Imagine if...
Part 1: A city designed for health. Reflecting on five years of looking at participatory research work in improving health for cities.
For the past five years, through freelance work and then our work at OURI Labs, I’ve worked with communities, NHS trusts, local authorities, and housing providers across England to understand what makes cities healthy and what stands in the way.
I’ve worked alongside communities, analysed post-occupancy evaluations, and facilitated workshops where residents, planners, and health professionals try to speak the same language about wellbeing.
What I’ve learned is this: we already know what healthy cities look like. The challenge isn’t evidence it’s implementation. This three-part series explores what a genuinely health-centred, participatory approach to urban development could look like, and why, despite the barriers, it may be more achievable than we think.
Imagine if you woke up in a city where every street, every building, every green space had been designed with one question at its heart: Will this make people healthier?
Not as an afterthought. Not as a tick-box exercise in a planning committee. But as the fundamental organising principle of urban development itself; because health isn’t separate from economic development. Health IS economic development. It’s a practical possibility, one that requires us to fundamentally rethink how we design cities and, crucially, who gets to make those decisions.
Not cities that treat health as a happy accident of good design, but cities intentionally built to nurture our bodies and minds reducing respiratory illness, fostering connection, supporting movement.
…the city listened
In this city, planning doesn’t happen in boardrooms and through top-down decision making from Councils alone. It happens in living rooms, community centres, and on the streets where people live. Urban development isn't just a local council’s priority, the decisions and shaping of it are genuinely placed in communities' hands.
Local communities don’t just get “consulted” (that tired word that so often means “told what’s already been decided”). They are active participants in shaping their neighbourhoods from the earliest stages of development. At the ideation stage, when communities identify land as an opportunity and Councils, community groups and developers enable that vision, residents are at the table from day one because they are the biggest stakeholders in what their neighbourhood becomes.
Health is embedded in every decision. When new housing is proposed, the conversation doesn’t start with density targets and building regulations. It begins with questions like: How will this support mental, physical and psychological wellbeing? Where will children play safely? How will older residents live in spaces that prevent isolation? Will there be space for community food growing that can feed a nearby school for their lunches?
…nature was infrastructure
Walk through any neighbourhood in this city and you’ll notice something immediate: green space isn’t an afterthought squeezed between buildings. It’s infrastructure, as essential as roads or sewers. Trees line every street, not just for aesthetics but for air quality, cooling, and mental health. Pocket parks appear every few blocks as residents identified where they were needed most.
Community gardens aren’t just decorative. They’re food production, social connection, and therapeutic space all at once. Waterways that were once culverted and forgotten have been brought back to the surface, creating blue-green corridors that manage flood risk while providing beautiful spaces for people to gather.
This integration of nature and health isn’t coincidental. It emerged from participatory processes where residents and health professionals worked alongside planners and ecologists, mapping not just land use but wellbeing needs, social connections, and health inequalities.
The so what…
Poor housing and disconnected urban design contribute to physical illness, mental health challenges, loneliness, and health inequalities that persist across generations. We know that communities excluded from decision-making processes often end up in environments that actively harm their health. As Sir Michael Marmot identified, health should not be a postcode lottery yet underrepresented communities consistently bear the worst impacts.
Despite this knowledge, we continue to develop cities in ways that prioritise speed and profit over health and equity. Communities are “consulted” without genuine co-creation that acknowledges and addresses the power imbalances necessary to enable resident voice. We add green space as a planning requirement rather than integrating nature as essential health infrastructure.
The city I’m describing here isn’t built on new technology or massive budgets. It’s built on a different set of priorities and a commitment to genuine participation. It requires us to trust that, given the right tools and real power, residents are best equipped to shape neighbourhoods that work for them. That trust and that transfer of power is imperative to building healthy, thriving cities.
At OURI Labs, we support organisations and communities working toward this vision through participatory research, evaluation, and collaborative processes. If you’re grappling with how to genuinely centre health and resident voice in your work, I’d love to hear from you. And if you’re already working in this space, consider joining the Health and Wellbeing in Planning Network (Join LinkedIn)- a community of 200+ practitioners navigating these exact challenges.
Coming next: Part 2 examines why participatory, health-centred development remains the exception rather than the rule, and Part 3 explores practical pathways forward.