What history and Covid tell us about building healthy cities

The roots of modernism are less revolutionary than reactionary. And the reaction was tuberculosis. The end of the 19th century was sick with tuberculosis. Dirty streets and smoky air, dark courtyards and rooms filled with velvet-covered furniture, draperies and ornaments.

The solution was the sanatorium. The crisp white hideaway in the mountains with its crisp air, invigorating breezes and blankets on the balcony. It was the world of Thomas Mann The magic mountainthe sanatorium as a metaphor for a break with the city, purified by modernity and the medical machine.

Architectural historian Beatriz Colomina suggests that “modern architecture was shaped by the dominant medical obsession of its time – tuberculosis – and the technology associated with it: X-rays”.

The X-ray made visible the dark interior of the body. Modern architecture, with its skeletal frames and bay windows, would do something similar, exposing the interior to light and public scrutiny. It was a very different design from the traditional masonry shield wall and window: the dark interior of the 19th century.

The city also had to be purified. Modernist planners envisioned roads as arteries, the landscape as lungs, and an architecture of light and views, towers placed in parks, a retreat from the street. It became, in the middle of the 20th century, the urban orthodoxy.

Yet even as she settled into the 1960s, the counterattack was on. Roads were ripped through historic neighborhoods, often inhabited by the poorest and people of color. Inhabitants were “decanted” into alienated towers in landscapes that quickly deteriorated into wastelands. At the end of the 20th century, the pendulum swung back and the healthy city once again became the traditional, pedestrianized street, a city with green spaces and active main streets.

But modernism survived alongside it, and today we are stuck in a hybrid world of gentrified historic centers, marginalized housing estates, and pseudo-modernist tower blocks clustered around city centers. Extremes have merged into a city that is often neither one thing nor the other.

The pandemic has made us question these assumptions. Long flouted modernism, with its balconies and open landscapes, conceived as a reaction to illness, is once again becoming topical. Those who could afford it fled to their country or beach homes. Town centers have emptied out. The notion of healthy city is back. But what is it? Although there is no single answer, Covid has brought to light some particular things, sometimes small and unexpected.

“During Covid,” says Ricky Burdett, director of the cities program at the London School of Economics, “it has become clear that your local park or green space has become an important part of your physical, social and psychological well-being.”

Urban access to nature is generally thought of in terms of the municipal park. However, it could also encompass urban agriculture. Rooftop gardens and urban vegetable gardens will not solve hunger but will do wonders for well-being, biodiversity and access to healthy food.

Burdett’s succinct answer to what makes a healthy city is “planning.” Whether it is sprawling or dense, and its relationship to nature, are critical.

The original modernism succeeded in some things – fresh air, landscape, terraces, natural light – but it failed in its dependence on the car and its isolated, poorly integrated blocks. But the once doomed 19th century industrial city now looks great: Paris, Manhattan or London as places of walkable neighborhoods, parks and convenience stores, fostering neighborhoods and encouraging exercise.

Most historical versions of the city had something going for them – until Epidaurus in the 4th century BC, which was made for holistic healing and equipped with a theater for catharsis, a dream clinic, stadiums , springs and temples, all set in an Aegean landscape of epic beauty. We could also turn to the incarnations of Kyoto, Beijing, Istanbul, or Sana’a in Yemen, each of which at some point was aware of health and the benefits of life beyond work and consumption. Even the European medieval city, which we associate with filth, pestilence and war, was a space with hospitals, almshouses, gardens and churches, places of charity and care.

Care is essential. Do we feel that the city cares about us? The consolidation of health care into medical buildings seems to absolve the city at large. But health must be in its fabric, from the reduction of polluting traffic to the provision of outdoor spaces, cycle paths, public transport, culture and social assistance.

Critically, Burdett also mentions the impact of inequality. “The difference in life expectancy in London from west to east can be up to eight years,” he says – yet we all, ostensibly, live in the same city. The paradox of the healthy city of the future is therefore that it could end up looking a bit like the city of the past. Can we retain the best of modernism and historical lessons?

The reaction to the evils of the 19th century was a revolution, the rebuilding of cities that left a contested legacy. The lesson could be more evolution than revolution, radical repair and bottom-up reimagining of the bones of a city already there and upon which we can build.