In a shock-prone world, city-level thinking is a new approach to optimizing the brain health and brain skills of citizens.
Kristalina Georgieva, managing director of the International Monetary Fund, recently emphasized the need to contemplate “unthinkable” scenarios in light of the “shock-prone world” we inhabit.1 The occurrence of shocks—as exemplified by the COVID-19 pandemic, climate catastrophes, and political instability—has become increasingly common and is projected to accelerate in the coming decades.
These shocks are placing tremendous pressure on our brain capital, encompassing our brain health and brain skills.2 During the pandemic, brain health declined, with rising rates of emotional disturbances in children, spikes in youth suicide, increases in mental health conditions such as anxiety and depression across the population, and the emergence of long COVID.3 Shocks put out brain skills to the test and required tremendous resilience and adaptability. Navigating future shocks will require creativity in order to generate novel solutions.
According to the World Bank, approximately 56% of the world’s population—4.4 billion individuals—live in cities.4 Therefore, the city-level approaches may be a new vector to boost the health of our minds and our brains in order to optimize our wellbeing, productivity, and innovation. Here, we propose 5 key city-level strategies to boost brain capital and to inspire a Brain Healthy City model:
1. Brain-healthy Built Environments
The built environment has direct and indirect effects on our brains. Exposure to better air quality has shown to impact cognitive functioning.5 Similarly, daylight and circadian rhythms are correlated with reduced stress and anxiety, increased task performance, and better sleep quality.6 Access to green spaces has been linked to various metrics of health from cognitive performance to emotional regulation and even health outcomes.7
Access to spaces where individuals can connect socially (even during passive pandemics) has been shown to reduce loneliness and social isolation, which in turn is related to longevity. In fact, researchers argue that enriched environments that provide access to physical, sensory, cognitive, and social stimuli can aid in neurogenesis—the development of new synapses in the brain—and counter neurodegeneration with age.8
Poor-quality housing also appears to increase psychological distress, while green and natural spaces reduce it.9 The brain health of psychiatric patients has been linked to design elements that affect their ability to regulate social interaction (eg, furniture configuration, privacy, etc).10 Patients with Alzheimer disease are better adjusted in buildings that accommodate physical wandering.
Residential crowding (the number of individuals per room) and environments with loud exterior noise sources (eg, airports) elevate psychological distress but do not produce serious mental illness. Malodorous air pollutants heighten negative affect, and some toxins (eg, lead, solvents) cause behavioral (eg, self-regulatory ability, aggression) and physiological disturbances (eg, inflammatory process, immune dysregulation).11 Insufficient daylight is reliably associated with increased depressive symptoms.
Indirectly, the physical environment may influence mental health by altering psychosocial processes with known mental health sequelae. Personal control, socially supportive relationships, and restoration from stress and fatigue are all affected by properties of the built environment. Managing distractions, avoiding multitasking, and cognitive training are key to staff wellbeing and productivity, according to a yearlong study12 of HKS employees in partnership with the University of Texas at Dallas’ Center for BrainHealth.
2. Equitable Brain Health Clinical Care for Healthy Communities
We cannot begin to solve some of our greatest societal issues—homelessness, incarceration, deaths of despair—without focusing on care for individuals with brain health disorders. Nearly 1 billion individuals worldwide have a mental disorder.13 Access to affordable, quality care is poor in high-income settings and is nearly nonexistent in many low- and middle-income settings. Preventive strategies are still in their infancy. Stigma surrounding mental disorders remains high in many areas of the world. For decades, health policy and insurance systems have offered minimal coverage of these conditions.
The World Health Organization’s (WHO’s) Comprehensive Mental Health Action Plan 2013-203014 lays out a range of approaches to achieving mental health equity. Cities can boost lay counseling practices—psychosocial support provided by staff or volunteers who do not have a mental health background or a formal degree in counseling—to assist people in need.15
The design of cities and shared spaces can also have a significant impact on individuals’ mental health. Urban planners can consider incorporating mental health facilities and resources into city plans to increase access to care. In addition, the mental health stigma can be addressed by creating inclusive and supportive shared spaces. Lay counseling practices can be integrated into public spaces and community centers.
3. Inoculation Against Fake News
Fake news, conspiracy theories, the shuttering of local newspapers, controversies over social media, rumors of bizarre adverse effects from COVID-19 vaccinations, and the erosion of basic trust in scientific facts increasingly distort our public debates and fray our democracies.16 Scientists and policy makers are working hard to reduce fake news and inoculate individuals against its harmful effects.
Google and a team of global academics recently conducted experiments using 90-second videos to explain common misinformation tactics including emotionally manipulative language and scapegoating.17 They found that, after watching the videos, individuals became better at spotting the techniques—and were less likely to say they would share posts that use them.
These types of strategies are ready to be scaled. The WHO has established anInfodemic Unit18 to develop evidence-based strategies to combat mis- and disinformation and ultimately strengthen democracies.
Architects and urban planners can consider novel spaces to foster shared critical thinking. Public libraries, community centers, and other shared spaces can serve as information hubs and engage in fact-checking activities. Additionally, urban planners can incorporate public spaces promoting open discourse, such as town halls and debate forums. Short informational videos can be displayed in public spaces.
4. Sustainability-focused Brains
Sustaining our planetary future requires a world with clean water, affordable energy, reduced carbon and methane emissions, reduced habitat loss, eradication of poverty, and reduction of global inequalities. Achieving these endpoints requires innovation, systems thinking, and, ultimately, mass human behavior change. This is attainable by fostering a clear scientific and economic evidence base, coordinated and diverse leadership, sustained motivation, and the right mindset and public messaging.
The concept of “green brain capital” places a central emphasis on the brain to deliver a healthy and sustainable environment, and vice versa, on a green environment to promote and safeguard brain health.19 The environmental determinants of brain health are foundational to this model, as brain health is key to navigating and thriving in the modern world.
Key brain skills include green skills, creativity, adaptability, digital literacy, and ecological intelligence. Green spaces in cities can provide a range of health benefits, including improved air quality, reduced noise pollution, and increased opportunities for physical activity, all of which enhance brain health.
Additionally, promoting green skills can foster innovation and mass human behavior change. The COP2 initiative,20 for example, focuses on promoting sustainable practices and innovation to combat climate change. Cities can leverage such initiatives to develop sustainable and brain-healthy urban environments.
5. Creativity at Scale
Crafting innovative solutions to improve performance on global climate targets and to overcome existing societal challenges is paramount to achieving a sustainable planetary ecosystem. Creativity is among the top skills for leaders and workers alike. Connecting creativity infrastructure development with brain capital has the potential to offer the global community exponential opportunities for collaboration and commerce through the lens of human flourishing.
The High Line Park in New York City is an example of a creative solution to repurpose an old, elevated railway into a public green space. Similarly, the city of Copenhagen implemented an extensive network of bike lanes and pedestrian streets, promoting sustainable transportation and healthy lifestyles. These projects not only improve the physical environment but also stimulate creativity and innovation in the community, driving economic growth and promoting human flourishing.
The C40 Cities network brings together experts from around the world to tackle climate change and promote sustainable urban development.21 The network encourages creative solutions and innovations, such as Paris’ car-free day, Milan’s vertical forests, and Copenhagen’s bicycle highways, to reduce greenhouse gas emissions, improve air quality, and create more livable cities. These initiatives promote both sustainability and the brain capital of the cities’ residents by encouraging physical activity and community engagement.
Sustainable urban development is also relational to a city’s investments to protect surrounding geography (eg, controlled tourism of the Rocky Mountains) and robust capitalization of investments, human expression, and shared storytelling (eg, the arts).
The science of awe suggests that experiencing moments of wonder and amazement can support human creativity.22 Awe is a complex emotion that can be triggered by various stimuli, such as nature, art, and music. When we experience awe, our brains release dopamine, a neurotransmitter associated with pleasure and reward.23 This can lead to increased curiosity, creativity, and openness to new ideas.
Studies have shown that individuals who experience awe are more likely to think outside the box, solve problems creatively, and engage in prosocial behavior.24 Therefore, by cultivating experiences that elicit awe, cities can tap into the creative potential of individuals’ minds and unlock new levels of innovation.
These approaches move us closer to a Brain Healthy City model that can be developed and disseminated globally. Taking inspiration from the WHO’s Healthy Cities model,25 we can leverage cutting-edge neuroscience to care for our most important brains. We must also work toward a Brain Healthy City Dashboard to quantify and track key metrics. This should align with the emerging tracking mechanisms recently outlined in The Lancet.26 The Euro-Mediterranean Economists Association has also recently launched a country-by-country global Brain Capital Dashboard,27 which may be instructive.
A recent report led by our group suggests that other brain health challenges such as misinformation may be contributing to the weakening of democracy.28 This same report suggested that brain health-directed could therefore be a new vector to strengthen democracy by, for example, increasing productivity, social cohesion, and wellbeing.
Given that cities have recently been noted as “reservoirs of democracy,” they should be given serious consideration for public policy innovation.29 In other words, city-level brain health policy-making may be a new approach to strengthening democracy.
Although many established cities will be using these approaches to reform their existing practices, new cities like Saudi Arabia’s Neom30,31 have the potential to build their city and communities with these policy innovations from inception.
Topics covered in this paper will be presented at the 2023 Cities Summit of the Americas, a US State Department-facilitated dialogue.
Dr Eyre is lead of the Brain Capital Alliance, co-lead of the OECD Neuroscience-inspired Policy Initiative, fellow with The Baker Institute for Public Policy, senior fellow with the Meadows Mental Health Policy Institute, and advisor to the Euro-Mediterranean Economists Association. Dr Chen is a partner of IO VC, a member of the faculty at UC Berkeley and Singularity University, and a Californian mental health commissioner. Dr Ayadi is founder and president of EMEA and a senior advisor to the Center for European Policy Studies (CEPS).
Dr Nanda is a partner and global director of research at HKS, Inc, as well as an associate professor of practice at the University of Michigan. Dr Ibanez is director of the Latin American Brain Health Institute (BrainLat) and a faculty member of the GBHI at Trinity College Dublin. Dr Edmonds is the directing co-founder of CU Denver’s Imaginator Academy.
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30. What is Neom? Neom. Accessed March 27, 2023. https://www.neom.com/en-us
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