'Epidemic obesity' and the challenge for urban design

This follows on (belatedly) from a BLDGblog post looking at the potential for urban design to limit the transmission of epidemic disease. In essence, sit people greater-than-sneezing-distance apart and they're less likely to infect each other with flu. Reading this I started to think about what might be seen as the defining 'epidemic' of modern times: obesity. How do the spatial requirements for combating this epidemic differ from other diseases?

The obesity-as-epidemic theory refers in the broadest sense to the social character of being seriously overweight. It's rooted in analysis of the massive longitudinal Framlington Heart Study dataset (15,000 people since 1948), carried out by Nicholas Christakis and James Fowler. This dataset not only covers people's health outcomes but also their behaviours and friends & family networks, making it a powerful resource to understand the social transmission of ill health.

Christakis & Fowler's finding: people don't get fat in a vacuum; instead, obesity spreads from person to person. People have thought for a while that bodyfat has a substantial social life, rooted in the norms we learn about how to eat and what food means; cultural representations of ideal and non-ideal bodies; comfort eating, exercise and dieting as a means to virtue... But that was a sociological hunch, whereas now the Framlington data offers statistical evidence that this 'epidemic' metaphor might really be valid. Not only do children learn unhealthy eating habits off parents (and their peers) but, says the theory, an increased prevalence of overweight people around you makes it more likely you will be fat / gain weight / not be able to lose weight.

That's the theory. While the pattern it describes is pretty rigorous, it's not unproblematic to medicalise obesity as a disease in this way (something discussed more below). At this point in the discussion, though, public health policy operates upon the population rather than the individual, and under this lens obesity isn't bodily experience or personal narrative but yes, epidemiological. So, using this public health framework, how would we engineer the city to avoid the spread and transmission of obesity?

People tend to approach obesity as a problem of calories in versus calories out. Under this schema we would first need a city that increases exercise and activity levels. This means walking and cycling, and promoting this through such things as the Paris Velib scheme, tolls to discourage cars in the city centre, school 'walking buses', not selling school sports fields for housing development, and so on. Investment in suburban public transport could switch people's commutes from a car journey door to door to a bus or train ride - and walking to/from the station at each end. Buildings get designed with more stairs, fewer lifts, and showers for cyclists and runners. Council-owned gymnasiums get subsidised so they're free to use - and so on.

Calories in? Public health interventions here would act upon school dinners, and ensure poorer areas of housing were properly served with supermarkets and fresh-food grocers, not just fried chicken shops. You tax fatty food, sugar, processed stuff; subsidise British and/or organic farming better than current EU agricultural policy. The urban environment loses its billboards advertising junk food, and gains allotments and public farming co-ops with egg-laying hens clucking free. The public health case seems clear, and (alongside economic stimuli) urban design would seem to play as central a role in tackling this epidemic as it has historically in tackling more familiar infectious diseases such as typhoid or TB.

The problem is that 'calories in less than calories out' doesn't work as a strategy for diminishing obesity. It's counterintuitive and you won't believe me, so I'll direct you towards the fantastic discussions of peer-reviewed scientific research on this front on the NYTimes' science & health blog. It's not the place to go into it all here, but in short the factors driving obesity are A Lot More Complicated than food and exercise. Obesity still shows epidemiological patterns of transmission, but the vectors are much more complex.

So what does this mean for the 'urban hygiene' thesis sketched above that suggests 'epidemic' obesity can be tackled by urban design and spatial organisation in an analogous method to combating other infectious diseases? Basically that it's not going to work. Now, walkable cities and access to affordable fresh food are still social goods and by all means need promoting - but not necessarily because they're going to make fat people thinner. (They should make the population healthier, but that doesn't mean people will lose weight.) Instead the more rigorous solution might be to start thinking about obesity as the symptom rather than the illness.

The symptom of what? Poverty, and more than that, social inequality. At some point in the last century the West passed a tipping-point where food became sufficiently abundant that the poor could afford enough of it to get fat. Poverty being in these societies a largely relative state (even in governmental definitions such as income <60% of average), in more unequal societies the poor feel poorer - and are fatter. Why? Because, as humanity overlays biological nature with social meaning, food is about a hell of a lot more than calories or 'fuel'. It's about sociality, comfort and indulgence. Even those with very little can afford access to 'luxury'-marked foods that are rich with fat and sugar and highly pleasurable. The problem is not the food. It's the social structures that make people feel bored, and demoralised, and of little self-worth, and consequently likely to turn to over-consumption for some relief. Even rhesus monkeys do this: "Essentially, eating high-calorie foods becomes a coping strategy to deal with daily life events for an individual in a difficult social situation."

Under this improved understanding obesity is still 'epidemic' - because low social mobility reproduces the same conditions of inequality for the subsequent generation. And, as the famous Whitehall Studies of civil servants show, it is specifically inequality that is the problem, rather than simply low social status: the lower-ranking civil servants weren't poor, but they still had more heart disease, obesity and mortality than higher-ranking staff. Is urban design still able to act on this issue as it can upon epidemics? Yes... Maybe.

It's a lot harder to design out social inequality than it is to put some bike lanes in, that's for sure. For example, do you mix up housing sizes & tenures so rich live next door to poor - is that leveling and pro-equality? Or does it daily remind some people daily of much less they have, and would they be better off in areas of more homogenous income/class where similarity might facilitate greater community? How'd you spatially plan school catchment areas to enable equality of educational opportunity for all - and yet not bus kids halfway across the city, disrupting both social groupings and pupils' ability to walk/cycle/exercise their way to school?

Urban design is important for tackling social inequality, of that much I am sure. It produces the spaces in which different people interact and meet, it sets up the lived, experienced context for ideas of the public and the social commons and solidarity within the social collective. But the specifics of what you design and build and where, as means by which to tackle social inequality (and its symptom, 'epidemic obesity') - it seems a lot more difficult than the urban hygiene of sewers and clean water that beat epidemics of old.

Holloway, May 2009

Who knows what the story is here?

New York, New York

Twelve days ago I went to New York for the first time. I didn't visit for the sake of the city at all - hell, I wish it didn't exist - oh, let's just say it separates me from someone, someone who's pretending for the moment that the City isn't the one true place to be. Nevertheless, this is enough of a someone that I would consider leaving my beloved City for his - so while I was there (and because I lack the money, and because I'm an anthropologist not a lousy tourist!) I was thinking about how NY operates as a place to live. A few comments on its urban space and architecture, to begin with:

The Bowery was one of the streets I liked the most, even as gentrification starts to go too far. (The less said about the hotel these days the better.) It let me take a satisfyingly evocative (cliched) photo, and still seemed to carry a few ghosts.



The Bowery hosts the New Museum of Contemporary Art, one of the very few bits of proper, committed new architecture I found in the city. (I didn't go even as north as Midtown, though, so I accept I may have missed a bit! Then again, no-one was trying to convince me that the Upper East Side was a happening place to see...) The rainbow 'Hell Yes' on its side didn't exactly 'fit' as such, but the building had a scale and a rhythm that worked well. I liked its texture, I liked its balanced imbalance, and it proided a fitting space for its gallery purpose.



One of the other rare bits of serious new architecture I saw in NY was Tschumi's Blue Building on the Lower East Side - I failed to get a decent picture, but thankfully the New York Times did. Apparently, "its contorted form has a hypnotic appeal that is firmly rooted in the gritty disorder of its surroundings." No no no! It's just a bog-standard tower block that happens to be wonky. It's a monolith of glass and steel that doesn't speak to any grittiness or disorder; it seeks to be a singular landmark rather than dispersed or multiple; it's blocky, aggressive, still fucking phallic. This longer review is more astute when it observes that the asymmetric form is all about maximising the square footage, i.e. capital-with-a-capital-C. If I gave a shit about the Lower East Side, perhaps I'd cry.

Oddly enough for America, New York's best buildings were its old ones, with their fragile rusty balconies and sense of speaking in harmony with their neighbours. I was surprised to find that the city had a facility for elegant decay, something I associate strongly with Mediterranean cities and perhaps Latin America. Paint peeled, graffiti layered on top of posters, the sidewalk fallen apart fit to break a leg... Unexpected, but quite beautiful in its anti-statist way. Sea air helps, too, I suppose. I'd thought Coney Island might have this quality but instead it was sadder than that, surrounded by housing estates and derelict land, an illustration of New York's segregation and deelopment rows. Shame. (Fucking enormous seagulls, too.)



Further commentary in another post regarding the 'suburbanisation' of New York and other suggestions as to why I didn't feel it was somewhere that worked very well. But as a teaser, I like this comment by Rocco Landesman, a Broadway producer:

But I think there has been a delibidinization of our city, I really do. ...In terms of public planning there’s been a kind of prudishness, a kind of social and political correctness that’s gone on.

Sex and the City, now there you go - and now that's such a topic for this blog, too!
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City-related lectures at LSE this autumn

There are a thousand reasons why the LSE is brilliant, and one is the quality of its evening lectures. The full list is available here, but below are details of the best on urban and spatial topics. I'd like to attend them all, but that'll be easier said than done!

Tues 21 Oct, 18:30 - Running Cities: London in context
Sir Simon Milton, Prof. Ricky Burdett, Deyan Sudjic
What is the new administration's vision for London? Speakers discuss how to design and manage the powerhouses of the global economy, assessing London's development compared to the megacities of the world.
Simon Milton was appointed deputy mayor for policy and planning after serving as chairman of London's Local Government Association. Ricky Burdett, chief adviser for the London 2012 Olympics, and Deyan Sudjic, director of the Design Museum in London, are co-editors of The Endless City.

Tues 21 Oct, 18:30 - Disparity and Diversity in the Contemporary City: social order revisited
Prof. Robert Sampson & Prof. Paul Gilroy
A look at classic urban themes as they are manifested in the contemporary city, focusing on social reproduction of inequality, the meanings of disorder, and the link between the two.
Paul Gilroy is Anthony Giddens Professor in Social Theory at LSE. Robert Sampson is Henry Ford II Professor of the Social Sciences and chair of sociology, Harvard University.

Tues 4 Nov, 13:00 - Big Ideas: Richard Wilson
Richard Wilson is one of Britain’s most renowned sculptors. He is internationally celebrated for his interventions in architectural space draw heavily for their inspiration from the worlds of engineering and construction.

Weds 12 Nov, 18: 30 - Desiring Walls
Prof. Wendy Brown
In this lecture, Professor Wendy Brown will draw on discourse analysis, psychoanalysis, and feminist theory to examine the desire for walls in the context of eroding sovereignty. Why the current proliferation of nation-state walls, especially amidst widespread proclamations of global connectedness and anticipation of a world without borders? And why barricades built of concrete, steel and barbed wire when threats to the nation today are so often miniaturized, vaporous, clandestine, dispersed or networked? Why walls now and how are they to be understood? While acknowledging variety in the explicit purposes of the new walls, this project argues for comprehending the recent spate of wall building in terms of eroded nation-state sovereignty. Above all, the new walls consecrate the boundary corruption they overtly contest and signify the ungovernability by law of a range of forces unleashed by globalization.
Wendy Brown is Professor of Political Science at the University of California, Berkeley.

Thurs 13 Nov, 18:30 - Our Urban Future: the death of distance and the rise of cities
Prof. Edward Glaeser
Improvements in transportation and communication technologies have led some to predict the death of distance, and with that, the death of the city. In this lecture Professor Ed Glaeser will argue that these improvements have actually been good for idea-producing cities at the same time as they have been devastating for goods-producing places. What, then, does the future hold for our cities?
Ed Glaeser is the Fred and Eleanor Glimp Professor of Economics at Harvard.

Tues 18 Nov, 18:30 - The Politics of Mobility
Peter Hendy
Sprawl versus dense? Public transport versus private car? This debate will outline how London's transport strategy shapes - and is shaped by - environmental policy, quality of life and political imperatives.
Peter Hendy is commissioner of Transport for London.