So it's a pleasure for me, and a great honour, to be talking at the Royal Society. So thank you
for this opportunity to present to you some of the research that we've been doing at RMIT University,
and over my 20 years of my career, asking the question: "Liveable Cities for All:
Are We There Yet?" There's been this growing concern about this rapid urbanisation that we're
experiencing across the globe, but also population growth. By 2050, our population will be expanding,
but 68% of our population is going to be living in cities, which makes cities a very important
place for us to think carefully about that. Our population is growing, even in highly urbanised
countries like Australia, and this calls to us that we need to really think carefully about the
way we're planning our cities. Now that's important because, by 2050, we're going to
need to build an extra 1.6 million new residences. It's putting pressure on our resources and our
infrastructure. We cannot continue to grow our cities, even if there are electric cars, because
traffic congestion is very expensive. The reason why I got involved in the concept of liveability
is because of this man, Dr Ian Butterworth. And he was very concerned about what was going on and he
asked me whether I would get involved in his area and this topic of "place and health." These are
the social determinants of health: the conditions in which people are born, grow, work, live,
and age, and the wider forces and systems that shape daily living. But the question for me:
could we reframe the social determinants of health through the lens of liveability? When
I think of really liveable cities, you know, I think of places that are a little bit smaller,
I suppose, but you know, things like Copenhagen. One could think of Barcelona and think,
well that's a terrific city. Now the problem with Barcelona, of course, is they've got air quality
and noise problems, because they haven't managed the traffic. So, one has to really - if you want
to have a compact city, which I think we need from a global perspective - one also
has to manage traffic. You can't just have compact - otherwise it's high-rise sprawl.
So it's really important that we're thinking about combining land use with transport, and that's why
we call for this idea of integrated planning because, unless you've got land and transport
being done together, you end up with perverse outcomes, and it's really, really important.
What is liveability? A liveable community is one that is safe and socially cohesive and inclusive.
It has to be environmentally sustainable. It has affordable housing and diverse housing, but
there's no point providing affordable housing on the fringe of cities if it's not linked by public
transport, walking and cycling infrastructure to employment, to all the services that you need for
daily living. We took the view that "what will get measured will get done." And we started to
ask the question "are we creating a liveable city for all?" We thought, well, what are the sort of
domains of liveability? We said it was access to public open space, access to public transport,
how walkable a neighbourhood is, how affordable the housing is, whether people have access to
employment, whether they have a supportive food environment - and we also put an alcohol
environment. This was something that one of our industry partners, our funders, wanted us to
measure, so we measured that as well. So, here we were, our primary question: "are there underlying
domains of liveability associated with health and well-being?" There are associations - the
measures of the built environment we created were all policy relevant, so it spoke to
policy - but we also wanted to identify which of these were most associated with health.
I think people are very different throughout the world and that's a challenge in terms
of how things are implemented on the ground in different cities. Most people need to have access
to a school; most people need access to doctors, however it's described in a different country;
most people need access, if we want people to walk, they need a walkable community,
with somewhere to walk to. But how it looks in a place may differ, but in some ways the metrics are
somewhat similar, because people everywhere will need those things. The second question
that we wanted to ask is "are there spatial variations in access to health promoting amenities
in Melbourne?" So the first thing we did was look at Melbourne's - this is just Melbourne's,
we've got data for this nationally - Melbourne's walkability, and you see a very clear pattern
here. You can see that we've got a nice, walkable grid, but once you start to get out to the outer
suburban areas, lots of pink, very low walkable areas, where you expect that everyone's driving.
We also had measures of social infrastructure, we looked at about 16 different types of social
infrastructure, whether people have access to a school, whether they've got new GP surgeries
nearby, whether they've got a supermarket, and we looked at, again, what's the pattern
across the city? And we find a similar pattern that in the inner city, where it's nice and green,
we see that it's really terrific, lots of access to social infrastructure. But if you're living
out in the fringe, the pink areas, some of those people are living out in the fringe with zero to
1.4 different types of social infrastructure - not much access at all. So the third question
that we wanted to address in our research was "does the concept of urban liveability
affect health and wellbeing?" And to do that, we wanted to provide an alternative way of looking
at the liveability index. The index that was developed by the Economist Intelligence Unit is
to actually decide what the loading should be for executives who are moving to Melbourne.
So we wanted to create a liveability index which was about the lived experience of people living in
Melbourne. So what we did to do this - that work that was done by Carl Higgs, it was a beautiful
piece of work - he pulled together all these different types of measures of liveability and
put it into an index and, lo and behold, you see a similar pattern as you might expect: people in the
inner city live in a very liveable area, people on the fringe have a much less liveable area to live
in. For every unit increase in urban liveability, the likelihood of people walking, cycling,
using public transport increased by about 10 to 15 percent and the likelihood of people driving
decreased by about 12 percent. We wanted to take this work nationally. One of the key questions we
wanted to ask in this was "do we have the policy environment or frameworks in place in Australia
to deliver healthy, liveable cities or not?" And when we look across the policies generally,
we don't have the policy frameworks in place in Australia to achieve the cities that we say
we want and need. We looked at Melbourne, Sydney, Perth and Brisbane, and you see a similar pattern
to what we saw with walkability. Not surprisingly, again, in the inner city, you're starting to get
up to the higher levels of density; out in the fringe, really low density. Sydney has more
density, but again, you could see a lot of areas where the densities are too low. Now, when we
look at where in these cities are these policies being delivered - so these are the only suburbs
where there was a significant number of people with this sort of level of an average density
of 15 dwellings per hectare - most of the rest of the city is not going to ever be walkable, because
it's very hard to achieve a walkable environment if you don't have access, the densities aren't
higher. For Melbourne, for example, 27% of people live and work in the same area,
okay, not everyone just in - even in the outer suburban areas. And quite a lot of people
live and work in their area, in the outer suburban areas, but very few of them
walk or cycle to get there. They will drive. That's a lot of people who could potentially
use an alternative, particularly my - we did a report a few years ago for the Australian
Council of Learned Academies, and in there was included some maps which showed what it
would look like in Melbourne and Sydney if we put cycle paths within five kilometres of all
the train stations. Now, if you also did that for all the activity centres across cities,
you'd be amazed how much of the city is connected by doing that. We made a number of recommendations
out of this report. First of all we argued that there needed to be evidence-informed policies;
we suggested that there needed to be short, medium and long-term targets - very hard to turn the
ship around when we've got the challenges that we have in our cities. We suggested that the spatial
indicators are very useful and actually seeing benchmarking and monitoring in cities so we can
actually see what we're delivering on the ground for the people who we're trying to serve with our
policies. And we suggested that if we really want to change our cities we need metropolitan
governance, because one of the challenges in terms of delivering these sorts of cities,
is that we need integration across all the different sectors, both vertically - federal
government state government and local government - but importantly, also horizontally, across all
the different government departments. So is any of this important? From a health point of view,
the sorts of risk factors that I'm talking about - walking, cycling, using public transport and
having more physical activity - is clearly really important for cardiovascular disease,
stroke, diabetes. So we see these patterns. So there are incredible gradients in people's health
and we would argue that the environment in which people live contributes to that. But of course,
the biggest threat to human health, we now recognise, is climate change. And the solutions
require a shift in the way we're building our cities as the contributor to reducing emissions.
So liveable cities for all: are we there yet? I think we can firmly say that we have
a way to go. And this is important, because not only is affecting chronic disease, but also,
with climate change, it will affect our health, all of our health, the ecosystem health,
into the future. This isn't a dress rehearsal. Cities are a major emitter of emissions,
and transport is a huge contributor to that. We really need to do things differently, we cannot
continue to put our hands over our eyes and say well, you know, we can continue to live just as we
always have. The work I've been doing is focused on chronic disease, but it ties really beautifully
to an agenda around mitigating and adapting to climate change. We all need to change and
that's not easy, but it's something that we all need to do. And I think what we're trying to do
is to provide the metrics to help what we need to do in our cities. And I think it'd be great
if we could - policymakers picked up and were able to contribute. But they'll only do what
the public want so I think go and speak to your politician. This is important stuff.