Building Cities for People, Not Cars

By Dr Bernhard Schwartländer

Opinion Piece

The saying goes ‘form follows function,’ meaning the look of something – its shape, movement, physical characteristics – are a result of its purpose. The concept was originally used in architecture, and later applied to industrial design, and even to evolutionary biology.

Form follows function. One only has to look at modern cities to guess what the function is – to support the rapid movement of cars.

Massive boulevards, which cannot be crossed by a pedestrian within the limit of a green light. Ever growing ring roads that divide neighborhoods and established communities. Roads without bike lanes. Cars parked on sidewalks. More and more cement and metal that isolates us from our environment and from each other.

Car is king in the modern city. The built environment reflects that. And it’s slowly killing us.

Globally the urban population is already over half of the total global population, up from just a third in 1960. Today more than half of China’s population lives in cities – by 2030 the number of Chinese living in urban environments will be just shy of one billion people.

China’s cities are some of the best in the world. They offer many opportunities for employment and access to better services. As currently designed and constructed, however, they pose unique risks to our health and well-being. China is facing a tsunami of lifestyle diseases – obesity, diabetes, heart disease, lung cancer, and more. The built environment has a major influence on China’s ability to tackle these diseases.

We have all seen and inhaled the alarming levels of pollution across China. Health costs and loss of productivity due to air pollution range between 3% -6% of China’s GDP each year. Beyond pollution, we take health risks as we move from home to work to school and back. Approximately 260,000 people in China die each year from road accidents each year. More than half of those are vulnerable road users – pedestrians, cyclists, and people on e-bikes. Road design disadvantages those on bikes or foot.

Our cities simply aren’t built for people; cities are now built for cars.

But it’s not only design. It’s also how the design reinforces behavior. Where design prioritizes the rights of motorized vehicles, it fosters a habit of prioritizing machines – cars and trucks – over people.

Our roads are overloaded and the combination of unsafe driving, congestion, road rage and a me-first mentality results in a lethal cocktail. Too often the mother with a pram struggles to cross a busy road or a cyclist is honked at and sometimes hit by an impatient car, rather than slowing to let them pass.

‘Form follows function’ only works if we have the right function. Shouldn’t our cities serve the people who live in them, and not just the cars they drive? What if we re-conceived of the physical environment in which we live and the policy priorities we advance in ways that benefit the well-being of the whole community? What if we embraced a way of living in the shared space of our cities in a way that facilitates sustainable growth, environmental health and individual health?

Changing this requires a healthy cities approach. It requires people-oriented urban planning, like bike lanes and pedestrianized centers where we can shop or eat in a café within walking distance of home. It requires design that builds social cohesion, allows elders to age in place, provides community centers and neighborhood sports facilities and parks, and addresses growing inequities and social isolation.

If our cities as currently designed are part of the problem, they also hold the solutions. Cities are the most dynamic environments, often at the forefront of innovation. Re-imagining urban life will happen in cities because this is where the inequities are most stark and apparent and, rather paradoxically, because it is in our cities that our common humanity is most clearly felt. It is here, in cities, that mayors and workers breathe the same air, walk on the same roads, and send their kids along the same routes to school.

People need – and are demanding – a healthy environment. This demand to rethink our urban experience is what has driven the shared-bike revolution. It is a uniquely Chinese innovation that is transforming how we commute and get around our cities in ways that benefit both our health and our environments. And it is an innovation that China will bring to the world.

Health is not only about doctors and disease. We need the leadership of city mayors and urban planners to prioritize health. These health challenges need to be incorporated into every discussion on the design, development and management of our cities. Health must be an important benchmark to measure the sustainability of our urban policies.

China is extremely fortunate to have a President and top leaders who have made health the center of all government policies. Putting health at the heart of urban strategies ensures broad public benefit, particularly for the poor and vulnerable.

Our cities need to be re-imagined for people. In China’s cities, the car may still be king, but hopefully not for long.

The author is World Health Organization Representative in China.

Note: An edited version of this opinion piece was published in China Daily.

About the World Health Organization

WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.

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