Complex Urban Systems for Sustainability and Health (CUSSH)

CUSSH worked with two partner cities in China to understand the most pressing environment and health concerns and the potential of different development strategies to achieve desired goals. By using participatory engagement and evidence development, CUSSH aimed to help create inclusive solutions to the cities’ environment and health challenges, and inspire broader city-wide changes based on scientific evidence.

"The challenge faced by our cities is how to achieve green and sustainable development on the premise of ensuring stable economic growth. CUSSH aims to identify city-wide changes, significant reductions in greenhouse gas emissions and dramatic improvement of air quality which will contribute a lot to the sustainability of urban development in cities in China." – Professor Liu Qi-yong - Chinese Center for Disease Control and Prevention, Chief Scientist for climate change and health adaptation

Kisumu faces multiple environmental challenges, including such issues as poor housing, industrial and household waste management, and contamination of Lake Victoria, with consequent reduction in fish stocks and adverse effects on water quality. Access to adequate sanitation has remained unattainable for slum households, the city faces a solid waste management challenge, and deforestation on the hills above the city have increased flood risks. Stakeholder engagement through participatory system dynamics workshops has brought together different sectors, including land, environment, housing, transport and public voices, to discuss sustainable solutions to the city’s longstanding challenges. This is done by assessing the decision making and implementation process of existing policies. Systems thinking provided an opportunity to the government to address challenges through a truly cross-sectoral approach. 

"The community expressed a need for housing and sanitation, especially in low income areas. We can synergise with programs looking at accessibility to congested areas, flooding, green energy, and housing. We are optimistic about the impact of the project in the next four years." – Evans Gichana - Chief Officer , Department of Climate Change and Green Energy, Kisumu County

In London, CUSSH examined strategies to help achieve the goal of becoming a zero-carbon city with ambitious improvements in environmental quality, including air pollution. Research focuses on green infrastructure and the Mayor’s Environment Strategy sets the target of making more than half of London green. The work from CUSSH involved investigating how natural spaces can foster health, support social and active communities, and be valued alongside the built environment. Understanding these areas better can help to develop green infrastructure strategies that deliver sustained improvements to local health, wellbeing, and carbon emissions. The best strategies for local green spaces depend on the people using them and the decision-makers implementing the agenda. Therefore, this priority benefits from a place-based, participatory research agenda driven by local residents, stakeholders and decision-makers. To combine multiple perspectives, the research focused on a whole-systems approach capable of capturing complexity. Evidence on the interactions between nature, behaviour, and health, as well as effective approaches to behaviour change and policy implementation, help to design local solutions that work.

Nairobi is the seat of both Kenya’s national and county governments and the focal point of service provision for both. The primary focus of engagement with the county government was on the development of spatial plans for two districts in which substantial development is planned. Participatory approaches involved all sectors, residents, and politicians to achieve buy-in contribute to the design of integrated district plans. These approaches gave the public a real voice in spatial planning. Nairobi County Government leadership, together with the CUSSH research team, applied systems thinking to drive fundamental rethinking of problems and solutions and to develop policy options and implementation strategies.

“All plans in the city must be grounded on the Nairobi Integrated Urban Development Master Plan (NIUPLAN), aimed at decentralizing functions to sub-centres. CUSSH’s contribution is in the two areas: one is in the western part of the city with more affluent residential areas (Woodley), while the other is in the eastern part of the city, with more high-rise developments, dense population, and poorer residents (Kasarani).” – Ruth Waruguru Muroki, Director of Urban Policy & Research, Nairobi City County Government

CUSSH worked with two partner cities in China to understand the most pressing environment and health concerns and the potential of different development strategies to achieve desired goals. By using participatory engagement and evidence development, CUSSH aimed to help create inclusive solutions to the cities’ environment and health challenges, and inspire broader city-wide changes based on scientific evidence.

“The challenge faced by our cities is how to achieve green and sustainable development on the premise of ensuring stable economic growth. CUSSH aims to identify city-wide changes, significant reductions in greenhouse gas emissions and dramatic improvement of air quality which will contribute a lot to the sustainability of urban development in cities in China.” – Professor Liu Qi-yong - Chinese Center for Disease Control and Prevention, Chief Scientist for climate change and health adaptation

Rennes has been in the vanguard of action on sustainability. Back in 1981, it was the first major city to implement differentiated management of green spaces, was a pioneer of public health initiatives through the founding of the French Healthy Cities Network in 1994. Rennes is now an important policy objective in moving towards a resilient zero carbon city is the low carbon transition (50% reduction in greenhouse gas emissions and energy consumption by 2030), within which shorter-term targets are part of Rennes’ essential first steps in an evolving, ambitious programme to achieve far-reaching change. Its Climate Plan had 10 objectives and 109 actions, with 350 million euros invested by 2024. Already committed to healthy sustainable development, Rennes’ aim was to translate its environmental commitments into commensurate action through testing an inclusive and equitable process that all residents are able to both contribute to and benefit from. Examples of actions include very low carbon transport systems and the promotion of active travel options and electric public transport, 20% of the city's area to become green space or watershed protection, to avoid heat islands, and improve health and well-being, high efficient building stock and the renovation of 6,000 public and private housing units per year, and the decarbonization of the energy supply using clean renewable options, so that by 2020, 100% of municipal facilities would be supplied using sustainable electricity, and 50% of their heating sourced from district heating networks. 

The CUSSH project was co-created with city stakeholders, through the use of a Participatory System Dynamics framework. Although many relevant datasets on urban sustainability and health are available in Rennes, there was been no formalized way of collaborating around complex systems issues. Rennes valued the input of CUSSH expertise to develop health and sustainability evidence, and inform decision-making and implementation by identifying interventions in the city that maximize co-benefits and minimize negative unintended consequences.

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Davies, M., Belesova, K., Crane, M., Hale, J., Haines, A., Hutchinson, E., ... & Wilkinson, P. (2021). The CUSSH programme: learning how to support cities’ transformational change towards health and sustainability. Wellcome Open Research, 6(100), 100. https://doi.org/10.12688/wellcomeopenres.16678.1

Deloly, C., Roué-Le Gall, A., Moore, G., Bretelle, L., Milner, J., Mohajeri, N., ... & Davies, M. (2021). Relationship-building around a policy decision-support tool for urban health. Buildings and Cities, 2(1). http://dx.doi.org/10.5334/bc.110

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Pineo, H., Moore, G., & Braithwaite, I. (2020). Incorporating practitioner knowledge to test and improve a new conceptual framework for healthy urban design and planning. Cities & Health, 1-16. https://www.tandfonline.com/doi/full/10.1080/23748834.2020.1773035

Pineo, H., Audia, C., Black, D., French, M., Gemmell, E., Lovasi, G. S., ... & Siri, J. (2020). Building a Methodological Foundation for Impactful Urban Planetary Health Science. Journal of Urban Health, 1-11. https://link.springer.com/article/10.1007/s11524-020-00463-5

Symonds, P., Milner, J., Mohajeri, N., Aplin, J., Hale, J., Lloyd, S. J., ... & Davies, M. (2020). A tool for assessing the climate change mitigation and health impacts of environmental policies: the Cities Rapid Assessment Framework for Transformation (CRAFT). Wellcome Open Research, 5(269), 269. https://dx.doi.org/10.12688%2Fwellcomeopenres.16345.2

Zimmermann, N., Symonds, P., Dianati, K., Baghaei Lakeh, A., Robertson, L., Wilkinson, P., & Davies, M. (2020). A participatory process for modelling green infrastructure implementation in London. SALUS Journal. https://discovery.ucl.ac.uk/id/eprint/10091476/

Zimmermann, N., Pluchinotta, I., Salvia, G., Touchie, M., Stopps, H., Hamilton, I., ... & Chen, T. (2020). Moving online: reflections from conducting system dynamics workshops in virtual settings. System Dynamics Review. ISO 690 https://doi.org/10.1002/sdr.1667

Dianati, K., Zimmermann, N., Milner, J., Muindi, K., Ezeh, A., Chege, M., ... & Davies, M. (2019). Household air pollution in Nairobi's slums: A long-term policy evaluation using participatory system dynamics. Science of the Total Environment, 660, 1108-1134. https://doi.org/10.1016/j.scitotenv.2018.12.430

Espinosa, A. V., Symonds, P., & Petrou, G. Modelling the Influence of Layout on Overheating Risk of London Flats. http://www.ibpsa.org/proceedings/BS2019/BS2019_210891.pdf

Li, X., Taylor, J., & Symonds, P. (2019). Indoor overheating and mitigation of converted lofts in London, UK. Building Services Engineering Research and Technology, 40(4), 409-425. https://doi.org/10.1177%2F0143624419842044

Petrou, G., Symonds, P., Mavrogianni, A., Mylona, A., & Davies, M. (2019). The summer indoor temperatures of the English housing stock: Exploring the influence of dwelling and household characteristics. Building Services Engineering Research and Technology, 40(4), 492-511. https://doi.org/10.1177%2F0143624419847621

Pineo, H., Zimmermann, N., & Davies, M. (2019). Leveraging the Urban Planning System to Shape Healthy Cities. Urban health. https://books.google.co.uk/books?hl=en&lr=&id=HiiPDwAAQBAJ&oi=fnd&pg=PT2... 

Sanchez-Guevara, C., Peiró, M. N., Taylor, J., Mavrogianni, A., & González, J. N. (2019). Assessing population vulnerability towards summer energy poverty: Case studies of Madrid and London. Energy and Buildings, 190, 132-143. https://doi.org/10.1016/j.enbuild.2019.02.024  

Symonds, P., Rees, D., Daraktchieva, Z., McColl, N., Bradley, J., Hamilton, I., & Davies, M. (2019). Home energy efficiency and radon: An observational study. Indoor air, 29(5), 854-864. https://doi.org/10.1111/ina.12575  

Symonds, P., Hutchinson, E., Ibbetson, A., Taylor, J., Milner, J., Chalabi, Z., ... & Wilkinson, P. (2019). MicroEnv: A microsimulation model for quantifying the impacts of environmental policies on population health and health inequalities. Science of the Total Environment, 697, 134105. https://doi.org/10.1016/j.scitotenv.2019.134105

Taylor, J., Shrubsole, C., Symonds, P., Mackenzie, I., & Davies, M. (2019). Application of an indoor air pollution metamodel to a spatially-distributed housing stock. Science of The Total Environment, 667, 390-399. https://doi.org/10.1016/j.scitotenv.2019.02.341

Watts, N., Amann, M., Arnell, N., Ayeb-Karlsson, S., Belesova, K., Boykoff, M., ... & Chambers, J. (2019). The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate. The Lancet, 394(10211), 1836-1878. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32596-6/fulltext

Zimmermann, N., Turcu, C., & Crane, M. (2019, July). Transforming thinking to address climate change in cities: The missing organisational perspective. EGOS-European Group for Organizational Studies. https://discovery.ucl.ac.uk/id/eprint/10091865/1/2019%20EGOS%20paper%20c... 

Belesova, K., Hale, J., Aplin, J., Baghaei Lakeh, A., Davies, M., Dianati, K., ... & Taylor, J. (2018, October). Complex Urban Systems for Sustainability and Health: A structured approach to support the development and implementation of city policies for population and planetary health. WHO. https://discovery.ucl.ac.uk/id/eprint/10063088/

Watts, N., Amann, M., Arnell, N., Ayeb-Karlsson, S., Belesova, K., Berry, H., ... & Costello, A. (2018). The 2018 report of the Lancet Countdown on health and climate change: shaping the health of nations for centuries to come. The Lancet, 392(10163), 2479-2514. https://doi.org/10.1016/S0140-6736(18)32594-7

Watts, N., Amann, M., Ayeb-Karlsson, S., Belesova, K., Bouley, T., Boykoff, M., ... & Costello, A. (2018). The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health. The Lancet, 391(10120), 581-630. https://doi.org/10.1016/S0140-6736(17)32464-9

Zimmermann, N., Symonds, P., Davies, M., Wilkinson, P., Dianati, K., Taylor, J., & Milner, J. (2018). Urban systems complexity in sustainability and health: an interdisciplinary modelling study. The Lancet Planetary Health, 2, S21. https://doi.org/10.1016/S2542-5196(18)30106-2  

1. Returning to net zero as a major public health priority:​ Learning the lessons of the pandemic
2. Recent emerging trends in the health impacts of climate change and learnings from COVID-19
3. Cities Rapid Assessment Framework for Transformation (CRAFT) tool
4. Healthy dwellings in Sub-Saharan Africa: from residential waste management to children’s health
5. Towards healthy urbanism: inclusive, equitable and sustainable (THRIVES)
6. Unequal exposures to environmental hazards contribute to health inequalities in the UK
7. Home energy efficiency measures can provide health benefits and protection against overheating
8. Dwelling and household characteristics can influence summer indoor temperatures
9. Urban planning can play a central role in optimizing urban environments to improve health
10. A new model has been developed to investigate the impacts of environmental policies on health
11. Indoor air quality in slum areas is a huge problem – but what is the solution?
12. Housing can influence exposure to carbon monoxide (CO) from outdoor and indoor sources
13. A link between apparent temperature and emergency visits for mental and behavioural disorders?
14. Energy efficiency measures for housing may affect indoor air quality and lead to radon exposure
15. What can we do to reduce high indoor temperatures in converted lofts now and in the future?
16. Energy poverty is no longer just about keeping warm at reasonable cost: it's about keeping cool too
17. Transforming cities to promote the health of their citizen and the planet

Belesova, K., Callaghan, M., Minx, J. C., Creutzig, F., Turcu, C., Hutchinson, E., ... & Wilkinson, P. (2021). Climate action for health and wellbeing in cities: a protocol for the systematic development of a database of peer-reviewed studies using machine learning methods. Wellcome open research, 6. LSHTM Data Compass: Search strategies for: "Climate action for health and wellbeing in cities: a protocol for the systematic development of a database of peer-reviewed studies using machine learning methods". https://doi.org/10.17037/DATA.00002094

Goodess, C., Berk, S., Ratna, S. B., Brousse, O., Davies, M., Heaviside, C., ... & Pineo, H. (2021). Climate change projections for sustainable and healthy cities. Buildings and Cities, 2(1). http://doi.org/10.5334/bc.111

Moore, G., Michie, S., Anderson, J., Belesova, K., Crane, M., Deloly, C., ... & Osrin, D. (2021). Developing a programme theory for a transdisciplinary research collaboration: Complex Urban Systems for Sustainability and Health. Wellcome Open Research, 6, 35. Open Science Framework: CUSSH Programme theory. https://doi.org/10.17605/OSF.IO/6EB9S

Symonds, P., Milner, J., Mohajeri, N., Aplin, J., Hale, J., Lloyd, S. J., ... & Davies, M. (2020). A tool for assessing the climate change mitigation and health impacts of environmental policies: the Cities Rapid Assessment Framework for Transformation (CRAFT). Wellcome Open Research, 5(269), 269. Extended data: Figshare: A tool for assessing the climate change mitigation and health impacts of environmental policies. https://doi.org/10.6084/m9.figshare.13011533.v3
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