A scientist’s opinion : Interview with Dr Hanneke Kruize on improving urban health through behavioural changes

We speak with Hanneke Kruize, Environmental Epidemiologist at the Dutch National Institute of Public Health and Environment (RIVM) about implementing initiatives that encourage healthier and more sustainable lifestyles.

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What are the main urban health issues in Europe?

Hanneke Kruize: The increase in the number of people living in cities puts pressure on green and blue spaces that not only help cities adapt to climate change, by reducing heat stress, for example, but can also improve the health of their citizens by encouraging physical exercise and social interaction. Densification also increases transport requirements; most people rely on cars that contribute to air pollution and noise. Other urban health issues are linked to inadequate housing and fuel poverty, and to demographic changes such as the increase in elderly people and one-person households. A growing problem is health inequality, despite a lot of research and policies in this area the differences in life expectancy between socio-economic groups do not decrease and may even increase. We are looking for solutions that can tackle more than one of these problems at once. For example, by promoting active modes of transport (cycling, walking) it is possible to reduce air pollution and improve health through exercise.

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Could you highlight any findings from the INHERIT project regarding Urban Health?

Hanneke Kruize: The INHERIT project produced 15 “triple-win” case studies that describe approaches to improve health, increase health equity and positively impact the environment. Some of the most interesting ones for me involve working with children. Teaching them about healthy and sustainable lifestyles is likely to influence their decisions and behaviours as adults. Cases like “Sustainable food in public schools” in Spain and “Green Gym and Meat Free Monday” in the UK encourage children to adopt healthy dietary behaviours, increase physical activity and use green spaces in schools. These initiatives could also help reduce health inequalities arising from unhealthy food choices associated to low-income groups.

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Can we start to see the effects of some of the sustainable practices captured in the INHERIT project?

Hanneke Kruize: Many initiatives outlined in the case studies are ongoing, stimulated by positive findings. They encourage small changes that together, as they become more widely adopted, will lead to a movement towards healthier and more sustainable lifestyles. We have produced guidelines and an online learning module with specific advice on what people can do to protect the environment, become healthier and reduce health inequalities. We believe that both local, bottom-up initiatives and high-level policy changes are required to achieve real change. In addition to working more closely with policy makers, the INHERIT project also highlighted the need to work with companies on new business models that value sustainability and reduced carbon footprint. The effects of the sustainable practices identified in the project on populations elsewhere around the globe and on future generations are yet to be investigated.

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How do you envision urban health will be improved in the next 5-10 years?

Hanneke Kruize: Heat stress and extreme weather conditions are heightening people’s awareness of the need for climate adaptation and mitigation measures. We are starting to see promising behavioural changes in food consumption for example, but I am curious whether this is happening in the lower socio-economic status groups. Similarly, we are seeing more energy efficient houses and increases in the uptake of active transport, but the expense of making these home improvements or owning a bike, is simply not affordable to everyone. We need to engage with lower socio-economic groups and big companies to make the sustainable choices affordable and easy. It is also crucial to keep looking at urban health issues, and funding them, in an integrated way.

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