Insight from "Health Disparity and Public Space in High Density Environments"
21 May, 2020

The webinar was initiated and hosted by Luisa Bravo (City Space Architecture/Journal of Public Space), Hendrik Tieben (Chinese University of Hong Kong) and Gregor H. Mews, (Queensland University of Technology / Urban Synergies Group), part of the series “2020: A Year without Public Space under the COVID19 Pandemic”. 

The virus does not affect everyone equally but heightens the health disparity and the vulnerability of certain groups. This webinar was designed to look into the context of urban density covering the scales of floor area ratio, dwelling units and population (The Density Atlas, 2011), illustrating case studies from New York, Delhi, and Hong Kong which were hit very differently in the pandemic.

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Miodrag Mitrašinović
Professor of Urbanism and Architecture at Parsons School of Design, The New School, USA

Miodrag presented the contrasting case between one of the wealthiest and one of the poorest neighborhoods in New York along subway line 7. Hudson Yards is the largest real estate development in the history of the United States that cost the city more than $5 billion in public funds. It required the subway line 7 to be extended, and together with the High Line has created the wealthiest white neighborhood in the city. A 45-minute ride east on the subway Line 7 brings one to 103 Street/Corona Plaza Station, an area with a high number of essential employees and their families. Risk factors such as income level, overcrowding, lack of health insurance, high percentage of individuals with serious health problems, and age had pointed to high public health risk even before the pandemic. Naturally, the COVID-19 pandemic has had a disastrous impact on the Corona neighborhood. Designed and built as a  part of the NYC Plaza Program, Corona Plaza was turned into a lively public space situated right next to the subway station, costing only $2 million in construction and $60,000 annually for maintenance. The plaza has been the epicenter of community life since 2018 when it opened, highly frequented by differentiated communities, weaving a web of resilient and interdependent relationships, which ironically was also the reason why the pandemic could spread pervasively. Miodrag argued that  Corona communities have created an ‘Infrastructure of Inclusion’ by catalyzing and sustaining processes of transformation – of themselves, their communities, and their society – towards more diverse, democratic, just, and inclusive city, by creating Corona Plaza and in the process the new public.

If you look at what you need in order to surpass the impasse we are in, you need resilience at the community level. Where you find the resilience at a community level are paradoxically places where coronavirus hit the hardest.

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Mindy Fullilove
Professor of Urban Policy and Health, The New School, USA

Mindy wrote the book Root Shock, illustrating how urban renewal programs in the US destroyed neighborhoods and removed people without careful considerations like plants are removed in gardening, causing a “Root Shock”. People were dispersed and entered into states of confusion and near despair, losing all or part of one’s emotional system. Mindy thought that the whole world is experiencing “Root Shock” in this pandemic, all of us face the risk of infection and experience some kinds of disruptions. With the closing of many businesses and organisations, we won't emerge into what we retreated from. Infrastructuring thus becomes the crucial physiatric and social process of managing this mental health crisis, which otherwise cannot be handled by the healthcare system through therapies. Mindy gave three recent examples. 1) New Orleans musicians videotaped second-line performances so that people in mourning could have access to it. 2) A Catholic church decided to take the church to people with priests circulating the neighborhood, stopping at each house who set their own altars and pray together. 3) The Poor People's Campaign had artists make posters “stay inside, stay alive, organize, don’t believe in lies” to lift people's spirits. With these joint efforts, they can hopefully manage the distress of the population, if not, would otherwise turn into serious civic conflicts

Infrastructuring is the key if we are going to have any kind of hope for peaceful re-entry into life given the extent and pain of the root the world is going through.

Mahak Agrawal
Founder & Researcher, The Spatial Perspectives, India

In highly dense slums/basis in India, social distancing is a privilege. Often, the only open space in slums is being used for various purposes, from bathing to dumping waste and washing clothes or just chilling. Despite the 100+ million toilets built since 2014, declaration of 'open defecation free India' in October 2019 by the Central government, over 300 million people continue to defecate in the open since the facilities are unusable. These unusable facilities present a high risk of faecal-water borne COVID-19 transmission. Also, the national lockdown enacted on March 24 prohibited outdoor activities and caused many industries to shut down, affecting the urban informal sector and its workforce. Embarking a journey in the scorching heat, hundreds of thousands of informal workers started moving from the informal settlements in the cities back to their original villages. Some- who left villages for cities for a better life and sold off their village land- decided to stay and rely on fickle aid packages from the government and NGOs. Amid the pandemic and social-economic crisis emanating from it, a huge challenge is to plan for safer and healthy communities after COVID-19, particularly for the informal sector and habitations.

There is no point in going back because right over here we can either die from the pathological virus or we can die from hunger.

FAN Ning
Chairman, Health in Action, Hong Kong

Fan Ning defined Space as “Social Justice, Public Health, Active Living, Co-Design, Equity'' in Hong Kong’s context. Public space is an interesting concept in Hong Kong; while the city has over 60% of green space, the urban settlements are so dense and the average living space is very low - over 116,600 households live in subdivided units. Although Hong Kong ‘enjoys’ greatest longevity, quality of life is yet to be determined. Poor households spend significantly more on essential items (housing, food, education, healthcare, transportation, recreation and culture) and Hong Kong reaches a poverty rate of 15% despite its economic prosperity on the surface. The working poor, disabled, and ethnic minorities suffer from higher rates of BMI (overweight), hypertension, diabetes, and they are oddly unfamiliar with local and governmental health care resources. 

 

Fan Ning reminded us of the International Covenant on Economic, Social and Cultural Rights Article 12, which states that everyone has the right to enjoy the highest attainable standard of physical & mental health. However, this responsibility should not be shouldered only by health workers, which is just one factor among the overlooked spectrum of social determinants of health. The concept of health equity is essential, in which social inclusion is an important notion, coupled with healthy access to space and a primary health care system that also takes care of social determinants of health in addition to plain symptoms curing. COVID-19 exposes the vulnerability of many such as street cleaners, security guards, delivery workers. Fan Ning hopes that Hong Kong can one day become a “healthy city”. This requires communal united effort: everyone can contribute and should understand and reach out to those who suffer most. 

I believe that health issue is a social issue, and we need a social solution to treat, not only drugs, vaccines, or injections.

Jens AERTS
ISOCARP Urban Health Community of Practice / BUUR, New York, USA

The International Society of City and Regional Planners (ISOCARP) initiated a working group on urban health back in March, yet COVID-19 prompted the group of planners to accelerate rethinking the role of city planning and how to design in the future with urban health at the core. Jens shared five comments in response to the presentations of the webinar: 

  1. Choice of words makes a difference, call for  ‘physical distancing’ over ‘social distancing’, and highlight the issue over overcrowding instead of an inaccurate judgment on density. A majority of countries opted for a lock-down including shelter-in-place, which highlights the challenge of those in low-quality housing and overcrowded neighborhoods to comply with physical distancing. In the meantime, social and local connections have proven to be crucial during the pandemic to keep resilience intact in communities, even in dense environments where space is limited.

  2. An opportunity created by the pandemic is to leverage public space as a component of a resilient urban health system, with the notion of ‘public space as a spatial vaccine’, especially for cities with populations residing in cities where public space and public transportation are limited. 

  3. The reversed migration patterns and the new ways of living and working supported by digital connectivity underline the importance of metropolitan planning, that recognises the urban-rural continuum, plans the layout of key urban systems that provide eco-services (such as nutrition, water and waste management) and recognises the need to improve quality of live and economy in both city center and underserviced peripheries.

  4. Build a health resilience system on neighbourhood-scale, with traditional and more innovative infrastructure for social services that embrace hybrid programs (such as schools that appear as key food hubs for children) and reflects principles of proximity and inclusion.  

  5. City designers have a role to play to develop healthy built environments that support systemic solutions for the other, slow pandemic that exists, related with non-communicable diseases and explaining the rise of cancer, pneumonia, obesity, stress and mental health issues. Health system is more than health care, it requires a holistic approach, including a built environment dimension.  
     

Jens closed by acknowledging how we are together still in shock, but this is exactly the chance to show solidarity and cope with our collective trauma together.