Measuring health and wellbeing in rapidly growing cities

The City Health and Wellbeing Initiative, also known as ‘CHeW’, looks at how rapidly-growing cities are affecting the wellbeing of residents. We are interested in people’s quality of life and mental and physical health. We’re also looking into how well these cities are functioning and the mixture of ‘services’ they provide to residents and the wider environment, known as the ‘city system’.

We have been working intensively in two cities – Nakuru in Kenya, and Udon Thani in Thailand, since 2018. These places are similar as they are both secondary cities experiencing rapid change, but they are quite different in terms of climate, cultures, and aspirations. They allow us to compare health and wellbeing in very different settings.

If we want to build healthy cities for the future, urban spaces need to provide for wellbeing, environmental and economic sustainability. Research under the CHeW initiative is helping to quantify and find solutions to these issues.

Secondary cities often get overlooked in research projects but they will see much of the urban population growth over the coming years. At the same time, they may be under-resourced and facing climate challenges, such as drought and flooding, which will require significant adaptation measures, from infrastructure and housing to services and systems.

In many cases, secondary cities also present an opportunity to avoid the development mistakes of larger cities, where urban expansion happened at a faster rate. Such rates of expansion can have negative impacts on the natural resources and ecosystem services that so many urban residents rely on to survive and thrive.

Smaller cities also present the opportunity to foster relationships with local stakeholders, from the municipal authorities to local civil society groups and community leaders.

So far, we have undertaken surveys to understand how mental wellbeing and quality of life in different neighbourhoods varies across the two cities. This includes working with low-income neighbourhoods, where environmental conditions and infrastructure provision is poorest.

Our data show significant differences in wellbeing levels between neighbourhoods. We can relate this to socio-economic conditions such as housing availability and employment. When these factors are met, other social and environmental conditions in the city begin to play a greater role in affecting people’s subjective wellbeing, for example, availability of green space. In both cities, there were also gendered differences within specific neighbourhoods.

We’ve also looked into how residents make use of and value different types of urban spaces and have helped residents use citizen science to better understand and quantify environmental issues affecting their health and wellbeing, such as urban waste and water quality issues.

For example, in Nakuru, local geology causes elevated levels of fluorosis in water, which can have significant impacts on physical health by damaging teeth and bones. Community sampling, alongside water supply management, is helping to better understand the scale of the problem and the solutions.

We have used recognised survey tools (Short Warwick-Edinburgh Mental Wellbeing Scale; Perceived Stress Scale) to explore how subjective wellbeing differs across the two cities. We have combined these subjective wellbeing scores with more novel approaches to explore how city spaces affect people physiologically.

In collaboration with the University of Virginia, we used smartwatches to measure heart rate variability, as people moved around their cities. This revealed how different environmental conditions such as noise, air quality, perceived safety and greenery affected their stress levels.

This has been an exciting innovation that we are now expanding on with sensor measurements of environmental conditions, to complement the stress recordings.

In Udon Thani, we shared the first phase of findings with 104 community leaders and municipal officials, including the Mayor who is driving the vision of a green and healthy city. We are also engaging with actors working on the city’s Charter, which sets out the city’s vision for the next 10 years in key sectors including jobs, health, transport, green and public space, and urban revitalisation. We also work closely with community leaders where we have focused our citizen science activities.

In Nakuru, we are co-designing our next community engagement activities with the city authorities to ensure its relevance for decision-making. This co-design can be challenging but ultimately pays dividends for local stakeholders, ensuring the findings will be used by decision-makers. Now we are investigating what types of spaces local people would prefer and what different plans could deliver in terms of climate adaptation and mitigation, such as urban cooling.

In terms of direct benefits, one example is our citizen science work in Nakuru. Here, the data about waste that the community gathered has been curated by the CHeW team to improve communications between the residents and municipality. This has led to improvements for over 50% of the concerns raised by the community, for example, the removal of waste blocking water which now prevents flooding. This demonstrates how citizen science could play a useful role in managing cities in the future.

COVID-19 has affected the cities differently as the virus has impacted on Kenya and Thailand differently so far. Kenya has had more significant disruptions with lockdowns and restrictions in movement. The measures to control the disease have been affecting the poorest the most, as they often work in the informal economy, earning erratic incomes with weak financial reserves.

Our findings show that the neighbourhoods they live in also typically offer the least infrastructure to support their wellbeing (green space, public realm spaces). We reported on this in a well-received blog earlier this year.

We are continuing to develop new projects linked to CHeW work. For example, we recently started projects looking at how to make travel more sustainable in East African cities and the climate change benefits that active travel could bring.

We are also exploring how to expand the work we initiated on fluorosis with Indian medical partners and to look more extensively at this problem in Nakuru, across Kenya and more widely along the Great Rift Valley where it is an issue.