How street design affects health

HEALTH + STREET DESIGN by Wandsworth Living Streets

Author: Ian Ralph


The design of our streets and spaces affects how we use them, how we perceive them and act beyond simply moving from A to B. The influence on physical, mental and social health is not solely down to injuries sustained from accidents, but also relate to wider concerns including stress, noise, air quality, obesity, anxiety, sense of community, inequality and of course activity. This all impacts the choices we make, the way we move around, the people we see and talk to and the time we spend at certain places with the most notable impact being the lack of activity undertaken.


What is stopping people from being active? Do subways, infrequent, complicated crossings, poor quality surfaces, unclear and indirect routes and busy, polluted streets put people at the bottom, deter users and increase risk or rates of inactivity? Are Wandsworth’s streets, spaces and centres enjoyable, safe, sociable spaces that facilitate healthy lifestyles?


Cost + Consequence

People’s rates of activity are low, and it’s affecting our health. 63% of men and 75% of women are not achieving at least 30 minutes of moderate activity 5 times a week[i] which results in a greater risk of a range of conditions e.g. heart disease and diabetes.


With the health cost in Wandsworth reaching over £110m when the cost physical inactivity (£66.8m) and annual casualty cost (£43.5m) are considered[ii]   how much and the way we move around is hard to disregard. Air pollution exacerbates respiratory conditions, leading to 34,000 premature deaths per annum nationally[iii] as well as mental health issues such as brain damage, even after short-term exposure to vehicle pollution[iv]. Businesses lose out too as pedestrians and cyclists have a higher rate of local spending than drivers[v]  and higher quality public realm has shown to improve rents and revenues[vi].



Physical Elements

  • Well located benches host an array of users, bring activity to the street and providing a pit stop for those who wish to walk further.
  • Signage promotes a more legible environment for those on foot, supporting more confidence in way-finding and linking important destinations.
  • Attractive routes invite activity and seem shorter than routes through dull areas[vii]. However, route continuity is crucial if people are to use the paths or cycle lanes.
  • Bus Stops in well overlooked locations, within walking distance are more likely to be used.
  • Crossings need to be located where people use them and support direct crossings and ideally accommodate material that promotes the facility, making drivers more aware[viii].
  • Street dimensions should avoid encouraging faster speeds and promote awareness, particularly at junctions where 80% of crashes take place[ix]. Narrowing, raised crossings/junctions, visual features (such as change in surface material), reduced visibility, decluttering and smaller turning radii all have had some influence in awareness and speed.  The removal of markings has shown to noticeably increase driver awareness and reduce accident levels. Unmarked junctions have a much lower risk than those marked as well as signaled.[x]


Greenery is an important part of enjoying our streets and spaces and comes with noticeable health benefits as simply viewing nature (including water) reduces the stress of daily urban life[xi]. It impacts positively on blood pressure, cholesterol, outlook on life, stress reduction and child development[xii] and in residential areas with high levels of greenery there is likelihood of physical activity increased by 300%[xiii]. Street Trees are an effective method of speed reduction[xiv] and also benefit mental psychological well-being[xv]. Combining the greenery and street dimensions, Liveable Streets projects in North America with narrower lanes and frequent tree planting, have witnessed significant reductions in injuries and an elimination of fatalities[xvi].


Access + Distance

Those who live within a 10 minute walk of stations or parks and open spaces are more than twice as likely to achieve their recommended levels of activity[xvii].  Children who live closer to parks tend to spend less time watching TV, or using computer games[xviii] whilst parks and green spaces accommodate physical activity in many forms from sports, to play or allotments and community gardens. The average resident of a walkable neighbourhood weighs 7lbs less than those in sprawling neighbourhoods, whilst those properties with a high walkscore have a higher value[xix].



Personal behaviour is linked to both the psychosocial-economic environment and physical environment[xx]. Traffic speed is major factor discouraging crossing, cycling, independent movement and play, all fundamental if people are to be more active. Traffic volume is a major deterrent to walking and activity[xxi] further impacting on health with busier streets removing the likelihood of losing social contact[xxii]. As “people benefit emotionally and physically from interpersonal relationships”[xxiii] we should seek to promote more sociable streets and spaces. With only a small percentage of the road network carrying the majority of traffic, many residential streets accommodate a low traffic volume, yet the street is still designed for the car, deterring people from using the street as an important open space. Shared surfaces, seating, street parties, gardens and markets have all been used to reset the balance.


Fear of crime and concerns for safety unsurprisingly deter people from being active, particularly at night, therefore good lighting is fundaments for increasing footfall[xxiv], but equally important is a streetscene that has frontage, supports activity and allows for natural surveillance[xxv].


Elderly people, children and other more vulnerable users should be accommodated to enable a better quality of life and ensure they are not excluded from the opportunities that others are able to take.


Interventions to improve our urban environment are possible

Low Cost – Get involved, join Wandsworth Living Streets (, our campaigns, local groups and influence council decisions such as in planning. Make our streets more livable through guerilla gardening, street furniture, street parties, put something intriguing in the street
 markets, supervise children playing on the pavement or the street, teach your kids to walk or cycle and join in walk to school programmes and walk/cycle to work, the shops…anywhere.


Medium Cost – Councils, businesses and the community can take part by delivering better signage, planting street tree, fruit trees, allotments, decluttering streets, activating spaces through better uses, better connecting private gardens and business units with the street, outdoor cafes, and introducing new street furniture, cleaning and maintaining streets and spaces, training and educating, better enforcement, better crossings and walking/cycling infrastructure, reduce rat-running and implementing 20mph.


Higher Cost – High value for money projects, such as town centre improvements, major pedestrian and cycling infrastructure, high quality public realm, pollution reduction and shared surfaces should not be discounted particularly when cost-benefit studies have shown it’s well worth investing in. Society benefits, as do councils, health authorities and businesses, from better, safer, more enjoyable streets and spaces.


Is it worth it?

The average cost-benefit ratio of walking and cycling interventions in the UK was 19:1  with retrofitting streets including implementing a 20mph speed limit having a ratio of 10:1[xxvi]. In Denmark the realisation that every km cycled brings net benefit to society of 30p has meant the government has been making great strides in promoting this mode of travel. Although good examples, such as Walworth Road in Southwark and Kensington High Street are good examples they are not the norm in this country. The benefits of investing in our streets and communities to promote more participation in active, safer, spaces, reducing costs to the public purse and creating fiscal opportunities have not been fully realised.


The steps needed to make the connected safe, enjoyable streets and spaces that create an enjoyable environment conducive to healthy lifestyles is dependent on the authorities – Wandsworth Council, TfL, NHS, the Metropolitan Police and others taking the lead. Working together, and with the community, other public sector organisations, schools, street users, businesses and voluntary organisations is needed to maximise the potential to make Wandsworth’s Streets accommodate physical and social activity.



Think – visit living streets website, identify where issues exist in your area, read Manual for Streets 2

Check out how other communities have changed their streets: DIY Streets(

Talk – with us, with the council, with your friends, colleagues, shopkeepers and neighbours

Do – walk, cycle, plant, garden, campaign for edible street trees, street parties, markets, community gardens, walking groups…

Support – campaigns for:






“Revisiting Appleyard’s Livable Streets”by Streetfilms (


“Speed Camera Lottery” by- the fun theory (









[ii] Dft estimated cost and Cabinet Office

[iii] Royal Commission for Environmental Pollution (2007) The Urban Environment: Summary of the Royal Commission on Environmental Pollution’s Report, HMSO, London

[iv] Emaxhealth “freeway pollution causes brain damage, alzheimer’s” (

[v] Bristol City Council “ A rapid desk-top review of interventions which increase the number of people cycling”

[vi] CABE (2007) “Streets paved with gold: the real value of good street design”

[vii]Zimring, C., Joseph, A., Nicoll, and G.L., Tsepas, S. (2005) “Influences of building design and site design

on physical activity: Research and intervention opportunities” American Journal of Preventive Medicine

28(2), Supplement 2 on Active Living Research, pp. 186-193.

[viii] Public Realm Information and Advice Network (PRIAN)

[ix] Barton, H. & Tsourou, C. (2000) Healthy Urban Planning: a WHO guide to planning for people, Published on behalf of the World Health Organization Regional Office for Europe by Spon, London

[x] Federal Highway Administration (

[xi] Jackson The relationship of urban design to human health and condition in Landscaping & Urban Planning 64 (2003)

[xii] Sustainable Development Commission (2008) presentation “outdoor environments and health”

[xiii] Greenspace Scotland (2009) Health impact assessmentof greenspace: a guide.

[xiv] Burden, Dan. 2006. Urban street trees: 22 benefits, specific applications. Glatting Jackson and Walkable Communities

Department for Transport in article (

[xv] Ulrich (1979) Visual landscapes and psychological well-being. Landscape Research.

[xvi] Dumbaugh, E. “Safe Streets, Livable Streets.”  Journal of the American Planning Association, Vol. 71, No. 3 (2005)

[xvii] Idgo “design of streets with older people in mind” (

[xviii] Deakin University (Feb 2011) “kids forced indoors by poor planning” – (

[xx] Tsouros and Draper (1993) Healthy Cities: Research and Practice, Routledge, London

[xxi] Zimring, C., Joseph, A., Nicoll, and G.L., Tsepas, S. (2005) “Influences of building design and site design

on physical activity: Research and intervention opportunities” American Journal of Preventive Medicine

28(2), Supplement 2 on Active Living Research, pp. 186-193

[xxii] Appleyard, D., and Lintell, M. “The Environmental Quality of City Streets.” Journal of the American Institute of Planners, JAIP, vol. 38, no.2. (March 1972)

[xxiii] Jacobs (1961). The Death and Life of Great American Cities, Random House, New York

[xxiv] Ramsey, M (1991) Crime Prevention Unit Paper No.29, The Effect of Better Street Lighting on Crime, Home Office, London

[xxv] Jacobs (1961). The Death and Life of Great American Cities, Random House, New York

[xxvi] Walk England (2010) Value for Money: An Economic Assessment of Investment in Walking and Cycling