Urban planning for health – experiences of building resilience in 12 cities

Emergencies can become transformative experiences for cities: an opportunity to rethink, replan and rebuild, and to push for changes that can make them more healthy, sustainable, equitable and resilient. Going back to “normal” may not be good enough – instead, cities should strive to build better urban futures. This report presents the results of a series of interviews with cities in the WHO European Region, which aimed to compile local insights on how to set priorities for becoming more resilient and for preparing for (or responding to) environmental and health crises. Interviews were conducted with local government representatives involved in urban planning, environment or health areas. They focused on how the cities had approached urban planning and infrastructure design as a response to specific disasters – or in a preventive manner for future ones – and how these efforts could contribute to healthier, more sustainable urban futures. A total of 12 case study cities in 11 countries in the WHO European Region were interviewed using a questionnaire sent in advance. They included three small (<100 000 citizens), five medium (100 000–500 000 citizens) and four large cities (>500 000 citizens). Of these, 10 had experienced at least one emergency event in the last decade, including major floods, forest fires, earthquakes, hurricanes, industrial accidents, power outages, heatwaves and snowstorms. Several cities had experienced multiple disasters at the same time – a trend that is likely to continue in the future. These events caused a broad range of effects, including substantial impacts on health. Thematic analysis was applied to interview extracts to identify common topics, ideas and patterns. Emergency preparedness is a key element of building the resilience of health systems and other systems, and a central component of emergency management frameworks. The interview extracts were therefore analysed using four distinct but interconnected phases of emergency management frameworks. These include two phases that take place during and after an emergency (response and recovery), and two to be carried out before a new emergency strikes (mitigation and preparedness). When considering response, the interviews highlighted the fact that cities face a number of challenges with actions taken during an emergency. Some touched on governance, collaboration and communication aspects; for instance, dealing with a lack of information and protocols, collaborating with government bodies at regional or national levels and effectively reaching out to the community during the crisis. Health risk management and giving attention to vulnerable groups were also identified as main challenges during emergency management: unexpected environmental health risks may arise from certain disasters; impacts on mental health may be disregarded initially, leading to a need for greater attention later; and cities may experience a lack of emergency material during critical moments. While early warning and information systems may contribute to mitigating the health and other effects of certain types of event, their spatial scope and accuracy can be limited, and some cities may not have them in place. The interview results identified some key factors for recovery after the event, including access to financial resources and contingency budgets, insurance coverage, flexibility in local supply and distribution chains and social awareness of the different exposures and health risks of the surrounding environment. In addition, the interviews outlined a number of factors in building resilience that are critical for a full and speedy recovery, including long-term investment in critical infrastructure, transforming the economic model to rely more on sustainable and green industries, and control over development pressure. When focusing on mitigation and preparedness for future emergencies, the interviews presented a number of lessons the case study cities had learned from the emergencies. These related to urban management and coordination, to physical and structural planning or interventions that contribute to mitigation and, especially, to preparedness. They included improving coordination across levels of government; clearly defining roles and responsibilities; ensuring effective communication with the community; building awareness; increasing emergency training; and creating a favourable environment for consultation, dialogue and public participation. Lessons learned also touched on issues related to the benefits of a “proximity lifestyle”, where infrastructure and services are spatially distributed in an equitable manner across neighbourhoods; mobility choices steer towards the promotion of walking, cycling and public transportation (over the use of private cars); and public spaces are designed “for the people”. The interviews highlighted that local production and supply of basic goods and services help cities stay functional during a crisis and make them less dependent on other cities or countries (which may become problematic during an emergency). In particular, local energy sufficiency (including more flexible power systems that include redundancies) is desirable in terms of reducing vulnerability to many types of crises. Lessons learned from past emergency experience also touched on the critical role of urban green infrastructure, given the many hazard mitigation benefits of nature-based solutions and a renewed recognition of the value of urban and periurban green spaces as a consequence of COVID-19-related lockdowns and restrictions. When considering regulations and urban planning, case study cities pointed to the use of preventive approaches to land use planning that integrate risk maps and implement mechanisms such as buffer zones, preventing building in risk-prone areas and protecting critical green infrastructure. Other factors included mapping and updating the physical infrastructure to better plan for and respond to emergencies (especially vulnerable areas, such as informal settlements), and strengthening regulations to make buildings more resistant to strong winds, seismic events, fires or water damage in case of storms or floods. viSecond report on protecting environments and health by building urban resilience Finally, the case study cities highlighted the importance of maintaining a long-term vision when it comes to emergency preparedness and building urban resilience – looking beyond the short-term capacity to cope with the immediate response and recovery to get “back to normal”. This entails testing various emergency scenarios and updating risk assessments to include the best available predictions (especially regarding climate change). It also requires evaluation of the local government’s response to and management of any emergency, to provide authorities with better understanding, identification and assimilation of the lessons learned, and to foster a faster and more efficient response to future environmental or health threats. Most of these lessons learned (and many of the actions carried out by the cities in response) are closely linked to healthy urban planning principles. In particular, they focus on promoting active mobility, reducing risk exposure through planning (where green infrastructure plays a critical role) and ensuring local access to basic services. The interviews also revealed three cross-cutting elements – equity, evaluation and learning mechanisms, and compilation of relevant information in advance – that do not seem to be embedded in the planning and preparedness strategies of the case studies. This report also touches on how cities learn from each other, and in what way (or to what extent) international framework documents (such as the United Nations Sustainable Development Goals, 2015 Paris Agreement and Sendai Framework for Disaster Risk Reduction 2015–2030) affect local authorities’ thinking about urban planning, emergency preparedness and urban resilience and their relationship with health in their city. Limitations of the study are presented and discussed, and the main challenges for better integration of health and urban planning are considered further. Planning has a prevention and risk mitigation role to play; it is a public health intervention that provides mechanisms to transform physical and social environments, reducing harmful exposures and facilitating healthy lifestyles. This report explores this potential through the case studies, considering both urban planning and management (including aspects such as city maintenance, governance, intersectoral coordination and urban and infrastructure design). The report aims to consolidate shared knowledge about the links between urban disaster management and planning and health, and provides 10 key messages extrapolated from the 12 case study city interviews.

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