Towards an equality of health

by Hamed Khalidi

Instagram: hamed_khalidi
Twitter: @hamedkhalidi


We are on the precipice of something big, aren’t we? It is palpable. 2020 has been, if anything, been a rude awakening of the frailty of systems – be it political, environmental, economic or health. Centered on a pandemic, these frailties exposed themselves, and have raised serious questions about how we think about society and urbanization. Cities are glorious generators of wealth and innovation1. However, the larger the cities, the greater the inequalities2. The last few years have revealed these inequalities in wealth and social justice. However, there is another facet that becomes a critical by-product of these inequalities – health.  The greater these differences, the wider the implications on our collective health. Food production, water distribution and proper sanitation are the visible implications of these inequalities. But there is yet another ‘invisible’ realm within the scope of architecture and urbanism, as a result of these injustices. Air. 

Rapidly urbanizing cities choke on their steadily deteriorating air. Cities in developing countries carry most of the burden, as they consistently exceed the air quality guidelines, sometimes by over 2000%3. Outdoor or Ambient air pollution was responsible for 4.2 million deaths globally in 2016; a further 3.8 million deaths globally were attributable to Indoor Air Pollution, out of which almost 250,000 were children under the age of 5 years4. All these mortality rates, can be directly attributed to the way we design and orient our cities and architecture. Most indoor environments in cities have become breeding grounds for dangerous diseases and chronic ailments. It is ironic, that in the time of global pandemic, the best strategy we have is to remain indoors – where these bacteria have been incubating for decades! 

In many ways, these microbial pollutants that affect are health, are very much like the social prejudices we so actively fight. They are a result of over-consumption, disproportionately affecting the urban poor and most critically, invisible. They are however measurable and quantifiable. There effects are visible in the short and long-term, and thankfully, in most cases, they are reversible. 

So, the question is: how can we build healthy cities? How can we improve the quality of air and water towards better user health? How can we make these solutions affordable, adaptable and sustainable? 

First of all, let’s look at the sources. Over the last four decades, the growing proliferation of chemical pollutants in consumer and commercial products, the tendency towards tighter building envelopes, reduced ventilation to save energy and pressures to defer building services to reduce costs and energy, have fostered indoor air quality problems in most of the built-up environments in cities. This effect of poor indoor health is compounded in developing countries, where citizens accept deplorable living and working conditions as they seek better financial prospects. People should not unwittingly compromise their health, with an empty promise of future wealth. 

Secondly, design could play a critical role in alleviating these pressures. Architects and designers play a significant role at building inception in determining the long-term health effects of its users5. While significant strides have been taken towards implementing green building or passive design norms and policies, indoor health remains a serendipitous result rather than a design objective. 

Finally, at the scale of the city, much can be achieved by improving regulations and reforms that can be localised and adapted to the local climate and context, which would be crucial in alleviating design hindrances, as well as catering to occupancy health. These regulations, should not be expensive add-ons to luxurious financial districts alone, but cater to every strata in the city through affordable and adaptable measures. Health should not be a privilege, it should be a basic human right.  

As we respond to the global pandemic of COVID-19, our occupancy of indoor space becomes more important than ever. The access, emissions and inhabitants’ occupancy all determine the cleanliness of indoor air, and it is here that architects and planners could play a crucial role in safeguarding the health of inhabitants. When we talk about inclusive cities, health cannot be an afterthought. It needs to be at the forefront of planning and design decisions. Planning for health and the efficient use of resources means creating a more holistic collaborative approach towards building engineers and medical experts.  A critical awareness of the threats we face while inhabiting our buildings will lead us to design with innovation and creativity, all within an interdisciplinary framework of action.


Association between symptoms and indoor environment parameters (Source: National Research Institute of Tuberculosis and Lung Disease, Iran (Redrawn by author)



[1] Brand, Stewart, “Whole Earth Discipline”, Chapter 2, City Planet, Penguin books, 2009

[2] Glaeser, Resseger, Tobio, “Inequality in cities”, Journal of Regional Science, Vol.49, no.4, 2009, 617-646,

[3] Sanya Mansoor, “Air Pollution Turned India’s Capital Into a ‘Climate Emergency’”, TIME, November 5, 2019,

[4] WHO, 2019

[5] Phillips, Scott, “Indoor air quality: Is it an issue for architects?”, Semmes, Bowen & Semmes, Presented to Maryland Society AIA, September 28, 2001, III,


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