Brain-Healthy Cities: How Urban Planning Can Foster Healthy Brains and Minds

Introduction

The average human life span has increased dramatically over the past few decades due, in large part, to our modern public health and medical systems. However, as the population ages, the focus on extending life span must be complemented by efforts to improve health span — the period of life spent in good health.

The rising prevalence of poor brain health is a major roadblock to enhancing the human health span. For example, a growing number of people suffer from neurological diseases such as Alzheimer’s disease and other forms of dementia. In fact, more than 6 million Americans are currently living with Alzheimer’s — and this number is projected to reach nearly 13 million by 2050.[1] Alarm bells are also sounding as rates of mental illness and substance abuse escalate. Brain health conditions — including mental illnesses — are the leading cause of disability worldwide and can significantly diminish one’s health span.[2]

This issue brief advocates for the development of urban environments designed to promote brain health, mental well-being and healthy longevity. By implementing supportive policies, improving infrastructure, fostering community initiatives, and utilizing innovative financing, we can design environments that optimize brain health and address the complex challenges of cognitive decline and neurodegenerative diseases. This, in turn, will extend and improve our brain health spans.

Improving Brain Health Span

Despite significant advancements in health care and rising life expectancies, most people spend a substantial portion of their extended lives in poor health.[3] This highlights the gap between life span — the total number of years we live — and health span — the number of years we live in good health.

Closing this gap requires a paradigm shift. Traditionally, health care systems have focused on treating diseases rather than preventing them. As a result, efforts to address brain health and mental well-being are often fragmented, with limited emphasis on holistic approaches. Instead, we must support comprehensive, preventive approaches to safeguard our health. By embracing the concept of brain health span we can work to improve the quality of brain function throughout our lives, ensuring enhanced cognitive performance, resilience, and overall mental well-being.

In response to the increasing impact of brain health disorders worldwide, a number of countries are developing local and nationwide frameworks to elevate brain health. For example, the Swiss Brain Health Plan was launched to value, promote, and protect brain health over the life course and provides a country-level framework that encourages collaborative efforts to raise awareness for brain health.[4] 

In line with these efforts, we believe that by embracing a brain health span approach and applying it to the principles of urban design, we can create brain-healthy cities that support cognitive resilience, mental well-being, and healthy aging.

Advancing Brain-Healthy Cities

A global demographic shift is underway as the aging population grows. Cities will be at the forefront of this shift with massive internal migration leading to nearly 70% of the global population moving to cities by 2050.[5] In the United States, 8 in 10 older adults already live in metropolitan areas.

Because of this demographic transformation, it will be crucial to develop brain-healthy cities that place citizens’ brain health and mental well-being at the heart of their design. Brain health is a central component of overall well-being and even impacts economic growth and urban viability. A population with healthy brains demonstrates resilience, productivity, and adaptability. A brain-healthy city takes a comprehensive approach to preventing brain health disorders not only to alleviate the strain on health care systems, but also to contribute to its economic vitality. Furthermore, brain-healthy cities prioritize brain health across workplaces in order to foster innovation, problem-solving, and positive work environments.

Incorporating brain health into urban planning and public health policy is critical for the development of modern cities and healthy citizens. Urban planning refers to the process of developing and designing urban areas to meet the needs of a community. It focuses on optimizing land usage, designing buildings, roads, and communal spaces, and building supportive infrastructure. By incorporating the concept of brain health into urban design, we can create cities that promote cognitive health across the life span.

For example, by prioritizing initiatives that foster intergenerational connections, support physical activity, ensure access to nutritious food, reduce air pollution, and leverage innovative technologies we can enhance the brain health of all city inhabitants. Figure 1 outlines why these elements are key to brain health and how urban planning can achieve them.

Figure 1 — Urban Planning Strategies to Support Brain Health

Foster Intergenerational Connections Value for Brain Health: Fostering intergenerational connections optimizes cognitive stimulation, empathy, learning, and adaptability, reduces aging, and can increase physical activity. Urban Planning Approaches: Design inclusive public spaces such as parks, gardens, community centers, and recreational areas. Institute mixed-use development via zoning regulations. Create walkable neighborhoods and provide opportunities for intergenerational housing. Promote Physical Activity Value for Brain Health: Boosts blood flow, reduces stress, stimulates neuroplasticity, and supports cognitive function. Urban Planning Approaches: Provide green and blue spaces such as parks, gardens, trails, rivers, and lakes. Ensure Access to Nutritious Food Value for Brain Health: High-quality foods aligned with the Mediterranean diet are key for weight management and brain development via the provision of protein, vitamins, minerals, and antioxidants. Urban Planning Approaches: Enhance food access by implementing policies, zoning regulations, and programs that influence food production, distribution, and consumption. Reduce Air Pollution Value for Brain Health: Air pollution adversely affects the brain, contributing to cognitive decline, stroke risk, and neurodegenerative diseases like Alzheimer’s and Parkinson’s. Air pollution can also cause inflammation and white matter damage. Urban Planning Approaches: Promote active and public transport modes, such as walking, cycling, and taking buses, trains, and trams. Regulate the cost of car emissions in certain high-density areas.

 

Designing Dementia-Friendly Communities

A key consideration when designing brain-healthy cities is to ensure that individuals suffering from dementia have access to an inclusive, caring community. Cognitive decline and neurodegenerative diseases like Alzheimer’s pose a significant threat to both quality of life and productivity, especially in underserved communities. The World Health Organization even recognizes dementia as a top public health priority due to its substantial economic and societal impact.[6]  

Dementia-friendly communities can be designed to ensure that individuals with dementia and their caregivers are valued and have opportunities to actively participate in the community. Initiatives such as disease education and targeted social interactions at supermarkets contribute to the development of dementia-friendly communities. Adaptations to the physical environment are another important element. These include clear signage and visual cues, calming color schemes, safety features, secure outdoor spaces, and sensory stimulation.[7]

Creating these communities will require commitments from municipalities, businesses, and health care and social organizations. The result will be more inclusive environments that can reduce expensive medical and long-term care costs and better support unpaid caregivers, who are most often women. 

Despite the urgent and global nature of this issue, only a quarter of countries worldwide have a national policy or plan to support those affected by dementia.[8] And while dementia risk factors are partially modifiable, their prevalence and impact on young adults (i.e., 18–39-year-olds) remain poorly understood. Researching early risk factors and creating policies to support individuals with dementia will help to shift the focus from disease treatment to prevention, improving brain health span and helping individuals maintain optimal cognitive function throughout life.

Policy Recommendations: Building the Foundations of Brain-Healthy Cities

Significant progress is already underway to advance “healthy city” models. In its 2016 “Urban Design, Transport, and Health” series, The Lancet highlighted the role of integrated upstream city planning policies in creating healthy and sustainable cities.[9] These city planning policies can shape the local built environment, influencing individuals’ choices and exposures and reducing their health risks. Based on the findings from this series, we offer five recommendations to build brain-healthy cities:

1. Concentrate on urban planning and policies to foster brain-healthy lifestyles for all ages. Brain-healthy cities represent a new approach to urban planning that prioritizes healthy aging. By reshaping the urban environment to encourage physical activity, healthier dietary choices, and wellness practices, residents can effectively maintain their health and boost their brain health span.

For example, neighborhood layout and design can impact residents’ behaviors and interactions. By designing walkable neighborhoods with plenty of green spaces, we can improve individual’s mental health by providing settings for social interaction and exercise.

Innovative approaches to architecture can also influence human cognition and perception. Designing buildings with natural light, good ventilation, and views of nature can actively support the health and well-being of the community.  Additionally, ensuring access to healthy food is crucial for citizens’ brain health.

Enhancing food security and food quality can be achieved by implementing city-level policies. Local food access programs can establish community gardens, farmers markets, and food co-ops, and subsidize the purchase of healthy foods. Zoning and land-use policies can also optimize urban agriculture, and retailers can take the lead on promoting healthy food options. Lastly, cities can implement nutrition education programs to support citizens via workshops, cooking classes, and nutrition counseling.

2. Increase financing for brain capital to build a new asset class focused on innovation and investment in brain health. By investing in brain capital — the brain health and skills of a population — we can prolong our brain health spans. Investments in brain capital recognize that brain health is crucial for individual health and well-being and a vital component of long-term economic and social resilience. Financing the development of innovative technologies and initiatives that foster skills such as systems thinking, creativity, and cognitive flexibility will maximize a city’s brain capital. This, in turn, will create a foundation for a thriving brain capital economy at community, national, and global levels.

3. Prioritize technologies and incentives to allow older adults to age at home while staying engaged in their communities. The home will become a hub for connected wellness and care. It will be crucial to support the aging population with tools such as telehealth, remote patient monitoring, and smart-home devices that allow care teams to monitor patient health. Smart devices, in particular, can play a crucial role in monitoring aging patients and helping them manage their daily lives, including doing activities that require complex thinking and are essential for independent functioning (e.g., cooking, driving, shopping, finance management, managing medications, etc.).  

These technologies also empower older adults to stay connected with family, friends, and community members through video chat, email, and social media. Aligning technologies to the needs of dementia-friendly communities is also key. These include clear signage and visual cues, calming color schemes, safety features, secure outdoor spaces, and sensory stimulation.

4. Design urban spaces that facilitate community-building and social engagement. Meaningful engagement with society is crucial for overall well-being. Studies indicate that older adults experience increased happiness and health when they engage more in the community.[10] According to a recent McKinsey Health Institute survey across 21 countries, having a sense of purpose and meaningful connections with others significantly improves the health of older adults.[11] Designing community spaces for older adults to engage with each other could help to provide these much-needed connections. Cities can also incorporate more parks, playgrounds, theaters, and sports facilities — all places where people can gather and interact. Providing good public transportation is another key way to encourage community-building by making other community areas more accessible and offering opportunities for people to interact on buses and trains.

5. Unlock novel financing models to propel sustainable development. Innovative financing models, including impact investing and venture capital, can drive sustainable urban development and support initiatives aimed at promoting brain-healthy cities.[12] Public pension funds and sovereign wealth funds also have the potential to play a significant role in financing these cities and other urban initiatives. With their long-term obligations and investment horizons aligning seamlessly with the nature of brain-healthy cities, these types of funds can provide patient capital well-suited to address the multifaceted challenges of sustainable urban development.

Conclusion

Brain-healthy cities are a promising solution to the growing challenge of cognitive decline and neurodegenerative diseases in aging populations. By integrating the concept of brain health span into urban planning, we can improve the cognitive resilience, mental well-being, and healthy aging of all residents. This, in effect, will help to close the gap between our life spans and health spans, allowing all individuals to live longer, healthier lives.

Notes

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[1] Alzheimer’s Association, “2023 Alzheimer’s Disease Facts and Figures,” Alzheimer’s & Dementia 19, no. 4 (2023), https://doi.org/10.1002/alz.13016.

[2] World Health Organization (WHO), “Disability-Adjusted Life Years (DALYs) Attributable to the Environment (%),” The Global Health Observatory, last updated March 9, 2016, https://www.who.int/data/gho/data/indicators/indicator-details/GHO/disability-adjusted-life-years-(dalys)-attributable-to-the-environment-.

[3] Erica Coe et al., “Adding Years to Life and Life to Years,” McKinsey Health Institute, March 29, 2022, https://www.mckinsey.com/mhi/our-insights/adding-years-to-life-and-life-to-years. 

[4] Claudio L. A. Bassetti et al., “The Swiss Brain Health Plan 2023–2033,” Clinical and Translational Neuroscience 7, no. 4 (2023): 38, https://doi.org/10.3390/ctn7040038.

[5] The World Bank, “Urban Development,” last updated April 3, 2023, https://www.worldbank.org/en/topic/urbandevelopment/overview. 

[6] WHO, “Global Action Plan on the Public Health Response to Dementia 2017–2025,” 2017, https://iris.who.int/bitstream/handle/10665/259615/9789241513487-eng.pdf;jsessionid=4DA480FA93471AC53988E52B35F416D8?sequence=1. 

[7] Fiona E. Walsh, Greg S. Walsh, and Harris A. Eyre, “Late-Life Brain Health Architecture: Leveraging Convergence Science Principles,” The American Journal of Geriatric Psychiatry 28, no. 11 (May 2020): 1221–3, https://doi.org/10.1016/j.jagp.2020.05.003.   

[8] “Time to Get Serious About the Global Action Plan on Dementia,” editorial, The Lancet Neurology 22, no. 8 (August 2023): 643, https://doi.org/10.1016/S1474-4422(23)00248-X. 

[9] “Urban Design, Transport, and Health,” The Lancet, September 23, 2016, https://www.thelancet.com/series/urban-design. 

[10] Hemant Ahlawat, “Healthy Aging Through Societal Participation,” McKinsey Health Institute, October 23, 2023, https://www.mckinsey.com/mhi/our-insights/aging-with-purpose-why-meaningful-engagement-with-society-matters?utm_medium=DSMN8&utm_source=LinkedIn&utm_user=14419233731638428. 

[11] Ahlawat et al., “Age is Just a Number: How Older Adults View Healthy Aging,” McKinsey Health Institute, May 22, 2023, https://www.mckinsey.com/mhi/our-insights/age-is-just-a-number-how-older-adults-view-healthy-aging. 

[12] United Nations Conference on Trade and Development, “Sustainability Integration by Public Pension and Sovereign Wealth Funds, 2022,” May 19, 2023, https://unctad.org/publication/sustainability-integration-public-pension-and-sovereign-wealth-funds-2022.

 

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