How pandemics shape town planning

Tuberculosis led to the rise of modernist public architecture. What will our cities look like after Covid-19?

Schoolâ?Ts out: children at Bostall Woods open-air school in London, set up in the early 1900s (Photo By LIBRARY OF CONGRESS/SCIENCE PHOTO LIBRARY)

When our local park reopened after the first Covid lockdown, banners attached to the gates announced new rules for park users, including no spitting. Similar prohibitions were common in public spaces when I was young: traces of an earlier pandemic that killed millions. Between 1882, when the tuberculosis (TB) bacillus was first identified, and the end of the Second World War, when the BCG vaccine became widely available, the programme to eradicate the disease was responsible for a revolution in public health policy, but it also gave rise to modern town planning. The relationship between the two has been central to public well-being ever since.

In 1875 Benjamin Ward Richardson, the president of the Social Science Association, outlined a model for a new kind of city, subsequently published as Hygeia: A City of Health. This was the same year as the UK’s path-breaking Public Health Act, which inaugurated a new era of clean water, the safe disposal of sewage, and regulations requiring homes to provide fresh air and natural light in the hope of eradicating TB.

TB gained attention because the list of casualties constituted a gazetteer of European high culture, including Keats, Chopin, Emily Brontë, Chekhov, Kafka and Edvard Munch. The majority of victims, however, came from overcrowded slums, where up to a quarter of all deaths were attributed to TB, circulating through the air from person to person, just like Covid-19.

[see also: The myth of natural morality]

For those with money, mountain air and sunshine were thought to slow the advance of the disease. For everybody else, it was a case of waiting for an improvement in living conditions. In a guide to the design of bungalows published shortly after the First World War, the architect Lawrence Weaver made the persuasive – but scientifically unsupported – claim that “a tuberculosis germ will live for two years out of the direct rays of the sun and not more than ten minutes in sunlight”. Inspired by works such as Hygeia and Ebenezer Howard’s 1902 publication Garden Cities of Tomorrow, architects and planners adopted the improvement of public health as the organising principle of urban design. Entirely new forms of settlement and public architecture appeared, starting with the Port Sunlight model village in Merseyside, in 1888, and followed by the first TB sanatorium in England (Mundesley, Norfolk, 1899), the first garden city (Letchworth, 1903) and the first open-air school (Plumstead, London, 1907). The cult of fresh air and sunshine was now in the ascendant. In 1901 the chairman of Birmingham Council’s housing committee, JS Nettlefold, announced: “We can, if we will, let light and air into our towns; we can, if we will, make the most of and not the least of the sunshine.”

Even the hardcore rationalists of the modern movement fell into step. The influential Charter of Athens issued by the Congrès International d’Architecture Moderne (CIAM) in 1933 – which had Le Corbusier’s fingerprints all over the draft – felt obliged to proclaim: “The sun, which governs all growth, should penetrate the interior of every dwelling, there to diffuse its rays, without which life withers and fades.” In Britain, the architectural pinnacle was reached with Berthold Lubetkin’s design for Finsbury Health Centre in Clerkenwell, completed in 1938. A TB clinic, dispensary, laboratory, solarium and lecture hall, it has distinctive glass brick walls and a large curved entrance lobby decorated with murals by Gordon Cullen, exhorting users to “live out of doors as much as you can” and take “fresh air night and day”. The postwar Labour government, which had four members of the Ramblers’ Association in the cabinet, created the 1949 National Parks Bill, which Lewis Silkin described at the time as “a people’s charter for the open air”.

Disillusionment with modernist town planning set in once the problems of large-scale “comprehensive redevelopment” – in which swathes of historic city centres were levelled to create shopping centres, ring roads, high-rise housing and peripheral council estates – revealed themselves. Disconnection from the life of the street and the neighbourhood was keenly felt. In The Birth of the Clinic (1963), Michel Foucault cast a revisionist eye on the whole médicalisation project, deriding “the dream of a festive city, inhabited by open-air mankind, in which youth would be naked and age know no winter, the… symbol of ancient arcadias”.

This scepticism is shared by Jan Gehl, the former professor of urban planning at the Royal Danish Academy of Fine Arts and today one of the world’s pre-eminent urbanists. “The modernists were helpful in the early days of combating TB,” he told me. “The problems began when the CIAM met in 1933 in Athens and agreed housing, work, recreation and commerce should be strictly separated in the interests of public health. Yet, by then, the problem of TB had already been solved. In 1998, I was invited by the European City Planners’ Association, again held in Athens, but this time we all signed a declaration saying you must never separate housing, work and recreation. It took 65 years to realise a mistake had been made.”

How does he see the post-Covid city? “The temptation is always to retreat to the countryside if you can afford it. This is what Hans Christian Andersen, Kierkegaard and other rich people did when cholera struck Copenhagen. But you are exchanging one problem for another.” For Gehl, the greater challenge is combating climate change, which is best done in cities – always more energy-efficient, sociable and economically viable. He supports recent proposals by the Paris mayor, Anne Hidalgo, to recreate “15-minute neighbourhoods”, where needs can be met within a 15-minute walk from home. “Covid is simply pushing something that was already happening,” Gehl said: the re-invention of the neighbourhood as the vital building block of urban planning.

Quality of life outdoors in the city is another key issue. With the current demand to support the hospitality sector in British cities, a major fault line seems to be developing between economic interests and health interests. While one part of government is working out how to get people back into pubs, clubs, bars and restaurants as quickly and safely as possible, another part is having to respond to the demand for safe outdoor spaces for social and physical recreation.

According to Martin McKee, a professor of European public health at the London School of Hygiene and Tropical Medicine, the one certainty about Covid-19 is the “recognition that in enclosed indoor spaces there is a real risk of transmission and that should be pointing us towards limiting the amount of exposure people have to confined indoor space”. One research company recently published evidence showing the top priority for “Red Wall” voters is more parks and places to meet locally. The political tension between the economic importance of supporting private leisure and hospitality (indoors) while improving public recreational amenities (outdoors) will be difficult.

Julia Thrift, who is responsible for health and planning issues at the Town and Country Planning Association (TCPA), agreed. “The problems were brewing before Covid,” she said, “but the pandemic has thrown into sharp focus those neighbourhoods that work and those that don’t.” Covid-19 has stress-tested many developments of the past 40 years and found them wanting. In those areas that were car-dependent, with few public amenities, whole communities were “confined to barracks” when lockdown happened. Thrift thinks a new NHS document, “Putting Health into Place”, is showing the way by insisting that in future, the NHS “should be involved in the planning and development of new places from the initial planning stages onwards”.

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Is this likely to happen? According to the TCPA, since 2013 “tens of thousands of new homes have legally bypassed the planning system” through the use of permitted development rights: these waive the usual requirements in the name of changes of use, such as conversions from light industrial to residential. Developers thus avoid contributing to the costs of public amenities, and they certainly don’t have to consult health professionals on matters of design. “We remain sceptical about how meaningful ongoing rhetoric from central government about the importance of place-making can really be,” said the TCPA chief executive Fiona Howie, “when the powers available to local authorities to shape the places within their area continue to be stripped away.”

It wasn’t always like this. Adorning the facade of the former Public Health Department of Southwark Council on Walworth Road is a large plaque inscribed, “The Health of the People is the Highest Law”. Translated from the Latin, the principle was first mentioned by Cicero, and became one of John Locke’s fundamental rules of good government. Facing one of the greatest public health crises of modern times, there is an urgent need to think strategically about the future. These risks are likely to exist for some time, irrespective of a successful vaccine. In the meantime: live out of doors as much as you can.