Jan 09, 2024
Urban environments, from infrastructure to green spaces, play a crucial role in shaping lifestyle choices, social dynamics, and overall quality of health. This intricate relationship between urban spaces and health underscores the need for comprehensive strategies that address the challenges posed by modern city living while fostering conditions that promote healthier, happier communities.
Tan Shin Bin is an Assistant Professor at the Lee Kuan Yew School of Public Policy (LKYSPP). She previously worked as an urban planner at Singapore’s Urban Redevelopment Authority, the government body tasked with guiding the physical development of Singapore in a sustainable manner.
She joins us to discuss how urban environments impact health, as well as the opportunities and challenges faced when developing policies to promote healthier lifestyles within urban spaces.
David Austin: Thank you for joining us.
Tan Shin Bin: Thank you for having me here.
David Austin: Could you start by just telling us a bit about what you do at LKYSPP and what kind of interesting work you're onto at the moment?
Tan Shin Bin: I'm currently an Assistant Professor at the Lee Kuan Yew School, and my research focus is on policies that shape the built environment and how that affects human health. I'm particularly interested in the more socially vulnerable populations that are at risk of poor health outcomes than the rest of the population.
David Austin: Now, I've noticed you've done quite a lot of research on Singapore, and Singapore is a small city state. Why do you think anyone else around the world would be interested in the urban planning research conducted in Singapore?
Tan Shin Bin: Yes, this is a perennial question that a lot of people doing work in Singapore grapple with, because you are right, Singapore is very small. But I would say that we are small and interesting because we are very different from the more studied contexts such as the United States (US).
Especially in the field that I'm working in, when I'm looking at the effect of “place” (i.e. the environment) on health, most of the research have been conducted in countries like the US, the UK, Europe, and Australia. So because of this, the knowledge is very much concentrated in what we might say is a Western context.
Because of that, it's quite difficult to translate what the field has gained over the decades to our region - in Asia – or some of the more developing parts of the world.
This is because the way that urban planning is done in different contexts is different. So the way that urban planning is done in Asia is very different from the way it’s done in more Western countries. Because of that, also, the kind of urban patterns that have emerged, the urban fabric of the city, really differs from here to there.
The cultures, the perceptions of space, the way that we interact with our environment, all these differ from region to region. Because of that, it becomes very difficult to map the lessons that have been gathered in the West to this part of the world.
Doing work in Singapore lends an insight into a much less studied context.
So, arguably, the work that we do in Singapore is more applicable to the region, more applicable to Asia. And for that reason, I’ll say that the work that’s coming out of Singapore is interesting.
I also think that when you think about urban research, Singapore is also very interesting because the way we do planning is quite top down, very government-led.
Because of that, we can dabble in difficult policy decisions that in other contexts might be very difficult to get passed. So, Singapore can be seen as a policy lab for testing more radical ideas, I think.
One example we can look at is Singapore’s congestion pricing scheme. We really were a frontrunner in the world in pushing through this policy. If you look at other countries or cities that have tried to push through congestion pricing, they’ve really encountered a lot of political pushback, and because of that, have been unable to unroll the policy.
This is an example of some of the stuff that comes out of Singapore that could be very interesting for other jurisdictions who might be interested in similar policies but, for whatever reason, were not able to implement.
And I think the kind of positive or negative lessons that come out from Singapore's experience offer really useful learning points for them.
David Austin: I'd like to ask specifically about healthier cities, and which of Singapore's urban planning policies might be of interest to those looking to build healthier cities, and what lessons might they glean from Singapore's experiences?
Tan Shin Bin: So, in my opinion, I think Singapore is doing a lot of the obvious measures to encourage healthy living.
One of the big areas where I think Singapore has done a really great job is in infrastructural improvements. I think if you look back at Singapore's history, we've come a long way in terms of cleaning up the city, in terms of putting in good water, sanitation, drainage infrastructure. These have gone a long way in improving the health of our people.
So that's one part of Singapore's urban planning policies that provides a good learning point for other cities interested in building healthy cities.
Other than that, I also think that Singapore has done well in terms of distributing spatial resources. I believe that Singapore is quite cognizant of the kind of spatial equity issues when it thinks about distributing parks and making sure that all the neighbourhoods have good access to affordable food through hawker centres.
This is also an area where I know Singapore provides a good case example for other cities interested in building up a healthy outcome through planning.
Some of the more obvious things when we think about planning for a healthy city — we think about parks, pedestrian paths, cycling paths, water infrastructure.
Another way that Singapore's urban planning policies are interesting lie in the less obvious ways that planning might affect health.
One of the big and controversial policies that Singapore has in place is our policies to prevent spatial segregation. Singapore has in place a quota system in our public housing estates to ensure that there's a good mix of different ethnicities within the public estates.
In Singapore, given that over 80 per cent of residents live in public housing, such a social mixing policy really goes a long way to ensure that our social fabric is very well mixed in terms of the urban landscape.
If you look at other contexts like the US or the UK, where spatial segregation has been shown to have strong links to negative health impacts, you can start to think about why a policy like the ethnic mixing policy in Singapore might be interesting to a city that's looking to tackle the problem of spatial segregation.
It gives an insight into how a policy can be implemented, but it is also an opportunity to look at the actual impacts of such a policy. So you can imagine that a study that looks at the spatial mixing in Singapore and whether this translates into good impacts in terms of health, actual social capital, social mixing, or whether there might be negative impacts in terms of greater sense of isolation for a minority group … That's something to think about.
And currently, I don't think there's a lot of empirical research looking at the actual health impact of social mixing policies in Singapore. This is something I think could be worked on in the future.
David Austin: Could we take a step back? I'd like to ask you just the concept of healthier cities, because you spoke about Singapore's history and I'm aware that at the very beginning of Singapore's history, if you're talking about health and cities, you're talking about basics like clean water, curbing waterborne diseases, and things like that.
But then through the years, you're talking about things that are less obvious, like spatial segregation and how that can affect health. Where are we on the path of what is considered a healthy city, and where are policy makers around the world, where are they looking next? What are their main concerns right now about what they're looking at, to make sure that their populations are as healthy as can be?
Tan Shin Bin: That's a good question. Different cities are at different places on this trajectory you’re describing, right? I think a lot of places are actually still grappling with the questions of water and sanitation. I think that's a big area of need that cities which are trying to build healthier cities are really focusing on.
Safe shelter, safe water, sanitation facilities and so on. I think a lot of places are still grappling with that. If you're thinking about cities that are more like Singapore, more developed cities, I think we have gone past that challenge, and it becomes more of an issue of how do you correct some of the mistakes that have been made?
When I say mistakes, I would say the fact that a lot of our cities are quite car-dependent is a bit of a mistake, because when you think about driving and you think about the impact it has in terms of air pollution, noise pollution, and now, we're even more concerned about climate change. Driving is really something that can be seen as detrimental to health, I would say.
I think a lot of cities are starting to also go on that path of trying to figure out how to reverse the car dependency that we have.
And Singapore is a city that's also grappling with the need to transition away from cars and then we have been putting in policies like cycling policies, putting in efforts to encourage more walking, more use of public transport, and I think that's a big area of health that a lot of cities are hopefully trying to push towards.
I'll tell you, another area that is emerging would be mental health as well. I think for a long time, we have had a lot of focus on physical health because that's something that is more readily measured. But in recent years, especially during the COVID-19 pandemic, which had a widespread impact on mental health, interest in how we can create environments that are conducive to mental health has become another big area where policymakers and urban planners are really interested in.
David Austin: Do you have any examples of policies that are considered urban planning, but are still contributing to greater mental health? Also, what are some of the challenges of implementing some of these new policies?
Tan Shin Bin: So I think in terms of urban planning and mental health, a lot of ‘intuitive’ work would be on increasing greenery. I think there's a lot of work around creating green sanctuaries, parks, urban greening, as a way to provide relief from the oftentimes, noisy, dense, smelly environment. And I think Singapore, again, provides a lot of examples of how greenery is used to soften the urban landscape.
But in terms of how this actually impacts mental health, I don't think that the understanding is so robust at this point. I think there's a lot of effort to try to play with these initiatives. I'm not sure there's a clear sense of how this translates into actual health changes.
I think another big piece of how urban planning might affect mental health is through the social networks and our social ties that we build. If you think about the way planning affects how people interact in space, you can imagine a well-planned city with a lot of opportunities for interaction, for socialising, for people to sit down and share a cup of coffee.
These would be places that people can accumulate more social resources and communities and friends. And I think it's very well documented how friend networks and social networks are very beneficial for mental health. And again, when we think about the COVID-19 pandemic and how the way we had to isolate from each other affected mental health, it's very clear that there is a link between the spaces we occupy and the kind of friendships and ties and networks we can build.
So I think there is probably a lot of interest amongst urban planners on how you can tap on the design of the urban space to encourage more social bonding. But again, I would say that this is not something that is solid science in the sense that we don't have very good empirical evidence to back this intuition.
David Austin: All of these policies that you've mentioned, whether in Singapore or in other cities around the world, what are some of the challenges that policymakers have to consider and overcome to implement these policies?
Tan Shin Bin: I would say that one big challenge which I've alluded to in my earlier discussion is the lack of really solid empirical work that gives policymakers the confidence that if I do X, it would lead to Y improvements. And I think that this is something that is really difficult to do research in the space of place and how place affects health, because there are a lot of ethical issues about changing the environment that people live in or putting people in different environments where you can test the impact of the environment.
Because of the way that the research has to be structured with a strong reliance on what is actually happening on the ground versus experiments, I think policymakers would struggle to find ‘strong’ evidence that certain urban interventions will lead to good health.
And I think because of that, there is a certain amount of uncertainty that policymakers have to work with when they are trying to interpret the research. Again, like I said, a lot of the research around health in place is focused on very specific contexts. So the US has a lot of research, but in Asia, Southeast Asia, the research is very thin on the ground.
So if you're a policymaker trying to make decisions based on US research, you can see where the translation becomes very tricky. So I'll say that's also another major challenge that urban planners would face when they're trying to put in healthy interventions.
And I'll say another thing – land is a resource that everybody wants a piece of, especially when you think about prime locations, and we also see this in Singapore because we're such a small country and every piece of land is very valuable.
So when you start thinking about, "should I be putting this piece of land to this use or that use", or "should I use it to test an intervention or not?", it becomes quite tricky because there's a lot of contestation around the use of land.
So these are some of the major challenges that urban planners who are trying to change the city for the healthier would face.
David Austin: I'd like to ask you a bit more about some of your specific research.
You wrote a paper exploring how socioeconomic status affects the obesity risks of residents in their surrounding neighbourhoods. Your analysis suggests that the effects of making changes or improvements in urban areas might vary amongst residents depending on their socioeconomic status.
Could you elaborate on this and help us understand it?
Tan Shin Bin: Sometimes we assume that everybody benefits equally from a change in the environment. So for example, when a planner comes in and says, I want to create this nice new urban park in this neighbourhood. There's a certain thinking that this is a universal good and everybody can partake in this good.
But the truth is, when you think about how people interact with spatial things in their environment, it really depends on who they are, the resources they have, the place they are in, emotionally. Someone who has a lot of time would probably be more amenable to exercising in this new park, for example, or walking their dog.
Whereas someone who has very little bandwidth, who might be struggling with the day to day, you know, having a new park next door might not make a dent in the change in their routine, because their schedule is already so tightly packed.
So this is where I think the observation that you made about my research comes from, that kind of intuition that depending on a certain set of resources that you have, the way that you interact with your environment would differ.
And this is something that I do see in several pieces of the research I've done. When you look at a change in environment, how it affects different groups, we see different relationships. What you described here was looking at obesity risks. So I saw that increased access to nearby park connectors, which are linear parks, was associated with a decrease in body mass index for students who are of low or middle socio-economic class.
So it seems like the reason for this could be that they access the park connectors, did a bit more exercise there, and so on and so forth. But we don't see a corresponding effect on students of higher socio-economic status. And here you can hypothesise the differentiating factors between students who have lower resources versus higher resources.
Could it be that students who are of higher resources have access to a family car, for example, that would bring them a lot further away so that they're not bounded by the immediate neighbourhoods? This is one hypothesis that could be tested further.
In terms of the actual research I did, I was looking very much at headline indicators. I didn't manage to drill into the actual pathways of change, but I think that's something that I'll be interested in doing and I think people should also be looking at the kind of causal pathways.
Although the study that you mentioned focused on differences by socioeconomic class, you can also think about how our relationship with the built environment differs by gender. Do women have a different relationship with a nice, shaded park in the neighbourhood?
Arguably they could be more concerned about crime compared to a man who would just breeze through the park with no concern. You can think about how ethnicity could affect the way that we relate to our environment, our age, so all of these are really important questions when we think about how the environment affects health.
David Austin: Do you have any research projects in the works that hope to answer some of these questions?
Tan Shin Bin: Yes. I think you might be able to glean from my discussion that I'm particularly interested in looking at the relationship that socially marginalised groups would have with their built environments.
One of the projects that I'm currently working on looks at the involuntary relocation of low-income rental flat communities here in Singapore.
Through surveys and interviews, we're trying to get an in-depth look into how changes in neighbourhoods might affect the well-being of this community, which is low-income, and socially vulnerable.
And I wanted to study how the day-to-day routines might change after changing neighbourhoods, how the move affected their social ties, changes their relationship with their friends, their families, and their immediate neighbours.
So all these would help get a better sense of how a group like this – who is relatively less studied, especially within a Singapore context – relates back to their environments. And because of that hopefully get insights into how the urban environment can be better designed to meet their needs.
Also, given that they are a group that is at higher risk of poorer health outcomes, there's a real urgency to make sure that our planning interventions are supportive of their health.
David Austin: And you've alluded to some of this already, but what other future trends are on the horizon that you see when it comes to urban planning and healthy cities? Anything that you're excited about or that you'd like to share with us?
Tan Shin Bin: One thing that I think seems to be emerging is looking beyond just overall population health. I think that interest in health is a big consideration that has come up in recent years.
So if we actually go back a bit and think about the history of urban planning, a lot of what we understand to be modern day urban planning came out of a concern for health — the desire to make sure that our environments are clean and safe, to separate the dirty and polluting users. All of that really was a primary driving consideration back in the day when industrial cities were starting to emerge, and that was what drove planning considerations.
And it feels like we've come full circle today on where we start to think about how urban planning affects health. I think this is a consideration that really came up also in response to COVID-19 where health concerns became really front and centre in a very global and very epic scale.
So I'd say that kind of urban planning and the link between urban planning and health is a hopefully sustainable trend that's going to continue in the future. But the reason I say I would like people to look beyond overall population health is there is a need to look at health equity as an outcome as well.
Planners have to explicitly consider the health of populations who are vulnerable to poorer health outcomes. We can think about lower income groups, we can think about ethnic, racial and minorities. Again, thinking about how COVID-19 has affected the health of the world, it seems like the health disparities that have emerged from COVID-19 have also made the issue of the need for thinking explicitly about health differences, about health equity, and has made all these concerns much more salient and real. When we look at the big ways in which health outcomes really differ, it depends on the resources that one has during the COVID-19 pandemic. Think about how racism affected outcomes from COVID-19.
So I'll say that going forward, I really hope that we can take some of the lessons that we, as a world, have seen from the COVID-19 pandemic and translate that into actual policies that explicitly try to target closing the gap between the resourced citizens of the world and those who are less resourced.
So that's what I'm hoping to see in terms of trends in urban planning.
David Austin: Thank you so much for joining us. That's been a really interesting discussion, and I look forward to hearing more of your research in the future.
Tan Shin Bin: Thank you very much. I'm glad to have this opportunity to talk about my work.