The foundations of contemporary town planning, civil engineering and public health were built on the leadership of social reformers in the late 19^th century, advocating comprehensive interventions to curb morbidity and mortality associated with people living in overcrowded, unsanitary, and polluted industrialising cities^1,2,3. Integrated infrastructure and policy interventions provided access to clean water and sanitation and improved housing conditions, the latter by requiring minimum lot sizes and separating noxious land uses from residential areas⁴. Prompted by 20^th century infectious disease epidemics, further improvements to higher density housing were achieved through regulations promoting natural light, ventilation and space^5,6. Hence, in many cities – particularly those in higher income countries with well-implemented environmental health programs – infectious, waterborne and respiratory diseases have appeared to be largely tamed, and the associated morbidity and mortality prevented or controlled.

همه گیری COVID-19 این فرض را به چالش کشیده است ⁷ . با گذشت سه سال از همه‌گیری، بیش از 600 میلیون مورد تایید شده کووید-19 و بیش از 6.4 میلیون مورد مرگ در سراسر جهان وجود داشته ^است . صرف نظر از موقعیت یا ثروت یک شهر، کووید-19 زندگی و اقتصاد را مختل کرده است، و جامعه جهانی را به یادآوری سلامت انسان و اثرات اقتصادی ویرانگر بیماری های عفونی کنترل نشده می اندازد ^{. نابرابری‌های اجتماعی-اقتصادی، به‌ویژه برای کسانی که در مسکن‌ها ، محله‌ها و شهرها با طراحی نامناسب یا نامناسب زندگی می‌کنند ،} تشدید شده است ^.. همه‌گیری بر نحوه و مکان زندگی، کار، خرید و بازی مردم تأثیر گذاشته و آسیب‌پذیری‌های شهرهای ما را آشکار کرده است، با درخواست‌ها برای استفاده از لنز سلامت برای برنامه‌ریزی، تأیید و ارزیابی طرح‌های شهری ^{6 ، 10 ، 11} . علاوه بر این، از آنجایی که سلامت انسان زیربنای سلامت اکوسیستم است، COVID-19 نیاز به رویکرد یکپارچه، یکپارچه و متعادل برای ارتقای سلامت موسوم به “یک سلامت” را برجسته کرده است که هدف آن بهینه سازی سلامت مردم، حیوانات و محیط زیست ¹² .

با توجه به چالش‌های کنونی و آینده جهانی که جمعیت شهری با آن روبرو هستند، برنامه‌ریزی شهرها برای کاهش و سازگاری با همه‌گیری‌های آینده، تغییرات آب و هوایی و بلایا باید در اولویت قرار گیرد. تأثیرات همه‌گیری، نیاز شهرها را به انعطاف‌پذیری و طراحی برای حمایت از ساکنان شهری برای مقاومت در برابر شوک‌های آینده برجسته کرده ^است . مطابق با مفهوم «یک سلامت» ¹² سازمان جهانی بهداشت ، زیستگاه ¹³ سازمان ملل، شهر تاب آور را به عنوان شهری تعریف می کند که «ارزیابی، برنامه ریزی و اقدام برای آماده شدن و واکنش به خطرات – طبیعی و ساخته دست بشر، ناگهانی و آهسته- است. شروع، مورد انتظار یا غیرمنتظره به شیوه‌هایی که می‌تواند از زندگی مردم محافظت و بهبود بخشد. این مقاله بررسی می کند که چه درس هایی را می توان از این 21 استفاده ^کردهمه گیری قرن، برای ایجاد شهرهای سالم، پایدار و تاب آور در آینده؟ ⁶

برای پرداختن به این سوال، از یک چارچوب کمی تغییر یافته از مسیرهایی استفاده می کنیم که از طریق آن برنامه ریزی شهری بر سلامت تأثیر می گذارد، که اخیراً در مجموعه سلامت جهانی Lancet در مورد طراحی شهری، حمل و نقل و سلامت منتشر شده است (شکل 1 را ببینید ) ¹⁴ . این چارچوب جامع در پاسخ به چالش‌های مرتبط مهم پیش روی شهرها در قرن بیست و یکم از جمله رشد جمعیت، شهرنشینی سریع، تراکم ترافیک، افزایش نرخ بیماری‌های غیرواگیر، آلودگی هوا و صوتی ناشی از حمل‌ونقل، تغییرات آب و هوا و از دست دادن تنوع زیستی ایجاد ^شده است ^. , 15 . رویکرد سیستمی به برنامه ریزی شهری دارد ¹⁶و سیاست ها و مداخلات یکپارچه بالادستی مورد نیاز برای بهینه سازی توسعه شهری فشرده را در نظر می گیرد که سلامت انسان، اکوسیستم و سیاره را تقویت می کند. توسعه شهری فشرده، استفاده از فضا را در داخل شهر از طریق مسکن با تراکم بالاتر در محله‌های قابل پیاده‌روی با کاربری مخلوط، فضای باز عمومی و زیرساخت‌های حمل‌ونقل چندوجهی کارآمد تشدید ^{می‌کند} . توسعه شهری فشرده که به خوبی انجام شود، سبک زندگی سالم و پایدار را تقویت می کند. اگر ضعیف انجام شود، می تواند ساکنان را در معرض خطرات فردی، اجتماعی و زیست محیطی قرار دهد و پیامدهای سلامت انسان، اکوسیستم و سیاره را مختل کند.

اصلاح شده از ¹⁴ با مسیر جدید که با رنگ سبز نشان داده شده است.

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This framework is relevant to both non-communicable and communicable disease risks¹⁴ and could usefully guide policies to create resilient cities that protect residents’ health in the event of future crises. Rather than focussing on one sector, it addresses the upstream multi-sector ‘causes of the causes’ of poor health and environmental outcomes and proposes the need for integrated cross-sector planning and interventions. Hence, this paper applies and expands the framework to highlight the role city planning could and should play in promoting healthy and sustainable lifestyles in the post-COVID-19 era, by mitigating future crises (e.g., preventing future novel infectious diseases)^11,18, creating built environments that support citizens to endure periods of lockdown and/or quarantine, and minimising the social, economic and health inequities that COVID-19 made so apparent.

This paper begins by exploring how the COVID-19 pandemic exposed the vulnerabilities of our cities for health and wellbeing; before considering the city planning features and lessons that could be applied to ensure future cities are designed to protect the health of all citizens in the event of a pandemic or other future crises.

COVID-19 spread quickly throughout urban areas, particularly amongst the more vulnerable, and those living in crowded and poorly ventilated housing^7,14,19,20. Without vaccines to protect citizens from serious illness, hospitalisation and death, governments worldwide introduced basic public health and social measures (PHSM) (e.g., handwashing, mask wearing, physical distancing and quarantine). In many cases, mandatory city-wide lockdowns restricted movement outside the home to essential activities such as food shopping, outdoor exercise and recreation, medical care and caregiving, and study or work that could not be done at home. Those classified as ‘essential’ workers, often disproportionately residing in disadvantaged neighbourhoods²¹, remained mobile across the city, increasing their risk of infection and transmission within and outside the home, particularly for those living in crowded households¹⁹.

Densely populated cities increase social interactions in public places and hence, potential exposure to infectious diseases. Initially, population density was implicated in accelerating disease transmission¹⁰. However, subsequent studies have challenged this assumption, observing that once strict PHSM were enforced, irrespective of the level of density, it was overcrowded living conditions²² and intra-urban mobility²³, particularly by public transport¹⁰, that affected disease transmission and hospitalisation, rather than density-levels per se^24,25. Indeed, some of the densest cities globally successfully curbed transmission by strictly enforcing PHSM^10,26,27.

Nonetheless, as lockdowns were extended, the challenges of living, working, and studying in poorly designed housing, with insufficient or inflexible space, or in neighbourhoods that lacked key local infrastructure, such as green spaces or shops, increased social isolation and affected mental health¹⁸. This prompted an exodus to outer suburban and regional areas²⁶, placing pressure on housing affordability and local infrastructure, and displacing lower income households, particularly in regional cities²⁸. If unchecked post-pandemic, this trend could exacerbate the urban sprawl already rife across many cities²⁶, and widen socioeconomic inequities²⁸.

Working from home was enabled by digital technology that saw telecommuting for office workers become normalised. With most people working and studying from home, commuting and private motor vehicle use plummeted, and cities worldwide saw rapid declines in traffic, greenhouse gas emissions and air and noise pollution²⁵. This was fortuitous because studies subsequently found an increased risk of COVID-19 transmission for those exposed to air pollution^25,29. Air pollution is already the 4^th leading cause of global mortality and morbidity¹⁴, causing almost 9 million premature deaths annually³⁰.

When exercise and essential errands were the only permitted activities outside the home, access to local shops and services and public open space were vital, and there were calls for more road space to be allocated to commerce, active transport and recreation to enable physically distanced circulation in the public realm³¹. This prompted a proliferation of ‘pop-up’ bicycle lanes in cities worldwide, providing opportunities for safe physically distanced travel³², particularly when people were fearful of disease transmission when using public transport. Such was the importance of cycling as a safe, effective and reliable form of recreation and transportation, cities such as Copenhagen classified bicycle shops as ‘essential services’^31,32. The preference for walking and cycling during lockdowns highlighted ‘that non-motorised transportation systems are more resilient during pandemics’²⁵, and must be prioritised post-pandemic, to create more resilient cities. Indeed, with more people working from home and spending more time in their neighbourhoods, urban dwellers and decision-makers alike began to appreciate the importance of living locally, with local access to shops, services, public open spaces, and multi-modal transport systems.

So, what lessons can we take from this experience, to protect urban dwellers during future pandemics or other crises? Here we reflect on and apply the Fig. 1 framework for creating healthy, sustainable, and resilient cities post-pandemic. First, we consider how city planning could mitigate future pandemics by reducing the impacts of urban development on natural habitats and avoiding biodiversity loss and climate change. Second, we explore how creating 15-minute cities that enable local living and sustainable mobility would reduce transport-related emissions and mitigate climate change while also enabling urban dwellers to adapt when confronted with a crisis, such as a pandemic. Finally, given higher density housing underpins achieving 15-minute cities, we consider how to ensure that higher-density housing is health-supportive, particularly in the event of a crisis.

Urban expansion is threatening biodiversity by ‘polluting, degrading and fragmenting habitat and displacing endemic species with introduced ones’ (p e923)¹⁴. The pandemic has been a timely reminder of the interconnection between humans and nature, given COVID-19 is a probable zoonotic disease that transferred to humans from an animal source³³. Established socioecological models of health situate ecosystems and nature as fundamental determinants of healthy urban populations^2,34. Emerging infectious diseases are a growing global health concern³⁵, driven by biodiversity loss, which increases interaction and disease ‘spill over’ between species^33,36. Once a new disease has appeared, crowded urban areas are perfect environments for transmission. Conversely, intact ecosystems reduce the risk of pathogen emergence and transmission among humans and animals^35,36.

To prevent future epidemics and pandemics, policies that foster nature-based solutions are needed (see Fig. 1). This includes curbing urban expansion to reduce biodiversity loss and human activity encroaching into wildlife habitats, and biodiversity-sensitive urban design. Economic activity and resource use in cities also needs to limit environmental alterations and biodiversity loss well beyond urban boundaries, from pollution, deforestation, agriculture, resource mining and climate change^14,33,37.

Climate change exacerbates the risk of infectious disease emergence and spread (including zoonotic, vector-borne, and water-borne disease) due to ecosystem disruption and the increased frequency and intensity of extreme weather and disasters (e.g., heatwaves, flood, bushfires)^33,35,38. Exposure to multiple disasters, such as a heatwave or flood during a pandemic, has compounding impacts on health and inequities^20,39,40. Transitioning to zero-emission cities is therefore imperative for disaster mitigation, and preventing the health impacts of climate change.

The COVID-19 pandemic brought a short-term dividend of reduced air pollution and emissions in cities, but these climate benefits need to be sustained and accelerated in the longer-term²⁰. Cities also need to minimise impacts of climate-change related disasters, especially for vulnerable populations who are less able to adapt and respond. Key components of disaster risk minimisation are development controls in areas prone to disasters such as fire or flood, and provision of resilient infrastructure and housing that can withstand extreme weather^14,38.

Policies that foster nature-based solutions and promote urban greening to integrate and protect nature within urban areas, not only make cities and neighbourhoods more desirable, but also have co-benefits for biodiversity, wildlife corridor protection, climate change adaptation, and resilience to urban heat, which impacts human health^14,25,41. Well-designed urban green spaces played a vital role in urban resilience during the COVID-19 pandemic, enabling socially distanced outdoor recreation and contact with nature, with multiple population health benefits^25,42. Thus, the size and equity of access to biodiverse green spaces and tree canopy cover should be key city planning considerations, along with biodiversity-sensitive design principles¹⁴. Planning resilient 15-minute cities post-pandemic is an opportunity to embrace the close connection between planetary and human health, and adopt an integrative approach to economic recovery and urban policy that safeguards biodiversity and ecosystems³³.

Healthy and sustainable cities are underpinned by compact urban development that enables citizens to undertake daily activities locally using active forms of transport¹⁴. Yet for decades, low-density car-centric planning has dominated the design of cities worldwide, robbing residents of the health and other benefits afforded by active transport access to local amenities⁴³. As the impacts of the pandemic became apparent, Moreno et al.³² and others^{6,9,10,25,43,44,45}, have argued for a rethink of city planning to reduce inequities and ensure that urban dwellers’ basic needs – working, commerce, healthcare, education and entertainment – can be met locally by walking, cycling or micro-mobility. Indeed, with more people now working from home enabled by digital tools and infrastructure, the importance of local neighbourhoods for fulfilling daily needs has re-emerged. For example, C40, the global network of city Mayors, has committed to ‘build back better’ by creating 15-minute cities that support local living and prioritise active, sustainable mobility with co-benefits for reducing urban inequities, improving public health, and climate change mitigation⁴⁶. Creating ‘cities of villages’ could make cities more resilient to future pandemics, enabling residents to adapt and thrive during lockdowns and potentially reducing geographic spread of disease associated with mobility²².

However, transitioning to 15-minute cities will require a new typology in the way cities are structured^25,32, focussing on decentralised⁴⁷, ‘proximity-based’ planning where all basic services required for daily living are available within 15 min by walking or cycling^9,44. Moreno et al.³² have argued that achieving the 15-minute city requires a focus on four Ds: Density (i.e., ensuring sufficient population to make shops, services and public transport viable, but as discussed below, this must be done well to protect the health and wellbeing of residents), Destination Proximity (i.e., creating a city of short-distances where shops and services are within a walkable catchment), Diversity (i.e., of housing to achieve increased population density and social diversity, and diversity of destinations to make local living achievable) and Digitalisation (i.e., access to high-quality digital infrastructure that enables more people to work from home at least on some days of the week⁴⁸).

همه این D ها حیاتی هستند. علاوه بر 4 بعدی مورنو و همکاران (سه مورد قبلاً در چارچوب ما بودند؛ و ما دیجیتالی کردن آنها را اضافه کردیم)، ما چهار D مداخله منطقه ای (دسترسی به مقصد (به عنوان مثال، افزایش حمل و نقل عمومی به مراکز اشتغال و فعالیت منطقه ای)، توزیع اشتغال (یعنی ایجاد شهرهای چندمرکزی با فرصت های شغلی متنوع که فاصله رفت و آمد را کاهش می دهد، تحرک پایدار را امکان پذیر می کند و پتانسیل کار محلی را در حداقل برخی از روزهای هفته افزایش می دهد)، مدیریت تقاضا (یعنی کاهش راحتی و افزایش هزینه رانندگی و پارکینگ؛ و کاهش بلایا (یعنی محدود کردن توسعه شهری در مناطق مستعد سیل و آتش سوزی؛ و استفاده از راه حل های مبتنی بر طبیعت که خطر سیل را کاهش می دهد و از زیستگاه های طبیعی و تنوع زیستی محافظت می کند)) (شکل 1). ما همچنین چهار D طراحی شهری اضافی را شامل می‌شویم: طراحی (یعنی طراحی شبکه حرکت برای یک سیستم حمل‌ونقل چندوجهی که زیرساخت‌ها و فضا را برای حمل و نقل فعال اولویت می‌دهد ³¹ ). فاصله تا حمل و نقل (به عنوان مثال، برای تسهیل استفاده از حمل و نقل عمومی). مطلوبیت (به عنوان مثال، سبز شدن شهری که دسترسی کافی به فضای باز عمومی را تضمین می کند، در حالی که از تنوع زیستی و زیستگاه ها محافظت می کند و تاج پوشش درختان را افزایش می دهد که به خنک سازی شهری کمک می کند). و توزیع شده (یعنی، دسترسی برابر به همه Dهای دیگر را تضمین می کند).

با این حال، موفقیت توسعه‌های شهری فشرده که شهر 15 دقیقه‌ای را تحویل می‌دهند، با کیفیت و انعطاف‌پذیری موجودی مسکن با تراکم بالا تعیین می‌شود. با توجه به فشارهای وارده بر ساکنان آپارتمان در طول همه‌گیری، بخش بعدی بر درس‌هایی برای بهینه‌سازی مسکن با تراکم بالاتر تمرکز دارد.

مطابق با چارچوب ما، تراکم مسکونی بالاتر برای ایجاد شهرهای 15 دقیقه‌ای ضروری است زیرا جمعیت مورد نیاز برای افزایش نزدیکی مقصد را فراهم می‌کند و فاصله تا یک سرویس حمل‌ونقل عمومی مکرر را کاهش می‌دهد ^. با این حال، موفقیت و تأثیرات سلامتی این شهر جمع و جور 15 دقیقه ای – به ویژه در شرایط همه گیر – به طراحی و مطلوبیت مسکن با تراکم بالا و سطح دیجیتالی شدن آن بستگی دارد که به ساکنان اجازه می دهد به راحتی از خانه کار کنند ⁵⁰ . این در طول همه‌گیری COVID-19 تشدید شد، با قرنطینه‌ها و محدودیت‌های فاصله‌گذاری فیزیکی و اجتماعی، «دوز» قرار گرفتن در معرض محیط خانه را افزایش داد و تأثیرات منفی مسکن با کیفیت پایین را تشدید کرد.

مانند سایر انواع مسکن، طراحی و کیفیت ضعیف آپارتمان می تواند ساکنان را در معرض دمای شدید، تهویه ناکافی، نور بسیار کم (یا بیش از حد) خورشید، حریم خصوصی صوتی و بصری ضعیف، و فضای ناکافی و/یا غیرقابل انعطاف قرار دهد که پیامدهایی برای سلامتی و رفاه خواهد داشت ^. ، 51 . با این حال، برخی از این مشکلات طراحی برای آپارتمان نشینانی که معمولاً کنترل کمتری بر شرایط محیطی داخلی، فضای خصوصی داخلی و خارجی کمتر، و چیدمان های انعطاف پذیر کمتری دارند، تشدید ^{می شود .}. این استرس بیشتری را بر ساکنان آپارتمان در طول کووید-19 وارد کرد، زیرا ظرفیت محدودی برای فاصله اجتماعی در خانوارها برای کاهش شیوع بیماری، تغییر مکان برای مدرسه، کار یا ورزش در خانه وجود داشت (علیرغم اینکه دیجیتالی‌سازی امکان تحصیل در خانه و/یا کار را فراهم می‌کرد) ، یا بازسازی آپارتمان ها برای رفع مشکلات طراحی که نور، تهویه، آسایش حرارتی یا تماس با طبیعت را محدود می کند ^{18 ، 52 ، 53 ، 54 ، 55} . در واقع، این بیماری همه گیر مجدداً بر نیاز به استانداردهای آپارتمانی که سلامت و رفاه را ارتقا می دهند و فرآیندهای تأیید ساختمان که تضمین می کند این الزامات مطابق مورد نظر اجرا می شود تأکید ^کرد .

The nature of apartment living also affects social distancing between households within the building or apartment complex. Individual apartments are accessed via shared circulation spaces – lifts/elevators, stairwells, and corridors – that increase the potential for transmission between households, via contact with surfaces (e.g., door handles, lift call buttons) or closer physical proximity⁵². Communal spaces, such as outdoor gardens, provide additional space and respite, assuming they include the design features that make these spaces attractive and encourage their use (e.g., trees, greenery, seating)⁵⁷. However, during COVID-19 peaks, many shared spaces were closed to residents to minimise infection⁵², confining residents to their apartment or forcing them into the wider neighbourhood, when permitted. While the closure of communal areas had worthy intentions, it had the potential to further penalise apartment residents, particularly those in smaller apartments where lockdowns increased mental distress¹⁸. Building designs that minimise physical proximity between residents (e.g., wider corridors, inviting staircases)^19,47, improve natural ventilation (e.g., openable windows in internal circulation corridors)⁵⁶, and incentivise larger communal areas with greenery would help minimise the impacts of future pandemics on apartment residents.

These policy settings for apartments and buildings are also important to adapt to extreme heat events associated with climate change (Disaster mitigation) and are vital for lower-income populations to reduce energy use and decrease the costs of mechanical heating and cooling⁵⁸. However, healthy apartment design policy requires the support of wider neighbourhood planning policies that deliver nature-based solutions and preserve green space. These increase the Desirability of local neighbourhoods and the potential for green views, promote urban cooling that reduces heat islands^19,52, and limit exposure to traffic and noise pollution¹⁴, all of which are important risk factors for health outcomes downstream (Fig. 1).

Transitioning to healthy and sustainable 15-minute cities is challenging. Yet cities and organisations around the world, including organisations such as C40, are committing to the concept⁴⁶. As Nieuwenhuijsen⁴³ points out, numerous urban models are already being implemented to improve established areas in cities through motorised traffic management and supporting active transportation in residential areas to reduce air and noise pollution and greenhouse gas emissions. This includes the Barcelona superblocks, London’s low-traffic neighbourhoods and Hamburg’s car-free city planning⁴³. None of this is easy, but with courageous leadership, change is clearly possible. Creating resilient 15-minute cities for all will require a rethink of urban planning³², a commitment to delivering health-supportive high density housing, greater emphasis on the timely-delivery and financing of digital, and social infrastructure, and a compact city structure that ensures that all citizens have access to basic amenities required for daily living by active transport²⁵. This necessitates a shift away from car-centric planning – whether electric, autonomous or not – and towards city planning that prioritises sustainable mobility: walking, cycling, public transport use and micro-mobility⁵⁹.

Addressing complex city planning problems requires sector and academic silos to be broken down, and for ‘nexus’ or cross-sector integrated planning to be prioritised^14,15,60. In nexus planning, each component is assessed without prioritising one over the other, to identify trade-offs and synergies to reduce the risk of negative externalities to another sector, duplication of efforts and resources²⁵. Nexus planning requires good and integrated governance and shared budgets across government: hence, political will and leadership is vital to create an authorising environment that enables action and integrated planning across all urban system policies¹⁵.

Indeed, political will from all levels of government and the private sector is essential⁶¹. To achieve healthy, sustainable and resilient 15-minute cities for all requires investment in both green and social infrastructure. In the 21^st century, neighbourhoods are rarely built without clean water and sanitation. Similarly, green and social infrastructure must be elevated to ‘essential infrastructure’;^61,62 and regulations and standards must ensure that human, eco-system, and planetary health are primary considerations in building new, and retrofitting existing, neighbourhoods and housing. Indeed, achieving healthy and sustainable 15-minute cities for all will require new legislation, regulations, and standards; cross-sector integrated horizontal planning across government departments, and vertical planning between different levels of government and the private sector as well as participatory planning with the community (particularly in established areas); and new co-funding arrangements across all levels of government to fund land and physical, digital, and social infrastructure development. Finally, inter-disciplinary research co-designed with policymakers and practitioners will be vital to optimise the 15-minute city, to benchmark and monitor implementation and to avoid any unintended consequences.