Why liveable cities are important for better health equity

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Gretchen Miller: Hello there, Gretchen Miller with you for Prevention Works, the podcast of The Australian Prevention Partnership Centre, recorded today on Gadigal and Wurundjeri land. Well, this year is the Prevention Centre’s tenth since we were established in 2013, so it’s a special year for celebrating lessons from a decade of Prevention Centre research. One of our first projects was on measuring the key factors to making our cities healthy and liveable, and that’s where we return on Prevention Works today. Dr Lucy Gunn is our guest, and her work has been an integral part of the Prevention Centre’s research almost from the start. Lucy works in econometrics and urban research to understand which urban environments are particularly supportive of health and wellbeing. Good urban design is critical to population health in a number of ways; the liveability, walkability, and transportation around our built environments impact significantly on mental and physical health, leading us towards healthy ageing. Co-benefits have been a theme of our interviews this year so far on the show and the more we understand the co-benefits of liveable cities the better we can adjust the consequences of urban design with population health in mind. Dr Gunn is a Senior Research Fellow at the Centre of Urban Research at RMIT University. Her work, along with that of her colleagues and the Healthy Liveable Cities Lab at RMIT has won multiple Planning Institute of Australia awards. Lucy’s drive, as we’ll hear shortly, is to ensure this research is communicated and understood by those in policy-making positions, to benefit the broadest segments of society. Lucy, welcome, and thanks so much for your ongoing contribution to this field. Broadly speaking, why is it important to understand the built environment for better population health outcomes?

Lucy Gunn: Well, the built environment, and this is what comes through the research, is one of the determinants of health that has quite a big impact on how people behave, and if we can get them to do more physical activity or more walking around their neighbourhoods then that contributes to better health overall in terms of physical activity levels, but also that flow on effect to reducing chronic diseases. What’s a bit special about the built environment is it’s something that’s structural, it is hard to change, it is heavy infrastructure, it is made out of bricks and mortar and concrete, there’s a real cost to getting it wrong, and retrofitting is much more expensive, and we really need to have policies in place that are sound, good, sound policies ideally built on research evidence so that we can make that link between what’s in our environment and how that influences people’s behaviour and then consequently their health.

Gretchen: Yes, and so your point about the built environment being made of bricks and mortar is evidence that we’ve actually got to try and get this right, right from the start if we can, and if we’re working with environments that are already built you’ve kind of got to consider that this is going to be a very expensive exercise, and so you really do have to be on top of your research and really considering these things whenever change occurs.

Lucy: Absolutely, so there’s a real opportunity, sort of in two directions, but one of those is the growth areas, so some cities are still building out on the periphery, and it’s an opportunity to get that right from the outset, so getting policies and plans in place that sit with the best available research evidence, so that’s one case, but the other case is looking at retrofitting an infill development, so taking this view that we don’t want to keep growing our cities into perpetuity, we actually want to restrict their growth and have urban growth boundaries in place, and to make use of existing infrastructure in the best possible way. So, there is some aspect of retrofitting and some of that does fit in with the policies that we have, particularly here in Melbourne where there is a requirements in Plan Melbourne, which is the overarching strategic planning document to have 70 percent infill density and 30 percent to be on the periphery of the city, so balancing that out a little bit through retrofitting.

Gretchen: Could you describe for us the work of the Centre for Urban Research, what disciplines are gathered there and what its role is?

Lucy: Okay, the Centre for Urban Research does look at urban issues, predominantly, but it does cover a number of different disciplines as well. So, I’m quite lucky in that I work with an interdisciplinary team, and that includes geospatial scientists and geographers, it also includes psychologists, and we also have computer scientists amongst us as well, and the reason for that is that it takes those different disciplines to be able to explore the different issues that relate to urban environments. Some of those issues relate to housing, some of it’s to do with things like public open space and trees, some of it is inherently spatial, and some of it is inherently economic, if you’re looking at housing and housing affordability as well. So it does take a broad range of different types of people to do that kind of research, and the whole point of it really is to create that evidence on which to have impact and change, so to influence policies and to influence decision making and governance more broadly, so feeding into that debate and that discourse about what should be rather than what is and looking to the future for what you could have if you were to have a crystal ball, so trying to influence those things for the greater good.

Gretchen: And it’s really interesting that it’s such a collaborative effort, you’re not working on your own here, and you’re not just working with people who are from your own discipline.

Lucy: No, we’re not, we need to have those different skillsets to be able to deliver the work, and it is big work, so some of that data being spatial data, so that’s essentially mapping, we might be looking at access to different types of destinations, we might be looking at land use specs or density, we might be looking at the structure of the streets, and we know that those sorts of features feed into this concept of liveability, and the concept of liveability is really looking at what’s in our environments that make them easy to live in, that’s the simple explanation, but through that link with the determinants of health, that influences our health and wellbeing and our behaviours, so having the best kind of environments is what influences health and wellbeing in the long run, but understanding who’s got the best environments and who doesn’t, these aspects of equity, also the trade-offs in behaviour. A lot of our work focuses on active transport and that is walking and cycling predominantly, some people would argue that it also relates to public transport because most people would walk to a train or a bus, and so there’s some component of physical activity in there that is active, hence the name active transport, but we’re trying to get people out of their cars and into more active behaviours, because that takes the pressure off the system, or the road system I should say, so that’s a trade-off between sedentary behaviour and getting more physical activity, which is good for health, but then there’s a trade-off for people who are driving as well, so by freeing up the network you get faster travel times in theory, so there’s a kind of hidden co-benefit in there, and more explicitly if you get more cars off the road you also have impacts on things like air quality and also accidents. So there’s a whole range of co-benefits that feed into this work but it takes a lot of different people to be able to deliver it and that’s really why we work together in this way, and it’s interesting work because you have to see things from someone else’s point of view that may not be your area of expertise, so it does rely on a degree of patience and conceptualisation of the work upfront because you can’t get that work done unless you see eye to eye at some point, so it’s great work, yeah, but I would have to say that I don’t spend much time doing it on my own, I do work with this team quite intensively and most of us work together and that’s why our publications have quite a few authors on there, but that’s really recognising the different skillsets that’s required to deliver the research. So it’s quite important, I do want to recognise the value of every single person on our team because they all contribute in their own unique way, and we wouldn’t be able to do this work without them.

Gretchen: So, look, what I wanted to raise was a point that you’ve made that is critical in your work, and that is communication, it’s a really interesting lesson for mid-career researchers, and I wondered how you personally engage with a variety of policy makers?

Lucy: That’s a really good question, actually. I guess it’s a multi-headed approach, really, because we do write our publications and that’s the formalisation of that research process, but we often write the softer version of that research, which might be a policy brief or it could be an article that goes out to a place like Planning News or The Conversation, but on top of that I’ve been very lucky to be involved in a number of different projects that have had project advisory groups where we’ve really had our finger on the pulse in terms of having access to high-level strategic people who work in planning and transport as well, and they have a very different perspective on what we do, they’re very interested in the research evidence, but they’re also interested in helping us develop the right kinds of research questions as well. So there’s things that would be strategic for them to learn about and to know about, but those advisory groups have really allowed us to have access to that thinking and to that way of working that academics don’t have because we work in a different area, so it’s quite nice to be able to sit on those advisory groups to hear what the key issues are, what’s up and coming, but also to learn what the problems are from a different point of view, because that helps drive the next generation of research as it comes up, coming back to your question in terms of working with the advisory group members or people who are in government, in industry, it takes a long time to develop those relationships and for me personally it’s a real privilege as well because we wouldn’t get that information any other way and to have them on our advisory groups helping to contribute to that research really gives us the best possible outcomes.

Gretchen: I think the point that you’re making too is that over the lifetime of your research you have gathered and built connections in a number of different policy arenas and you’re able to draw on those connections to bring groups together, to bring policy makers together from different sectors, perhaps, so that you could have a more holistic approach, but that’s a whole-of-career learning, and a fostering, really.

Lucy: Very much so, yes, and it happens in unusual ways as well, sometimes you’ll be at a conference and there’ll be different people at that conference and you’ll be rubbing shoulders and networking and you might have a common interest and then you might pass on a publication, they’ll pass it onto someone else and all of a sudden you’ve made a new connection, so it’s definitely not a linear process, it’s very much a lateral process, and I think attending these different kinds of events and meeting and greeting different people and doing presentations and writing articles, it all contributes to your standing as a researcher but also to that conduit of getting in with people in government and industry to learn a bit more about their point of view, which is pretty crucial for what we do.

Gretchen: So, across your work you’ve been using indicators of liveability by which to assess cities and population behaviour, I wonder if you could outline these indicators of liveability?

Lucy: So the indicators come from the definition of liveability, that’s the first thing, and we tend to define a liveable community as one that has good access to shops and services, to education, healthcare, to cultural opportunities, so being able to go to an art gallery or a museum, for example, and employment as well, but all of that being accessible through different modes of transport, ideally the sustainable ones such as public transport, trains and trams and buses, but also walking and cycling. So when you start to look at that definition of liveability, it’s essentially looking at the environments in which we live and then connecting that back to health. But when you’re looking at that environmental aspect we can measure those different components of that definition, we can measure whether a person has access to shops and services, we can measure whether they have access to public transport, to a bus stop, or to a train station, we can measure whether they have access to healthcare or to educational opportunities, or even to places of employment. So we tend to do that in different kinds of data sources, some of it is open access, so OpenStreetMap, for example, tends to locate lots of destinations, we can also look at the street connectivity, so we tend to walk along streets, and so we can measure that using different kinds of maps, so Google Maps would be one example, but OpenStreetMap itself is another. So we can measure all of that and we’re quite literally taking everyone’s house, place where they live, and we’re connecting that to the closest bus stop to get a sense of accessibility in a broad sense, and we can do that with all the different features of the environment that relate to liveability.

Gretchen: And there are nine domains of liveability, I think.

Lucy: That’s right, so a lot of our work is related to the Australian Urban Observatory, and the Australian Urban Observatory breaks up the liveability indicators into nine different domains. One of those is liveability itself as a compound measure, which covers everything, so it rolls it all into one convenient measure. Now, the foundation of liveability falls back on this concept of walkability, which is really measuring the ease of walking in an area, and that’s built on at least three components, which is the street connectivity, so how interconnected the streets are, the population density, which is really a measure of the number of people, and then connecting that to destinations or destination accessibility, so it’s really putting people close to places where they need to go, which is the destinations, and then giving a sense of how easy it is to get there through the streets themselves, so that’s another domain, but then we also have other domains such as housing, public transport, public open space, food environments, alcohol environments, so it’s a whole stack more of them under those nine headings, which is sitting in the Australian Urban Observatory, and it’s a wonderful resource. It is free to access it and you can see these maps in there that show you what this looks like spatially, indicator by indicator. And the reason that’s quite interesting is that these indicators are socio-spatial, so that means that we can see them spatially on a map but you can see also where the people are located from a population point of view, and that shows you where there’s gaps, and if we start to measure these things across time, and we have lots of different maps sitting there across time, you can see how the gaps change or new gaps get created which then need to be, I’m going to say rectified or fixed or some attention needs to be given to those issues, so this is the benefit of having this stuff measured, but also in an easily accessible place that different organisations and individuals can simply look at to understand that picture of liveability for a given area across all of those different indicators.

Gretchen: That’s really interesting, I can just imagine how rich a resource this is, would be for health policy makers and planners.

Lucy: Absolutely, and the other thing that’s actually in the Australian Urban Observatory is one of our other protects, and this is bult on the modelling work of Belen Zapata-Diomedi, and so she has this quite nice health model that looks at physical activity, and it looks at how much physical activity can be done if you get rid of short car trips, and so that can be rolled into either walking or cycling or a combination of both, and if you’ve got the minutes spent walking or cycling that measured across a lifetime, across a cohort of people, can change chronic incidents and prevalence and mortality, so there’s a really nice tool that sits inside the Australian Urban Observatory, and we have that tool for Melbourne but we’re currently developing one for Brisbane, and we’re working on producing that in the next few months.

Gretchen: I’m looking forward to asking you about that in just a moment. I’m wondering at what level of government you think this research is best aimed? I mean you’ve actually done a lot of consultation for Victorian councils right through to the Environment Protection Authority Victoria, can you talk about working across government levels and what kinds of cross-department conversations can go on there?

Lucy: Yes, well, I think it does apply at all levels, the different levels of government have different controls in place as to what they need to look after, what they manage, so local governments look at some of the local roads, but then state government would look at the arterial roads, and so if you were putting in, for example, a cycle lane that’s going to involve both local and state governments, and so we need to have conversations with both local governments and state governments to learn a bit more about where some of these cycle lanes could go and where we could do different kinds of, I’m going to say intervention, but planners might prefer the word scenario, but looking at how we can build up these different scenarios for testing inside some of our models to learn how massive infrastructure changes might actually influence behaviour or uptake of cycling, as an example. So, coming back to your question, this idea of local versus state, they do work together, hand in hand, but they do have different remit, as in they control different components of the road network, for example, and so it’s important for us to be engaging with both of them. Some of that also feeds right the way back up to federal as well because there’s different policies that come into place at the federal level that can relate back to health and also to funding that gets divided out at the state level, so it involves all of them, and so we try and engage with all of them in order to get the point across that there’s research evidence on which to help make decisions.

Gretchen: So, before we wrap up, let’s go into details via some of the projects you’re working on. You are lead co-investigator in the Transport Health Assessment Tool for Brisbane, which builds on a similar project for Melbourne, what are you doing in Brisbane and what are you bringing there that you learnt from Melbourne? And that’s where you won that Planning Institute of Australia award, I think.

Lucy: Well, at this stage the plan is to replicate the Melbourne tool, but people in Brisbane don’t necessarily behave in the same way as the people in Melbourne, and so…

Gretchen: It’s a completely different environment, you’ve got a flat cool climate city, and then you’ve got a hilly, humid one, I mean they’re two very contrasting places.

Lucy: Well, that’s true. I guess, from our point of view, the tool itself will be very similar, so the model is going to be broadly the same, but we have an opportunity with Brisbane to discuss the chronic diseases and whether we include a few more, our vision is really to create a tool that allows people to understand the health impacts that come from taking sedentary behaviour away and swapping it with more active behaviour, which is the physical activity that comes from walking or cycling, but in a transport context, so the model is essentially going to be the same but there’s some tweaks that we can build into it, and we’re going to be discussing those changes with our advisory group, which is coming up soon.

Gretchen: Well, Dr Lucy Gunn, thank you so much for joining us here on Prevention Works.

Lucy: Thank you very much, Gretchen, thank you for having me.

Gretchen: And The Australian Prevention Partnership Centre, host of this little podcast, has been involved with several research projects around liveable cities; we’ll link to all those on our website. Please, do leave us a review, makes a world of difference to our findability, and let your friends and colleagues know about the growing resource of conversations around preventive health that is Prevention Works. I’m Gretchen Miller, I’ll see you next time.

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