Chief Medical Officer’s report calls for active travel, improved housing, and cleaner air in cities

The Chief Medical Officer’s annual report, Health in Cities, published last month, has highlighted the profound impact of urban environments on the health and wellbeing of England’s population.

Drawing on extensive data and expert analysis, the report focuses on the critical links between urban living conditions and pressing health challenges, including housing quality, homelessness, mental health, active travel, air pollution, and the needs of ageing populations.

In his foreword to the report, Chief Medical Officer Chris Whitty calls for policymakers to “be brave in support of the health of children and vulnerable people now and in the future,” emphasising the need for targeted action on transport, housing, and pollution.

He notes, “It is possible to design cities in such a way that they enhance health through decisions on transport, housing, schooling, food policy, licencing and pollution.”

Whitty argues that while such decisions may come at a political or financial cost, “the impact of pro-health decisions can be substantial and usually long lasting.” Whitty also highlights the importance of addressing concentrated deprivation in urban areas, advocating for tailored interventions to optimise health outcomes in cities.

With over 80% of England’s population living in cities, the report underscores the pivotal role of the built environment in shaping public health. Aimed at policymakers, it calls for evidence-based interventions to tackle entrenched inequalities and create healthier, more sustainable urban spaces.

The report identifies housing quality as a major determinant of health, noting that poor-quality homes – often damp, mouldy, or inadequately insulated – are linked to respiratory illnesses, cardiovascular conditions, and poor mental health. It highlights disparities in housing standards, with inner-city areas showing a higher proportion of poor-quality housing compared to suburban areas.

According to the report, 16.3% of urban homes fail to meet the Decent Homes Standard, with flats performing particularly badly. The document calls for targeted interventions, including retrofitting older homes and expanding affordable housing to mitigate health risks associated with substandard housing.

Urban housing design and location are also scrutinised. The report suggests that compact homes in dense urban environments may help reduce fuel poverty due to easier heating but warns of increased risks of overheating, particularly in flats. It advocates for design strategies that address thermal comfort year-round and promote ventilation to improve indoor air quality.

The report describes active travel as a “win-win-win” for public health, economic efficiency, and environmental sustainability

Homelessness is also identified an acute public health challenge, with the report stating that England has the highest homelessness rates among OECD countries, with one in 51 Londoners affected. The document highlights the severe health implications of homelessness, including increased mortality rates and higher prevalence of conditions such as respiratory illnesses, tuberculosis, and mental health disorders.

The report references the short-lived successes of the COVID-19 Everyone In initiative, which housed thousands of rough sleepers during the pandemic, noting significant health improvements among participants. However, it emphasises that systemic issues, including insufficient affordable housing and a lack of permanent solutions, continue to exacerbate homelessness.

The report urges the adoption of a long-term approach similar to Finland’s Housing First model, which prioritises stable housing as a foundation for addressing other health and social issues.

Urban living is associated with higher rates of mental health issues, including depression, anxiety, and psychosis, compared to rural areas, according to the report. Factors such as social isolation, exposure to crime, and limited access to green spaces are seen as contributing to these disparities. Air pollution and noise, both prevalent in cities, are also linked to mental health risks.

The report highlights the critical need for urban planning to integrate mental health considerations by addressing issues such as access to green space. 

Active travel – such as walking, cycling, and wheeling – is presented as a key strategy for improving urban health outcomes. The report describes active travel as a “win-win-win” for public health, economic efficiency, and environmental sustainability, noting its potential to reduce chronic health conditions like cardiovascular disease and diabetes.

Children in the UK have higher rates of active travel compared to other age groups, but in urban areas, around one-third of children aged 5 to 16 are driven to school while fewer than 5% cycle.

According to the report, “Parents, carers and young people are often concerned about driver behaviour and perceived risk of harm from other adults and young people,” which limits children’s ability to travel independently and actively. This, in turn, restricts their opportunities for individual development, education, and risk assessment skills.

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It acknowledges significant barriers, including poorly maintained pavements, limited cycling infrastructure, and safety concerns around active travel, particularly for women and children. It advocates for investment in protected cycle lanes and pedestrian-friendly urban design to encourage wider adoption.

Integrating active travel with public transport is also recommended as a means of extending journey lengths and promoting equitable access.

The report also emphasises the importance of age-friendly urban design, with accessible housing, reliable public transport, and proximity to healthcare facilities identified as critical needs.

It also highlights the risks posed by air pollution to older residents, particularly those with pre-existing health conditions. Conversely, the concentration of healthcare facilities in cities is seen as a potential advantage for managing complex health needs, provided that primary care services are adequately supported and accessible.

Air pollution is described as a “major threat to health,” with cities disproportionately affected due to their density of people and vehicles. The report links pollutants such as PM2.5 and nitrogen dioxide to a range of health issues, including asthma, cardiovascular disease, and dementia.

While acknowledging progress in reducing emissions from vehicles and industrial activities, the report calls for further action, including stricter regulations on wood-burning stoves and enhanced public transport systems. The introduction of low-emission zones and investment in electric vehicles are also highlighted as opportunities to reduce urban air pollution.

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