The Miracle Pill

by Peter Walker

  The most feasible scenario, and certainly the one being most heavily pushed by governments in the UK and elsewhere, is a simple like-for-like replacement of petrol and diesel cars with electric ones. These would stop exhaust pollution, if not the spread of harmful particulates from tyre and brake wear. But that would be as far as the benefits went, not least on activity.

  Chris Boardman is adamant it is not enough of a change. ‘Electric cars are our biggest threat,’ he tells me. ‘And at the highest level of politics, people haven’t heard it. Because these cars don’t pollute, that’s a good thing. But the unintended consequence is that you don’t really get people to change anything. You won’t touch health. You won’t touch congestion, you won’t touch road danger. I run an electric car. There’s nothing wrong with an electric car. But it’s not the bloody answer. It’s part of the problem.’35

  Another possibility, albeit in the slightly longer term, is the almost complete disappearance of all private cars from cities. But what will take their place? Will it be the hoped-for healthy mix of walking, cycling, public transport plus the occasional taxi or share ride? Or, if the technical challenges are finally met, could the newcomer be fleets of app-hailed driverless cars, an endlessly available, cheaper successor to Uber where people would expend even less energy than driving, dispensing with even the marginal exertion of pushing pedals and turning a steering wheel?

  There is an alternative model to the slightly theme-park likes of Woven City. Vauban is a suburb in the south of Freiburg, a small and famously liveable city in the southwest of Germany. A former military base which for years was occupied only by squatters, Vauban was chosen in the late 1990s as the site for something of an experiment in sustainable, community-led living. Its design and ethos were set out by residents, who chose a layout of low-rise apartment blocks surrounded by green space. But the most radical idea was to dispense entirely with cars, even parking.

  Under city laws, some parking had to be provided, but this was put all in one place, on the edge of the development, and is rarely used. Instead, the great majority of people rely on walking, bikes and an adjoining tram link into the city. The lack of cars, and particularly of parked cars, offers not just space but safety for everyday movement, including for children.

  The photographs of Vauban looked so appealing that I planned a final research trip there for this book. My hope was to take my son, now nine, and see how it looked through his eyes. Then coronavirus intervened, scuppering travel of any sort. Luckily I was able to talk to Tim Gill, a British author, researcher and sometime government adviser who is an expert on mobility and play in children, and who had previously visited. ‘I was there on a cold February afternoon, but the place was full of kids of different ages, with and without their parents, more or less occupying all of the available outdoor space,’ Gill tells me. ‘Of course, the space itself was well designed and had lots of playful features. But the first crucial step to really open up neighbourhoods and make built environments better for kids to be out and active is to take out cars.

  ‘If you see the car as a consumer product, it’s astonishing how many resources, both in terms of money but also physical space, we allow this consumer product to take up. Places like Vauban show what you can do if you just reconfigure neighbourhoods. The whole of the public realm then becomes a sociable, playful, welcoming space.’36

  Movement for all

  For all that I was perhaps a bit sceptical about BIG’s Toyota Woven City concept, one theme it explores is hugely interesting. Among the reasons for the green, welcoming, car-free streets is to make the public realm more open to older people, and to those with disabilities. The former is particularly relevant given Japan has such a rapidly ageing population, with forecasts that around a third of all its population will be sixty-five or older within a decade from now.37 The new Toyota community will, Rost tells me, be designed so older people ‘feel invited to come outside’. He says: ‘It’s a continuation of the notion of accessibility. Right now it’s considered to be a minimum requirement, almost like a tack-on, or a drag for architecture. But what if we think about it as a maximum – to make it extremely enticing and pleasurable, to draw people out.’

  This is an important and often-neglected subject. Activity-thwarting design fails everyone, but it fails some more than others. Perhaps even less noticed than the divides of age and disability is the way so much of our public space discriminates against women and girls.

  If I tally all the people I talked to in researching this book, around 40 per cent are women – a figure which could be higher. But then consider this chapter: you might not have noticed, but aside from the brief, in-passing mention of Rachel Aldred, every expert heard from so far has been male. An element is coincidence. But I’d argue it highlights a wider issue. The worlds of architecture and city planning have long had deserved reputations for being very male-dominated. In some areas this is changing, but there is still a long way to go. Even in a forward-thinking practice like BIG, of the seventeen partners, just two are women.38

  Decades of male dominance have had inevitable repercussions for the built world, which has tended to be shaped, almost by default, for the needs of men. It is probably not a coincidence that in pretty much every country men and boys tend to be more active than women and girls. Both UK and global figures show that more women than men fail to meet minimum activity levels, usually by three or four percentage points. This gender gap is wider for children, particularly among adolescents.

  Eva Kail possibly knows more about this divide than anyone. A city planner in Vienna for almost thirty years, she has been a pioneer in pointing out the different ways that various groups of people navigate through a city, and their often competing needs. In 1991 she organised a pioneering and hugely popular photo exhibition about the female experience in the city’s public space. The reaction to this was so positive that the city carried out a gender-based survey of transport use. It found that two thirds of car use, an area which dominated the city planning budget at the time, was done by men. The same proportion of walking trips involved women, but with hardly any consideration given to pedestrian welfare.

  ‘That was really convincing for the politicians,’ Kail tells me from Vienna. ‘At the time, nobody spoke about pedestrian issues or about public space. Now public space is extremely hip.’ The result was years of work in areas such as widening pavements to assist walking with a pushchair, and better lighting in pedestrian areas.

  Much of this was instigated by a new Frauenbüro, or Women’s Office, created in 1992 with Kail as its head. This also instigated wider city-planning efforts, seeking submissions from female architects. One early project was the Frauen-Werk-Stadt, or Women’s Work City, a 350-unit housing complex in the north of the city. Designed to be welcoming and usable for women and families, much of this translated into assisting play and other types of activity, with safe areas for children to be outside, with clear sightlines from apartment windows. Similar projects have followed, the biggest of which is Aspern, an outer Vienna district where a family-friendly suburb of 20,000 people is being planned, and where all the streets will be named after women.

  Kail is nonetheless still refreshingly outspoken about the attempts of her employer to redress the gender design balance: ‘If you ask me, I think Vienna could do a lot more. If it comes to a conflict of interest – and in planning processes, it’s all about the conflict of interest – it comes down to how much your perspective counts,’ she says. ‘You could call the gender strategy a bit of a good weather programme – if it doesn’t hurt too much, maybe we can do it.’39

  The often unconscious, in-built sexism of city planning is one of the areas highlighted by Invisible Women,40 a fascinating and anger-inducing book by the British writer Caroline Criado-Perez, about the consequences of a world where the default design or decision is male. One example she highlights is the 2013 decision by Stockholm to change the order in which snowploughs cleared areas of the Swedish capital in winter. It
had always started with the roads, and then the pavements and cycle paths. But as with 1990s Vienna, this disadvantaged the city’s women, who are less likely to travel by car and more likely to walk or cycle. Criado-Perez notes in the book that in the UK, even during recent years of public spending costs, investment has been maintained in roads, on the apparent assumption this is the standard way to travel. And yet statistics show men drive on average twice as far a year as women.

  One of the most pressing issues in modern public health is the way so many girls are lost from sports or other physical activities during adolescence. In the UK, teenage girls are about 10 per cent more likely than boys to do no sport at all, or to be inactive.41 There are a variety of issues in play here but one of them is the design of urban recreational areas, which are almost all aimed at and used by – through inattention, if not actual design – predominantly boys.

  To take one example very close to my life, my sister, her husband and their teenage daughter live in Frome, a town in Somerset. Over the past ten years or so the local council has built three outdoor activity or recreation facilities intended for older children, at a combined cost of £130,000: a skateboard park, a BMX track and a multi-use sports pitch. These are all used, almost entirely, by boys. Now the council plans to spend even more refurbishing the skate park. My sister is pushing the council to reconsider, pointing out that, so far, no sports facilities have been built with the needs and desires of girls in mind and that no equality assessments appear to have been carried out for any of these plans.

  Thanks in large part to the efforts of Eva Kail and her colleagues, Vienna does think about how to make its parks and public sports facilities more welcoming to girls. Engagement at an early stage is the key, she says. Asked how cities can keep girls active, Kail tells me: ‘It’s very simple. You just have to talk to them, to watch them, and ask what they would like to do.’

  Among ways to improve the gender mix, Kail says, is to avoid a single, fenced-in pitch, for example for football or basketball. ‘We call them cages,’ she says. ‘This is really like the law of the jungle, because in this small cage there’s only one playing field, and so the strongest take it over.’ Kail and her planners instead developed a W-shaped area, with a series of separate, smaller spaces, so different groups can play at the same time. Some changes can be even more subtle, such as open entrances, rather than a gate which has to be opened.

  ‘From watching girls it’s clear that they are more timid, and also want to watch,’ Kail says. ‘So you need seating facilities, and then some quieter corners where they can also exist. This helps the less self-assertive groups. And if there are some open entrances then it’s easier for the weaker groups to come in. All these open-air playgrounds are much more designed for boys’ interests.’

  In terms of particular sports, Kail says, girls in Vienna have tended to enjoy volleyball or using slacklines. ‘These are things where you have separation, where you don’t have close contact with the enemy,’ she explains. ‘This is what girls really like. And for them it’s also about meetings and social life, to sit together and chat in small groups, in a half-protected position so you can have an overview of what’s going on, but you also feel a bit sheltered.’

  And skate parks, the supposedly gender-neutral choice of Frome and so many other UK towns and cities? Kail views them as a symbol of how far this consideration of gender and activity still has to go. ‘We are still a bit at the beginning of this discussion,’ she says. ‘Skate parks are very hip now, and they take up a lot of public space, but again it’s a very male interest, and a very hard sport. Girls can be so modest sometimes, and it would be great if they could be given more space and more independence.’

  Next steps:

  For most people, active travel is the biggest activity gain there is. Think about how you get around. Could you replace some shorter car trips with walking or cycling? Could you ride to and from your job or place of study? There are far too many potential tips for enjoyable cycling to list here, so maybe ask friends or colleagues who already cycle. But one idea is to try to use a quieter, back-street route. There are plenty of phone apps which will plan these and, if you attach your phone to the handlebars, can give step-by-step directions.

  6 Being Slim Isn’t Enough: Why Inactivity and Obesity are Different

  When Tom Watson first decided to become more active as part of efforts to turn around a lifestyle he feared was on course to kill him, he started with the very basics. The then-Labour MP, who spent four years as deputy leader of his party, had been overweight since his twenties. By now he was fifty and clinically obese, weighing somewhere near 22 stone, or 140 kilos. One early part of this new regime, Watson tells me, involved trying to walk a bit more, something he admits was not exactly a long-standing habit. ‘Before, a five-minute walk would have been too much,’ he says. ‘I would have felt it was a waste of time – why walk somewhere when a cab can get you there marginally quicker? I started with a target of 5,000 steps a day, which for me was quite a challenge. At first, if I walked even half that, like from parliament to my flat, I’d feel a little light-headed from the exertion.’1

  When I speak to Watson it is two and a half years on from that time, and he is around eight stone (50kg) lighter, having had to, along the way, replace more or less his entire wardrobe of clothes. We speak on the phone – even after quitting parliament he is permanently busy – and as we chat he is striding between one engagement near Covent Garden in London towards another in Whitechapel, just over two miles to the east.

  Watson says he now aims for 12,500 steps a day, ‘and I probably get way over that five out of seven days’. The previous evening, after dinner with a friend in north London, he spent more than an hour walking to his flat, just south of the Thames. ‘The city opens up to you when you walk around it,’ Watson says. ‘Now a walk is an absolute joy. What a privilege it is to be able to find an hour to be able to do it. It’s a completely different relationship with movement that I have.’

  The trigger for Watson’s decision to change his life, as he recounts in Downsizing,2 his very readable and well-researched autobiography-meets-treatise on the slimming process, came a few years earlier at a party. A guest he had never met before, a doctor, told Watson that given his weight and extent of stomach fat, along with sweaty skin and frequent trips to the toilet, he most likely had undiagnosed type 2 diabetes. This turned out to be correct, although with the subsequent weight loss and increase in activity, Watson’s diabetes is now in complete remission. Before he started to transform his lifestyle, Watson tells me, he began with ‘pretty powerful periods of self-reflection’. He says: ‘I literally thought that if I didn’t change I would die. That took time to sink in, to realise the magnitude of that. And then I just thought, “Okay, you don’t want to die, how do you get out of it?” ’

  Watson’s eventual answer to this self-posed question gets to the heart of the complex and intertwined relationship between excess weight and inactivity, which this chapter examines. As well as gradually becoming more active, he completely reshaped his diet, not just the amount he ate but the types of food. For Watson, this meant cutting out all forms of sugars and processed carbohydrates and adopting the so-called keto diet, which instead involves considerable fat intake. While proponents argue this can both help lose weight and improve the body’s relationship with insulin, at the centre of type 2 diabetes, some nutritionists urge caution. It is a vexed issue, and I’m not about to start offering specific advice on diets. But the type of food regime Watson decided to adopt is, to an extent, irrelevant. The wider point is that physical activity and losing weight are by no means the same thing. Yes, regular physical exertion is hugely helpful in maintaining a healthy weight and can assist with gradual weight loss. But, as we’ll see later, barring a pretty extreme and virtually all-day exercise programme, movement alone is not enough to prompt the sort of physical transformation experienced by Watson. You also need a reduction in caloric intake, involving a healthy
mix of foods.

  This brings us to another key point, perhaps the most important in this chapter: even weight loss is to an extent a secondary issue, and certainly in health terms. This can sound an anomalous, even heretical thing to say in our era of – entirely justified – worries about the global public health crisis caused by obesity. And it is not to suggest that losing weight is irrelevant. All things being equal, someone of what doctors would term a normal weight has better average health outcomes than someone who is overweight, particularly so if the excess weight moves into clinical obesity.

  But this is not the only calculation in play. To begin with, as we’ll see in a minute, weight, as judged by the standard metric of body mass index (BMI), is not the only gauge, with research increasingly showing that other measurements such as waist size and the location of body fat can be equally, if not more, relevant for health. Also, study after study has shown that someone who is active generally receives health benefits even if they are overweight, though again this effect tends to diminish with serious obesity. Finally – and this is where things get perhaps the most controversial – some research suggests that, overall, it could be better for your health outcomes to be regularly physically active and have some excess weight than it is to be slim and immobile.

  While this ‘fat and fit’ narrative is still challenged by some academics, it is undoubtedly true that if someone is overweight it is just as important for them to be active as it is for anyone else, perhaps even more so. However, becoming active can be particularly challenging for people who start the process obese. Part of this can be the sheer effect of the weight, as Tom Watson recalls: ‘Imagine carrying eight stone in a rucksack. It’s a lot more tiring. And your physical movement is restricted.’ There are other practical obstacles for heavier people seeking to be active. For example, some bicycles have recommended weight limits of 120kg, which would have excluded Watson. The same is true for many home running treadmills.