UCL Health of the Public


The Elephant in the Planning Room - Transcript

Xand Van Tulleken  0:05 

Hello and welcome to season 2 of public health disrupted with me Xand Van Tulleken… …

Rochelle Burgess  0:11 

and me Rochelle Burgess.

 Xand is a doctor, writer & TV presenter, and I’m a community health psychologist and Associate Professor at the UCL Institute for Global Health

Xand Van Tulleken  0:22 

This podcast is about public health, but more importantly, it’s about the systems that need disrupting to make public health better. Join us each month as we challenge the status quo of the public health field, asking what needs to change, why and how to get there.


Rochelle Burgess  0:38 

In today’s episode, we’re exploring what sort of impact our environment might have on our health: what does architecture have to do with our wellbeing? Can we draw any links between the way our cities are designed and the health of those who inhabit them? Could clever interior design help us engineer a positive mindset? We can all appreciate a beautiful environment for its aesthetic value, but we have two guests today who have it on good authority that when it comes to architecture and interior design, beauty is in fact more than just skin deep!

 So - let’s get straight to it, and introduce today’s guests…


Xand Van Tulleken  0:38 

First up is Michelle Ogundehin. Michelle is a writer, author, and TV presenter. She’s a Trustee of the Design Museum, a Visiting Professor to the Manchester School of Architecture and the award-winning former Editor-In-Chief of Elle Decoration. Michelle is internationally renowned for her authority on interiors, trends, colour and style. She is also the lead Head judge on the BBC landmark series Interior Design Masters. In Michelle’s first book, titled ‘Happy Inside: How to Harness the Power of Home for Health and Happiness,’ (an Amazon bestseller by the way!) she presents the link between home and wellbeing, drawing on her 20 years of experience editing interiors magazines, her early training as an architect, and her personal study of colour psychology, meditation and mindfulness.


Rochelle Burgess  1:59 

Also joining us today is Professor Matthew Carmona. Architect, planner and Professor of Planning and Urban Design at The Bartlett School of Planning, Matthew’s research has focused on urban design, the governance of design quality and the design and management of public space. He regularly works as an advisor to governments in the UK as well as in other countries. He Chairs the Place Alliance which uses evidence to advocate for the importance of a high-quality built environment.

 Michelle and Professor Matthew – welcome to the Public Health Disrupted podcast…



Xand Van Tulleken  2:34 

Michelle and Matthew, welcome to the public health disrupted podcast. Thank you so much for having us. Thank you very much for both coming on. Matthew, can we come to you, first of all, for a sort of tour of today's discussion, put it into context for us? What do we mean when we're talking about architecture and in particular, urban design and planning


Matthew Carmona  2:57 

To put it very simply just just a sentence, I suppose we can think in terms of scales, from the design of individual buildings, that's the architecture to the way, buildings come together to create places. That's the urban design to the way those places then come together to create towns or cities. And that's that's urban planning, essentially,


Xand Van Tulleken  3:16 

This stuff seems intuitively and I think in everyone's experience, that it would affect our health and well being. And yet, in my training in public health and in medicine, we never really once talked about architecture, or urban design, or those kinds of things. Can you give us a bit of a run through how architecture and urban design impact our health and wellbeing


Matthew Carmona  3:38 

Sounds very familiar, because in my training as an architect, we never once talked about health. So there's clearly a gap here. There's a really a very clear and direct link between the design of the built environment and our health and well being and it goes back a long way. And you know, we, I suppose initially, the the concern, the linkage happened when people were worried about issues like fire spread, we can think about, you know, the rebuilding of the City of London after the great fire and the government at that time, introduced the rebuilding of London act to ensure that buildings were sufficiently spaced apart and that buildings were built of materials that weren't likely to burn. So safety was the first issue. But then, much later on, we became worried about other issues, other sort of well being and health related issues and a formal planning system was was created that really relates to the industrialization of our cities. And in particular, in the sort of 18th and 19th centuries, we went through a period of unplanned urban expansion and the creation of slum living conditions that were overcrowded and unsanitary and polluted and just simply dangerous diseases like cholera and later influenza became sort of major urban problems. So much so that when we got to the Great War 1914 They are authorities at that time was shocked by the very poor quality of recruits to the British Army. And whilst not all of the, you know, all of those problems can be laid at the door of living conditions a large part was and after the First World War, there was this huge drive to build homes fit for heroes. And at that time, I said, a planning system and a concern for the quality of our built environment and its relationship with health was born. And initially, they look to the sort of great visionaries like Ebenezer Howard who had the idea for creating garden cities that were healthier places with more space and more air for people to breathe, places like Hampstead garden suburb, were created. And, and that sort of initially drove many of our policy decisions. But then, as the night as the sort of 20th century wore on, and sort of advances in medical technology ensured that we were living sort of healthier lives, we sort of forgot about the link between health and our built environment, and we became a bit blase about it. And in particular, the sort of the elephant in the planning room crept up on us. And that was the private car, the private motorcar, he started to build cities around the car, and we forgot that people actually need to walk to do exercise, places to breathe, and children play out in streets and so forth, the ability to cycle.


Rochelle Burgess  7:50 

Yeah. And I just want to stick over to Michelle for a second, because I think Michelle, what strikes me about your work is very much this idea of mental health and health, enabling environments, but bringing it sort of much more local and closer to the minutiae of our everyday lives. And I wondered if you could talk a little bit about the importance of things like aesthetics and design and the simple act of hanging something on a wall and what that has to do for our well being?


Michelle Ogundehin  8:49 

No, absolutely. I mean, as someone who trained as an architect, I always love this concept of from the city to the detail. And I think it also reflects quite beautifully the nature of our discussion, from the kind of the public responsibility of the built environment, to what I write about. It's the personal responsibility we have for our health. And so in my book, I'm really encouraging a new way of thinking about the home to recognise and really realise its power, if you like. And I think pre COVID Typically, home was thought of somewhere that you raced out of in the morning and then crashed back into at night. So if we are permitted to take one small silver lining from the whole horror of the pandemic, it is that during lockdown, so many people intuitively turned to addressing their home spaces.

If just as it's absolutely innate in us to wish to decorate the space in which we live, and to have it reflect how we are, I mean, we've been doing that since man first walked on the world. So my kind of fundamental belief or what drives my desire to write the book is that what surrounds you affects how you feel, and how you behave. And in order for us to be our best selves, which I define as being able to deal with the modern world.

And so therefore, it is, I feel imperative that we learn to create homes that really, truly support and sustain us. And what's interesting is that this is something that I know intuitively through the sort of the journey of my life. I've also I know it experientially, but now a lot of these kind of thoughts and feelings, and we can even reference the sort of Feng Shui or kind of Buddhist ideals of creating kind of altars within the home. But now all of this is supported by science. I mean, I just slightly rail against our kind of contemporary need to have to have hard empirical data before we believe anything, why we don't kind of believe in our kind of intuitive self as well as we believe in the sort of the pragmatic, empirical nature of data. But we now have science that supports the fact that colour affects mood, that we need to feel safe to be able to relax that, you know, daylight boosts serotonin, that good sleep underpins, like everything. And even that mess creates stress, or that furniture layouts can kind of and the way they're implemented can engender a sense of flow. And most relevantly, I think for now, also that our over reliance on tech can in fact, be quite injurious.

What are the sort of practical tips for the average person wanting to promote a healthy environment internally and in our homes?


Michelle Ogundehin  14:44 

I think one of the most staggering bits of research that I ever came across was a statement that said the average home is more polluted inside than a busy street corner outside because we are what we breathe and combined with the fact that on average, now most people spend 90% of their time indoors. I think addressing air quality, it has to be the kind of the critical issue for anyone at home, whether they're moving into a new home or whether they're renovating a home or whether they're just sitting in a home that they have no intention to do anything with. Because many of our homes are not supporting us at all, they're actually sabotaging us. And I'm not talking here about obvious visible pollutants like smoking or mould or potential allergens like kind of pet dander. I'm talking about paints off gassing. We know that they quite a lot of paints are quite smelly when you apply them. But I don't think it's common knowledge that those paints are giving off toxic, volatile organic compounds all the time. It's fumes from things like paraffin wax candles, they're so common because they're so cheap. And yet, paraffin wax is a byproduct of the petroleum industry. And many of the perfumes within those candles are also a kind of cocktail of toxic chemicals. So you might as well just stick your head in the garbage. fire retardants is something we're kind of looking at. Now, you know, it had to be it was a law that all of our furniture is drenched in this stuff. And yet, there are ways of making furniture that are naturally fire resistant, but you still got that off gassing from your furniture. And then that's even before we get into things like resin in fabricated woods like MDF, or toxins within cleaning products, or ironically many air fresheners or microfibers are nylon carpets. So I think there's a lot we can everyone can do with things that you must take out of your home, or if you're starting on a new home to not even consider bringing in in the first place. So that's what we need to take out. But then there's also things that we must add in. I mean, I love the fact that we know that stroking a pet calms your nervous system and boosts oxytocin, I love hormone. So we can surround ourselves with materials that prompt the same responses. So a very textural environment. And I think that's both to touch, but also to visually behold. So when we're looking at our walls, we're not looking at the equivalent of a kind of blank white room that we have got sort of textual variety and integrity to look at. And then also the, I think the one thing that now many, many people do understand is the importance of the nature. And that can be real or imagined. So it can be if you're lucky enough to have a garden or a balcony, then you've got a direct connection with nature. But it's also even just putting up a leafy print wallpaper will engender some of the same effect. It's the fact that the colour green calms our nervous system and lowers our blood pressure plants to clean the air or even materials that are naturally antibacterial, like cork or cedar is naturally antifungal, even copper too.


Rochelle Burgess  18:30 

I mean, there's so much there, Michelle, and a lot of what you've said just sort of moves us into thinking about how very easily the external becomes an internal matter. I'd love to hear your thoughts about how can we think again, about designing the healthiest external environments? You know, are there any classic faux pas that we've been doing that we should be avoided if we want to sort of build healthy and enabling societies or help enabling societies?


Matthew Carmona  19:00 

Absolutely there are I suppose the good news is that when it comes to the external built environment, it's not rocket science. What we need to do that there's some pretty straightforward things that we need to think about. One is we need to have a good availability of green open space and places for people to exercise and play within easy, walkable distance of every home we need to have everyday amenities and services like GP surgery, local shops or primary school within walkable distance that people turn. We need to have streets that allow people to walk and cycle safely and that people feel good in with street trees. For example, a little bit of greenery for people to look out on. We need to be living away as far as we can from as far as it's possible, I should say from roads with a lot of pollution and noise. Noise pollution is a major problem for children for example, we need to have enough space within our homes for families to thrive in space, both for social activities. but also for privacy needs and home working, for example, we're all doing a lot more of that these days. And we need enough space in our homes to allow that. And we also need access as far as possible to some private open space. Now that might be a garden or, or it may just be a balcony. So the classic faux PA is not to provide any of these things, which too often, I think happened. We did some research back in the first pandemic lockdown in 2020. We surveyed people from right across the UK 2500 households, to ask them about their experience of lockdown. And the good news was that overwhelmingly, the vast majority of people felt that they were well housed, and they were comfortable in their homes and comfortable with their neighbourhoods. But the bad news was that a minority felt very uncomfortable, and that represented many sort of millions of people across the country. And disappointingly, when we correlated those responses with the sorts of houses that they were living in, and the sorts of neighbourhoods, what we found is that those who were living in social housing, so social renters often came off worse, they were least happy, but also those who are living in New Homes, so that actually the newer the homes that the less contented people were with those homes in their neighbourhoods during lockdown. And amongst these groups, a lack of space in the home and access to private open space seem to be a particular problem. But also importantly, get access to those basic local facilities and amenities, the local part of the local shop and an inability to walk or cycle to many of these local facilities, which was what we had to do during lockdown, because we weren't allowed in our cars. And we weren't allowed to, you know, go out and about. So during the pandemic, there's been a lot of talk about the need for us to be building 15 minute cities, that means no further than 15 minutes walking to key facilities like a park or a shop. But actually our research shows that we should be building a five and certainly no more than a 10 minute city. And in fact, people's sense of well being dramatically declined after five minutes. So if you can't put a walk within you to a shop within five minutes or a local park, then actually we found that people were were less happy. So the challenges of poorly designed home environments, of course, were multiplied during the lockdown. But I think they are everyday concerns that affect us all. And fundamentally, the design of our built environment affects our mental and physical health and well being.


Xand Van Tulleken  22:45 

I think you both really painted an amazing picture of ideas that are very accessible to everybody, but made a very, very good case for these kinds of incredibly important, serious issues affecting our health that go, you know, everyday well being I think is often underestimated in terms of its importance, but you're also talking about exercise pollutants, toxins, I mean, things that actually no one could deny the importance of so I find myself as I go through London and I spend a bit of the weekend Manchester, as I'm cycling along thinking, well, something must be done about this, this should be fixed, this should be different. This is terrible. I can't get here, I can't get there, the pollution, overcrowding, all sorts of issues. And yet, if we're thinking about disruption on this podcast, where do we point the finger? Whose responsibility is it to create better homes and better, better environments for us? Matthew, can I start with you? Should we be thinking about planners, house builders, the government, you know, who do I phone? Who do I email? Where do I Where do I hold the sign up to make things better?


Matthew Carmona  23:55 

Good question. Well, I said, you know, the solutions, in a sense aren't rocket science, we understand well, what we need to do in terms of our built environment. But getting there is really difficult, because we're dealing with what, you know, academic classes that are wicked problems, namely, that they're complex. They involve many, many different actors in organisations and individuals, all who play a small part in how we shape the environment, but nobody has overall control over the whole thing. And so if we think, for example, about the epidemic of obesity that we see in the in the Western world, then the solution is often seen as perhaps a medical one to address the consequences of obesity rather than the solution being well actually, can we reshape our built environment to allow people to choose to lead a more healthy life and avoid perhaps becoming obese in the first place? Because that is a fundamentally more difficult problem to address back in a couple of years ago to COVID-19 the place Alliance which which I chair conducted a national audit of large scale housing developments across England, we looked we assessed 142 of these things. And we found that in recent years, the emphasis at all levels has been far too much on the quantity of new homes, how many were building and far too little, from national government, to local government, and to developers, far too little emphasis on the quality of those homes and the quality of the environment. In fact, we found that three quarters of the homes being built fell into our poor and mediocre design categories. And tracking why this was, it was very clear that local authorities, in other words, our councils, those that took design matters seriously, and required house builders to deliver better design. On the whole were able to ensure that house builders did it. And those which didn't generally had a much poor quality of environment being produced in those localities. So I suppose the answer to your question is the responsibility is shared. And it's complex. Too often, collectively, we don't take it nearly seriously enough. And collectively, we need to take it more seriously, I suppose, from government down to local government, to communities and also to house builders.


Rochelle Burgess  26:28 

I mean, it seems to me that the community aspect and the local aspect is more important, we sort of need to be able to demand from builders, better space, you know, in the sense that what we expect, and what we would want from these new builds must reflect something different. I think that's why Michelle's work is also so important in sort of creating that sort of grassroots bottom up demand for space that looks a bit different. I mean, Michelle, what, what are your thoughts about how we can make these ideas about, you know, the home environment more accessible and owned by many others who think of it as our responsibility to sort of demand these things from government and those other spaces?


Michelle Ogundehin  27:15 

Oh, gosh, I've got so many thoughts running through my head at the moment, I think it's again, it's that city to the detail concept. The promotion of well being quite frankly, just needs to be understood as something that's absolutely critical for developers not a kind of nice to have. And I think some of that attitude, the nice to have attitude comes because well being is seen as a bit of a Gwyneth Paltrow word or it's a bit flaky, isn't it? Or is it was or kind of maths or something. And it's almost like we need to rebrand it like the we all have a right to have a basic level of well being. And again, I define it as just the ability to deal with contemporary life, which is getting faster and harder and more chaotic. I mean, could we have anything more thrown at us at this present moment. And yet, if we build this in to what our expectations of good housing should be, the positive repercussions are just so many from personal health and happiness to a reduction of the burden on the NHS, because quite simply encouraging people to be well through their environment is always going to be a better solution than medicating them. I mean, there's a wonderful Stanford study that proves that your environment is more critical to the health of your immune system than genetics. I mean, I literally think you can't state it any kind of louder or more shouty than that. But at the same time, I think we also need to be very careful. One of the things you said Matthew, was that we need space to thrive. And I think we don't necessarily need internal space, we need adaptable space. I think there's this sort of natural impulse to think, Oh, well, if I had another room, or if I had a garden, or if I had this, then I would be happier. I mean, I think we know already that having kind of connection to exterior space. Absolutely. That's quantifiable. But if you do not have that access, the answer to all problems or mental health problems, physical problems that may not be in a larger home, there is a need for a degree of private space to be able to take yourself away from the maelstrom of your household, however, that is composed. But a lot of people, they simply have too much furniture. I mean, sometimes I think, you know, we're asking very big questions that have very, very simple answers. And that ties into what we were talking about earlier, Rochelle, that this development of the courage of your own convictions, I mean, how many people still think okay, I've got a lounge Therefore, I must have in it a sofa and two arm chairs because that's what you do. Not if you don't need that, you know, you'd be better off with one On a very large three seater sofa that you can all bundle on as a family to watch something together on the TV and leave space for you to roll out a yoga mat if we want to kind of use that cliche, or it's about kind of considered consumerism where you are buying what you need, not what we think we need.

So I think it is about improving, not moving a lot of the time. And some of the things that we can do to improve are so simple, and so kind of immediately actionable. And that's really where my passion lies, to kind of really get people on board with us. Because we know that when you are happy inside your home, you are on the fast track to becoming happy inside yourself. And when we are happy inside ourselves, we create better communities, we create better societies, and on and on and on it goes


Rochelle Burgess  31:52 

Gosh, I mean, this has been so, so great. And so wonderful to hear from you both, were just coming towards wrapping up. And I just love to hear and I'm taking notes to help myself. What sort of changes both of you have made to your own environments that have helped to promote health or happiness, or both.


Matthew Carmona  32:13 

So the change that I made recently was not so much to do with my environment was but was to do with the way I use it. And that was to get a dog, like many people in the pandemic, and that forced me out of the house to use our local park and to walk in the streets and so forth. And a year later, I've lost a stone and a half in weight. And just that simple action of getting a dog and walking mores has been really good for my health and enjoying the environment, the built environment, which which I'm lucky enough to live in, and we don't all have to get a dog. But I think there are simple things that we can do just to enjoy the environment that we live in, if we're lucky enough to live in, in a pleasant place.


Rochelle Burgess  32:53 

Yeah, fantastic. And Michelle.


Michelle Ogundehin  32:57 

Yeah, I always find this question so hard, because clearly I've devoted my entire life to creating an environment that completely supports and sustains me on on every level, literally, from the weight of my cutlery to the feel of my sheets. So when the whole pandemic started, I was a bit kind of like, oh, you know, that's not fair. I don't have anything to do. I mean, I'm saying this.


Xand Van Tulleken  33:21 

Absolutely love that.


Michelle Ogundehin  33:23 

But perhaps ironically, the one thing that I did have to do within kind of a matter of months is put a door on my study. So because previously, I worked from home quite a lot, but I was home alone. So I didn't I didn't need a door, I wanted that sense of connection. But within hours of I think homeschooling you soon realise that it is absolutely impossible to do any work or achieve any level of concentration with cbbs or other channel kind of playing in the background. So I had to source a door, but it's has glass panels in it. So I still have the visual connection to the rest of the house and I don't feel locked in. That was the kind of major thing and I think it it does tie into the bigger picture of what we're talking about. Because within my home the whole of the ground floor is essentially kind of open plan. It runs through different zones. But I'd always built in a study as a private space. There has been a wholesale kind of push towards open plan living it was seen as the panacea to all ills we will be superbly connected to our family at all times. And we very quickly realised that that's a pipe dream that's perfect for when you're just sharing your home for a few hours a day. But when a real life family that is not kind of waking merrily together and then baking cookies together in the kitchen, you need rooms. So I see a move towards kind of we will separate our living spaces from our kitchens, we will bring back the dining room and everyone hankers today after for their own private home office.


Matthew Carmona  35:02 

He's interesting, Michelle, that came through strongly strongly in the research that I referred to earlier we did during the pandemic and people just saying that they wanted to have their houses more compartmentalised than it had been. But how long that that that change will last? I don't know, we'll have to see.


Xand Van Tulleken  35:16 

I love the I love the sort of practicality of those answers. We're interested in disrupting, thinking everywhere, not just in public health. So we wanted to know, we ask every guest this what piece of art, music, poetry, anything you like, has disrupted your perspective,


Matthew Carmona  35:35 

from my perspective. As an architect, I would choose a piece of architecture as my piece of art, on the piece of architecture that most disrupted my thinking was the Pompidou Centre in Paris, and that the Pompidou Centre designed by Richard Rogers, who tragically recently died, and he designed it with Renzo Renzo Piano, but I remember seeing it on family holiday when I was young. And it inspired me to take up architecture. And it's often described as an inside out building because IT services are on the outside. But for me, it just simply reminds me that we shouldn't be scared to think differently and creatively about about about urban problems. And I tried to bring that perspective to my research, I don't always succeed, but that's what I tried to do.


Xand Van Tulleken  36:19 

Oh, that's brilliant. I have not seen that building for many years. And we will go and seek it out.


Rochelle Burgess  36:24 

That's great. Michelle,


Michelle Ogundehin  36:26 

I love this question, because it's, it really gave me pause for thought to think, Gosh, what if I had to pick one thing, and then in that wonderful way that our brains often work, something popped into my memory, that when I was about 11, or 12, my English teacher introduced the class to the poems the war poems of Wilfred Owen. And I have always been someone that I do not like poetry, okay, I'm just going to put that out there doesn't do anything for me. Generally, I prefer music or films, poetry generally leaves me cold. But the poem does say at decorum s by Wilfred Owen just resonated for me so profoundly. I mean, it's, it's a poem that he wrote from the frontlines of World War One, obviously, it feels very topical. Now he's using phrases like that they are drunk with fatigue, or an ecstasy of fumbling when they're trying to put their gas gas masks on. And there's a chlorine gas explosion. And it's telling in this incredibly visceral language, how he's watching one of his comrades fumble to put his mask on, and not being able to achieve it in time. And so the last line of it is, you know, my friend, you would not tell with such high zest to children ardent for some desperate glory, doll, say it decorum est pro patria mori which roughly translates as how sweet and honourable it is to die for one's country. And it just told me the power of language, and that we must choose our words so carefully. And I think particularly at this moment, there's so much easy rhetoric isn't there about kind of people being heroes or glorying stuff or how patriotic and yet, you know, life is visceral, and difficult and chaotic and hard. And we should never turn away from that. And in that one poem, The only poem that I have ever remembered in my entire life, I just thought was the most outstanding thing ever. So thank you for actually reminding me how much I love it.


Xand Van Tulliken  38:49 

Oh, that's a phenomenal final answer, isn't it?


Rochelle Burgess  38:53 

It's, you know, I haven't thought about that poem in a long time either. And as soon as you said it, gosh, to everyone listening, if you haven't read it, I think it is worth going to look it up. Well, what a lovely and important message to sort of wrap us up with today. Thank you both. So so much. That was so much fun. Thank you for being such wonderful guests.


Xand Van Tulliken  39:19 

Really. Thank you both so much. Thank you.


Rochelle Burgess  39:24 

You've been listening to public health disrupted. This episode was presented by me Rochelle Burgess and Zan van telecomm produced by UCLA health the public and edited by Annabel Buckland at decibel created. Our thanks again to today's guests, Michelle Logan to him and Professor Matthew Carmona


Xand Van Tulleken  39:42 

If you'd like to hear more of these fascinating discussions from UCL health and for public, make sure you're subscribed to this podcast so you don't miss any future episodes. click and subscribe. Come and discover more online and keep up with the school's latest news events and research just Google or whatever your search engine choice is  - UCL health of the public. This podcast is brought to you by UCL minds bringing together UCL knowledge, insights and expertise through events, digital content, and activities that are open to everybody.


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