of the green paper, please email humancities@thermegroup.com.

To learn more about the Therme Group vision, projects and organisation, please visit www.thermegroup.com or follow us at linkedin.com/company/therme-group.

Editor: Geraldine Bedell

© Therme Group RHTG AG and its licensors.

PREFACE

We are living in an increasingly polarised and divided world. Our global community has been driven into progressively binary world views. Every action we take seems to represent what we oppose. Technology promises to connect us all, but ideas are largely shared in ‘echo chambers’ of like-minded people.

At Therme Group, we see a future with new ways to connect, share ideas and evolve our thinking. Bridging the divide between points of view in a way that can benefit us all. Making positive progress towards a better and fairer future, and benefiting the wellbeing of both people and planet.

The need for this positive new approach is particularly evident in cities, where communities are isolated and insulated from each other based on wealth, class, politics and ethnicity. Research into this paper was underway prior to the coronavirus crisis and has continued throughout the pandemic. Due to Covid-19, we are now seeing a greater focus on the challenges of urban life and an accelerated drive for cities to prioritise the health and wellbeing of their citizens.

Therme Group is future-focused and part of the solution. We see an opportunity to create a human city, with the wellbeing of the individual connected to that of the wider community. We envisage unifying spaces where people from every element of society can gather together in environments that are safe, natural and accessible.

We have created an experience founded in the relaxing, unifying and health-giving effects of water, nature and culture. This essential part of daily city life is a place to meet and share ideas in an environment optimised for health and wellbeing.

In every city we serve, we make a profound impact on the wellbeing of millions of people. But we are also part of the wider city system, an interconnected structure that touches on every aspect of life. In this publication, we are seeking to further the global wellbeing movement. The connections and debates the paper develops will contribute to our mission to improve wellbeing for all. It will enable us to work together with all people invested in the collective wave of innovation towards human cities of the future.

DR. ROBERT C. HANEA Chairman and CEO of Therme Group

INTRODUCTION

We are engaged in a giant evolutionary experiment.

1. https://www. un.org/development/ desa/en/news/population/2018-revision-of-world-urbanization-prospects.html

2. For discussions of this, see for example: J Lawrence Broz, Jeffry Frieden and Stephen Weymouth: Populism in Place: The Economic Geography of the Globalization Backlash, International Organization, September 2019; David Goodhart, The Road to Somewhere: The New Tribes Shaping British Politics, Penguin, September 2017.

to 68% by 2050.1

Such a startling shift over a mere few hundred years would be a shock to the system of any organism - and for humans, it has not come without problems. We have been reminded by the coronavirus crisis of some of the fragilities of cities, including poverty and overcrowding. Reduced congestion, noise and pollution have made us realise how, in normal times, they often do not provide ideal living conditions. With uncertainty about the long-term mental health implications, we are reminded of problems that may be less tangible but are equally hard to manage - loneliness, anxiety, and stress.

We embarked on our history of urban mass-migration without much sense of the consequences. Cities tend to separate us from the natural world, and in an era of climate crisis, inequality and global pandemics, we need to think beyond their effect on individuals and consider their impact on the planet.

We can certainly be optimistic about the future of cities, but it is clearer than ever that they will have to adapt to shed some of the aspects of city living that are bad for individuals, for sociability, and for the environment. In this Green Paper, we look at some of the ways they might do that better.

Cities continue to attract ever more people for good reason. Urban life has always offered freedom from traditional authority; cities are places where individual selfexpression is often newly, and thrillingly, possible. By bringing together people from disparate backgrounds and with different ideas, cities foster exploration, creativity, invention and innovation. One reason the populist parties that are on the rise in so many countries often seem suspicious of cities is that they are places where tolerance of difference and openness are often seen to work.2

Cities can be exhilarating, creative and purposeful but urban life can also be overwhelming. In some cities, there is little green or blue space. There are high

Over the course of human history, only a tiny proportion of people have ever lived in cities. Human beings have evolved over millennia in response to the natural environment, to seasonal and circadian rhythms. Yet today, over half of the world’s human population lives in the man-made environment of cities, and, according to the UN, this figure is projected to rise

3. https://wellbeingeconomy.org/ iceland-government-unveils-wellbeing-framework

levels of obesity. Crowded roads are thick with toxic fumes. People often spend hours commuting in unpleasant conditions (maybe this will change, maybe it won’t). Many of us sit too much and get too little exercise. Levels of anxiety, depression, and mood disorders are high. Many people work long hours, often in precarious occupations. Even those in relatively comfortable circumstances worry about technology, competition or health shocks undermining their jobs. The economic future looks precarious. Social inequality is often stark and highly visible, breeding resentment, fear and alienation.

Cities are multifaceted - highly complex adaptive systems - and the question of what makes people thrive in urban settings has engaged researchers from a wide range of disciplines - sociology, ethnography, anthropology, geography, politics, environmental science, physiology, psychology, economics, art, design, architecture and culture.

In this paper we draw insights from all of these disciplines to offer an overview of the current thinking on wellbeing in cities. Even before the pandemic, there were signs that policy was increasingly being framed through a lens of wellbeing. Iceland, for example, recently established a framework of 39 indicators covering social, economic and environmental dimensions of quality of life against which to judge policy initiatives.3 There could be political pressure in the post-coronavirus world for more of this: recent months have brought a new awareness not only of our physical but also our mental, social and cultural vulnerabilities. In addition to exposing cities’ fragilities, however, the pandemic might also suggest ways in which they can be more resilient.

Our aim in publishing this Green Paper is to stimulate discussion. To bring together people who are thinking innovatively about what makes cities fit for humans, to foster discussion and debate, and to promote fresh thinking in the quest for solutions.

At Therme Group we believe that we have a part to play. Our business combines technology and nature to promote a culture that draws on deep-rooted traditions while also being essentially innovative.

SYSTEMS AND EMPATHY

Sometimes the assumption is that cities are systems in need of fixing. The smartcities debate has been a case in point: the implication often seems to be that if technocrats can only collect enough data, everything can be fixed.

But cities are not simply data points. They are living organisms made up of millions of people with preferences, prejudices, passions. Cities have an impact on their inhabitants; and their inhabitants, in their millions of day-to-day actions, have an impact on the city. It is a constant, dynamic process. Technology may be able to sort out some problems efficiently - track-and-trace apps may turn out to be successful approach - but it needs to be balanced with a wider sense of what makes for wellbeing.

People don’t want to see themselves primarily as part of a mechanical system designed for efficiency and productivity. Many of the things we care about mostour relationships with other people and with the natural world, our care for others, love, dignity, pride, respect - cannot be quantified. They cannot be turned into data. You can’t put a monetary value on them. Which is not to say that money is irrelevant to wellbeing - poverty and inequality are undeniably associated with higher levels of mental distress - but there is only so much you can count. And counting doesn’t always tell you what matters. As the coronavirus pandemic showed, the people we deem essential in a crisis are often quite poorly paid.

As our often visceral reactions to cities suggest, our environment has an emotional as well as a physical impact upon us. Cities are not abstract, mechanical systems with human beings mere datasets moving through them more or less efficiently. To maximise wellbeing in cities, we need to apply emotional intelligence: to see cities and our interactions with them holistically.

We need empathy as well as systems. We need to discover what is human in cities. We need to appreciate how cities can sit alongside, respond to, and belong in the natural world and work from there.

5.

Stevie

WHAT IS WELLBEING?

Edward Diener, the seminal theorist of wellbeing, argued that it consists of ‘three distinct but often related components… frequent positive affect, infrequent negative affect, and cognitive evaluations, such as life satisfaction.’4

The fact that wellbeing involves subjective feelings based on moods and emotions (as well as conscious judgements of quality of life) makes it a concept difficult to get hold of and hard to measure.5 Discussions of wellbeing frequently dodge the tricky issue of defining exactly what it is, and this ambiguity can make it seem a slippery concept. Though we all instinctively know what wellbeing feels like, and, conversely, what it feels like to be lacking. Therme Group is undertaking a five-year research programme on the philosophy and science of wellbeing with Cogito, the University

We are a product of a connected nature. We are not standing next to nature, we are nature. We are in every way a product of it, and I believe that we disconnected ourselves from this universal truth.

DR. ROBERT C. HANEA Chairman and CEO of Therme Group

4. Edward Diener (1984). “Subjective well-being”. Psychological Bulletin. 95 (3): 542–575.

See for example

C. Y. Yap et al, The Effect of Mood on Judgments of Subjective Wellbeing: Nine Tests of The Judgment Model, J Pers Soc Psychol, December 2017, 113(6): 939-961

of Glasgow’s epistemology research group, in an effort to unpick some of these issues.

As well as knowing wellbeing when we see it and feeling its absence when we don’t, we also instinctively understand the inextricable relationship between wellbeing and the environment. You are much more likely to feel a sense of wellbeing on a quiet beach or in a forest glade than you are while waiting to be seen in hospital. Ugly, neglected places, as found in some parts of cities, are likely to generate a sense of hopelessness and a feeling that no one cares. Humans intuitively respond positively to natural greenery and the presence of water. In many of the growing megacities of the world, it is hard to feel any connection with the natural world at all - and that has an impact on all the other interactions we have in a place.

If inhabitants of cities are in a constant cycle of being influenced by their environment and influencing it in turn, the dynamic interplay involves not only the intellect but also the emotions: it is a fully human process, physical, emotional, social, and spiritual. It engages everything about us.

In this paper, we look in turn at these aspects of wellbeing in cities - physical, mental, social and spiritual. In reality, they overlap and are interdependent. All of them are underpinned by our relationship to our environment: we know, to take one relatively minor example, that people who can see greenery from their hospital windows recover better from heart surgery.6

Looking at cities through the lens of wellbeing leaves us with no alternative but to focus holistically. If citizens are to thrive, cities must be responsive to people in all their humanity - and to all of their citizens. Wellbeing cannot be solely the preserve of those who already have the basics covered - financial security, housing and health. It isn’t (despite the way the term has sometimes been used) an indulgence for the affluent, an optional bit of consumerism. When it comes to health, we are affected by the health and behaviour of other people.

Therme Group believes that wellbeing for all is a matter of natural justice. It is also a practical necessity. Global disease reminds us of John Donne’s maxim that ‘no man is an island’. Our vulnerability to one another is often exacerbated in cities, which involve proximity to other people, a great deal of moving about, and complex economies in which the rich are dependent, in a crisis, on the immigrant hospital cleaner and the female supermarket worker.

People’s relationships to the places they live, work and pass through have an impact on the many others against whom they jostle and bump up against in cities minute-by-minute, hour-by-hour, day-by-day. Not even the super-rich can isolate themselves entirely. Higher levels of wellbeing across the board make for a more civil and agreeable city for all, and allow everyone to flourish.

6. Roger S. Ulrich, Health Benefits of Gardens in Hospitals, Jan 2002.

7. https://www. linkedin.com/pulse/ we-ancient-creatures-living-moderntimes-oliver-payne/

8. https://www. health.harvard. edu/blog/saunause-linked-longer-life-fewer-fatal-heart-problems-201502257755

STARTING FROM THE HUMAN

At Therme Group, we believe that we have an important part to play in helping to increase the wellbeing in cities of the future.

That means starting from the human - which in practice means looking not only for innovations, but also at what has sustained people for millennia. ‘We are ancient creatures living in modern times,’ as Oliver Payne, author of Inspiring Sustainable Behaviour, puts it. ‘We are fit for a world that no longer surrounds us.’7

Many of the most reliable ways of promoting wellbeing reach back into the roots of our culture, taking instincts and preferences that humans have had for generations and refashioning them for a different world. Today we can scientifically measure whether sauna bathing is good for us and learn that it lowers blood pressure and is beneficial to those at risk of heart disease.8 But the benefits of sauna bathing, as of thermal baths, have been well understood by those for whom they are part of the culture, for centuries.

At Therme Group we work with nature, technology and culture to combine deeprooted thermal traditions (think Japanese onsen, Korean jjimjilbang, Roman baths, Turkish hammams, Finnish saunas) with indoor tropical ecosystems, creating the world’s most advanced wellbeing resorts in the heart of cities, accessible to all.

Historically, the thermal spa was a place to meet, socialise and share ideas, somewhere people could get together on a more equal footing. We follow this tradition, offering a place to unplug, to be in tune with nature, to engage with art and culture and enhance mind, body and soul.

At Therme Group we believe in making connections to address issues of wellbeing in complex, dynamic environments. Through Therme Forum, for example, we bring together leading thinkers around sustainability, culture and cities to collaborate in working towards changes at scale. We see citizens as more than consumers: it is no accident that art lies at the heart of everything we do. Therme Art is central to our vision, commissioning art in Therme Group’s facilities. We will take art to people and create experiences that engage the whole person, fostering wellbeing in the widest sense.

THE RISE AND RISE OF CITIES

Of the estimated 108 billion people who have ever lived, according to the Population Reference Bureau, only around 4% have ever lived in cities.9

Modern humans have been around for roughly 200,000 years. Cities have existed, at most, for 10,000 years. Their recent rise to dominance has been rapid and has taken place on a vast scale. Today, more than half the world’s population lives in an urban area. As little as a hundred years ago, that figure was only 20%.

The United Nations10 reports that:

• 65 million people a year join the world’s urban population

• 2.5 billion more people are expected to move into urban environments by 2050, with 90% of the growth in Africa and Asia

• India (with 404 million more urban dwellers), China (292 million and Nigeria (212 million) are together expected to account for at least 37% of the growth of cities

9. Harold Takooshian, Urban Psychology: its history and current status, Journal of Social Distress and the Homesless, Vol 14, 2005.

10. United Nations, Department of Economic and Social Affairs, Population Division (2018). The World’s Cities in 2018—Data Booklet (ST/ESA/ SER.A/417).

• The world’s urban population exploded from 746 million in 1950 to 3.9 billion in 2014. The global urban population is projected to pass 6 billion by 2045

• Many smaller cities are also growing rapidly, becoming medium-sized cities. Dubai, which currently has a population of 2.8 million, is growing at a rate of 10.7% annually: by 2030 it is thought it could be home to 3.4 million people

• In 2000, there were 371 cities with 1 million or more inhabitants. By 2018 there were 548. It is projected that by 2030, 706 cities will have at least 1 million or more inhabitants

11. United Nations, Department of Economic and Social Affairs, Population Division, The World’s Cities in 2018 - Data Booklet 2018

12. See for example

Thomas Fuchs, Lucas Iwer, Stefano Micali, Das überforderte Subjekt - Zeitdiagnosen einer beschleunigten Gesellschaft, Suhrkamp Verlag, 2018, p71

13. Lydia Krabbendam, Jim van Os, Schizophrenia and Urbanicity: A Major Environmental Influence - Conditional on Genetic Risk, Schizophrenia Bulletin, 31(4): 795-9

14. Mazda Adli, Urban Studies and Mental Health, , LSE Cities, November 2011

MEGACITIES - AND CITIES ON THEIR WAY TO BEING MEGACITIES

The number of megacities around the world (defined as cities with more than 10 million inhabitants) is estimated by some to be as high as 47 and others to be around 33. The discrepancy is accounted for by differences in marking city boundaries. For example, measuring the ‘metropolitan area’ of Toronto - its areas of economic and social interconnectedness - more than doubles the population of the ‘city proper’ - the administrative area - from 2.6 million to 5.6 million; and these areas are growing at different rates. Some places that make it into the higher estimates of global megacities are more accurately urban agglomerations, such as Kyoto-Osaka-Kobe.

What is not disputed is that megacities are increasing in number. The UN projects that there will be at least 10 more by 2030, mostly in developing countries. New megacities by 2030 include cities as diverse as London, Seoul, Luanda, Chengdu, Tehran and Ho Chi Minh City.

In addition, 66 cities are projected to have between 5 million and 10 million inhabitants by 2030, including Singapore with 6.3 million and Toronto with 6.7 million inhabitants.11

We are a highly adaptive species, but it would be odd if such a sudden and remarkable change in our living conditions didn’t impose some strains. For one thing, our new environment is man-made and we rarely get everything right. Until very recently, we have tended, as a species, not to pay very much attention to nature other than as something to be ‘tamed’, managed, and largely banished from cities. Its sudden, rapid regeneration outside our windows during lockdown surprised and delighted many. We have created a division between ‘town’ and ‘country’ which has not been beneficial to cities, which could be much greener and more biodiverse.

The German philosopher and psychiatrist Thomas Fuchs has linked the currently observed high levels of depression and anxiety to strains on our adaptability.12 One study by Lydia Krabbendam and Jim Van Os reported that levels of serious mental health problems can be twice as high in cities as in rural areas.13 And research consistently suggests that the bigger the city, the bigger the impact on mental health.14 The causes are complex and, while strongly associated with poverty, also include overcrowding, excessive noise, and environments that are detached from the natural world and perceived as bland, hostile or soulless.

15. Interview with Jan Gehl, American Society of Landscape Architects, https://www. asla.org/ContentDetail.aspx?id=31346

16. See for example WHO, 2005 https:// www.who.int/globalchange/climate/summary/en/index5.html; and Nita Madhav et al., Pandemics, Risks, Impacts and Mitigation in Disease Control Priorities, The World Bank (2017)

17. https://www. weforum.org/agenda/2020/03/biodiversity-loss-is-hurting-our-ability-to-prepare-for-pandemics/

18. Mazda Adli, ibid

EGILL SÆBJÖRNSSON

We have moved from small places in which it was possible to know everybody, to large, teeming cities in which we constantly jostle up against complete strangers. The more congested areas can seem utterly alien to nature.

Our new way of life has delivered better economic opportunities, education and healthcare, and other freedoms. Those of us who live in cities - even those of us who love living in cities - cannot help but be aware that, much of the time, the urban environment feels bewildering. As the Danish architect Jan Gehl has observed: ‘We definitely know more about good habitats for mountain gorillas, Siberian tigers or panda bears than we do about good urban habitat for homo sapiens.’15

It is perhaps not surprising that vast metropolises are often the background to dystopian fiction, since they concentrate urban problems such as slum housing, poor drainage and sanitation, disease, higher crime rates, traffic congestion, air pollution and strain on resources, including water and energy. Climate crisis, food and energy security, intercultural living, overstretched resources, poverty and inequality all present threats to urban stability. Scientists have linked the rise and spread of zoonotic diseases (viruses that jump from animals to humans) to patterns of development.16 And it isn’t only scientists: John Scott, Head of Sustainability Risk at Zurich Insurance Group, writing for the World Economic Forum, says: ‘The increasing frequency of disease outbreaks is linked to climate change and biodiversity loss.’17

Meanwhile, in one global survey prior to the coronavirus pandemic, concerns over economic inequality were shown to ‘trump all other dangers’ in fears about the future. There is widespread recognition that high levels of inequality lead to crime and social and political unrest. When citizens feel they have no stake they are more likely to take matters into their own hands and seek radical and violent solutions.18 Climate change, pandemics and social inequality - the three big challenges we face globally - are interlinked.

We need to bring more nature into the city because the city used to be the exception to nature… and now it’s the other way around. Now everyone is inside the city, so nature is actually the exception.

Icelandic artist at Cafe Bravo, KW Exhibition Space, November 2019, celebrating the commission of a work for Therme Bucharest.

Cities can be social and hopeful. They can feel outward-looking, exciting and full of opportunity. But too often they can also seem fast, furious, exhausting and alienating. Our senses are assaulted by video screens and billboards; by traffic, noise, fumes and the press of other people. We can feel over-stimulated, slightly out of control. We struggle to assert some agency. It is easy to get lost in the crowd, to feel so anxious about getting on we become detached from the values and relationships, the connections to the natural world, and the sense of meaning that together make us human. We long, in normal times at least, for spaces in which to be slow and contemplative, to be in nature and to reflect on our place in it. During lockdown it was commonly remarked that the sound of birdsong was much louder with the absence of traffic. We long to reconnect with the meaning of our lives, and a connection to the natural world helps us do that.

Wellbeing in cities, then, can’t be fixed solely by better architecture or an improved public transport system - though both of those will help. Wellbeing encompasses all the aspects of being human. The term captures a nexus of interconnections. And if we are trying to help people thrive in the urban environment, then all the aspects of being human and existing on this planet have to be taken into account.

PHYSICAL WELLBEING

19. https://www. centreforlondon. org/publication/ health-and-wellbeing/

20. https://medium. com/slowdown-papers/6-a-language-incrisis-b88b39475fee

21. https://www. moh.gov.sg/docs/ librariesprovider5/2019-ncov/ situation-report---28apr-2020.pdf

22. https://www.ons. gov.uk/peoplepopulationandcommunity/ birthsdeathsandmarriages/deaths/ articles/coronavirusrelateddeathsbyethnicgroupenglandandwales/2march2020to10april2020

23. https://www. theguardian.com/ world/2020/apr/16/ inquiry-disproportionate-impact-coronavirus-bame

24. https://www. ethnicity-facts-figures.service.gov.uk/ housing/housing-conditions/overcrowded-households/latest#by-ethnicity

Even before coronavirus, there was growing recognition among governments of the need to invest in public health and, in particular, preventative healthcare. Coronavirus has brought a renewed awareness of our bodies. Early in the crisis, governments moved fast to prioritise health over commerce. As restrictions ease, change will be accompanied by a stronger awareness that citizens’ health and economic success are not in opposition, but intrinsic to one another.

We have long known that more affluent groups are healthier compared to poorer people in the same city. Recent research by Centre for London, supported by Therme Group, found that Londoners in the leafy suburbs in the city’s south west have some of the best health outcomes in Britain. Those in the poorer, grittier east had some of the worst.19 Access to greenery in cities often goes hand-in-hand with affluence; it is the poor who are most deprived of nature. Dan Hill argues in The Slowdown Papers that if the 1918 flu epidemic is anything to go by, air quality and social inequality will join speed and depth of response to coronavirus as significant determining factors in numbers of deaths.20

In many countries across the world, from Brazil to Qatar, from England to India, migrants and the native poor have been hardest hit by coronavirus. In Stockholm, the suburbs containing large immigrant populations have seen the most deaths. In New York City, black and Hispanic residents have been badly affected. In Singapore, migrant workers in dormitories accounted for 85% of cases at the end of April, despite being only 3% of the population.21

The Office for National Statistics in the UK estimated that people from BAME backgrounds were four times more likely to die from Covid-19.22 The causes are not fully understood, and the government has launched an inquiry,23 but it is already clear that people from BAME backgrounds were more likely to come into contact with more people who are infected; more likely to work in essential services; to live in densely populated areas; and to live in overcrowded housing. Less than 2% of white Britons live in housing where there are more residents than rooms, compared with 16% of those with black African background, 18% of those with Pakistani background, and 30% of those with Bangladeshi background.24 It should come as

Cities don’t have to be bad for your health. But many aspects of city life - pollution, overcrowding, busy roads, stress - are very bad for health, and, for large numbers of people in the city, impossible to escape.

25. Jacqui Stevenson and Mala Rao, Explaining levels of wellbeing in black and minority ethnic populations in England, University of East London (2014)

26. https://www. nytimes.com /2020/04/24/us/ politics/coronavirus-protests-madisonwisconsin.html

27. Maija Palmer, What your commute will look like in 2050, Financial Times, June 17, 2019\

28. GLA, Estimation of changes in air pollution in London during the Covid-19 outbreak, April 2020 https://www.london. gov.uk/sites/default/ files/london_response_to_aqeg_ call_for_evidence_ april_2020.pdf

29. https://www. theguardian.com/ environment/2020/ apr/11/positively-alpine-disbelief-air-pollution-falls-lockdown-coronavirus

30. https://cicero. oslo.no/en/posts/ single/the-flip-side-ofthe-new-coronavirusoutbreak-reduced-airpollution-mortalities

31. https://www. centreforcities.org/ publication/cities-outlook-2020/

no surprise that people from BAME backgrounds in the UK have always reported lower levels of subjective wellbeing than their white counterparts.25

Those countries that have been most successful in protecting the health of their citizens were able to emerge from lockdown sooner and are likely to be more economically resilient. Health and economic activity are not in opposition, despite sometimes having been presented as such (by the protestors at Madison, the Wisconsin State Capitol, on 24 April, for example26). They are inextricably linked, and the health and care of citizens is likely to be a central concern for governments for the foreseeable future.

TRANSPORT AND AIR QUALITY

Cities have developed over time partly in response to the influence of new transport technologies. They have also constrained the spread of those technologies. For example, the motor car has had a much bigger impact on urban form in the US than it has in Europe, where medieval city centres restricted road building. In America, cars enabled the growth of ‘dispersed’ cities with low-density housing and scattered jobs, like Phoenix, Salt Lake City and Dallas.

Cars are increasingly seen as a barrier to the creation of liveable cities and neighbourhoods. More and more, they don’t work even for drivers, let alone for pedestrians. In central London, Transport for London reports, the average car speed is 7.4 mph. In Bogota, drivers spend an average 272 hours a year sitting in cars.27

Cities with denser concentrations of jobs and better designed public transport systems have much lower energy-use than cities in which jobs are scattered and cars are required. They are also healthier. People sit less, traffic fumes are reduced and calmer streets offer more opportunities for social interactions which - as we shall see - have a marked impact on wellbeing.

Air quality correlates to the number of cars on the road: more congested roads have more toxic air. In London, levels of nitrogen dioxide (NO2) almost halved in the month following the introduction of coronavirus lockdown measures, according to a report published for the Mayor of London.28 When Delhi’s 11 million registered cars were taken off the road, the city saw the clearest and bluest skies for years. Normally toxic megacities such as Bangkok, Beijing, São Paulo and Bogota reported unprecedented declines in pollution.29 Researchers at CICERO, Norway’s climate research institute, estimated that 50,000 to 100,000 premature deaths may be avoided in China by reduced levels of air pollution during the crisis.30

Excluding the impact of the COVID-19 pandemic, more than one in 19 deaths in Britain’s largest towns and cities is linked to air pollution, the Centre for Cities reports.31 While research from King’s College London found that when air pollution was in the top half of the UK national average there were an extra 124 heart attacks a day, on average. This is on top of the 500,000 deaths a year in Europe which are

32

already attributed to air pollution, which is also linked to strokes, asthma, especially in children, and a range of other illnesses.32

Centre for London research, supported by Therme Group, found that 2 million people in London live with illegal levels of air pollution. This is not an intractable problem: the introduction of the Ultra Low Emission Zone (ULEZ) has already made a significant difference to air quality, improving roadside air pollution by 44%. As with health more generally, however, low income and ethnic minority groups, who are more likely to live in polluted areas and on busy roads, are disproportionately affected by poor air quality. Women, too, who still do the bulk of unpaid labour - shopping and childcare - tend to make more journeys on foot. In Vienna, surveys have shown that roughly two thirds of car journeys are made by men, while two-thirds of journeys on foot are made by women. ‘If you want to do something for women,’ says Eva Kail of the city’s planning unit, ‘do something for pedestrians.’33

TAKING ACTION

Walton, Personalising the Health Impacts of Air Pollution, King’s College London, November 2019, http:// www.erg.kcl.ac.uk/ Research/home/ projects/personalised-health-impacts. html

33. https://www. washingtonpost.com/ politics/2020/04/25/ wisconsin-protestors-attack-stay-at-home-orders-unnecessary-or-government-cabal/

34. https://www. iea.org/reports/global-ev-outlook-2019

35. https://www. telegraph.co.uk/ news/2019/09/09/ electric-scooterswould-beat-cars-70per-cent-city-centrejourneys/

Increasingly, European cities are trying to rid city centres of cars altogether, to encourage more walking, cycling and use of public transport. Paris has eliminated cars from the lower quays of the Seine. In Ghent, 35 hectares of the centre are almost car free (taxis and permit holders may enter, but must not exceed 20mph). The city of Pontevedra in Spain has eliminated cars from its centre, resulting in no road deaths since 2009 compared with 33 fatal traffic accidents between 1996 and 2009. Carbon dioxide emissions are also down by 70% and Pontevedra has gained 12,000 residents at a time when other cities in the region are shrinking.

Masdar City in Abu Dhabi is a government-backed eco-city, designed to be car free in a region where cars have long been seen as essential to the smooth running of modern life. China has launched a number of similar initiatives, including the Great City on the outskirts of Chengdu.

Many cities have introduced car free days or times, or pedestrianised quarters in city centres. In Paris, Mayor Anne Hidalgo has brought in car free days in the centre one Sunday a month, and has developed a 15 minute city strategy. The strategy ensures all basic everyday needs (for education, culture, healthcare and commerce) are no more than a 15 minute walk or cycle ride from everyone’s front door.

The global stock of electric cars is growing (by 63% to 5 million in the year to 2018)34 - which offers the hope of reducing pollution. The growth of micromobility start-ups, such as Bird, Lime, Voi and Bolt, offers the possibility of getting more people out of cars onto electric bikes and scooters. Electric micro-mobility is often faster in cities than travel by car. One study showed that e-scooters could reduce journey times in UK cities by 70%.35 There have, however, been concerns about safety so, if micro-mobility is to be a ongoing solution, there is a need for better infrastructure.

. Martin Williams, Dimitris Eveangelopoulos, Klea Katsouyanni, Heather

In 2017, the Chinese city of Xiamen opened a 7.6km elevated cycleway linking all the city’s major business districts, five residential areas, and 11 bus stops. The cycleway can take 2,000 bicycles an hour. Xiamen, which had already banned motorcycles and mopeds, has much cleaner air than most Chinese cities.

Barcelona

Until recently, air pollution in Barcelona caused 3,500 premature deaths a year in the metropolitan area (population 3.2 million). Barcelona and its surrounding areas consistently failed to meet EU air quality targets. Traffic was the chief cause of noise pollution, with 61% of residents living with noise levels higher than those deemed acceptable by legislation. The city also had a high level of road accidents (9,095 in 2015) and a growing obesity problem.

An ambitious new plan currently being implemented aims to create 503 ‘superblocks’ across the city turned over to ‘citizen spaces’. Traffic is routed around them. The superblocks are complemented by 300km of new cycling lanes and a plan for no one to be more than 300m from a bus stop.

The first superblock to be implemented in Poblenou in the north of the city in 2017 met resistance from car owners and local businesses, but much of the hostility has dissipated. There are 30% more businesses in the district than there were. Many more people make journeys on foot or by bike. It is estimated that if the superblocks plan were implemented in its entirety, the life expectancy of the average resident in the city could increase by almost 200 days and would save the city €1.7bn a year.

Xiamen

36. https:// www.nytimes. com/2020/04/16/ health/coronavirus-obesity-higher-risk.html

37. https://www.nhs. uk/news/heart-andlungs/having-deskjob-doubles-risk-ofheart-attack/

38. Alpa Patel et al, Leisure Time Spent Sitting In Relation to Total Mortality in a Prospective Cohort of US Adults, American Journal of Epidemiology, vol 172, Issue 4, August 15, 2010

Copenhagen is the cycling capital of the world, with 41% of trips to work, school and college made by bike. Citizens cycle a total of 1.4km on an average weekday. Residents own five times more bicycles than cars and, as more people have taken up regular cycling, individual safety has improved. Cyclists’ feelings of safety have risen by 43% since 2006.

The city has more than 40km of cycling track. Over 40 years, parking spaces have been progressively cut by 3% per annum, enough to make a difference over time without triggering opposition. This has allowed for extensive cycle lanes and wider pavements on main streets, as well as shared surfaces on smaller streets.

A ‘green wave’ coordinated traffic light system minimises cycle congestion at peak times, keeping cycle traffic flowing. Cycle storage on suburban trains and changing facilities in offices help to ensure that a third of all trips are by bicycle, a third by public transport, and only a third by car.

OBESITY

In the rich countries of the OECD, obesity currently affects 19.5% of people. In the US, the figure is 35%. Obesity has doubled in US children since 1988 and quadrupled in adolescents.

Centre for London research, supported by Therme Group, found that 38% of London’s 10- and 11-year-olds were obese. As with health outcomes generally, the situation was worse in the poorer outer London boroughs in the east and better in the more affluent south west.

Poorer places tend to be saturated with cheap, unhealthy fast food. ‘Where you grow up strongly influences your chances of being overweight and obese’, notes Kieron Boyle, Chief Executive of Guy’s and St Thomas Charity, ‘and for families on the lowest incomes, this correlation has only got stronger over time’. People with obesity frequently have other medical problems, such as diabetes and high blood pressure. Early research suggested that obesity and diabetes were factors in hospital admissions for younger people (under 55) with coronavirus.36

Without wishing to romanticise manual work, it’s clear that many inhabitants of cities don’t get enough exercise. People with sedentary occupations - a high proportion of those who live in cities - can easily sit for up to 15 hours a day. And people who sit a lot are twice as likely to have a heart attack, and two-and-a-half times as likely to suffer cardiovascular disease.37 Men who sit for six hours a day or more increase their mortality risk by 20%. For women, it’s almost double that.38

Copenhagen

Cities weren’t always sedentary places. Up until around 1850, in most cities - even big ones - everyone travelled on foot. Charles Dickens regularly records walking from one side of London to the other and back in a day. Cities don’t have to be sedentary places now: urban walking is one of the great joys of city life. For many commuters using public transport it’s also a necessary part of everyday travel. But some cities are much better set up for walking than others - and the difference is their relationship to cars. It is much safer, healthier and more pleasant to walk in streets that have less traffic and fumes.

THE PHYSICAL EFFECTS OF STRESS

We deal with stress more comprehensively in the next section but for now it is worth saying that stress leads to direct physical effects, releasing cortisol into the blood and bringing a heightened risk of heart disease. Types of work with no ‘skill discretion’ or ‘decision authority’ have repeatedly been found to have this sort of direct physical consequence.

In cities, where increasing numbers of people work in the gig economy, stress may be exacerbated by long hours and a feeling of living precariously on the margins, leading to a host of other physical problems.

AGEING

Before the coronavirus pandemic, the proportion of the world’s population over 60 was expected to rise from 12% in 2015 to 22% in 2050.39 Covid-19 has affected the elderly more than any other group: in late April 2020 the WHO reported that up to half of those in Europe who had died of coronavirus were in care homes. But the underlying trend remains: older people are the fastest-growing cohort of the population.

Recent months have shown how inextricably linked the lives of older people are with those of everyone else. Fear for personal safety - particularly acute for the old - has had an impact on the personal behaviour of everyone and, profoundly, on the economy. The coronavirus crisis has also exposed failings in care of the old: care workers in most developed countries have typically been characterised as low skilled and poorly paid.

Post coronavirus, public health infrastructure will have to respond better to the needs of older people. Cities are set to age faster than rural populations but they are rarely designed with much attention to the needs of their older citizens. As the WHO notes, beyond biological changes, ageing is also associated with other life transitions such as retirement or the death of a partner. ‘It is important,’ they conclude, ‘not just to consider the approaches that ameliorate the losses associated with older age, but also those that may reinforce recovery, adaptation, and psychosocial growth.’40

Coronavirus and the fear of future contagions may leave a lasting mark. How, in such circumstances, are older people to escape the stereotypes of passivity and vulnerability that are, in themselves, detrimental to resilience?

In future, there will be a need to rethink the urban form and infrastructure so that cities are liveable over the life course, with affordable and flexible housing. Easy access to services will become more important, as will flexible jobs and opportunities for lifelong learning.

A better designed urban realm could help mitigate social isolation and offer opportunities for preventative healthcare, including more opportunities for contact between people in the community and more opportunities to exercise and be in touch with nature. A renewed concern with public health, plus the tendency of older voters to be politically engaged, is likely to make provision for people as they age a more significant priority. Ensuring citizens can stay healthy will become increasingly important in reducing long-term healthcare costs. This could and should improve the wellbeing of people of all ages.

Philadelphia

In collaboration with the AARP (formerly the American Association of Retired Persons), the city of Philadelphia evaluated the safety of its pavements and intersections with the aim of making it easier for older people to walk around the city. An Executive Order for Complete Streets was enacted to ensure pedestrian and cyclist safety was prioritised. While this brings benefits to everyone, the initiative was prompted by a desire to make it easier for older people to access public services.

THE BUILT ENVIRONMENT

Cities, then, pose many hazards to physical health, and any proposal to improve wellbeing should take into account the myriad physical interactions that take place in cities every day, and the impact of the built environment on human health.

The possibility of a reduction in traffic offers the hope that cities could become much greener; that spaces currently given over to parking, for example, could become growing spaces, ‘parklets’ or filled with trees. With our increasing awareness of living in the Anthropocene era - a period of geological time in which human actions are the dominant influence - tree planting has become less about civic improvement and beautification, and more about the ecosystem, helping to improve air quality and slow the build of atmospheric carbon dioxide. Cities would be very different if streets were redesigned with wellbeing as their purpose, rather than the efficient movement of traffic.

Faced with ageing populations and growing strains on health budgets, cities will increasingly have to focus on preventative healthcare, on helping people to interact with nature and with each other. If this is done properly, it will change the urban fabric so that more attention can be paid to exercise, healthy food, and experiences that refresh and renew people, offering a sense of wonder and meaning that helps reduce stress with all its debilitating physical consequences.

MENTAL WELLBEING

41. Nuffield Trust: https://www.nuffieldtrust.org.uk/chart/ categories-of-nhsspending-per-head

42. Royal College of Psychiatrists et al, Mental Health and the Economic Downturn: National Priorities and NHS Solutions, 2011

43. https://www. thelancet.com/ journals/lancet/ article/PIIS01406736(20)30460-8/ fulltext

44. https://www.who. int/whr/2001/media_ centre/press_release/ en/

45. Jaap Preen et al, The Current Status of Urban-Rural Differences in Psychiatric Disorders, Acta Psychiatr Scand, Feb 2010 https://www. ncbi.nlm.nih.gov/ pubmed/19624573

It is too early to judge whether the coronavirus crisis will have long-term effects on mental health. Mass quarantine has been described as the world’s largest-ever psychological experiment; and a literature review in the Lancet found numerous negative effects.43 Even if the immediate symptoms subside, the likely shrinkage of the economy resulting in joblessness and the demands on people to absorb sudden and dramatic changes are likely to have an impact on mental health, although much will depend on how things are handled as we come out of the crisis.

Before lockdown, the World Health Organisation reported (in 2019) that 450 million people worldwide were currently suffering from a mental disorder, making mental health one of the leading causes of disability and death.44

The WHO concluded:

• Determinants of mental health and mental disorders include not only individual attributes such as the ability to manage one’s thoughts, emotions, behaviours and interactions with others, but also social, cultural, economic, political and environmental factors such as national policies, social protection, standards of living, working conditions, and community support.

• Stress, genetics, nutrition, perinatal infections and exposure to environmental hazards are also contributing factors to mental disorders.

Research from a group led by Jaap Preen found that city dwellers were over 21% more likely to experience anxiety disorders. Mood disorders were also significantly more prevalent in cities - 39% higher than in rural areas.45

Clearly, we are in the middle of a crisis of mental health. The causes are complex: like most illnesses, mental health disorders are a combination of genetic and environmental factors. Too often, though, mental health is treated simply as an individualised problem. In the interaction between the human brain and the environment, it is mostly the human brain that is seen as failing and in need of

Prior to the coronavirus pandemic, mental health disorders were the single highest category of NHS spending in Britain.41 The cost of mental ill-health to the economy was put at £110bn a year, which is more than the economic cost of crime. This was expected to double in the next 20 years. Most of the money was spent on crisis management, rather than prevention.42

Vienna

treatment. But, as the psychologist and urbanist Chris Murray puts it: ‘Experience of place determines much of our development and wellbeing, and we should not separate the policies of one from the other.’46

Mental illness can be affected by personal stress caused by health, finances, relationships, or a sense of self worth - and also by collective stressors. Among wealthy nations, the rate of mental illness closely correlates with the level of economic inequality across society. The United States, for example, has extremely high levels of inequality and penalties for poverty, alongside very high levels of mental illness.47

Vienna is regularly cited as one of the world’s most liveable cities. Strict land-use codes mean that half the city is reserved for green space. Vienna (population 1.9 million) is a small city by contemporary standards but it is adding around 25,000 new residents a year, for which it builds about 13,000 new housing units.

A century-old tradition of social housing means that 62% of the population, including a broad swathe of the middle class, live in social housing. Strict rent controls mean that housing accounts for a much smaller percentage of outgoings than in most European cities. For an annual fee of €365 - one euro a day - citizens can travel anywhere on public transport. More than 73% of transport needs are met without the use of private cars.

Not coincidentally, Vienna has led the way in ‘gender mainstreaming’ its planning policies. In the new neighbourhood of Aspern, due to be home to 20,000 people by 2028, all the streets and public spaces are named after women (compared to traditional Vienna where 3,750 streets are named after men). The symbolism is backed up by an emphasis on better street lighting; traffic lights that prioritise pedestrians; plenty of benches and places to sit; and parks designed to allow girls’ play as well as boys’. Inside buildings there is pram storage; wide stairwells encourage social interaction; flat layouts are flexible. Buildings are low enough for residents to be able to keep an eye on the street.

Environmental stress is not, of course, exclusive to cities. The Brexit referendum in Britain suggested that town-dwellers were experiencing an acute loss of purpose and community. And climate crisis, fears of pandemics, financial insecurity, insecure work, relentless work performance measures, images of social perfection,

46. Chris Murray, States of Mind, RSA Journal, Issue 2 2019

47. See Richard Wilkinson and Kate Pickett, The Spirit Level, Penguin, 2010

and the attention economy of social media platforms can have just as much of an impact on people who live outside cities. But it is the case that the characteristics of urban settings - systems of technology and work, production and consumptioncan also make us feel uneasy.

Even those who are materially comfortable can feel overstretched by the ubiquitous presence of technology. It is hard to switch off. The video call can be a tyranny, while the pressure to respond to texts and emails immediately is draining. Even for messages of friendship. We are ‘always on’, always alert, always shadowed by the anxiety of not measuring up.

Digital technologies additionally promote a sense of being both ‘here’ and ‘there’. Even though we are physically present, we may be mentally elsewhere: focused, even if only momentarily, on something else that seems more insistent. Digital technology fragments our attention and detaches us from the places - homes and neighbourhoods - that should anchor us.

Meanwhile, work doesn’t always provide the underpinnings of stability that we feel it should, or imagine that it did for many, in the two generations before us.

Work in the gig economy is precarious, often involving long hours and multiple jobs. Even those in regular employment can feel insecure as occupations are disrupted by shifts in economic priorities, new technology, including AI, and competition. Those who are relatively financially well-off can feel they nevertheless live on tight margins, with few buffers to withstand shocks.

Add to this the sensory stress of living in big cities: the noise, the bombardment by advertising, the fumes, the crowds, the competing and jostling architectural styles, the sheer size of everything - and it is not surprising that people feel they need some respite, some place to be quiet and contemplative and to get back in touch with the world around them, and particularly with nature. Technology, congestion, overwhelming architecture and bustle are things we can cope with much of the time - but when they come without respite, we yearn to return to feeling more simply, solidly, fully human.

THE URBAN REALM

We often describe places as ‘soulless.’ Settings that are perceived as ugly, where there is endless asphalt, noise, pollution, and unkempt buildings, can have a lowering effect on the spirit, making people feel depressed. Places that are beautiful, on the other hand, can make people feel positive, conveying the impression that the world is stable and hopeful.

People want to live in cities that have character, atmosphere, something to nourish the soul. The city of Songdo in South Korea, which cost $40bn to develop from scratch on reclaimed land, opened in 2005 as a sustainable, low-carbon, high-tech, western-style city only two hours away from Tokyo, Shanghai and Beijing. Fifteen

48. https://www.citylab.com/life/2018/06/ sleepy-in-songdokoreas-smartestcity/561374/ 49. https://gothamist. com/news/robertcaro-wonders-whatnew-york-is-going-tobecome

years on, only a handful of companies, universities and non-profits had moved there. Given a choice, people want more than convenience: they want a sense of place, civic identity and cultural sustenance.48

Believing that the built environment can have a significant impact on mood, Therme Group - and, in particular, Therme Arc and Therme Art - seeks to promote the transformative power of fine, uplifting buildings.

Alain de Botton argues that an aesthetically pleasing environment reminds us of our search for a life well lived, for fulfilment and happiness. Bad architecture, he insists, ‘is as much a failure of psychology as of design.’

Sir Richard Rogers has described architecture as ‘a physical manifestation of society’s wish to be civilised’. Therme Art is leading discussions about what imbues buildings with meaning and values in the face of constraints on resources and an imperilled natural world, engaging artists, architects, scientists, engineers, city planners and philosophers to think about what architecture can do to make cities civilised for the 21st century.

I’m sure we’re going to create a better world by connecting people again to nature, to humanity, and not just to the economy. In nature, you don’t have rightangles. Life is never straight, like natural material is never straight...we have to be aware that whatever you do in cities affects people’s lives.

FRANCIS KÉRÉ Architect of Therme Art’s Talks Pavilion at Design Miami 2018

Architecture and urban design have the power to exclude people, as well as include. The American master builder Robert Moses boasted to his biographer that he deliberately designed some overpasses on Long Island too low for buses to drive under, impeding access to some beaches for low income and ethnic minority groups.49

Exclusion doesn’t have to be deliberate: it can be the consequence of unconscious bias. Places which are legally and technically accessible to all may not be practically accessible to people with disabilities, to the old, to children, or to women. Planners need to think not only about whether they are providing libraries, but who is using

them and who feels welcome in them. Security cameras that may feel reassuring for some, might, for others, seem more like an act of aggression. Young black men, for example, who may feel that the first assumption about them is always that their actions are suspect, criminal or illegitimate.

A human city has to combine practical solutions not only with beauty, but also with a wider sense of equity, access to opportunity, health, and participation in public life. Since humans have a profound need to be in touch with nature, a human city must at once have the power to move us, be connected to the natural world and sustainable.

TIME

A linear sense of time is a relatively recent concept, different from the more circular and circadian sense of time that preceded it. What mattered most in the past were light, darkness, the weather, seasons and hunger. Time was conceived of in its relation to the natural world and our needs.

In cities, time is often seen as something that has to be used or lost: measured in financial terms by monthly repayments, or annual salaries. Time is literally money, no longer an expression of our needs, but something outside us that has to be chased down, its utility maximised.

This sense of having to be productive, to use time, can lead to what has been called ‘the urban accelerator effect’50 - a sense of time being speeded up. The city can feel like a clockwork machine, constantly demanding a faster pace and better performance of its inhabitants. Yet most of what we value - love, dignity, pride, respect - has nothing to do with performance or productivity. These aspects of our humanity cannot be bought - and, were you to try, you would immediately lose what is most important about them.

Sometimes, humans want to step outside time, to be in settings where it doesn’t much matter how many minutes have passed, where time is measured by experience or not measured at all. We seek places in which our relationship to the world becomes less instrumental and transactional; places in which time is not pressing, in which we do not feel harried, and where there is no pressure to be productive.

Cultures of ancient bathing rituals understand this. Therme facilities follow their lead, offering spaces of recreation, culture, reflection and meditation. In Undesigning the Bath, the classic design book on baths and bathing, Leonard Koren writes: ‘Bathing is best enjoyed in a place where you feel safe enough to put aside your social roles, relax your body armor, and open your psyche to the moment.’51

50. Charles Landry and Chris Murray, Psychology and the City: The Hidden Dimension, Comedia, 2017

51. Leonard Koren: Undesigning the Bath, Stone Bridge Press (1996)

SMART CITIES

We hear a good deal about smart cities and their potential to improve the urban realm, whether by lessening traffic congestion or reducing waste. Smart technologies undoubtedly have the potential to make city life more comfortable and sustainable - although the controversy over Waterfront Toronto, where there has been resistance to private control of the city’s data, suggests that a lot hangs on who exactly gets to be smart. Perhaps ways can be found to engage citizens not merely in (often unwitting) data collection, but also in shaping the questions asked of the data and how the results are used.

One problem, as far as mental health is concerned, is that the new ways of navigating knowledge have inequalities built into them. Some privileged groups own the power of data-mining and algorithmic analysis - social media platforms, market research companies, the security services. For the rest of us, there is simply too much information to comprehend. We don’t have access to the necessary, expensive, proprietary algorithms. As William Davies says, ‘“We” simply feel our way around while “they” algorithmically analyse results.’52 Most of us are thrown back on impulse and emotion to orientate ourselves. Davies argues that this reliance on instinct and ‘feeling’ is one reason for the current rise of populist politics and mistrust of authority.

Humans are essentially emotional creatures, and emotions will take over if we cannot find a way to temper our feelings with reason. In this sense, technology is quite bad for us, at least as currently organised. On the one hand, it makes the material with which we might reason more elusive: how can humans compete with vast datasets crawled by complex and mysterious algorithms? On the other hand, technology offers all kinds of stimulus to outrage, nervousness, and anxiety. Cities are such emotional places partly because it is difficult to be rational when there is too much to comprehend. We can’t think straight because we can’t get our heads around everything that’s going on. It is not surprising that many people have the sense that the world is slightly out of control.

It is easy to see how our perceptions of space, time and belonging can be undermined in cities, and how a sense of calmness and human rhythm is increasingly hard to find.

A FEW SIGNS OF RESISTANCE

Some cities have taken steps to reduce the sensory overload: São Paulo, followed by Chennai, and later by Grenoble and Tehran, have led the way in banning billboards.53 The Slow Cities movement, which began in Italy in 1999 as an offshoot of the Slow Food movement, has spread across the world.

52. William Davies, The Happiness Industry, Verso, 2015

53. Charles Landry and Chris Murray, ibid

Slow Cities

The Slow Cities movement promotes sustainable, green policies, emphasising a slower, more relaxed way of life. Slow Cities resist homogenising trends; they support local products, processes, crafts and events. The movement also recognises the need to embrace new technologies to improve the quality of the environment. While membership is currently limited to cities and towns with fewer than 500,000 inhabitants, the movement’s leaders say they would like to see its principles adopted in cities great and small.

Mass gatherings in which people can lose a sense of time, escape from pressure and be present in the moment are increasingly popular. This includes festivals of all kinds, such as the Winter Festival of Light in Helsinki, or Carnival in Rio or Venice; even marches, demonstrations and protests. The rise and rise of festivals testifies to a human need to escape into a different kind of relationship with the environment and other people, away from the clockwork demands of the city into nature, the arts, and a different kind of connectedness.

Therme Group recognises that people are more likely to feel positive if they have connections to the natural world through light, trees, plants and running water. The right to be in public parks during the coronavirus crisis became a topic of anguished debate in a number of cities as governments wrestled with conflicting impulses to protect health and allow people to be in green space for their mental health and exercise. In London, where some parks were closed and some open, it was reported that in the top 10%, one third of all land was taken up by private gardens, whereas in the poorest 10%, private gardens only covered one-fifth of land - complicating the debate with issues of equity.

Even small hints of the natural environment in urban settings can have a significant impact on wellbeing. People who live in sight of trees are healthier than those who don’t, as Rachel and Stephen Kaplan argued in their influential work on ‘restorative effects’. Too much attention focused on anything can lead to mental fatigue, they noted - and the remedy is to be found in nature.54

54. See, for example, Kaplan, Rachel; Stephen Kaplan; Robert L. Ryan (1998). With People in Mind: Design And Management Of Everyday Nature. Washington, DC: Island Press

In increasingly technological, high-rise, congested and polluting cities, there is a need for access to places that are clean, fresh and green, and which follow natural forms, colours and flows. Where it is possible to breathe freely and touch plants and water. Organic materials, maximum natural light and vistas that stretch the horizon help to create a sense of ease.

55. Reported in the Guardian: Elle Hunt, We do like to be beside the seaside, 4 Nov 2019

56. White, M. P., Depledge, M.H., Wheeler, B.W., Fleming, L.E.F., 2016. The ‘Blue Gym’: What can blue space do for you and what can you do for blue space? Journal of the Marine Biological Association of the UK, 96 (1), 5-12

Water, in particular, has a psychologically restorative effect. Spending time in and around aquatic environments has consistently been shown to have even greater benefits than those from green space, according to Dr Matthew White, a senior lecturer at the University of Exeter and an environmental psychologist with BlueHealth, an EU-funded project researching the benefits of blue space across 18 countries. The rewards of being in and around water include positive moods and reduced negativity and stress.55

The UK’s BlueGym research project, backed by the NHS, showed that we associate ‘blue space’ - areas of water - with feelings of greater happiness, and that ‘blue exercise’ - in and around water - is good for us. 56

Cities are not incompatible with green and blue space. There is no reason for cities not to be full of biodiversity. They would look different. They would need to be more localised because efficiency and streamlining would be less important than accessibility and resilience. But they would still be cities.

We co-evolved with plants, so this is something we need to understand. We are in symbiosis with plants: it’s impossible to imagine a form of life without plants.

STEFANO MANCUSO

Professor of Botany, University of Florence, at Therme Forum’s Free Future Cities discussion at the British Pavilion, Venice Biennale 2018

Singapore

At the time of its independence in 1965, Singapore was a city of slums, congestion, and almost no natural resources. Limited land meant that there was no choice but to go for highdensity development - which has, however, been carried out with a strong emphasis on pockets of green and blue space between the buildings. There are 3 million trees in the citystate; high-rise buildings are interspersed with parks, rivers, and ponds (which also help flood control).

Developers are required to include plant life - green roofs and walls, cascading vertical gardens - in any new building. The city’s extension at Marina Bay has created one of the largest freshwater city reservoirs in the world; 250 acres of prime real estate were set aside for nature, the Gardens by the Bay.

Singapore’s parks are currently being linked together to aid walking and cycling: eventually citizens will have access to several hundred kilometres of trails. Parks feature threegeneration playgrounds. The city’s innovative approach to housing, which means that 90% of Singaporeans own their own homes on long leases, allow for different configurations of households, including several generations.

SOCIAL WELLBEING

Relationships make us what we are. They help to establish our identity and provide us with a sense of support and solidarity. People thrive when they have strong, intense relationships with a few other people and also weaker, dispersed ties to a much larger group.

As Dan Hill has pointed out, the phrase social distancing is inherently paradoxical ‘in only two words, something that feels like a fundamental challenge to humanity itself.’57 The weeks and months of lockdown have brought home the extent to which human beings are social animals. We are not meant to be distanced: being in the same space as both those we know well and those we don’t matters to us.

Cities offer us the ability to reinvent ourselves and find our own groups. In relative anonymity, it is possible to forge more mutually satisfying relationships than the enforced and authoritarian ties of the past. The city has long been seen as an escape from traditional authority (behaviour decreed by village elders) into a more authentic and expressive way of being.

Given the human history of tribalism, cities have shown themselves to be remarkably successful in uniting disparate groups in a communal whole. There is plenty of evidence that people who live in cities are more tolerant and outward looking. At their best, cities unite strangers in a shared project, building community out of disparate cultures and perspectives, and creating collective and engaged citizenship.

57. https://medium. com/slowdown-papers/6-a-language-incrisis-b88b39475fee

58. https://www.citylab.com/life/2019/02/ city-race-class-neighborhood-whiteblack-rich-segregate/583039/

59. ComRes poll for the BBC https://www. bbc.co.uk/news/ uk-england-24522691

At their worst, cities concentrate poverty and discrimination. The old idea of the ‘inner city’ versus the affluent suburbs no longer makes much sense now that so many former industrial urban centres have become appealing to artists, the young, and the affluent groups that follow them. For example Chelsea, Soho, Tribeca and the Meatpacking District in New York City. But neither is the pattern fully inverted, poor suburbs surrounding a vibrant centre; rather, it is what Elizabeth Delmelle, a geographer of US cities, describes as ‘a patchwork of polygons.’ What has not fully changed however, is cities’ ability to function as a sorting mechanism, keeping ethnic groups and the native poor apart from the rich.58

Cities can be lonely places. More than 9 million people in the UK, almost one-fifth of the adult population, say they are always or often lonely. London is the loneliest part of the country; more than half of its citizens (52%) say they experience varying degrees of loneliness.59 Feeling lonely increases the risk of developing coronary

60. Campaign to End

Loneliness https:// www.campaigntoendloneliness.org/threatto-health/

61. Alex Evans, A Larger Us, The Collective Psychology Project

62. William H White, The Social Life of Small Urban Spaces, republished by The Project for Public Spaces, 2001

63. https://www. citiesalliance.org/ Global%20Programme-gender

64. ibid

65. https://lac. unwomen.org/en/ noticias-y-eventos/ articulos/2018/11/feature-women-in-guatemala-steer-changeseek-solutions-to-endsexual-harassment

66. Stop street harassment (2018) The Facts Behind the #MeToo Movement: A National Study on Sexual Harassment and Assault. Unites States

heart disease, stroke, cognitive decline, depression, and raises the risk of mortality. A lack of social connection is as much of a risk for early death as smoking 15 cigarettes a day, and worse for you than obesity.60

There is also strong evidence (70 years after Hannah Arendt said that ‘loneliness is the common ground of terror,’) that loneliness is a factor in vulnerability to radicalisation. Feelings of powerlessness are on the rise. As Alex Evans of the Collective Psychology Project notes, a sense of powerlessness nearly trebles the risk of anxiety and depression, and is strongly associated with authoritarian beliefs. He sees loneliness as one part of what he calls an epidemic of disconnection.61

In short, many people feel left behind, let down, and left out.

For a time during lockdown, social purpose trumped profit as an organising principle of society. It remains to be seen whether the lifting of restrictions will lead to a desire to return to business as usual. There will undoubtedly be an urge to put the months of lockdown behind us. But a new awareness of the strains of isolation could potentially lead to greater focus on ways of supporting social connection and bringing people together.

The public realm has a very important part to play in increasing connections, especially in enabling that web of looser ties that comes with nodding to someone in the street or exchanging a few words at the market.

In his classic 1970s study of New York City plazas, William Whyte found that the best public spaces allowed people to be together without pressure to socialise.62 He discovered - in findings subsequently reproduced in places as different as Denmark and Australia - that these successful social spaces typically offer places to sit, trees, warmth, an absence of draughts, food, and water that isn’t simply ornamental, but accessible, touchable, and splashable.

Street safety is important, particularly for women. More than 83% of female citizens of Cairo say they have been sexually harassed on the city’s streets.63 In New Delhi, a rape is reported every 29 minutes.64 More than half of the women in Guatemala City feel unsafe in public spaces during the day. 65 Much of this is due to cultural inheritance - but there is a good deal that city planners can do to mitigate its effects. And, lest it be thought that this is solely a problem of emerging economies, research from the US shows that around two-thirds of women have experienced some form of sexual harassment in public spaces in their lifetimes.66

Liveable neighbourhoods reproduce the good things about village life, including collective hubs such as parks and squares. People who live in walkable, mixed-use neighbourhoods are more likely to know their neighbours, more likely to engage in social, political or voluntary activity, and more likely to trust people around them.

Many cities have to contend with a growing privatisation of once civic spaces. Therme Group is committed to the principle of free space - undetermined and flexible areas that foster creativity and wellbeing - and our vision is that Therme facilities will include public spaces. A grand piazza is planned for the front of Therme Manchester, alongside the creation of a biodiverse environment including

footpaths and cycleways across the whole of the TraffordCity site, which currently lacks greenery.

Green space is known to increase empathy, trust and generosity. Parks have positive effects on mental health. They shouldn’t be seen only as destinations. The best neighbourhoods have pockets of greenery everywhere.

Designing for sociability is also important for an ageing population, whose social networks may be declining.

Freiburg is one of Germany’s most attractive cities, with a pedestrianised centre of medieval buildings painstakingly rebuilt after the bombing of World War 2. Two brownfield sites became available for development within easy reach of the centre: an old sewage works at Rieselfeld and a former French army barracks at Vauban. Tram connections (15 minutes from the centre) were built before any homes were started. Cars are banished from home zones except for loading and unloading and kept in communal underground basements or car parks on the periphery, making most journeys easier by bicycle or tram.

There are no high-rise buildings: the principle is that parents should be able to call in children from the top floor. The streetscape was designed for sociability, with areas between blocks for children to play and residents to meet. In Rieselfeld, while several adjoining homes may share facades, internal designs were customised to individual needs. More than a hundred different builders were involved. In Vauban, superblocks around a semi-public open space were undertaken by local building groups, each with its own architect.

Future residents were involved in the design process from the start. By the time people moved in, there was already a community. Design focused on good contemporary architecture with uniform height and massing. The result, as Peter Hall, the leading commentator on cities, has written, is a contemporary version of Georgian London.67

Freiburg is Germany’s most sustainable city, and its new suburbs make the most of solar energy and sustainable waste and rainwater management. Rich and poor live alongside each other in mixed neighbourhoods and Rieselfeld and Vauban are sought-after places to live.

Vauban and Rieselfeld, Freiburg

67. Peter Hall, Good Cities, Better Lives: How Europe Discovered the Lost Art of Urbanism, Routledge, 2014, p261

SPIRITUAL WELLBEING

Money is not, however, the sum of everything that human beings need. Economists such as Richard Layard and David Lane on both sides of the Atlantic have concluded that money alone is far from a guarantee of wellbeing. Once people are past a certain threshold, getting and spending money doesn’t make them happier. Kate Pickett and Richard Wilkinson argue in The Spirit Level68 that once this point of comfort is passed, the acquisition of money increasingly becomes about competition and status-anxiety, which are actually antithetical to a sense of wellbeing.

As the Canadian philosopher Charles Taylor puts it: ‘The individual pursuit of happiness as defined by consumer culture still absorbs much of our time and energy - or else the threat of being shut out through poverty, unemployment or incapacity galvanises our efforts...and yet the sense that there is something more presses in.’

People everywhere are in search of that something more, a greater meaning: experiences that move, touch and surprise them; that make them feel authentic, that cannot be reduced to usefulness or to a sum. Looking up at a starry sky, for example, the overwhelming impression you have is one of insignificance - yet paradoxically, the sight of millions of stars is also transcendent. It fills us with a deep sense of meaning. A brush with mystery has the power to transform us, to inspire a feeling of awe.

The eighteenth-century philosopher Adam Smith wrote that awe occurs ‘when something quite new or singular is presented,’ and ‘memory cannot, from all its stores, cast up any image that nearly resembles this strange appearance.’

Urban migration is often driven by money. The promise of having enough money offers autonomy and freedom, better education and healthcare, hope for the next generation.

68. Richard Wilkinson and Kate Pickett, The Spirit Level, why equality is better for everyone, Penguin, 2010

Awe is transformative, in other words, because it challenges our mental models of the world and forces us to update them. It makes us feel and think anew. Awe might be induced by contact with nature, by a ritual, or by a work of art - by anything that inspires a subjective feeling that cannot be fully captured in words and must be directly experienced.

Art has been crucial to people since the beginning of human time. From cave painters onwards, people have looked to art to express the ineffable, to offer revelations, to dissolve anxieties and petty concerns, and to create connections with others. It might be argued that the power of art is needed now more than ever because we tend to identify less than our grandparents did with the sort of large, abstract collectives - class, occupation, religion - that once offered belonging, purpose, stories about life, something more, something bigger than ourselves. Those abstract notions gave meaning and, sometimes, transcendence.

The moments we find meaning allow us to step outside linear time. What matters is the intense experience of the present, when we find space to reflect on ourselves and what matters most.

These spiritual aspects of being human are often neglected in technocratic discussions of planners and urban theorists.

I think, in order to reach audiences, there has to be an aspect of wonderment, curiosity, but also unexpectedness - and that you can share that moment with other people.

LONNEKE GORDIJN

Co-founder of Studio Drift, at Therme Forum on Free Future Cities, Venice Biennale, 2018.

The art market is still very much dominated by something that you can have, something that you own... this obsession with owning something, I think, is evolving. And younger generations no longer have this obsession with owning something; they want to experience it.

SIMON DE PURY

Art auctioneer, adviser and collector, member of Therme Art’s advisory board.

Therme Art is a global initiative that sees the quest for meaning - for something more - as a central human need. Therme Group believe that spaces geared to reflection which allow people to unwind and relax can be transformative.

Art links humans to the natural environment, posing questions about what it means individually and collectively to be alive now, on this planet. Therme Art takes art out of the white walls of galleries and into public space, bringing people into the presence of work that reflects the connection between nature and culture.

Therme Art’s year-round programme engages artists, architects, scientists and philosophers. New commissions will make thrilling artworks available to much wider audiences, allowing citizens of all kinds to be in the presence of transcendence, of new ways of confronting and grappling with the beauty and challenges of the world.

Art is central to being human. It speaks to us of the past and the future, of loss and possibility, of suffering and hope. It suggests the existence of meaning outside of ourselves, of spiritual connection, of something more.

Therme Group sees spiritual wellbeing as profoundly connected to physical, mental and social wellbeing. Art and architecture are central to discussions around making cities human.

THERME GROUP’S ROLE IN THE ECOLOGY OF WELLBEING

Therme Group believes that experiences of the city are best understood by recognising and analysing intersectionality. How the city is experienced depends on a host of conditions including gender, race, ethnicity, class, age and sexuality. Each citizen’s sense of the city is inflected by background, circumstance, identity and experience, and is not reducible to simple formulae.

We seek to engage with everyone - from policymakers to artists, health and care workers to mayors - concerned with wellbeing in cities. Together, we believe, it should be possible to make cities more human, to bring people into a holistic relationship with nature and each other. We have some powerful ideas of our ownand we aim to be part of the global debate.

As we have seen, there is a strong correlation between deprived, socio-economic groups, who are often hard to reach with positive interventions, and health challenges. Therme Group’s research indicates that our projects appeal to people across the board. In Manchester, for example, in-depth research among the 12 million people who live within 90 minutes of the city showed that all socioeconomic groups were equally enthusiastic about the concept of a Therme Group resort.

This gives us the potential to stimulate positive, lasting change. We can help physically, by teaching guests cardio exercises and strength conditioning. By introducing people to healthy food that is popular with all ages, we can help make changes that will affect long-term health and wellbeing.

We provide areas in which people can come together to be social, in which they can recharge mentally, and in which they can experience the wonder of plants, water and art.

To make cities work for humans, Therme Group combines leading engineering and technology with deep-rooted cultural traditions and connections to the natural

The problems we have outlined in this paper are complex and interrelated. They can only be addressed by similarly interconnected and converging solutions.

world to produce solutions geared towards sustainability.

The Roman baths were traditionally a place of physical and mental renewal. They also allowed for egalitarian socialising: they were places where citizens could meet, talk and be together. Therme Group is developing the concept of the Roman baths for the twenty-first century, harnessing nature, technology and culture to create a unique space: thermal baths, botanical gardens, spas, health & fitness activities and a space for socialising and culture.

Therme Group resorts will be designed to be green and sustainable. Watersaving technology will ensure the highest level of water quality while minimising consumption. Exceptional energy efficiency will be achieved through advanced building design, the use of natural daylight, LED lighting, and natural ventilation, plus air- and water-heat recovery.

The resorts will lead to the creation of some of the world’s most advanced sustainable buildings, targeting the highest levels of official accreditation including LEED (Leadership in Energy and Environmental Design) Platinum, a certification already achieved for Therme Bucharest. The LEED rating system, developed by the US Green Building Council (USGBC), is the foremost global certification for recognising best-in-class strategies and practices in green building.

Nature and water are at the heart of Therme Group’s 10-year plan to roll out facilities to cities in the UK, mainland Europe, North America and Asia-Pacific. Each Therme Group resort will contain more than 200 plant species. Saunas and mineral pools will offer intense physical experiences that have benefits for mental health. Wellbeing will be enhanced by outstanding architecture, emphasising natural shapes and forms. Turquoise, warm-water lagoons in spectacular biodiverse gardens will lift the spirits. A few hours in a Therme Group resort offers the opportunity to unplug, to be calm and contemplative, and to focus on beautiful surroundings and oneself.

Therme Group believes that wellbeing should be accessible to all, not just to a privileged few. Therme Bucharest had 1.2 million visitors in its first year, and attracts both old and young. Therme facilities are intended to be inclusive, within the reach of most people; they appeal to families, older people, and adults visiting in groups, as couples or alone. We prioritise high quality materials, sustainability, and accessibility. Therme saunas are beautiful and communal, often involving multisensorial rituals such as aufguss guided sauna sessions.

Spiritual wellbeing is enhanced by the presence of nature and water, beautiful architecture and an extensive art programme of permanent and temporary installations. Each Therme Group resort offers an opportunity for artists to go beyond galleries and museums. Therme Group is working with some of the leading names in the contemporary art world, including Icelandic artist Egill Sæbjörnsson, the Studio Drift collective, and leading architects including Francis Kéré, Junya Ishigami, Frida Escobedo, and David Adjaye. Therme Group offers artists the opportunity to produce work that promotes discovery and wonder, contemplation, playfulness, and engagement with others.

Cities, as we have seen, are complex, dynamic, shifting agglomerations that influence citizens and are influenced by them in turn. As we emerge from the coronavirus crisis, health and wellbeing will be more important than ever. Citizens will be more aware of their vulnerability and interdependence. Lockdown has shown us some of the ways we might change our cities to be cleaner, greener, less estranged from the natural world, less polluted, and less busy for the sake of busyness. Drawn back into our homes, we have focused on the arts of life: caring, cooking, gardening, talking, teaching, learning, walking. We would be unwise to lose touch with all of this as we re-emerge, not least because this crisis may be followed by further shocks. We will need to find a balance between systems and empathy, including empathy for the planet on which we find ourselves.

If we are to achieve widespread wellbeing, we have to take a fully human approach, one that takes into account physical, mental, emotional, social and spiritual needs. There are no quick fixes. At Therme Group we want to bring people together in a movement for urban wellbeing. Together, we believe we can create the conditions for humans to thrive in urban settings.

WORLD CITIES INDEX

Cities referenced in Human Cities with page numbers

BEIJING 17,26

SEOUL 13

CHENGDU 13,18

BANGKOK 17

TOKYO 26

KYOTO-OSAKA-KOBE 13

SHANGHAI 26

XIAMEN 19

HO CHI MINH CITY 13

SINGAPORE 13,16,32

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