The relationship between health and urban design is complex, shaped by multiple elements that play different roles within the urban system. Cities are socio-physical constructs made of buildings, streets, open spaces, landscapes and, crucially, the people who inhabit them (Carmona, 2019). As numerous international studies have shown (Montgomery, 2013), places influence opportunities, well-being, happiness, cultural participation and social interaction. They shape housing conditions, the real estate market, and above all physical and mental health.
To capture this multifaceted value, Carmona (2019) uses the term positional value, defined as the measure of how and why a place matters. England’s CABE (2006) identifies six categories that help unpack this: exchange value; use value; image value; social value; environmental value; and cultural value. These dimensions together reveal how place quality is woven into economic, environmental, cultural and social outcomes—and why interventions in the built environment ripple across the lives of residents.
In the literature, the idea of “quality of place” is deeply tied to concepts like liveability, sustainability, and urban design. Carmona and de Magalhaes (2009) describe 12 attributes of local environmental quality—clean, distinctive, safe, robust, green, accessible, attractive, inclusive, vital and more—each linked to a broader set of spatial and social concerns. The World Health Organization reinforces this view, highlighting that air quality, green and blue infrastructure, waste management and water supply all directly influence public health and climate resilience (Capolongo et al., 2018).
As urbanisation accelerates—projected to reach 60% of the global population by 2050—cities must simultaneously accommodate growth and mitigate its downsides: pollution, heat-island effects, and the loss of urban green space. These pressures create environmental and social vulnerabilities that can push people to migrate toward healthier areas.
Health is inseparable from urban policy. Planning decisions shape behaviours and exposures—encouraging healthy lifestyles or reinforcing unhealthy ones. Globalisation, ageing populations and sedentary habits contribute to chronic diseases. Properly planned public spaces become therefore essential tools in health promotion.
Disease prevention can be supported through place-based strategies. Key actions include fostering environments that make healthy choices easy; improving living conditions; designing cities for all ages; creating resilient neighbourhoods; reducing inequalities; promoting participatory governance; and measuring progress through performance indicators. These actions align with broader goals of environmental sustainability, climate-change adaptation and social well-being.
Climate-change mitigation requires interventions such as improved communication during weather emergencies, conservation of forests and vegetation, and food-resilience planning for vulnerable communities. At the same time, sprawling, low-density development exacerbates pollution, noise and car dependence. Monitoring sprawl, evaluating its impacts, and planning public green spaces can counter these effects and promote physical activity.
Housing policy plays a central role in health: not only by providing adequate shelter but by ensuring socially, culturally and environmentally sustainable contexts. Strategies include affordable housing models, new co-living or community-oriented forms, and services that support elderly or non-self-sufficient people. These approaches depend on strong urban networks that integrate transport, neighbourhood planning and open-space design.
Recent studies (McCay, 2017) show that people in cities face greater health risks due to disparities, overcrowding, noise, pollution, scarce green space and reduced leisure. Green areas, in particular, are essential: they influence air quality, stress reduction, physical activity and social cohesion. Effective green-space strategies include planning coherent networks, choosing species suited to local habitats, improving lighting and accessibility, and involving communities in design.
McCay’s Mind the Gaps framework identifies four themes to make cities healthier. The first—access to urban nature—is widely recognised for its positive effects on exercise, social interaction and mental health. Yet, as several theories illustrate, benefits depend on design quality: inaccessible, poorly managed or unsafe green spaces can discourage use. Successful green spaces must be walkable, visually open, and welcoming to diverse groups—not monopolised by a few.
Active mobility is another essential factor: good pedestrian and cycling networks reduce sedentary habits. Public spaces should support flexible uses, encourage social interaction, and enhance a sense of belonging. Safety—both perceived and real—depends on lighting, clear landmarks, and well-designed edges.
Lucy Saunders (2017) emphasises that as people live longer, cities must provide environments that support healthier lives. Daily activities—work, travel, leisure—are inseparable from the qualities of the places where they occur. Air pollution, noise, road danger and social isolation all influence health. Saunders argues for addressing these factors together, through holistic urban design at scale.
Her Healthy Streets approach identifies ten indicators for people-centred places. The two most important—“pedestrians from all walks of life” and “people choose to walk and cycle”—aim to create streets where everyone can participate in public life. The remaining indicators (feeling relaxed, clean air, places to rest, shade, safety and more) outline the essential conditions for healthy, inclusive environments.
Implementing these principles is challenging: streets are contested spaces and must balance social, physical, political and financial demands. Yet the goal remains clear—public spaces that work better for people, and in doing so, support healthier, more resilient communities.
Although it is difficult to prove direct causal links between good design and specific health outcomes, improvements such as increased walking and cycling are measurable signs of success. Healthy places encourage daily physical activity, access to healthy food, social cohesion and economic opportunity—showing how profoundly design shapes the well-being of urban life.
CABE (2006), The Value Handbook, Getting the Most from Your Buildings and Spaces. Cabe, London
Carmona, M. (2019), ‘Place value: place quality and its impact on health, social, economic and environmental outcomes’, Journal of Urban Design, 24(1): 1-48
Carmona, M., and C. de Magalhaes. 2009. “Local Environmental Quality: Establishing Acceptable Standards in England.” Town Planning Review, 80 (4-5): 517–548.
McCay, L. (2017), ‘Designing Mental Health into Cities, Urban Design Journal, 142: 25-27
Saunders, L. (2017), Healthy Cities, Urban Design Journal, 142: 12-39
Sepe, M. (2023) Designing Healthy and Liveable Cities, Routledge, London-New York
