'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.

The City in High Heels - New Methods in Urban Studies

Men cannot understand the urban surface. Sadly they design most of it, but paths trodden in Converse allow no appreciation of the myriad textures and challenges of the different pavements in this City. Sturdy flat shoes stride onwards unimpeded, unthinking - let's trip this shit up.

I propose a high-heeled method for this exploration, this opening up of that which is in plain sight. As high as you can, please - 5" does nicely - as this walk must take on both altitude and danger. One needs to walk in something that makes the very practice of walking rather difficult. Perverse? But that is the point - to complicate walking in the richest social-science sense of 'to complicate': to make multireferential, contradictory, challenging. For this purpose Balenciaga's legendary high-heeled hiking boot would be ideal:



The first lesson of this methodology is fetishistic. We wish to expand the notion of the erotic from mere genital origin into the very fabric of the city itself. On an elementary level, the very concept of hiking boots with a 5" heel is perverse. Good. Then, to walk in such shoes lengthens the leg and forces a certain sashay into the hips. In such a heel the buttock is tightened, the body tautened; there is a physical awareness and an awareness of the eyes of others, especially the admiring glance from those gentlemen who have a kink for these things. One no longer merely walks but struts - the stroll becomes a passegiata, a promenade, and the role of pedestrian spaces for style and display and flirtation is brought to the fore. The possibility of an erotic encounter is trodden into the city with every step.

The second lesson of this methodology is about disability. To be sure in high heels one restricts oneself voluntarily, so it hardly offers meaningful insight into the urban experience of people with mobility problems. Nonetheless the pavement is transformed into a place of hazard - and the pedestrian now aware of the slightest irregularity. Gaps between paving slabs; tree roots; this particularly slipperty type of tarmac. Uneven paving slabs offering just enough of a step to trip you up. Uneven kerbs, sloping streets, metal gratings and un-flat manhole covers - even frequent changes of pavement surface or inexpertly patched tarmac become a problem. Give yourself a balance impediment, restrict your stride length, and suddenly such things as these become real obstacles - furthermore if you trip and fall it is not so easy to recover. Accessible distances become another issue, the long walks at Bank tube station exhausting in a way the Converse-clad cannot see. High heels offer a chance for empathy with those who find it hard to walk, and spotlight all the places where the pavement is exclusionary. High heels tell us what to change to make these public spaces really public for all.

Under this methodology all New York is hell - the city cannot mend a pavement for shit. In one particularly epic pothole a high-heeled friend did in fact fall and break her leg - transforming voluntary impediment into real disability for some months. This, you understand, is why it is important to wear stilettos rather than wedge heels: they'll snap in place of your fibia.

The final lesson of the high-heeled method is in texture: for this we must abandon the platform heel for something with a thinner sole. (But please not the ballet flat: these are not chic when terminating an English cankle.) The heel puts pressure on the ball of the foot and again focuses attention as to what's underneath. This intimate contact between sole and pavement allows hitherto unconsidered differentiation between different surface materials - the cool pleasures of smooth flagstones; the dozen genres of tarmac; dimpled concrete versus cobblestones. With practice one might locate oneself to the exact street within a handful of closed-eye steps - now that would be urban knowledge.

Yes, I would make every urban planning student walk in high heels for a semester - transvestite shops cater for all sizes no excuses. More navigable pavements would be a victory for disabled access, sure - but, shit, shouldn't urban designers pay some attention to the needs of high heel wearers as a fundamental principle? Stiletto-navigable streets inconvenience no-one, help many, and yet women's specific needs for urban space are inadequately sufficient. From another angle, Barbara Penner's work on the politics of public toilets makes a similar point - as she puts it:

" As one of the last openly sex-segregated spaces in Western cities, toilets fit the bill, allowing me to think about the ways in which the male-dominated professions of planning, engineering, and architecture fail to accommodate and even actively suppress female needs.

In the late nineteenth century, George Bernard Shaw, then heavily involved in local government, complained that the barrier of the “unmentionable” meant that women’s bodies were never visible at the political level. This silence about needs and provision, in turn, has historically had a real impact on women’s mobility, comfort, and sense of belonging in the modern city."

Sinclair (1997) 'Lights Out For The Territory': A review, or perhaps a mauling

So Iain Sinclair's Lights Out For The Territory is "Quite simply one of the finest books about London ever written", says the Spectator; "A book about London, in other words, a book about everything" (Peter Ackroyd in The Times).

Bollocks.

There are no people there, not in his writing. The city is empty, inhabited only by poets and booksellers: educated, broke but certainly not poor; white or maybe a bit Jewish, and monolithically middle aged and male. What ghost town is this? I wouldn't want to go there. Sinclair walks, he says, but his words are so terribly disembodied for such a project; there he goes, the anti-phenomenologist mimbling off into history, always the past, as though he hasn't found any there there at all. In seeing a palimpsest beneath the city, he loses sight of what's in front of his eyes; oh, Sinclair obsesses over graffito scrawls as though they are authorless, solipsistically taking them all as signs for him to read, to interpret. Hermetic fucking arcana - what about the unknown? What about the proposition that the city is chaotic, is vast, is unknowable? No, let's be afraid of that and search for Dan Brown hidden traces, let's go chasing castles in the sky, this airy semiotic fantasy and forget that the real links, the real connections - the real goddamn mystery - is in the people, the messy illiterate gorgeous mass of people from whom Mr Sinclair is running walking away.

Walk II: Regent's Canal east

So I went for a walk.



That map torn and battered, had it since the day I first moved here, guide and gospel to the city I at first struggled to like. Places I go most it gets tears, loses pages, each new friend and each new flat bequeathing rings on their pages, got to find that place again. But this low-tech doesn't work any more, Highbury, Lea Valley all changed but the drawings on the paper haven't - so time to draw back, write my own geographies on top of those already marked.



The estate's boarded up, condemned - but I've lived in worse places than that, those blocks last alright enough so what do they want to go knock it down for? Ah, the canalside got cleaned up no longer a rubbish dump but an amenity too good for social tenants. So knock it down, build it up, sell it to the middle classes at £500 a square foot. That's the capital.







[Skipping over Queen Mary university and all its Serious Architecture (as if in competition with London Met's Libeskind); capoeiristas in Mile End Park; an artic tern fishing in the canal; smell of salt air ahead of me unexpected and drawing me on]



Shiny yuppie stuff's back. Limehouse Basin a weird area committing the same residential-only zoning sins as NY. Nice, but too far from anwhere with there there, and nowhere to eat, so not actually nice at all. Wapping a slog along its cobble-lined uninhabited so-called High Street, luxury warehouse developments hogging the riverbank for theirs alone. We'll watch your BMWs in the basement garages flood when the Thames Barrier fails, just you wait...



Body aching just the sight of the water is refreshing; the sun after the cavernous closed-off streets a relief. The river is wide here, the birds and yachts maritime. I had not known this as my city before, and finding it has exhausted me.





But when she's this beautiful you forgive, don't you.

WalkScore: Quantifying urban experience

WalkScore is a piece of genius that quantifies a neighbourhood's 'walkability'. Enter your street address or postcode, and it uses shop and amenity data from Google Maps to give your specific address a walkability score out of 100.

So what does this concept of 'walkability' entail? They say:

Walkable communities tend to have the following characteristics:

* A center: Walkable neighborhoods have a discernable center, whether it's a shopping district, a main street, or a public space.
* Density: The neighborhood is dense enough for local businesses to flourish and for public transportation to be cost effective.
* Mixed income, mixed use: Housing is provided for everyone who works in the neighborhood: young and old, singles and families, rich and poor. Businesses and residences are located near each other.
* Parks and public space: There are plenty of public places to gather and play.
* Accessibility: The neighborhood is accessible to everyone and has wheelchair access, plenty of benches with shade, sidewalks on all streets, etc.
* Well connected, speed controlled streets: Streets form a connected grid that improves traffic by providing many routes to any destination. Streets are narrow to control speed, and shaded by trees to protect pedestrians.
* Pedestrian-centric design: Buildings are placed close to the street to cater to foot traffic, with parking lots relegated to the back.
* Close schools and workplaces: Schools and workplaces are close enough that most residents can walk from their homes.

However, their algorithms are not this complex. (That'd be some pretty hardcore GIS!) Instead, they're working off Google Maps to assess the distances from a particular location to its nearest amenities, then combining these figures and finally ranking that location's cumulative walkable accessibility from 0 to 100, bad to good. This means it doesn't actually address most of the criteria of 'walkability' above. So is it any use - does it provide any assessment that makes real-life sense when compared with our own detailed, lived knowledge of places?

I'm impressed. I currently live in the City's northern inner suburbs in a nameless locale not quite part of half a dozen districts. My address gets a walkability score of 60, which I think bang on. 24-hr petrol station & grocery store 500m up the hill; a medium size Tescos 10 minutes walk a way, as is the tube. Bus stop outside the door, tailors and dry-cleaners 100m away, bank and library and coffee shops (aka civilisation) about 15 minutes up the hill and down again. Of course there are innumerable chicken'n'chips and pizza takeaways in walking distance - or should I say fat-arsed waddling distance? re. issues of obesity and food poverty - as easy access to cheap fried grease make up the very fabric of the City's 'burban fringes! But 60% walkable? I think so. Day-to-day maintenance is by-and-large local & walked - but for work, pleasure, socialising it's straight on the bus into Central.

Does me good. First place I've lived in this City that I've remained in for more than six to nine months...

...Though damn, yes, I still miss the yuppie student brat pad I shared in Bloomsbury a while back, affordable courtesy of a friend with a daddy who was 'something in mineral extraction'. Not quite up there with LSE's Russian oligarch-spawn and their penthouses in Covent Garden, but not miles away either... Walkability score 95% + Soho in 12 minutes = bliss.

Grew up on the edge of the City's commuter belt in a supposed market town that was more one big dormitory 'burb. Now, it's clear that Google Maps doesn't provide such good shops/amenities tagging outside the City - the library's not tagged, the sports centre's not tagged - and, more generally, there's a problem that newsagents don't seem to get tagged, when they're the standby saviour shop for residential areas. So perhaps the WalkScore for my childhood home of 5% is a little harsh - but shit, it felt that cut-off from any life, so I do not criticise too far!

My friend Ash: "I say keep hating your hometown: it encourages aspiration."

WalkScore currently works for the UK, the US and Canada - with more countries to be added soon. So give it a shot and tell me - how's its alogrithms compare to your subjective feel for your neighbourhood's walkability?