The economics of urban wellbeing: why population mental health is critical for the economic resilience of our cities
COVID-19 is not just a health and economic pandemic but a psychological one that has taken a heavy toll on our urban populations. We must therefore recognise that cities and wellbeing are both key to any recovery strategy
It is important to recognise COVID-19 not just as a health and economic pandemic but also a psychological one, impacting profoundly on our mental and emotional wellbeing. The paradox of being ‘alone together’ has rubbed painfully against the grain of human need for contact, while continued uncertainty does nothing to reduce anxiety.
Cities and other urban areas have particular challenges to meet. They were hardest hit by the health impacts of COVID, largely due to pre-existing issues linked to deprivation. Prior to the pandemic, urban mental health was twice as bad on some measures as in non-urban areas, with prescribing rates for depression and anxiety already increasing and a so-called ‘loneliness epidemic’ that was, ironically enough, worse in densely populated areas.
Add to this the economic impacts of COVID on city centres, and we can see there is a big hill to climb.
Yet cities have already bounced back remarkably quickly. Footfall is returning, and we have seen a wave of innovation in the way services are organised and spaces are used. What we have definitely not seen is the mass exodus from cities that had been predicted by some, or a lessening in their economic importance.
There have been changes and adaptations, of course – through homeworking, for example – but we should recognise that cities are a big part of any solution to this crisis, crucial to creating positive emotional and mental health. They can confer a kind of psychological robustness, build an identity that transcends national and cultural boundaries, enable collective action at a level of detail – and they are the places where, increasingly, most of us live. To be blunt: whatever we do next, we’ve got to get it right in cities.
Cities can be challenging
A moment of crisis is always a time for pet-projects and beliefs to be aired about a better future. That’s a good thing, although simply getting back to where we were before, even on the basics, remains a challenge.
But there is one fundamental issue that has been revealed by the pandemic (if we weren’t aware of it before), and that is the intimate connection between a well-functioning economy, public services, and population health – including mental health.
Going forward positively does, in a sense, necessitate going backwards, to deal with pre-existing health issues and their causes. Many of these can be linked to deprivation, worklessness or poor employment – the biggest health indicators bar none – but that’s not the only cause. Cities can be challenging for us: we are very adaptive, but our psychological apparatus predates cities which, in evolutionary terms, are very new.
Noise, pollution, crowding, over-stimulation and even the way we experience time as linear and speeded up, rather than cyclical and more organic (as our ancestors did), all have an impact – what neuroscience would refer to as ‘stressors’.
The quality of the built environment and urban space really matters. For example, access to high-quality green space increases pro-social behaviour: trust, empathy, understanding, volunteering. Meanwhile the worst effects of stressors tend to be located in deprived areas, creating a kind of ‘biological inequity’ as well as an economic one.
Place really matters
Yet we all know cities can be made in a way that counters these effects – creating attachment, belonging, anchorage. Think of an urban space that gives you a good feeling: what are the elements that create it? It might be bustling or quiet, green or built-up, but there will likely be common factors: a sense of community, pride, safety, quality, interest or intrigue. These are things we can nurture as we look to move on from the pandemic, healing the fracture between people and place, strengthening place-making for the future.
Place really matters. It can affect our development and sense of self quite radically – as demonstrated in Place Attachment theory from psychology, literally shaping who we are; our brain function and immune system. We internalise our relationship to place in a similar way we do to family; if that relationship is negative, it has consequences.
These points all loop back to the economy when seen through the lens of productivity. Up to 40% of low productivity in the UK’s large cities is strongly linked to deprivation. If we want to grow the economy sustainably, increase population health, reduce the burden on public services and get more tax revenues into government, we must deal with this single issue.
Building economic recovery and future resilience means adapting to economic shifts that have been accelerated by COVID: online retail, digital working, the need to increase innovation (to which cities are central), sector diversity and labour market skills. But it also means building population resilience and framing this within a mental as well as physical health context, recognising they are wholly linked.
A major opportunity
Achieving these outcomes will be complex, but it can build on work that is already under way. For example, many cities already have inclusive growth strategies which seek to understand these issues, and there is a growing sense of a need to put wellbeing at the heart of economic development.
But it also requires a place-based approach – i.e. understanding how different parts of the system read-across and interact, such as the impacts of decisions in planning, housing, transport and other areas on mental health. Likewise, how mental health services can support skills and employment strategies, for example.
We already have some of the tools to do this, but lack others. We need local and national services and investment to operate more collaboratively at the local level. This is not new thinking; it’s something many of us have been arguing for years, but the pandemic gives us a new impetus to take systemic, cross-organisational approaches. In particular, it has starkly highlighted the links between how we make and manage places, mental and emotional health, and economic outcomes.
But there is also a major opportunity here. In many ways, we are ahead of the game in the UK. Place-based working is sophisticated, local government is highly innovative, and the groundwork has been done. However, pieces of the jigsaw are missing: the ability to create real alignment, to co-commission and jointly deliver on this kind of agenda, is too limited.
The forthcoming Levelling Up White Paper offers an opportunity to address these gaps. However it happens, we should understand that the places which really grasp this set of issues and act are the places likely to do best in the long term.