Covid-19 should spur us to think like cities

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9th June 2020

Michele Acuto

BMJ Opinion



Pandemic outbreaks regularly surface global lessons in urban health and planning. Michele Acuto looks at what the covid-19 pandemic can teach us
Now destined to be associated with post-apocalyptic images of eerily empty streets within major metropolises and quarantined urban dwellers, the covid-19 pandemic might fundamentally affect the way we see and live in cities the world over. Will city planning practices change after the pandemic? Will it be a clarion call for a reform in urban health institutions and governance? Will it help us think of cities in a more inclusive way? The seeds for change are there but the challenges, especially when added to our climate and inequality crises, are formidable.

Pandemic outbreaks regularly surface global lessons in urban health and planning. For instance, the SARS outbreak taught (and, to some, reminded) us how in a world centred around global cities and their many connections, epidemics can go pandemic. It showed how global health and economic geography can meet. A few years earlier, the 2009 H1N1 pandemic stressed the necessity of acknowledging what epidemics mean when superimposed on top of urban poverty. The 2014-16 Ebola outbreak in west Africa underscored the fundamental relationships between urban centres in the global north and south, as it pushed “planetary health” thinking in relation to urban development planning.

The story of how these crises shaped the built environment and our appreciation of how cities should be planned goes, of course, further back to the way civilisations developed cities in the wake of great plagues. Outbreaks of cholera in the 19th century first exposed the modern era’s urban thinking to the impacts of epidemics on urban dwellers, and underlined the importance of local governments’ role in the wake of disease in cities. Major epidemic outbreaks, in short, are often critical moments for the way we conceive of urban life. 

In the same way, covid-19 can be a turning point for cities and their governance at a local and global scale. The coronavirus crisis forces us to question much of the core tenets of contemporary urbanism. For many, it seems to have pitted the accepted trappings of 20th century life, such as urban density, crowd management, and mass transport, against the need to manage the contagion of people increasingly pressed against each other. 

Covid-19 asks us to understand infection (let alone non-communicable disease prevention) in complex multi-storey built environments, which are linked viscerally with each other through global flows of travellers, goods, and even ideas (and panic). These places are connected, but increasingly splintered along socioeconomic lines. 

Equally, these urban environments are not just made up of the “central” city featured in covid-19 reporting, like the Piazza del Duomo in Milan or Piccadilly Circus in London. They also—if not predominantly—comprise places that are sub-urban, peri-urban, informal settlements, and outer metropolitan areas, where in fact much of contemporary urbanisation is taking place. We therefore need a far more refined understanding of what the “urban” and the city are in the 21st century, and the influence they have at a planetary scale.

Covid-19 challenges the “global city” model that our multilateral system, and much of the dominant global urban health thinking, is based upon since the lessons of SARS. We now cannot simply think of cities as major internationally connected hubs that link continents and make the world economy function. The boundaries of these cities are increasingly blurred. Covid-19 puts front and centre the size and relative unmanageability of the complex urban sprawl of our settlements. Outbreaks like coronavirus might often start and spread, as Roger Keil and colleagues note, “from the edges” of our cities. It is these peripheries that the “global city” ideas of the late 20th and early 21st century largely overlook.

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