New active design practices promoting physical activity and wellbeing are becoming a key strategy for tackling chronic non-communicable diseases caused by sedentary lifestyles.

Walking the streets of Manhattan, one cannot fail to be struck by the immense stature of New York's iconic skyscrapers, nor the sheer dynamism generated by one of the most densely populated areas on earth. Surges in immigration - especially at the turn of the twentieth century - meant more and more people arrived in the city via Ellis Island - all of them requiring shelter. Whilst innovations in technology and engineering at the time - such as the elevator and air conditioning systems - meant commercial structures in particular could be built higher and higher, the darker side of the population boom was an explosion in tenement housing that packed immigrant families together in poorly-lit, inadequately ventilated and unsanitary living conditions. Like other major cities of the industrial era grappling with the phenomenon of slum-living, reformers in New York could confidently trace a direct line from prevailing urban design practices (and oversights) through to the public health crises of the day: cholera, tuberculosis and other infectious epidemics.

Fast-forward 100 years and the situation - at least in the developed world - has altered radically. People drink clean water, eat safe food and wash regularly. Architects, designers and engineers have contributed to a revitalization of urban living conditions through developments in site- and street-planning, clean water delivery systems, sewage and sanitation technology, and green spaces. In New York, the introduction of new residential building regulations requiring ventilation and lighting prevented the recurrence of tragedies like the 1896 heatwave, when hundreds of tenement dwellers died in cramped windowless spaces that could sometimes reach 49°C. Building codes and hygienic advances proved crucial in controlling and preventing the spread of acute communicable diseases in high-density urban environments.

And yet, while the fabric of our twenty-first century cities may have changed, so too have the public health challenges faced in modern urban settings. Surges in the incidence of chronic non-communicable diseases (NCDs) - such as hypertension, diabetes and heart disease - are the result of an accelerating global phenomenon: increasingly sedentary lifestyles, poor dietary choices and excessive consumption of alcoholic beverages and tobacco. According to a growing school of researchers, the rise of these "diseases of energy" (or rather the lack thereof) can be seen, in part, as a result of the incremental engineering of physical activity out of our daily lives.

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By Arun Luykx