Journal of Environmental Planning and Management
ISSN: 0964-0568 (Print) 1360-0559 (Online) Journal homepage: http://www.tandfonline.com/loi/cjep20
Environmental health in the complex city: a coevolutionary approach
Thomas Verbeek & Luuk Boelens
To cite this article: Thomas Verbeek & Luuk Boelens (2016): Environmental health in
the complex city: a co-evolutionary approach, Journal of Environmental Planning and
Management, DOI: 10.1080/09640568.2015.1127800
To link to this article: http://dx.doi.org/10.1080/09640568.2015.1127800
Published online: 10 Mar 2016.
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Date: 10 March 2016, At: 09:04
Journal of Environmental Planning and Management, 2016
http://dx.doi.org/10.1080/09640568.2015.1127800
REVIEW ARTICLE
Environmental health in the complex city: a co-evolutionary approach
Thomas Verbeek* and Luuk Boelens
Civil Engineering Department, Centre for Mobility and Spatial Planning,
Ghent University, Gent, Belgium
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(Received 14 November 2014; final version received 1 December 2015)
While public health and urban planning were closely linked in the past, today both
domains are institutionally separate. In most cases, health intersects with spatial
planning processes only through obligatory evaluations, such as environmental impact
assessments, or restrictive environmental legislation. This institutionalisation of health
criteria in most western countries has difficulty in dealing with recent environmental
health challenges, leading to continual distrust and conflict between citizens and the
government. This impasse has recently been discussed by academics who
acknowledge the complexity of both city and health issues. It seems, however, that the
full extent of the issue has not been covered yet, leading to recommendations and
frameworks that are useful but fixed and retrospective. This paper moves beyond
those fixed frameworks to develop a better understanding of the complexity of the
current disconnect and explores ideas for a future planning approach, grounded on
new ideas of co-evolutionary and adaptive planning.
Keywords: public health; environmental planning; adaptive planning; co-evolution
1. Introduction
Although the direct impact of the built environment on public health seems to have
decreased (de Hollander and Staatsen 2003) largely due to sanitary developments and
improved housing ever since the end of the twentieth century, a renewed interest in the
relationship between the built environment, public health and general well-being has
been evident (Dannenberg et al. 2003; Frumkin 2003; R.J. Jackson 2003). However,
despite growing scientific evidence and rising public awareness, planning professionals
rarely choose to include health in their planning processes. In spite of a series of reports
by various governmental bodies (e.g. the World Health Organisation, United Nations and
European Commission) highlighting the necessity of including health issues in planning
and decision making and drawing on the support of legal requirements (e.g. the EU
Directive 2001/42), the practical implementation is very limited (Chapman 2010). While
both professions serve the public interest, the respective sources of praxis and theory
differ greatly. Spatial planning is, in most cases, carried out by specialised departments
staffed by professionals such as spatial planners, urbanists, engineers and architects who
are not familiar with ‘determinants of health’ and other related terms. Health and
environmental issues, on the other hand, are the responsibility of health and
environmental agencies, with their specialists focused on providing service and treatment
rather than prevention (Kørnøv 2009). Although these disconnected specialisations occur
elsewhere for example, in housing and transport or landscape and recreation planning
*Corresponding author. Email: [email protected]
Ó 2016 University of Newcastle upon Tyne
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T. Verbeek and L. Boelens
the separation between public health and urban planning causes more problems for
‘sustainable’ or ‘just’ planning. Today, a new planning paradigm is coming up which
recognises that the essential principle of healthy urban planning is interdisciplinary,
interagency and intersectoral collaboration, with shared recognition of the problems and
shared will to address them. There is still considerable scope for a governance
perspective to build new bridges between the two professions (Vancutsem et al. 2009).
Historically, public health concerns served as the major impetus for the emergence of
urban planning as a discipline in the nineteenth century. Therefore, we will start with a
historical framework, giving a general overview and explanation of the changing
relationship between urban planning and public health. This framework relies primarily
on secondary sources and thus does not aim to be exhaustive. It will show the
argumentative evolution of the new dilemmas relating to today’s relation between
planning and urban health issues. We will argue that due to institutionalisation this
relation has turned into a ‘lock-in’ of procedurally interrelated, but in fact two separate
domains of knowledge and action. On that basis we will explore current ideas in academic
planning literature that try to open up and reconnect urban planning and public health in
real-life situations. Nevertheless, we will also show that these new ideas are generally too
static to cope with the dynamic, volatile, fragmented and context-dependent social interests
of today. Ultimately, we will suggest a more adaptive and healthy planning approach, to
conclude with recommendations for further exploration along this track.
We wish to acknowledge that this paper is written from a Western European, AngloSaxon point of view. In particular, the historical framework and the description of the
current disconnect do not apply to the situation in developing countries. However, the
proposed new planning approaches could still be useful in these countries too.
2. Historical framework
Historically, we have always been aware of the interrelation between the environmental
landscape and our physical and mental health (R.J. Jackson 2003). The Greeks advocated
against climatic extremes and tried to settle their people in healthy and secure
environments. This view is clearly illustrated by Hippocrates in Airs, Waters and Places,
in which he distinguishes unhealthy places (such as swamps) from healthy places (such
as sunny, breezy hillsides) (Duhl and Sanchez 1999). The Romans sought to ‘fix’ the
environment with engineering. They were the first to introduce a public health system
with a fresh water supply (through aqueducts), a network of sewers, and public baths and
lavatories. However, in medieval society, these engineering solutions, and the idea of
public health, gave way to the notion that the medieval plague pandemics were a
punishment from God. Nevertheless, at the time, some early scientists propagated a
miasma or contagion theory (Slack 1988). Adherents of the miasma theory believed that
diseases were caused by bad air and advocated measures like burning tons with pitch and
herbs in the streets. On the other hand, supporters of the contagion theory believed that
diseases were caused by direct physical contact. They advocated the establishment of
plague houses where infected people were put into quarantine, a practice that has lingered
on until today (see, for instance, the quarantine facilities for tuberculosis, those in
industrial harbours and those for the 2014 outbreak of the Ebola virus).
In the seventeenth century there occurred a renewed interest in the relationship
between health and the built environment. In 1690, Sir William Petty wrote his influential
Political Arithmeticks on the relationship between sanitary conditions and human
mortality. In the same era, John Graunt carried out the first statistical health surveys by
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3
collecting numbers and causes of death to construct the first life expectancy schemes.
These initiatives marked a new approach to health and the built environment, originating
in the context of the unhealthy conditions of the first pre-industrial cities. As population
densities, numbers of marginalised populations, pollution and crime increased, infectious
diseases also flourished and mortality rates rose (Galea and Vlahov 2005). However, it
was not until the massive congestion of early nineteenth-century cities that the discipline
of urban planning took root (de Hollander and Staatsen 2003). The key reason for this
was the explosive economic growth of the industrial revolution in Western Europe,
which led to a tremendous population drift towards the already highly populated cities. It
incited a public health revolution, where the so-called hygienists
an alliance of
physicians and civil engineers
made proposals regarding healthy drinking water
services, drainage systems and the removal of refuse (de Hollander and Staatsen 2003).
By the end of the century, not only in England but also in the rest of Europe and the USA,
advocates were demanding comprehensive solutions for their cities’ unsanitary
conditions. As these sanitary reformers pleaded for a systematic, large-scale reshaping of
cities, they laid the foundation for a more systematic approach to urban planning (Perdue,
Gostin, and Stone 2003). As a result, in many cities the urban environment and the health
of its residents improved enormously by the turn of the twentieth century (Galea and
Vlahov 2005).
However, this sanitary awakening coincided with a conceptual shift in
epidemiological theories. The focus turned to the germ theory, a paradigm that focused
on the specific agents of infectious disease (i.e. microbes) and related them, one by one,
to specific diseases (Corburn 2004). Consequently, treatment and disease management
began to supersede physical strategies of removing hazards, although some attention was
still given to the impact of the built environment on health. The British sanitarian
Benjamin Ward Richardson (1876) proposed a public health ideal in his work Hygeia, a
City of Health, focusing on elements of climate, water supply, street layout and the park
system. At the same time, (social) Utopians, such as Arturo Soria y Mata, Ebenezer
Howard and Le Corbusier, sketched healthy urban concepts, combining them with
contemporary ideas in modern technology, functionality and social justice (Fishman
1982).
Concurrently, modernism was introduced in the urban planning practice, with its main
focus on the rational and hierarchical ordering of land uses (Corburn 2004). This
approach was based on the ideas of another Utopian, Tony Garnier, who presented in his
work Une Cit
e Industrielle (published in 1918, but already developed by 1904) the idea
of separating functional spaces with several categories of zoning, which would be linked
in a network of functional logistics and circulation routes. Primarily, the new professional
class of city planners believed that this rational design would inspire functional, social
and moral improvement; they also thought it would lead to healthy environments. To an
extent, the resulting zoning laws were instrumental in separating homes and schools from
odours and toxic emissions (Jackson 2003). However, the tables quickly turned when,
especially in the USA, apartment buildings, businesses and retail stores were also
excluded from residential districts, causing massive travel between zones, which in turn
has an enormous impact on air quality and urban health (Schilling and Linton 2005).
Around the 1950s, the public health paradigm shifted again, moving from the germ
theory towards the biomedical model of disease. This model addresses the ‘hosts’ over
the ‘environment’. In this view, diseases were attributed to molecular-level pathogens
brought about by individual lifestyles, behaviours, or hereditary biology or genetics. As a
result, public health policy began to refocus mainly on immunisation and vaccination, as
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T. Verbeek and L. Boelens
well as the modification of individual ‘risk factors’ by promoting more healthy lifestyles
(e.g. good diet, no smoking, more exercise) (Duhl and Sanchez 1999; Corburn 2007). At
the same time, separate areas of expertise and government departments were created,
thus establishing distinctive disciplinary boundaries between urban planners and public
health officials. Though public health officials may have been the first urban planners in
the late nineteenth and early twentieth century, by the 1930s and 1940s, others had taken
over the field, creating new areas of expertise, such as environmental science, traffic
engineering and building safety (Perdue, Gostin, and Stone 2003). The focus shifted from
attempting to restrain harmful ‘spill overs’ from private market activities to promoting
economic development through large infrastructure and transportation projects. The
creation of a department of public works enabled higher involvement for the government
in the planning and construction of the built environment, resulting in large-scale, lowdensity suburban developments (Perdue, Gostin, and Stone 2003; Corburn 2004;
Gutmann and Leeming 2011). The downside of this economic efficiency was urban
divestment and residential segregation, as well as massive (auto)mobility, which partly
evolved out of the zoned environmental conditions and had a profoundly negative impact
on health in the end (Corburn 2004).
Subsequently, during the second half of the twentieth century, public health policy
turned to health promotion (Glouberman 2001), which was majorly influenced by the
Canadian Lalonde Report (1974). Although Lalonde identified four major determinants
of health (i.e. lifestyle, human biology, health care organisation and environment), the
explicit focus was on encouraging people to assume more responsibility for their own
health. It is in this era that public health policy evolved gradually from an effective
medical discipline towards a politicised bureaucracy entwined with the state (Bennett and
Di Lorenzo 2000). This politicisation of science and medicine made cooperation with
urban planners even more difficult. At the same time, suburbs and metropolitan areas
continued to grow, infused by the automobile and the accompanying state-supported
highway infrastructure. Even subsidised mortgages took part in this process. In the late
1960s, the cores of many major cities had lost their economic vitality and were left with
declining neighbourhoods and rising crime rates (R.J. Jackson 2003). The urban planning
discipline was grappling with widespread social unrest, and the field was hard-pressed to
respond to activists’ claims that large-scale public development projects, and their
accompanying modernist designs for urban renewal, were not any better than the
piecemeal changes of the past (Goodman 1971). As a result, new planning approaches
received more attention, in which aspects of social cohesion and justice were deemed
more important than economic efficiency and functionality. Jacob’s The Death and Life
of Great American Cities (1961), Davidoff’s ‘advocacy movement’ (1965), Lefebvre’s
Right to the City (1968) and Castells’ work on grassroots movements (1983) are just a
few examples of this change in the planning paradigm.
While public health faded into the background of the planning discipline,
environmental departments reinforced their role in environmental health, building on the
principles of public nuisance in common law (Schilling and Linton 2005). In addition to
the establishment and enforcement of air and noise standards, the environmental
assessment process also came into effect at this time. The environmental impact
assessment (EIA) was introduced in most western countries in the 1980s or 1990s as a
basis for analysing the ecological and human health effects of large (infrastructure)
projects (Corburn 2004). The assessment was intended to catalyse healthier spatial
planning (Kørnøv 2009), accompanied by a new generation of social epidemiologists
who would redirect attention towards structural and environmental influences on health
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Journal of Environmental Planning and Management
5
(Fitzpatrick and LaGory 2004), but the disciplines of planning and public health remained
largely disconnected. Public health was further institutionalised, adding to the EIAs the
establishment of the health impact assessment (HIA) for the US and other countries in the
1990s and the strategic environmental assessment (SEA) for Europe in the 2000s. While
the SEA was meant to analyse environmental effects at a strategic level for plans,
programmes and policies, the goal of the HIA was to analyse the general direct and
indirect health effects of public policy, including urban planning (Joffe and Mindell
2002). Although both assessments promised better collaborative ties among the health,
transportation and urban planning sectors for mitigating the many negative effects of the
environment on health (Dannenberg et al. 2006), in the end both serve merely as periodic
interventions, typically focusing on individual projects, and continue to be regarded as
obligatory evaluations by most planners. Moreover, in most countries the results of these
assessments are not legally binding, rather, they are merely considered policy
recommendations (Kørnøv 2009). Therefore, at present, the input of environmental
health in planning is highly institutionalised, while overall, spatial and urban planners
remain disconnected from health issues.
3. The current dilemmas
As history shows, the domains of urban planning and public health arose at the same time,
developed in reciprocal evolution to one another, and have become structurally separate.
Today, health and environmental issues are the responsibility of their own specialised
departments, while planning departments remain focused mainly on geographical or
architectural approaches to space and time (Kørnøv 2009). This disconnection,
resembling a political structure with its specialised bureaucracies, hinders the inclusion
of intersecting issues like health in spatial policy (Corburn 2007). At best, concerns about
public health enter the planning process in the final stages through an obligatory SEA, or
they are evaluated in connection with building permits through an EIA. The initiator of a
plan or project public or private is responsible for carrying out the environmental
assessment, but usually it subcontracts consulting companies that work with specialised
experts in environmental science for different parts of the assessment report (e.g.
environmental noise, air pollution, water pollution). The resulting report has to be
approved by the government offices, often with advice from the environmental
department, but in the whole process interdisciplinary collaboration with the planning
department is generally lacking. Moreover, the environmental assessment process is
based on generic environmental norms and regulations, with thresholds on an array of
environmental risks.
Despite its undeniable achievement in preventing serious environmental conflict, this
institutionalisation of environmental health no longer works in today’s complex,
fragmented and volatile socio-reality (Boelens and de Roo 2014). It has produced
environmental assessments and regulations that are increasingly contested by involved
citizens, experts and companies, resulting in the delay or even cancellation of planning
processes. This situation demonstrates the discrepancy between the existing institutional
order and the general practice of policy making (Hajer 2003). In Hajer’s opinion, our
inherently dynamic and complex society challenges the legitimacy and efficacy of the
institutional codified arrangements (e.g. the environmental assessments) with new and
contingent developments, eroding the self-evidence of the classical modernist institutes
and policies. Furthermore, in this institutional void, public policy actors are caught
between the demands of orderly, rational criteria based on the generic idea of human
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T. Verbeek and L. Boelens
welfare and the messy, a-linear reality of everyday local conditions and contradictions
(Geyer and Rihani 2010). As such, we identify at least three major dilemmas regarding
the interaction between environmental health issues and the current networked society.
These dilemmas are coherent with the overall critique of modernism at large
(Horkheimer and Adorno 1947; Foucault 1966; Lyotard 1979): (1) the supposed
‘manipulability’ of society, (2) the alleged ‘rational comprehensiveness’ of the
environmental regulatory framework, and (3) the ignored situational and contextdependent aspects of space.
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3.1. Manipulability
First, the ‘manipulability’ of a healthy living environment is disputed, since our society
has become highly dynamic, volatile and a-linear. Due to ever-new insights and changing
spatial settings, SEAs, EIAs and HIAs have frequently become obsolete by, or shortly
after, their completion. This is especially true of assessments for large-scale, public
development projects that take many years from planning to completion, such as the
Oosterweel connection, which is trying to close the Ring Road around the city of
Antwerp (Belgium) (Claeys 2013). The Oosterweel connection’s empirical research
(from 2007 onwards) demonstrated that fine and ultrafine particles (PM2,51 and PM0,1)
are related to traffic-induced air pollution. These smaller particles have the largest impact
on human health (Ibald-Mulli et al. 2002; Zhu et al. 2002). Despite these findings, the
SEA continued to use the PM10 threshold. Thus, legislation and environmental
regulations lagged behind scientific knowledge on the topic and did not deliver a
convincing guarantee to the public. Not only does the knowledge on environmental
impacts change in the course of planning processes, but also the awareness and the
societal importance given to health impacts constantly change and influence the involved
actors. While the Oosterweel connection was initially planned in a very traditionalist,
top-down framework, involving minimal participation, during the planning process other
players unexpectedly came onto the field, who were also concerned about public health
impacts (Claeys 2013). Citizens and entrepreneurs drew up alternative plans and
attempted to either adapt or stop the government-led planning process. They delayed the
project’s process and its ultimate realisation with protests and legal battles, thus
extending the discussions until the present.
Scholars agree that these kinds of large-scale projects need a new kind of transition
management in order to deal with their complex and changing settings (Geels and Schot
2007). Because change occurs randomly in a wide variety of dynamic multi-dimensional,
multi-actor and multi-level settings, there is a need for more evolutionary transition
management that does not seek to control or diminish uncertainties, but instead tries to
indirectly influence or redirect developments towards improved health conditions (Innes
and Booher 1999; Healey 2007). In spatial planning, this has already resulted in
approaches for more adaptive, actor-relational and co-evolutionary planning (Boelens
2009; de Roo, Hillier, and Van Wezemael 2012; Boelens and de Roo 2014). These ideas,
however, are not yet applied in environmental health issues, where standards and norms
should not be seen as something that should be met or dealt with, but rather as specific
factors of importance, which play a reciprocal role in a process of undefined,
heterogeneous (and if possible, collective) becoming. It would also mean a more dynamic
approach for health assessments. These assessments regularly deal with ‘wicked’
problems, in the sense that these problems are not only difficult to solve, but also their
solutions pose new (wicked) questions in and of themselves (Rittel 1972).
Journal of Environmental Planning and Management
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3.2. Rational comprehensiveness
EIAs, SEAs and HIAs are often considered black boxes. They are often highly specialised
assessments, characterised by oblique language, which exacerbates the gap between
academic and common understanding and contributes to distrust between citizens,
experts and the government. Also, in common spatial planning practice, and in the initial
phase of planning processes, planners do not have the requisite technical expertise to
truly understand environmental pollutant information and incorporate it into policy. This
is partly due to the enormous increase in research on the different relationships between
the built environment and its impacts on health and well-being (Frumkin 2003; L.E.
Jackson 2003). For example, residential exposure to air pollution caused by high traffic
has been linked to asthma, deficits in lung development and allergy manifestation in
children, as well as a higher mortality rate and risk of coronary disease for the whole
population (for a recent review: Health Effects Institute 2010). Conclusive associations
have been found between traffic-related noise exposure and sleep disturbance, disrupted
cognitive development for children and (slightly) increased risk of hypertension and
coronary heart disease (for a recent review: Basner et al. 2014). Since the start of the
twenty-first century, a broader perspective has been used and many indirect relationships
have been proposed, albeit mainly cross-sectional studies showing correlation but not
causality (L.E. Jackson 2003; Galea and Vlahov 2005). This new research field has seen
particular development in the association between a green living environment and
improved mental health or decreased mortality (for a recent overview: Lee and
Maheswaran 2011). Other research suggests that a walkable, mixed land-use environment
promotes physical activity and greater overall health (for a recent overview: Durand et al.
2011). Finally, new research sees urban design as a tool in mitigating or moderating the
growing health risks of the urban heat island effect, aggravated by expected global
warming (Tan et al. 2010). This significant growth in research coincides with an
increasing specialisation in the different research fields, necessitating the participation of
highly trained experts in the environmental assessments. However, this increasing
specialisation of information on environmental impacts burdens an integrated healthy
planning approach and widens the gap with citizens. To overcome this, a governance
perspective is needed, which brings together all experts and stakeholders across the entire
urban health and planning spectrum, combined with a loosening of the old ‘silo’
mentality within government agencies and between professionals (Vancutsem et al.
2009).
3.3. Context dependency
In company with the relationship between health and environment, there is a dependency
between the effect of an impact and its context. In our highly fragmented and complex
society, generic standards for noise, water, soil and air pollution can no longer meet the
increasingly unique expectations or specific needs of the environment. On the one hand, a
paradox has emerged among different policies (and policy levels) of sustainability. For
example, there can be a disconnect between a compact city policy and the European
standards for air pollution and noise, resulting in growing tension between European and
local environmental policies. The data currently available indeed suggest that the
standard densification strategies often recommended for reducing the ecological
footprints of cities are riddled with drawbacks when viewed from a local public health
perspective (Næss 2014). On the other hand, new research on environmental health
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T. Verbeek and L. Boelens
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shows that personal disturbance caused by environmental impacts, as determined by
personal susceptibility, is a greater indicator of health impacts than measured exposure.
For example, a study on the health impact of noise pollution showed that physical and
mental health variables were not associated with noise exposure, but rather with the
subjective level of noise annoyance for the individual, which was, in turn, influenced by
personal noise sensitivity (Schreckenberg, Griefahn, and Meis 2010). This illustrates the
divide between what is objectively regarded as (un)healthy, and how impacts are
subjectively perceived. In response to this, de Roo (2011) rejects generic standards and
advocates ‘net quality’, which encompasses not only health, sustainability and quality of
life, but also emotional states, such as a sense of security, belonging, social warmth and
esteem. However, so far impact assessments include data on environmental problems that
can affect health, but typically do not consider health and well-being issues in a
systematic manner, or recognise the complex interrelations between social and
environmental factors (Vancutsem et al. 2009).
4. New frameworks on urban planning and public health
With such major dilemmas in environmental health and planning, there is still a real need
for politicians to take these aspects of public health and sustainability into account when
deciding between urban alternatives in the realm of an ever more complex society.
Because predictions will never be perfect and decisions will never encompass all the
impacts and effects, there is a need for approaches that deal sufficiently with those
uncertainties or that are able to adapt to changing circumstances. In other words, there is
a need ‘to negotiate uncertainty’ (Christley et al. 2013), and to regard (the integration of)
planning and health as ‘complex adaptive systems’ (Innes and Booher 1999).
In the field of public health, from the 1990s onward, a new generation of health
epidemiologists laid the foundation for a more engaged framework. They went beyond
the biomedical model of disease and again gave greater importance to structural and
environmental factors in explaining population health (Fitzpatrick and LaGory 2004).
Initially, they tried to build a holistic model in which all direct and indirect impacts on
public health were summarised, but it lacked specific elaboration on the space health
interrelationship (Evans and Stoddart 1990). More recently, in the last 10 years, new
approaches arose that specifically focused on the health impacts of the built environment
and started to recognise the complexity of the relationship between health and urban
development (Corburn 2005; Galea, Freudenberg, and Vlahov 2005; Glouberman et al.
2006; Rydin et al. 2012). One of the most well-known approaches for uncovering the
complexity of the interrelationship between the built environment and health is the
Planning Healthy Cities Conceptual Framework of Northridge et al. (2003) (Figure 1),
which merges the ideas of several different approaches. It adopts a multi-scalar and
multi-dimensional idea of the ecosystems approach by building a framework of four
interacting levels (Hancock and Perkins 1985). At the same time, by detailing the
relationships between the different components, the framework follows the health
determinants approach (see the ‘General Health Determinants Framework’ of Evans and
Stoddart [1990]). Northridge et al. particularly emphasised the intermediate factors,
because that is where the impact of policy manipulation (e.g. of the built environment)
has the greatest potential benefit for improved population health and well-being. It is
notable that the interactive relationships among the various domains are not made fully
clear, remain limited to the aggregate domains and do not cut across the main elements.
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Journal of Environmental Planning and Management
9
Figure 1. Planning Healthy Cities Conceptual Framework (Northridge, Sclar, and Biswas 2003).
As such, this framework is criticised for being deterministic and static, with each level
affecting only the ones below or above it, rather than tracing more ‘complex’ lineages
(Rydin et al. 2012). This critique is part of the changing vision among academics who
acknowledge that, in the past, the unique nature of cities and their impact on the health of
their residents have been addressed in fragmented and often narrow ways. No adequate
framework can represent the complex web of dynamic processes through which the
various determinants of health have their effects (Evans and Stoddart 2003; Glouberman
et al. 2006). Health is also increasingly understood as a highly complex concept, unable
to be reduced to its component characteristics and shaped by numerous, perhaps even
countless, forces in many different spheres of influence, ranging from the molecular to
the socio-economic (Glouberman 2001). As a result, the ideas of stability, linearity and
regularity that drive evidence-based policy are challenged, emphasising the limited
ability to predict, plan and control the behaviour of social systems.
In this respect Glouberman et al. (2006) advocate a ‘post-modern approach’ to
improve health in cities by making numerous, small-scale interventions that are
supported by local contextual information, selecting those that prove effective, learning
from errors, encouraging self-organisation among city inhabitants, and constantly
modifying approaches as the system continually changes and adapts. Accordingly,
Corburn (2009) discusses five general challenges in the evolution towards a healthy and
equitable city-planning framework. The two most interesting ones are (1) the shift from
over reliance on scientific rationality to the co-production of scientific knowledge and
new measurement and monitoring networks; and (2) the shift from moral
environmentalism and physical determinism to a relational view of place, in which
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T. Verbeek and L. Boelens
meanings and interactions in urban spaces are crucial to understanding how place shapes
human well-being.
One of the most recent contributions in this area is the framework of Rydin et al.
(2012). Drawing from Batty’s idea of health and cities as “the example par excellence of
complex systems”2 (Batty 2008, 769) they propose a complex systems approach to the
analysis and promotion of healthy cities, marked by the following characteristics: a
recognition of the multiplicity of associations, non-linear relations and multi-directional
causation, feedback loops to maintain equilibrium, and inherent uncertainty about the
prediction of effects. Their new framework describes urban health outcomes as the result
of the mutual interconnections among four descriptors: (1) society and governance
processes, (2) urban planning, policy making and management, (3) aspects of the built
environment and its social use, and (4) how the built environment directly affects health
(Figure 2). Their ideas are made more explicit through a focused framework that
identifies the ways in which interventions in the urban environment may affect health
outcomes. The framework identifies 15 elements relating to both the built environment
and health outcomes (Figure 3).
5. Complicated or complex
Each of these ideas elaborates on the complex relationship between health and cities,
originates from the (dissipative) idea of complex adaptive systems and provides
situational and innovative policy recommendations. But do they really present a practical
way for planners to approach environmental health issues in today’s complex and a-linear
society? While Glouberman et al. (2006) give only general policy advice, both Corburn
(2009) and Rydin et al. (2012) illustrate their ideas with some interesting case studies
characterised by a co-production of knowledge, a relational view of place, adaptive
Figure 2. The complexity of urban health problems (Rydin et al. 2012).
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Figure 3. Connections between health outcomes and the urban environment (Rydin et al. 2012).
policy and feedback loops. However, the case studies are only intended to reveal the
complexity of urban environmental health issues rather than substantiating a practicable
policy framework. Moreover, the focused framework, encompassing all relationships and
feedback loops between the built environment and health outcomes, produces the
impression of control over the reciprocal and wicked problem3 of health and the city. But
it seems that even highly sophisticated models of complex adaptive systems, elusive and
ungraspable as they might be, seem to collapse into simple, reduced structures when
compared to the emerging complexity of reality (Allen 2012, 82). In their article, Rydin
et al. made it clear that “such an approach cannot be fully comprehensive and is in danger
of both leaving out specific aspects and failing to capture crucial interconnections”.
Nevertheless, it is “a useful heuristic method of analysis and policy development” (Rydin
et al. 2012, 2086). On this point they agree with Prigogine and Stengers (1984), who
stated that modelling complex adaptive systems like the interaction between health and
urban development could never be used to plan or predict (proactively). Instead, they
could only analyse and explain (afterwards) and, as such, train stake- and shareholders to
deal with uncertainty. Despite the theoretical merits of the cited work, the available
frameworks do not provide sufficient guidance for contextualised spatial health policies.
For further clarification, and to draw up a new framework, we must first return to the
distinction between complicated and complex systems, or between fixed and living
systems.
A complicated system, such as a clock or turbomachine, can be sophisticated,
consisting of several parts all working together as one unit. However, a specialist would
be able to break up the system as a whole, analyse its parts separately and then put them
back together again without a loss of information. This is because the relationship
between the parts would not change; instead, they would continue functioning in closed,
static and rational ways.
In complex systems, this is not the case, since each part influences the other parts
reciprocally; all exchange (dissipate) information in connection with each other and in
accordance with specific circumstances or contexts. Deconstruction and reassembly, if
even possible for complex systems and their fluid behaviour, would not work, as the
conditional circumstances would change and, in the system, the parts and context would
be in discontinuous flow. As such, complex systems can never be grasped as a whole,
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T. Verbeek and L. Boelens
because there are too many interactions, flows and movements running through and
around each system. Furthermore, it is those movements, flows and interactions that
constitute a system; a complex system exists because of its relationships. By breaking up
the system in an attempt to find the basic principle that governs it, this relational
information would be lost (Cilliers 1998). Complex systems are hardly fixed and
predictable. Their elements are constantly emerging and are fundamentally different at
various points in time (Bovaird 2008).
We have the impression that most of the new models described above have more to do
with complicated than complex systems. However, both systems
complicated and
complex
are still extant within society. Complexity has not overtaken or replaced
complicated realities. Both co-evolve, just as clocks and turbomachines still exist in
company with complex adaptive weather systems, or just as technical innovations in
transport systems co-evolve with ever-changing mobility styles. De Roo (2000)
anticipated this by 15 years by taking a more moderate view and suggesting that,
depending on the complexity of an environmental conflict, another approach may be
needed. For relatively simple yet complicated environmental conflicts, standard
(modelling and framework) solutions will suffice, but for complex environmental
conflicts, another more open form of planning is needed, which would include greater
local participation, a shift of attention from predefined goals to process-related aspects,
and the abandonment of logically deducted knowledge as the starting point. He advocates
a new approach, one that is not a substitute for environmental standards, but rather is an
additional strategy that puts environmental conflicts into a wider perspective.
6. Proposals for a new approach of healthy planning
Following the ideas of de Roo (2000), we propose an expansion of the current
structuralist (complicated) management approaches to environmental health conflicts,
along with additional complexity approaches. We do not wish to completely abandon the
current approaches because we still believe that they have their merits in solving simple
or complicated issues and framing contextualised, dynamic and fuzzy issues of space and
health. But, at the same time, we think these structuralistic approaches are not sufficient
in tackling all current urban environmental health problems, and that they cannot cope
with the current fragmented, volatile, contextual developments described earlier.
Additional management strategies are needed, ones that facilitate a self-organised, actorrelational approach to health and planning and try, as much as possible, to come up with
co-evolutionary, adaptive and associative practical solutions that correspond to the daily
practice of contingency and volatility. Here we refer to the new insights in complex
management theories that make a distinction between the detail and the dynamics of
complexity in order to engage different types of problems within various settings of
social (un)certainty: e.g. simple, complicated, complex and wicked problems (Hertogh
and Westerveld 2010).
In accordance with these ideas, we propose a matrix of healthy planning management
approaches (Figure 4), which could serve in addition to the complicated schedules
mentioned above. This scheme focuses particularly on the dynamic, context-dependent
and dissipative relationships among elements of the complicated schedules. It establishes
a distinction between the static or fixed settings (on the left) and the dynamic, open or
fuzzy settings (on the right). Furthermore, it differentiates between situations or problems
that involve only a few fixed actors (at the bottom) and situations that involve many
different actors that possibly also change over time (at the top). For the complicated
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Figure 4. A matrix of complex management approaches to environmental health conflicts.
schemes of health and urban planning (e.g. Figure 3), each of the quadrants determines
the way in which the relationship between the various elements must be dealt with: pathdependent, collaborative, adaptive or co-evolutionary. For each urban environmental
health issue, a specific combination of complicated models and different quadrants is
needed; for some, a predominantly path-dependent management approach could suffice,
but for more complex challenges, other management approaches are more appropriate, as
specified below.
The left side of the matrix deals with fixed settings. When the actors are also fixed or
certain, this results in a path-dependent management approach in the lower left section,
which represents the established procedures of the environmental command-and-control
policy and its associated generic norms, regulations and guidelines for environmental
impacts with indisputable evidence (e.g. the EU air quality standards). This management
approach is supported by objective data collection (e.g. urban noise maps) and empirical
research on environmental impacts, as well as deterministic frameworks that try to
uncover the environment health links in a holistic way. Also, the environmental
assessment processes can be considered an example of path-dependent management.
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T. Verbeek and L. Boelens
Especially in this kind of management, government officials and appointed experts are
involved. Such management could be sufficient for some simple environmental health
conflicts, e.g. the obligatory installation of an air purification system in polluting
industrial facilities.
For most conflicts, however, and especially when more and ever-changing actors are
involved, a more participatory, communicative or collaborative approach is needed in
order to deal with all the interests involved, albeit within strict and predefined objectives.
This kind of management mainly represents the current attempts for collaborative and
participatory planning, enabling the inclusion of bottom-up expertise and contextual
knowledge in policy processes. The involved actors can be ordinary citizens, but also
may be civil society organisations, such as environmental associations and
neighbourhood associations, environmental experts, public health workers, and many
others (companies, landowners, automobile associations, etc.). In reference to the
schemes illustrated by Figure 1 or Figure 3, it would mean that the specific course and
direction of the relationships between the various elements, and the applicable norms and
thresholds, would depend on the specific interests and actors involved. An interesting
example of this collaborative strategy relates to the Hemmes peninsula in Zaandam
(Netherlands). This peninsula would be a unique place for new innovative residential
developments close to the city centre, but unfortunately this kind of development is
impossible at the moment, because the activities of two industrial companies in the
vicinity lead to exceedances of the noise thresholds. Therefore, the city tries to come to
an agreement with the companies on relocating or reducing the exposure in the future,
but in the meantime already wants to initiate residential development. Specifically, the
city is exploring the option of concluding a contract with future residents, in which they
agree to accept a few decibels higher noise exposure for some years. This means that
stakeholders ‘negotiate’ what level of noise exposure is acceptable. This creative solution
however clashes with the strict environmental regulations.
However, this quadrant would not be sufficient within more complex spatial settings,
where volatile and changing objectives occur over time. Therefore, in the lower right side
of the matrix, an adaptive management approach can be found, which is needed to cope
with these changing settings in space and time. Depending on spatial and temporal
context, the interpretation of the norms and thresholds of the path-dependent approach
can be more or less strict. For this kind of adaptive management approach, there is a need
for contextual and local knowledge. Although adaptive management can go together with
collaborative management, it can also be truly government-led. In itself, this approach
deals with a fixed number of actors with fixed and manageable interests and ambitions. In
reference to the marked relationships in Figure 3, specific adaptive translations to the
problem and context in question would be necessary. An example of government-led
adaptive management in the field of urban planning and health is the Directive on
Sensitive Facilities adopted by the Amsterdam City Government (Netherlands).
Supplementary to national administrative regulation, which makes it difficult to develop
sensitive facilities (schools, day care centres, hospitals and elderly homes) within
300 metres from the edge of a highway and within 50 metres from the edge of a classified
major road, the city administered that no new sensitive facilities can be constructed
within 50 metres of a high traffic urban road. To discern these roads, the city uses the
criterion of 10,000 motor vehicle passages per 24 hours. Hence the measure is both
adaptive to spatial context and to temporal context, in case the indication of high traffic
roads is regularly revised.
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Situations can become even more complex when both the objectives and the interests,
especially their number or character, change over time and space. For these situations, a
co-evolutionary planning approach is needed, where the objectives, procedures and even
interests would dissipatively co-evolve with changing settings and adaptively follow selforganising pathways to facilitate improved environmental health resilience. This kind of
management starts on the outside and works in, beginning with collective experience and
concern about a certain environmental health problem in real life. It is a reciprocal, coevolving management, without pre-set procedures, a fixed set of stakeholders or a static
regulatory framework with norms and guidelines. Following the ideas on coevolutionary, actor-relational planning, it is an undefined becoming, with many possible
directions in changing actor-network settings, but which all move towards situational
improvements for (unhealthy) situations. It would require a very engaged and committed
planner, one who is not the initiator of the process but merely one of the participants. As
such, for complex environmental health problems with a wide range of changing interests
involved, the generic, traditional approaches need to co-evolve with specific situations
and changing circumstances. In reference to Figures 1 and 3, this quadrant not only
discusses the relations between the elements, but also the number and importance of the
elements themselves, depending on the context, actors and issue at hand. A good example
is ‘Lab van Troje’ in Ghent (Belgium), a living lab with different partners (citizens, civil
society, companies and governments). The initiative and the organisation are with the
civil society; the government is only one of the partners who facilitates. A successful
project is the temporary closing of city streets for motorised traffic, to create space for
meeting, green and experiment. Although this kind of experiment works well on street
scale level, one can question the feasibility at the urban or regional scale.
Essential to the co-evolutionary management approach is the self-organising power of
neighbourhoods for environmental health issues, allowing each neighbourhood to follow
its own path to a healthier environment. Glouberman et al. (2006) remarked that
grassroots, self-funded groups often arise to address perceived health issues and
concluded that this self-organising quality was a ‘free good’ that could be very valuable
in producing novel approaches to spatial conflicts. However, Glouberman et al. did not
make clear how these kinds of self-organising elements could work within the overall
vision of a robust and healthy society, with its standards, norms and healthy impact
assessments. In our opinion, this is where the concept of co-evolution could come in.
Although the idea of co-evolution is, like the evolutionary theory, rooted in general
Darwinism, with its notions of heritage, fitness, adaption, selection, mutation and variety,
it also goes beyond that idea with the view that groups of organisms are evolving not only
by themselves in specific biotic circumstances, but also in explicit circumstances through
reciprocal selective interaction with other related organisms or systems (Ehrlich and
Raven 1964). Over time and space, subjects and objects dissipatively and continuously
influence each other and co-evolve towards a new and, if possible, more resilient
situation (Durrant and Ward 2011).
The same goes for the matrix of management approaches for planning and healthrelated questions. Although co-evolutionary theories of becoming
like general
evolutionary theories
would depart from the species (in this case, the pro-active,
grassroots activists of healthy cities themselves) it is acknowledged that activists are also
evolving in relation to other initiatives and in response to existing rules, regulations,
health impact assessments and models with regard to health outcomes of urban changes,
and vice versa. As such, the idea of co-evolution could become more overarching. This is
illustrated by the mutual existence of different management approaches in Figure 4,
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T. Verbeek and L. Boelens
which could not only be executed in specific cases or settings, but could also refer to each
other in the improvement towards more healthy cities or regions. Moreover, the
complicated models and standards for space health issues could also over time and
space co-evolve with these more open and complex approaches to these issues, including
local participation, a shift of attention from predefined goals to process-related aspects,
and the abandonment of logically deducted knowledge as the starting point. As such,
planning and health expertise could again become two mutually acting and respected
forces, operating interactively in an ocean of agents and agency within continuously
changing settings. This view accepts that planning health processes unfold in time,
without a clear beginning or, at least, without a clear and definite end, but still in
reference to mutually set standards or norms. It could start with the uniqueness of every
issue and urban health challenge and, considering the interaction of what is decided, and
by whom, adapt planning to what is emerging, and vice versa. Thus, resilient translations
of co-evolution for health and urban development could be facilitated in an undefined,
but possibly more resilient, becoming (Boelens and de Roo 2014).
7. Discussion
This paper starts with the observation that the disciplines of urban planning and public
health are largely disconnected, with health entering the planning process only through
generic environmental norms and regulations, whether they are part of an imposed
environmental impact assessment process or not. In contrast, a historical overview shows
that modern urban planning originated out of public health concerns, and that both
disciplines were much more integrated in the past. Today, the rigid framework, which
developed in the twentieth century, has difficulties in dealing with recent contextual
evolutions, such as the growing empirical evidence of environmental impacts and the
growing empowerment and engagement of citizens.
The absence of a detailed policy framework that reconnects both disciplines led us to
develop a matrix of planning management approaches for urban environmental health.
The matrix builds on recent ideas of co-evolutionary and adaptive planning in a complex
network society. The main idea is to expand the current management approaches for
environmental health conflicts to include additional approaches that capture the selforganising capacity and expertise of grassroots initiatives, at the same time allowing
flexibility for adaptive planning solutions in changing spatial and social contexts. The
flexible attitude of the government and the will to look beyond strict environmental
regulations and rigid procedures are critical. This idea of combining robustness (i.e.
generic environmental rules and regulations) with flexibility (i.e. adaptive applications in
changing settings) is also used in other planning and environment debates, such as flood
risk management, as an approach leading to more resilience in a complex (eco-)society
(Tempels and Hartmann 2014).
Knowing that the proposed matrix of management approaches is based on academic
and theoretical insights, the next step is to assess whether and how the matrix could be
helpful in analysing and managing current environmental health conflicts. The key
question is which combination of management approaches is suitable for which kinds of
situations. Therefore, the matrix could be applied to real urban environmental health
conflicts that differ in scale, complexity and dynamic. First, the current management of
the conflict could be analysed, thereby assigning the various actions to the different
quadrants of the matrix and resulting in an overall composition for the four quadrants.
Then alternative paths could be explored, in which adaptive, participative and
Journal of Environmental Planning and Management
17
co-evolutionary management approaches would gain importance, resulting in an
alternative composition. If successful, the use of the matrix could change the paradigm of
tackling urban environmental health conflicts, towards more open and co-evolving
approaches. Spatial planning and health agencies could again become interrelated driving
forces towards a new, dynamic and resilient healthy future of undefined spatial becoming.
Disclosure statement
No potential conflict of interest was reported by the authors.
Notes
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1.
2.
3.
PMx D microscopic particles with an aerodynamic diameter less than x mm.
“Emergent, far from equilibrium, requiring enormous energies to maintain themselves,
displaying patterns of inequality and saturated flow systems that use capacity in what appear to
be barely sustainable but paradoxically resilient networks”.
A wicked problem is a problem that is difficult or impossible to solve because of incomplete,
contradictory and changing requirements that are often difficult to recognise. Moreover,
because of complex interdependencies, the effort to solve one aspect of a wicked problem may
reveal or create other problems (Rittel and Webber 1973).
References
Allen, Peter M. 2012. “Cities: The Visible Expression of Co-Evolving Complexity.” In Complexity
Theories of Cities Have Come of Age, edited by Juval Portugali, Han Meyer, Egbert Stolk, and
Ekim Tan, 67 89. Berlin: Springer.
Basner, Mathias, Wolfgang Babisch, Adrian Davis, Mark Brink, Charlotte Clark, Sabine Janssen,
and Stephen Stansfeld. 2014. “Auditory and Non-Auditory Effects of Noise on Health.” The
Lancet 383 (9925): 1325 1332. doi:10.1016/S0140-6736(13)61613-X.
Batty, Michael. 2008. “The Size, Scale, and Shape of Cities.” Science 319 (5864): 769 771.
doi:10.1126/science.1151419.
Bennett, James T., and Thomas J. Di Lorenzo. 2000. From Pathology to Politics: Public Health in
America. Piscataway, NJ: Transaction Publishers.
Boelens, Luuk. 2009. The Urban Connection: An Actor-Relational Approach to Urban Planning.
Rotterdam: 010 Publishers.
Boelens, Luuk, and Gert de Roo. 2014. “Planning of Undefined Becoming: First Encounters of Planners
Beyond the Plan.” Planning Theory. Advance online publication. doi:10.1177/1473095214542631.
Bovaird, Tony. 2008. “Emergent Strategic Management and Planning Mechanisms in Complex
Adaptive Systems.” Public Management Review 10 (3): 319 340. doi:10.1080/
14719030802002741.
Castells, Manuel. 1983. The City and the Grassroots: A Cross-Cultural Theory of Urban Social
Movements. Berkeley: University of California Press.
Chapman, Tim. 2010. “Health and the Urban Planner.” Planning Theory and Practice 11 (1):
101 105. doi:10.1080/14649350903537956.
Christley, Robert M., Maggie Mort, Brian Wynne, Jonathan M. Wastling, A. Louise Heathwaite,
Roger Pickup, Zo€e Austin, and Sophia M. Latham. 2013. “‘Wrong, but Useful’: Negotiating
Uncertainty in Infectious Disease Modelling.” PLoS One 8 (10): e76277. doi:10.1371/journal.
pone.0076277.
Cilliers, Paul. 1998. Complexity and Postmodernism: Understanding Complex Systems. London:
Routledge.
Claeys, Manu. 2013. Stilstand [Standstill]. Leuven: Van Halewyck.
Corburn, Jason. 2004. “Confronting the Challenges in Reconnecting Urban Planning and Public
Health.” American Journal of Public Health 94 (4): 541 546. doi:10.2105/AJPH.94.4.541.
Corburn, Jason. 2005. “Urban Planning and Health Disparities: Implications for Research and
Practice.” Planning Practice and Research 20 (2): 111 126. doi:10.1080/02697450500414652.
Downloaded by [Ghent University] at 09:04 10 March 2016
18
T. Verbeek and L. Boelens
Corburn, Jason. 2007. “Reconnecting with Our Roots: American Urban Planning and Public Health
in the Twenty-First Century.” Urban Affairs Review 42 (5): 688 713. doi:10.1177/
1078087406296390.
Corburn, Jason. 2009. Toward the Healthy City: People, Places, and the Politics of Urban
Planning. Cambridge, MA: MIT Press.
Dannenberg, Andrew L., Rajiv Bhatia, Brian L. Cole, Carlos Dora, Jonathan E. Fielding, Katherine
Kraft, Diane McClymont-Peace, et al. 2006. “Growing the Field of Health Impact Assessment
in the United States: An Agenda for Research and Practice.” American Journal of Public
Health 96 (2): 262 270. doi:10.2105/ajph.2005.069880.
Dannenberg, Andrew L., Richard J. Jackson, Howard Frumkin, Richard A. Schieber, Michael Pratt,
Chris Kochtitzky, and Hugh H. Tilson. 2003. “The Impact of Community Design and LandUse Choices on Public Health: A Scientific Research Agenda.” American Journal of Public
Health 93 (9): 1500 1508. doi:10.2105/ajph.93.9.1500.
Davidoff, Paul. 1965. “Advocacy and Pluralism in Planning.” Journal of the American Institute of
Planners 31 (4): 331 338. doi:10.1080/01944366508978187.
de Hollander, Augustinus E.M., and Brigit A.M. Staatsen. 2003. “Health, Environment and Quality
of Life: An Epidemiological Perspective on Urban Development.” Landscape and Urban
Planning 65: 53 62. doi:10.2105/AJPH.94.4.541.
de Roo, Gert. 2000. “Environmental Conflicts in Compact Cities: Complexity, Decision Making,
and Policy Approaches.” Environment and Planning B: Planning and Design 27 (1): 151 162.
doi:10.1068/b2614.
de Roo, Gert. 2011. “And Deliver Us from Evil… On Quality of Life, Environmental Health and
Hygiene, Compact Urban Development, and the Shaky Foundations of Policy and
Regulations.” In Compact City Extended: Outline for Future Policy Research and Design,
edited by Luuk Boelens, 72 88. Rotterdam: 010 Publishers.
de Roo, Gert, Jean Hillier, and Joris Van Wezemael. 2012. “Complexity and Spatial Planning:
Introducing Systems, Assemblages and Simulations.” In Complexity and Planning: Systems,
Assemblages and Simulations, edited by Gert de Roo, Jean Hillier, and Joris Van Wezemael,
1 34. Farnham: Ashgate.
Duhl, L.J., and A.K. Sanchez. 1999. Healthy Cities and the City Planning Process: A Background
Document on Links Between Health and Urban Planning. Copenhagen: WHO Regional Office
for Europe Expert Group on the Urban Environment. http://www.euro.who.int/__data/assets/
pdf_file/0009/101610/E67843.pdf
Durand, C.P., M. Andalib, G.F. Dunton, J. Wolch, and M.A. Pentz. 2011. “A Systematic Review of
Built Environment Factors Related to Physical Activity and Obesity Risk: Implications for
Smart Growth Urban Planning.” Obesity Reviews 12 (5): e173 e182. doi:10.1111/j.1467789X.2010.00826.x.
Durrant, Russil, and Tony Ward. 2011. “Evolutionary Explanations in the Social and Behavioral
Sciences: Introduction and Overview.” Aggression and Violent Behavior 16 (5): 361 370.
doi:10.1016/j.avb.2011.02.010.
Ehrlich, Paul R., and Peter H. Raven. 1964. “Butterflies and Plants: A Study in Coevolution.”
Evolution 18: 586 608.
Evans, Robert G., and Gregory L. Stoddart. 1990. “Producing Health, Consuming Health Care.”
Social Science and Medicine 31 (12): 1347 1363. doi:10.1016/0277-9536(90)90074-3.
Evans, Robert G., and Gregory L. Stoddart. 2003. “Consuming Research, Producing Policy?”
American Journal of Public Health 93 (3): 371 379. doi:10.2105/ajph.93.3.371.
Fishman, Robert. 1982. Urban Utopias in the Twentieth Century: Ebenezer Howard, Frank Lloyd
Wright, Le Corbusier. Cambridge, MA: MIT Press.
Fitzpatrick, Kevin, and Mark LaGory. 2004. Unhealthy Places: The Ecology of Risk in the Urban
Landscape. New York: Routledge.
Foucault, Michel. 1966. Les Mots et les Choses: Une Arch
eologie des Sciences Humaines [The
Order of Things: An Archaeology of the Human Sciences]. Paris: Editions Gallimard.
Frumkin, Howard. 2003. “Healthy Places: Exploring the Evidence.” American Journal of Public
Health 93 (9): 1451 1456. doi:10.2105/ajph.93.9.1451.
Galea, Sandro, Nicholas Freudenberg, and David Vlahov. 2005. “Cities and Population Health.”
Social Science and Medicine 60 (5): 1017 1033. doi:10.1016/j.socscimed.2004.06.036.
Galea, Sandro, and David Vlahov. 2005. “Urban Health: Evidence, Challenges, and Directions.”
Annual Review of Public Health 26 (1): 341 365. doi:10.1146/annurev.publhealth.26.
021304.144708.
Downloaded by [Ghent University] at 09:04 10 March 2016
Journal of Environmental Planning and Management
19
Geels, Frank W., and Johan Schot. 2007. “Typology of Sociotechnical Transition Pathways.”
Research Policy 36 (3): 399 417. doi:10.1016/j.respol.2007.01.003.
Geyer, Robert, and Samir Rihani. 2010. Complexity and Public Policy: A New Approach to TwentyFirst Century Politics, Policy and Society. London: Routledge.
Glouberman, Sholom. 2001. Towards a New Perspective on Health Policy. Ottawa: Canadian
Policy Research Network. http://rcrpp.org/documents/2686_en.pdf
Glouberman, Sholom, Michael Gemar, Philippa Campsie, Glenn Miller, Jim Armstrong, Chayim
Newman, Ariadne Siotis, and Philip Groff. 2006. “A Framework for Improving Health in
Cities: A Discussion Paper.” Journal of Urban Health 83 (2): 325 338. doi:10.1007/s11524006-9034-9.
Goodman, Robert. 1971. After the Planners. New York: Simon and Schuster.
Gutmann, Christine, and Daniel Leeming. 2011. “Rekindling the Planning/Health Relationship.”
Ontario Planning Journal 26 (3): 1 3.
Hajer, Maarten. 2003. “Policy without Polity? Policy Analysis and the Institutional Void.” Policy
Sciences 36 (2): 175 195. doi:10.1023/a:1024834510939.
Hancock, Trevor, and Fran Perkins. 1985. “The Mandala of Health: A Conceptual Model and
Teaching Tool.” Health Education 24: 8 10.
Healey, Patsy. 2007. Urban Complexity and Spatial Strategies: Towards a Relational Planning for
Our Times. London: Routledge.
Health Effects Institute. 2010. Traffic-Related Air Pollution: A Critical Review of the Literature on
Emissions, Exposure, and Health Effects. Boston, MA: Health Effects Institute. http://pubs.
healtheffects.org/view.php?idD334
Hertogh, Marcel, and Edward Westerveld. 2010. “Playing with Complexity. Management and
Organisation of Large Infrastructure Projects.” PhD diss., Erasmus University Rotterdam.
Horkheimer, Max, and Theodor Adorno. 1947. Dialektik der Aufkl€
arung [Dialectic of
Enlightenment]. Frankfurt: Fischer.
Ibald-Mulli, Angela, H.-Erich Wichmann, Wolfgang Kreyling, and Annette Peters. 2002.
“Epidemiological Evidence on Health Effects of Ultrafine Particles.” Journal of Aerosol
Medicine 15 (2): 189 201. doi:10.1089/089426802320282310.
Innes, Judith E., and David E. Booher. 1999. “Consensus Building and Complex Adaptive Systems:
A Framework for Evaluating Collaborative Planning.” Journal of the American Planning
Association 65 (4): 412 423.
Jackson, Laura E. 2003. “The Relationship of Urban Design to Human Health and Condition.”
Landscape and Urban Planning 64: 191 200. doi:10.1016/S0169-2046(02)00230-X.
Jackson, Richard J. 2003. “The Impact of the Built Environment on Health: An Emerging Field.”
American Journal of Public Health 93 (9): 1382 1384. doi:10.2105/ajph.93.9.1382.
Jacobs, Jane. 1961. The Death and Life of Great American Cities. New York: Random House.
Joffe, M., and J. Mindell. 2002. “A Framework for the Evidence Base to Support Health Impact
Assessment.” Journal of Epidemiology and Community Health 56 (2): 132 138. doi:10.1136/
jech.56.2.132.
Kørnøv, Lone. 2009. “Strategic Environmental Assessment as Catalyst of Healthier Spatial
Planning: The Danish Guidance and Practice.” Environmental Impact Assessment Review 29:
60 65. doi:10.1016/j.eiar.2008.04.003.
Lalonde, Marc. 1974. A New Perspective on the Health of Canadians. A Working Document.
Ottawa: Government of Canada.
Lee, A.C.K., and R. Maheswaran. 2011. “The Health Benefits of Urban Green Spaces: A Review of
the Evidence.” Journal of Public Health 33 (2): 212 222. doi:10.1093/pubmed/fdq068.
Lefebvre, Henri. 1968. Le Droit a la ville [The Right to the City]. Paris: Anthropos.
Lyotard, Jean-Francois. 1979. La Condition Postmodeme [The Postmodern Condition]. Paris:
Minuit.
Næss, Petter. 2014. “Urban Form, Sustainability and Health: The Case of Greater Oslo.” European
Planning Studies 22 (7): 1524–1543. doi:10.1080/09654313.2013.797383.
Northridge, Mary E., Elliot D. Sclar, and Padmini Biswas. 2003. “Sorting out the Connections
Between the Built Environment and Health: A Conceptual Framework for Navigating
Pathways and Planning Healthy Cities.” Journal of Urban Health 80 (4): 556 568.
doi:10.1093/jurban/jtg064.
Perdue, Wendy C., Lawrence O. Gostin, and Lesley A. Stone. 2003. “Public Health and the Built
Environment: Historical, Empirical, and Theoretical Foundations for an Expanded Role.” The
Journal of Law, Medicine and Ethics 31 (4): 557 566. doi:10.1111/j.1748-720X.2003.tb00123.x.
Downloaded by [Ghent University] at 09:04 10 March 2016
20
T. Verbeek and L. Boelens
Prigogine, Ilya, and Isabelle Stengers. 1984. Order out of Chaos. New York: Bantam.
Richardson, Benjamin W. 1876. Hygeia, A City of Health. London: Macmillan.
Rittel, Horst W.J. 1972. “On the Planning Crisis: Systems Analysis of the ‘First and Second
Generations’.” Bedriftsokonomen 8 (8): 390 396.
Rittel, Horst W.J., and Melvin M. Webber. 1973. “Dilemmas in a General Theory of Planning.”
Policy Sciences 4 (2): 155 169.
Rydin, Yvonne, Ana Bleahu, Michael Davies, Julio D. Davila, Sharon Friel, Giovanni De Grandis,
Nora Groce, et al. 2012. “Shaping Cities for Health: Complexity and the Planning of Urban
Environments in the 21st Century.” The Lancet 379 (9831): 2079 2108. doi:10.1016/S01406736(12)60435-8.
Schilling, Joseph, and Leslie S. Linton. 2005. “The Public Health Roots of Zoning: In Search of
Active Living’s Legal Genealogy.” American Journal of Preventive Medicine 28 (2,
Supplement 2): 96 104. doi:10.1016/j.amepre.2004.10.028.
Schreckenberg, Dirk, Barbara Griefahn, and Markus Meis. 2010. “The Associations Between Noise
Sensitivity, Reported Physical and Mental Health, Perceived Environmental Quality, and Noise
Annoyance.” Noise and Health 12 (46): 7 16. doi:10.4103/1463-1741.59995.
Slack, Paul. 1988. “Responses to Plague in Early Modern Europe: The Implications of Public
Health.” Social Research 55 (3): 433 453.
Tan, Jianguo, Youfei Zheng, Xu Tang, Changyi Guo, Liping Li, Guixiang Song, Xinrong Zhen,
et al. 2010. “The Urban Heat Island and Its Impact on Heat Waves and Human Health in
Shanghai.” International Journal of Biometeorology 54 (1): 75 84. doi:10.1007/s00484-0090256-x.
Tempels, Barbara, and Thomas Hartmann. 2014. “A Co-Evolving Frontier Between Land and
Water: Dilemmas of Flexibility Versus Robustness in Flood Risk Management.” Water
International 39 (6): 872 883. doi:10.1080/02508060.2014.958797.
Vancutsem, Didier, David Gee, Chris Gossop, Ulla Hoyer, Dorota Jarosinska, Pierre Laconte,
Manfred Schrenk, Herbert Hemis, and Roman Seidl. 2009. Urban Planning and Human Health
in the European City Report to the World Health Organisation. Edited by James Colman.
The Hague: International Society of City and Regional Planners (ISOCARP).
Zhu, Yifang, William C. Hinds, Kim Seongheon, Si Shen, and Constantinos Sioutas. 2002. “Study
of Ultrafine Particles Near a Major Highway with Heavy-Duty Diesel Traffic.” Atmospheric
Environment 36: 4323 4335. doi:10.1016/S1352-2310(02)00354-0.