Environment and Planning A 2009, volume 41, pages 2437 ^ 2454

doi:10.1068/a41309

Designing the fit city: public health, active lives, and the (re)instrumentalization of urban space
Clare Herrick

Cities Group, Department of Geography, King's College London, Strand, London WC2R 2LS, England; e-mail: clare.herrick@kcl.ac.uk Received 7 October 2008; in revised form 28 November 2008; published online 6 August 2009

Abstract. The relationship between the built environment, physical activity, and well-being is currently attracting concerted government attention in the UK which has been formalized through new sets of urban planning and design guidelines. In light of this, the author argues that the domains of intersection between the physical environment and governmental health and social agendas need further exploration. Furthermore, she asserts that urban geographers are theoretically and empirically well placed to undertake valuable and much needed research agendas within these domains. To explore these assertions, the author first sets out the recent turn to physical activity as an explicit policy concern. She then critically interrogates two recent sets of design guidelines, Active Design (Sport England) and the 2008 NICE guidance within the context of current UK policy thinking, before exploring the problematic nature of the instrumental readings of space they present. It is argued that this instrumental rationale may sanction the neglect of the intrinsic value and importance of active lives themselves to urban spaces, which, it is asserted, can have marked impacts on wellbeing. An appreciation of this opens up new geographical research agendas with respect to the built form, public health, and governance.

``We need a culture shift if we are going to increase physical activity levels in England. This will only be achieved if people are aware of, understand and want the benefits of being active. Opportunities will be created by changing the physical and cultural landscapeand building an environment that supports people in more active lifestyles. We need to provide choice and a range of options so that people can be active on a daily basis. Department of Health (DH, 2005, page 6) 1 Introduction In early 2008 the UK's National Institute for Health and Clinical Excellence (NICE), a Department of Health (DH) quango, published its guidance on Promoting and Creating Built or Natural Environments that Encourage and Support Physical Activity. Although the document is ostensibly designed to inform and set standards of best practice in the National Health Service (NHS) and DH, in reality it cross-cuts a broader swathe of governmental agendas from transport, to urban planning, urban regeneration and investment, education, and housing. As part of the broader pre-Olympic agenda to create a lasting health `legacy' (particularly among children and young people) and to reduce the anticipated economic costs of poor health by enhancing population-scale physical activity uptake through environmental rather than behavioral interventions (CABE, 2006; Chief Medical Officer, 2004; DH, 2004; Edwards and Tsouros, 2006; NHF, 2007; NICE, 2008, page 8), the guidelines are the latest addition to the arsenal of measures being used to meet some highly ambitious national aims and targets. These include: securing ``better health and wellbeing for all'' through reducing the rate of all causes of mortality among all age groups [Public Service Agreement 18 (PSA 18)]; increasing the uptake of sporting and cultural activities among adults and young people (PSA 21); delivering a successful Olympics with a sustainable legacy (PSA 22);

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and avoiding dangerous climate change (PSA 27) (NICE, 2008). Whilst offering a highly anticipated set of recommendations for policy makers, the guidelines also reflect a more fundamental epistemological shift within public health and urban governance back towards what has, somewhat ironically given the historical coevolution of public health and urban planning (Hamlin and Sheard, 1998), been described as the `emerging field' of the built environment and health (Jackson, 2003, page 1383). This move towards viewing the built environment as a `tool' to meet specific public health goals (Cummins, 2003; Curtis et al, 2002; Foster and Hillsdon, 2004) as part of a wider range of urban policies is thus one deserving of attention by urban as well as health geographers. The recent reclamation of the built environment in attempts to locate the direct and indirect influences on well-being in general (Hamlin and Sheard, 1998), as well as more specific health outcomesespecially those related to physical (in)activity (Ogilvie et al, 2007)has become accepted wisdom in public health thinking across the EU (see CEC, 2005; Edwards and Tsouros, 2006) and is slowly permeating policy circles in North America (Kochtitzky et al, 2006). Indeed, `healthy urban planning' is now one of three core themes of the World Health Organization's European Healthy Cities programme (WHO Europe, 2003). Yet, while some health geographers have been swift to pick up on this trend (for example, Cattell et al, 2008; Cummins, 2003; Fleuret and Atkinson, 2007; Macintyre, 2007; Macintyre et al, 2002), urban geographers have had relatively little to say. This omission of such a clear policy trend, which stretches far beyond health alone, is particularly notable given some of the current (and exceptionally relevant) debates within the subdiscipline concerning: the `materiality' of the urban (see Latham and McCormack, 2004; Lees, 2002); recent provoking contributions on the relational nature of urban space (Amin, 2007); the role and value of public space (Amin, 2008); and critical accounts of the policies, strategies, and discourses of New Labour's `urban renaissance' (Helms et al, 2007; Imrie and Raco, 2003). Indeed, given the centrality of lifestyle to health, the built environment and public space to lifestyle, and, moreover, the current semantic lingering on `place' as a strategic locus of UK governmental activity, especially in the public health domain (DCLG, 2007a; Sport England, 2008), there would seem to be great scope for critical attention to these shifts by urban geographers. In this paper I argue that the domains of intersection between the physical environment and governmental health and social agendas need further exploration. Physical activity represents a particularly prescient example of this, especially given the high status it is currently enjoying as a result of government concern with rising obesity rates across the UK, the impending Olympics, and within broader social inclusion agendas. This last link is made explicit in the assertion in the the Choosing Activity White Paper that ``any strategy to increase physical activity needs to link with broader work to tackle inequalities'' (DH, 2005, page 5). While the concept of `the environment' may be central to geography's very self-definition and disciplinary identity, the pursuit and act of being physically active within this has, with the exception of some notable works within the specialized field of sports geography (Bale, 1996; 2003; Bale and Sang, 1996), not been subject to the same degree of conceptual scrutiny as could be expected given the strides being made towards a `corporeal turn' more broadly within the discipline (see Longhurst, 1995; 2000; Valentine, 1999). In reality, the realm of physical activity marks out some distinct relationships between individuals, groups, communities, and certain localitiesstreets, parks, courts, pitches, pools, tracks, or any number of domains in which practices of being active are undertaken. Such spaces and places may be formalized, but they may also be defined by their informality. Physical activity may involve competitive (team or individual) sports of many guises in regularized,

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publicly or privately owned, delineated spaces; but it might also quite simply involve walking for its own sake, of the kind explored by de Certeau (1984). As a consequence of these potential spheres of geographical relevance, this paper suggests that the recent spate of design guidelines marks a valuable point of interjection for urban as well as health geographers and provides plentiful opportunities for some novel and badly needed research agendas. To pursue this line of reasoning, the body of the paper is divided into three sections. The first considers the question of physical (in)activity as a recent policy concern and its latest expression in the drive to create and plan what might, in effect, be termed `fit' (or at least `fitter') cities as a way of mitigating the anticipated health, economic, and social costs of individual and collective lifestyle choices. The second discusses this current turn to built environmental form and quality in public health policy, as well as across a wide range of social policies more generally, through a critical examination of the embedded rationales of two of the most recent and significant guidelines for designing physical activity back into local environments: Sport England's Active Design (2007a) and the NICE guidance (2008), both of which are applicable to England only. (1) The third part considers the possible consequences of the modes of thinking set out within these guidelines. It asserts that attention to the role of specific, codified built environments in physical activity outcomes prioritizes an instrumental reading of space in which the individual behavioral choices of its users are, in effect, nullified as a problem by assuming that they will simply be predictable (and thus inevitable) reactions to particular environmental traits or features. This reading merits further scrutiny, by both health and urban geographers, particularly if the increasingly general policy aspiration of catalyzing a `culture shift' (DH, 2006, page 6) in social attitudes to sport and physical activity in the UK are to be truly realized. 2 The inactive city In recent years sedentary lifestyles and low uptake of physical activity have become chief public health and social policy concerns for the UK's Labour government. This has been fuelled in no small part by alarm over the UK's `obesity epidemic' (Prentice and Jebb, 1995, page 437) and its predicted costs, and has achieved momentum alongside the etiological culpability assigned to the `obesogenic environment' (Egger and Swinburn, 1997, page 478, GOS, 2007, page 3). In 2007 the estimated cost to the NHS of treating conditions for which elevated body mass index (BMI) was a risk factor was 17.4 billion, of which overweight and obesity (exacerbated by physical inactivity) accounted for 4.2 billion (GOS, 2007, page 40). Regular physical activity is linked to a reduced risk of cardiovascular disease, some cancers, and type 2 diabetes, and also has marked psychological benefits (GOS, 2007), meaning that being physically active can induce some of the same attributes of general, community, and individual well-being (as well as potentially reducing the costs of obesity) so closely tied to New Labour's aspirations for urban regeneration and revitalization. Consequently, encouraging the uptake of sport and physical activity seems to represent a relatively simple and politically attractive route by which to move towards certain economic, social, and public health goals while steering clear of increasingly common accusations of `nanny
(1) While

NICE guidance applies across the UK, its public health guidance (under which category Promoting and Creating Built or Natural Environments that Encourage and Support Physical Activity falls) is applicable only to England. Although in this paper I may occasionally refer to some UK-scale policy documents (eg DfT, 2007), the discussion contained in this paper is focused on England and, in general, refers to England-scale health survey data unless indicated otherwise.

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state' governmental behavior. As Stamatakis and Chaudhury aver, ``sports participation not only optimizes the advantages to physical health but is associated with enhanced social wellbeing, general sense of belonging, lower unemployment, less crime and stronger community cohesion. For all these reasons, increasing the levels of sports participation in the UK has moved up the political agenda'' (2008, page 1). The UK government has therefore promised between 1.5 and 2 billion in funding for sport in the decade to 2010, as well as undertaking Active People, a large-scale annual survey on sports participation in England (Stamatakis and Chaudhury, 2008, page 2), to augment existing data from the Health Survey for England (HSE). There are thus clear and important interrelations between urban and public health policy agendas which merit further empirical scrutiny. Inculcating elements of urban design, planning, and transport management that make possible and support physical activity as part of daily routine means a fundamental reshaping of the built environment such that physical activity becomes an inevitable and unavoidable part of daily life. However, before exploring the routes through which this is being undertaken, it is essential to reflect on the complicated picture of the current physical state of the nation. With only 37% of adult men and 24% of adult women meeting the recommended levels of 30 minutes of `moderate activity' in the UK (eg brisk walking, cycling, swimming) five days a week (DH, 2005, page 5), the target of 50% participation by 2020 laid down by Wanless (2004) means that uptake rates among adults need to climb by 1% a year nationally. Such an increase is a far from insignificant challenge, especially given the further identification of particular `high-risk' target groups: women and girls; ethnic minorities; people with disabilities; and people in the lowest socioeconomic groups (Sport England, 2008, page 7) and, by extension, particular spatial targets (eg deprived or black and minority ethnic [BME] neighborhoods). However, physical activity rates collected in Sport England's (2006) Active People survey in 2005 ^ 06 demonstrate not only marked socioeconomic and demographic disparities in uptake rates across England, but also some quite distinct geographic variations. It should be noted, however, that Active People defines `participation' as 30 minutes of moderate activity on three days of the week, thereby presenting optimistic participation rates in relation to government recommendations. Despite this, the figures provide a useful starting point for exploring the current state of the spatiality of the nation's fitness levels. Figure 1 shows that variations in participation at a local authority scale vary from a high estimated at 29.8% in the affluent London commuter suburb of Richmond-upon-Thames to a low estimated at 14.3% in Boston in the East Midlands. Large-scale clusters of low uptake rates are also found across East London and the Thames estuary, along the rural North Norfolk coast, as well as in West Yorkshire and the East Midlands. High uptake rates equally demonstrate regional agglomerations: North Yorkshire; Oxfordshire, Hampshire, Wiltshire, and parts of Surrey; a clear swathe of South West London; and a corner of Northumberland. Such data, despite being medium layer super output area (MSOA) estimates, nevertheless provide an instructive overview of the geographies of physical activity uptake in England and demonstrate that the need for environmental or behavioral intervention is not equally distributed across the country. While the geographical distribution of those undertaking desirable levels of physical activity displays some discernible evidence of fit and less-than-fit regions, socioeconomic and demographic variations in activity levels are far more complex, although some general trends can be discerned. When local authority Active People data are agglomerated by region it can be seen that, on average, men are more active than women (figure 2), those of the highest socioeconomic status have participation

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Figure 1. Participation rate of 3 6 30 minutes a week of moderate-level activity by local authority (Sport England, 2008).

rates on average 8% higher than those in the lowest grouping (figure 3), and that activity levels decrease markedly with age (figure 4). While an awareness of socioeconomic and demographic trends is essential, the policy rationale actually rests on a far shakier assumption of specific temporal trends in physical activity correlated with rising rates of obesity. Recent work by Stamatakis and colleagues (Stamatakis and Choudhury, 2008; Stamatakis et al, 2007) directly challenges the assumption that rapid

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25

Male Female

20

Participation (%)

15

10

East

East London Midlands

North East

North West

South East

South West

West Yorkshire Midlands

Figure 2. Physical activity participation estimates by local authority region 2005/06 (source data: Active People, 2006).
25 Socioeconomic status
NS SEC1, 1.1, 1.2, 2 NS SEC3

20 Participation (%)

NS SEC4 NS SEC5, 6, 7, 8

15

10

East

East London North Midlands East

North West

South East

South West Yorkshire West Midlands

Figure 3. Physical activity participation by region and socioeconomic status (source data: Sport England, 2006).

increases in obesity rates and the ``lack of a clear trend in dietary intake ... may imply that the overall physical activity energy expenditure levels of the population are declining'' (Stamatakis et al, 2007, page 416). As the authors point out, these assumptions are based on temporal trends in ecological proxy measures (eg increased TV viewing hours and increased car usage) which, logic dictates, replace the time available, the need for, and the desirability of physical activity (Stamatakis et al, 2007). In examining HSE physical activity question responses from 1991 to 2004, these authors conclude that, contrary to the assumptions inherent within the `obesity epidemic'

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40 35 30 Participation (%) 25 20 15 10 5 0

Age group 16 34 35 54 55+

East

East London Midlands

North East

North West

South East

South West Yorkshire West Midlands

Figure 4. Physical activity participation by region and age group (source data: Active People, 2006).

rhetoric, ``mean time spent in sports of moderate to vigorous intensity increased steadily among all age groups'' and that this climb was ``particularly pronounced among middle-aged and older groups'' (Stamatakis et al, 2007, page 418) where rates rose from 26% in 1991 ^ 92 to 42.6% in 2004 among men, and from 25.1% to 35.4% for women. Similarly, the average time spent per week walking at moderate intensity increased from 50 to 60 minutes among men and from 38 to 50 minutes among women. From 1999 to 2004, those meeting the recommended levels of physical activity actually rose by 1.7% among all age groups, with those in the 35 ^ 49 year-old age band meeting these levels increasing by over 6% (Stamatakis et al, 2007). The final conclusion of this innovative research is that ``during the decade 1997 ^ 2006, overall participation increased but the increase did not occur equally across socioeconomic, demographic and ethnic groups'' (Stamatakis and Chaudhury, 2008: page 6), an assertion corroborated by the recent Active People data. As the authors suggest, a surge in health awareness (which has ironically climbed alongside reported increases in obesity rates) has increased the `social desirability' of physical activity (Stamatakis and Chaudhury, 2008) over the past decade, evidenced by the fact that the category of gym and fitness club usage showed not only the highest degree of participation, but also the largest increase in uptake over time. Yet `social desirability' risks veering dangerously close to social exclusion, a trend with the potential both to cause and to reinforce the continuing gap between high and low socioeconomic groups (figure 3) and white and nonwhite ethnic groups (figure 5). Trends in physical activity may be more encouraging than they are frequently portrayed but, even so, there is endless scope for creating a fitter nation. This is especially true among certain `at risk' groups and, thus, by extension in certain `at risk' or `risky' places if the optimism of the Olympic health legacy rhetoric is to be realized. This policy drive both demands and opens up opportunities for new approaches to the study of urban environments.

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25

Ethnicity White Nonwhite

20 Participation (%)

15

10

East

East London Midlands

North East

North West

South East

South West Yorkshire West Midlands

Figure 5. Physical activity participation by region and white/nonwhite ethnicity (source data: Active People, 2006).

3 Building the active city The current governmental commitment to unraveling and intervening in the complex and contested links between place of residence, deprivation, and poor health outcomes (DH, 2004, page 14; Orford et al, 2005; Shaw et al, 2005) is a promise formalized by the assertion that ``within 10 to 20 years, no one shall be seriously disadvantaged by where they live'' (PM Strategy Unit, 2005, page 7). Such `disadvantage' may be manifest in any number of ways, but it is understood that ``disadvantages arising from poorer quality environments ... amplify individual disadvantages ... in ways that are detrimental to health'' (Macintyre, 2007, page 32). This ``deprivation amplification'' (Macintyre, 2007, page 32) thesis thus lends further credence to the current drive to plan physical activity back into both the existing built environment and new developments. Two sets of design guidelines are consequently of particular salience in the goal to build ``an environment that supports people in more active lifestyles'' (DH, 2005, page 6): the NICE Guidance (2008) and Active Design (Sport England, 2007a). While these documents are just two among an increasingly diverse array of similar publications (Edwards and Tsouros, 2006; Mayor of London, 2007; NHF, 2007), they merit further scrutiny on two levels. First, the NICE guidance represents the culmination of several years of consultation and scoping work and is unusual in that has originated from a public health organization. Second, Active Design was shortlisted for the Royal Town Planning Institute's annual awards an indication perhaps of the degree to which its central assertions have shifted from the avant garde to accepted wisdom. While the involvement of Sport England in urban design may initially seem unexpected, it is logical given the host of initiatives now aiming to increase physical activity uptake. With walking and cycling now categorized as desirable `moderate' intensity activities that count towards weekly targets, attention to the built environment and its influence on physical activity undertaken as part of daily routines and everyday activities has brought with it a new, instrumental reading of urban space by the UK government. Further increasing the remit of this instrumental thinking, these plans to increase physical activity uptake through environmental intervention do not exist in isolation: rather, they merge with a host of other ``area-based social policy initiatives''

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(Cummins, 2003, page 221) including Sports Action Zones, Health Action Zones, and Neighbourhood Renewal Areas, which target resources and funding through `strategic partnerships' to areas of deprivation where a definitive need for infrastructural improvements and investment has been identified. In Active Design, Sport England (2007a, page 1) offers a series of guidelines or an `essential checklist' specifically aimed at new developments or master plans and, in contrast to the NICE Guidance, does not cover improvements to existing environments. The Active Design principles are consequently particularly pertinent to the massive developments being undertaken in East London in advance of the 2012 Olympics, which aim to deliver the kind of sustainable legacy at the root of the city's winning bid. Active Design asserts that `activity' falls into one of two spheres: `physical activity' (eg structured sport/leisure/recreation) and `lifestyle activity' (Sport England, 2007a, page 10), such as active travel (eg getting from A to B by bike or on foot). These both require and make use of different spatial and social realms the spatial being the provision of specific facilities and delineated outdoor open space, and the social the use of streets and parks as routes, framed by points of origin and destination. As such, physical and lifestyle activities place different demands on the urban landscape and invoke, to varying degrees, the core guideline objectives of: improving accessibility, enhancing amenity, and increasing awareness (Sport England, 2007a). Active Design must also be considered alongside the expanded appreciation of the potential role of sport in ``supporting the delivery of local community and shared priorities'' (Sport England, 2007e, page 2), including community cohesion, social inclusion, and reducing antisocial behavior (Sport England, 2007b) ideas that have also been expressed in the upcoming report Shaping Places through Sport (Sport England, 2008) as well as a series of recent publications under the series titles of Sport Playing its Part. These aspirations for the transformative role of sport also extend to ``economic vitality and workforce development'' (Sport England, 2007c), as well as meeting the particular needs of children and young people (Sport England, 2007d). It would seem that the drive to increase participation in physical activity has also brought `place' firmly into the governmental orbit as both cause and effect, not just of health status, but of a wide array of social indicators. This dialectical association of people and places, long a core tenet of geographical reasoning, is now appearing as innovation in government policy concerned with `place-focused principles' (DCLG, 2007a, page 11). However, such principles, while discursively concerned with place, in practice may well be focused on a very narrowly defined conception of the environment. The NICE guidance, for example, starts from a definition of the environment as ``any aspect of the physical (natural) environment or the urban or constructed environment that unconsciously or consciously relates to an individual and their [health enhancing physical activity] HEPA behavior'' (Foster and Hillsdon, 2004, page 756). This definition constructs the environment as a mere conduit for physical activity, whose nature and qualities should therefore only be considered in relation to their potential and actual influence on activity levels. This would seem at odds with the broader and more complex conceptualizations of the meanings, values, and potential generative capacity of the environment enshrined within well-being and social inclusion agendas. This prescriptive definition of the environment is one in which it is assigned an instrumental role as a tool to catalyze certain public policy goals and, therefore, by extension, its quality and value can be read back through the degree to which policy targets are met. Before discussing the consequences of such thinking, the central tenets of the guidelines are critically examined.

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Table 1. Summary of NICE recommendations (NICE, 2008). Recommended action 1 2 3 4 Full community and expert involvement in planning decisions to ensure that opportunities for physical activity are maximized Give cyclists and pedestrians highest priority in street maintenance and development Plan and provide a convenient, safe, and attractive network of routes for walking and cycling Ensure public spaces can be reached by foot, bicycle, and public transport and that they are maintained to a high, safe, and attractive standard Link campuses with walking and cycling routes, both new and linked into existing infrastructure Staircases in new or renovated buildings to be repositioned in prominent place to encourage use Use innovative playground design to encourage varied use and active play Suggested actors Local community and expert actors in planning, strategies, and policy Transport and local authorities Planning and transport agencies, local and regional authorities Designers and managers of public space, paths, and rights of way Architects, designers, developers, employers, and planners Architects, designers, and facility managers Children's services, school sport partnerships, and governing bodies

5 6 7

According to NICE (2008, page 17), ``environments that encourage physical activity need to be welcoming, attractive, interesting and even inspirational.'' To achieve this, NICE puts forward seven recommendations across the governmental sectors of transport, crime and security, sustainable development, planning, education and children's services, nongovernmental and commercial sectors, and multifarious settings including schools, open green space, and workplaces (see table 1). In contrast to Sport England, for NICE these guidelines are not just for new developments but, rather, offer a compendium of ways in which proscribed amelioration of the urban environment might help national government, the NHS, and local authority agencies fulfill a range of policy targets by increasing ``the routine level of physical activity achieved by the population'' (NICE, 2008, page 16). The NICE Guidance lays out accepted `best practice' in the field of urban design and physical activity, but seems to offer little by way of the kind of innovative thinking that might catalyze the desired `culture shift' that requires people to ``understand, be aware of and want the benefits of being active'' (DH, 2005, page 7). This is somewhat ironic given the degree to which obesity itself is cast in the hyperbolic lexicon of novelty, magnitude, or emergence. Innovative thinking instead demands attention to the impacts that active lifestyles (and resultant physical and mental well-being) can have on the perceived value of places. While this is acknowledged in the Department for Transport's Manual for Streets (DfT, 2007), this thinking is not built into the NICE rationale. The recommendations offer commonsense advice for what might be called in equally simple terms, `good' urban design which emulates the features of those places deemed to enjoy a high quality of life and, in effect, therefore, embody traits of urban `fitness'. The NICE Guidance is not concerned with the existence of amenities per se but, rather, issues of access that permit and encourage people to be active. Yet, amenity provision (eg leisure centers and swimming pools), although enjoying a somewhat inconsistent relationship both with levels of neighbourhood disadvantage (Pearce et al, 2007) and with (vigorous) physical activity levels (Giles-Corti and Donovan, 2002), are still potentially important catalysts for activityboth in terms

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of the facilities offered and of the potential for walking or cycling to get there. Despite asking how the built environment might ``prioritise the need for people ... to be physically active as a routine part of their daily life'' (NICE, 2008, page 6), NICE is more concerned with facilitating incremental movement in daily life than calling for more sports facilities. Urban design is but one layer of a complex urban fabric and it is this complexity which has most likely produced what is, in essence, an extremely generic and basic set of guidelines. While Active Design sets out a very detailed compendium of questions that need to be considered by master planners and architects, further delineated by being of macroscale or microscale applicability, the NICE Guidance is perhaps merely a reflection of the paucity of evidence linking environmental modifications directly to increased physical activity. However, the difficulties in establishing causality in studies of the environment and physical activity (Lee and Vernez Mouden, 2004) mean that it may have a limited degree of specific applicability and, instead, represent those planning and design practices that are considered, sui generis, as best practice. This lack of evidence of the causal role that environments play in shaping health behaviors may also, consequently, reinforce a wider trend within policy making to what might be thought of as `toolkit thinking'. Here, generic advice for specific problems may start, ironically, to remove the impetus to develop an understanding of the context(s) from which poor health arises from the ground (or individual) up. The existence of such guidance may also, in contrast to the fact that physical activity rates seem to be climbing in England (Stamatakis and Choudhury, 2008; Stamatakis et al, 2007), reinforce the assumption that there continues to be a general and persistent decline in activity of the type that only a generic set of recommendations (eg better quality and connected cycle routes, and staircase use promotion) might be able to address at a population scale. However, the guidelines merely present those aspects of urban design that have been shown to facilitate physical activity, with no guarantee that they will actually be used in the ways assumed or intended. The reality is far more complex and encompasses more social and political agendas than might ever be possible in the `toolkit' rationale. For, as Amin asserts, ``people have to enter into public space as rightful citizens, sure of access to the means of life, communication and progression. Without this guarantee, now so severely tested by market society and related forms of corporatism, interventions in public space will amount to no more than tinkering on the edges'' (2008, page 23). The environmentally determinist thought captured by both Active Design and the NICE guidance is perhaps symptomatic of the need to address the present challenges to public health, which include smoking, alcohol consumption, poor nutrition, sexually transmitted diseases, and chronic disease in the elderly (Gray et al, 2006, page 109), in addition to physical inactivity, even though evidence of best practice is often highly contradictory, and lacking or inconclusive at a scale beyond the immediate locale under study. The assumption that poor quality urban environments present barriers to physical activity sanctions the logic of environmental rather than behavioral interventions to enhance activity rates. Such thinking not only marks out places as pathogenic, or essentially `unfit', but also risks underplaying the value that engaged and active residents can accord to and invest in neighborhood environments. Despite the inherent importance of both the urban and the geographical in questions of deprivation and health (see Curtis and Rees Jones, 1998), the potential consequences of this instrumentalist reading of the environment in the context of physical activity seems to have been overlooked. In the next section, I therefore offer a sustained critique of the rationale of these guidelines and, in the process, suggest some of the ways in which urban geographers might have a role to play in a field of study from which, so far, they have been remarkably absent.

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4 Design guidelines, physical activity, and geographies of instrumental space The turn to the built environment in public health and, especially, in the politically charged drive to increase the UK's physical activity levels, suggests a high degree of faith in the ability of certain environmental features to make physically active lifestyles inevitable or, in the language of Choosing Activity, to ``help to ensure that our everyday surroundings maximise opportunities for activity'' (DH, 2006, page 20). However, maximizing opportunities is only one side of an equation that needs to be considered if we are to ignite and realize the `culture shift' said to be at the root of increasing physical activity levels in England (DH, 2006, page 6). The instrumental readings of space encapsulated by the logic of the design and planning guidelines considered in this paper run the risk of underplaying the importance of a crucial feedback loop the intrinsic value of active lifestyles, well-being, and societal participation to urban space itselfand, consequently, the salience of this for the efficacy and legitimacy of urban governance measures. These ideas represent fascinating potential areas for urban geographical research and are exceptionally relevant to urban policy agendas, especially given the attention given to the potential role that sport can play in fostering social inclusion by bodies such as Sport England as well as in the Neighbourhood Renewal Plan (Social Exclusion Unit, 2001). The importance of sport to the social inclusion agenda was formally brought home by the publication of the report Game Plan: Achieving the Government's Sports and Physical Activity Objectives in 2002 by the Social Exclusion Unit and the Department of Culture, Media and Sport (GSU, 2002). This government document was one of the first in the UK to cast sport in instrumental terms as a means through which to achieve a host of directly and indirectly linked policy goals, and marked a definitive shift away from the idea that sport was something to be played for its own (frequently moralized) sake. Yet, in so doing, it also sanctioned a shift away from making the links between physical activity as an end in and of itself (simply for the pleasure of exertion, teamsmanship, fresh air, etc), the kind of feelings of mental and physical well-being fostered by this and the potential influence this might have on perceptions of urban environments. The question remains, as it often does, of how these assertions might best be broached through urban geographical research. However, opportunities for interjection and innovative input within this broad field are rife. There is now a ``sustained interest by public health researchers in the neighborhood social and material environment as a potential `risk factor' '' (Cummins et al, 2005, page 249). This has sparked a recent surge in informative research on the relationship between the local environmental quality or amenity provision and physical activity behaviors (Ball et al, 2006; Cradock et al, 2005; Giles-Corti and Donovan, 2002; Macintyre, 2007; van Lenthe et al, 2005). `Ecological' studies are now increasingly common within public health approaches to the study of the environment as a risk factor for adverse lifestyle choices (Eggar and Swinburn, 1997; Papas et al, 2007; Pickett et al, 2005; Reidpath et al, 2002; Swinburn et al, 2005). At the same time, the `ecological' has become a powerful theoretical construct and scale for studies of the urban (see Heynen et al, 2006) among geographers. Consequently, at a time when generalized health-based environmental guidelines are mushrooming, ecological studies concerned with group-scale and area-scale determinants of health (see Cummins and Macintyre, 2006; Ellaway et al, 2001) might be fruitfully combined with geographical research on specific urban ecologies. In so doing, urban geographers might be able to go beyond the realms of ecological proxies and assumptions of trends into the far more productive realm of exploring the kinds of recursive relationships between citizens and their environments that might or might not be considered risky. As a consequence, this awareness of the centrality of recursiveness should help reorient the research direction away from trying to divine causal

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influences of the environment on behavioral choices, and towards the ways in which these choices and the actions they involve may construct new readings, perceptions, meanings, and values of urban space as powerful in their effects as its material form. `Cultural change' around physical activity cannot therefore simply be imposed by the environment, but can only emerge from a productive engagement with a wide variety of spatial and social settings which, in themselves, then reconfigure the cultures of environmental understandings. The search for causal relationships between environmental features and levels of activity is thus not only shortsighted, but also is complicated by the fact that urban design does not go hand in hand with particular behavioral choices, as the (often inbuilt) failures of social architecture have long shown (see, for example, Holston, 1989). Indeed, as Cattell et al (2008) note, individual perceptions of local environments and their correlation to health outcomes are uncertain at best. As a result, ``we cannot automatically assume that the association between neighborhood assessments and health are causal. People in poor health may be more likely to be negative about their areas; or people with a generally pessimistic world-view may be more likely to report both their health and their neighborhoods as being poor'' (Ellaway et al, 2001, page 2314). Consequently, faith that modifications to the built environment will foster the ability and propensity to be more active is a strong statement of the desirability and utility of `instrumental' urban spaces. Gauging whether `desirable' spaces are instrumental in the sense of producing increased levels of physical activity demands the kind of surveys of behavior and attitudinal change which are increasingly common among ecological approaches to public health and yet absent in the drive to reduce the `beneficial properties' of urban spaces to ``a set of design-based natural or aesthetic criteria'' (Cattell et al, 2008, page 556). One of the research priorities of NICE is thus to develop ``reliable and valid impact assessment methods that can identify changes in physical activity levels resulting from changes to the physical environment'' (2008, page 22). It should be added to this that an understanding of the ways in which changed perceptions of the physical environment through the uptake of physical activity whether cycling or walking to work, or through sports participation is also needed. This necessitates the kind of qualitative, participative, ethnographic research that might offer sustained theoretical engagement with the notions of culture, health, and the environment. If space is to be successfully reconfigured to help people lead active lives and provide them with the amenities to do so, it cannot exist in isolation. Spaces become places by virtue of their multiple, contested, and recursive interconnectivities and, in so doing, derive value, meaning, and relevance. However, unless the intentions of urban planners and designers enshrined within the guidelines considered in this paper are rendered legible to residents and users of space, then the hope of catalyzing a `cultural shift' will remain silent. In other words, for environments to be read as spaces of possibility for physical activity, these cross-governmental aspirations of an `active' societyboth in body and mindmust be made clear and their links to immediate environments rendered explicit so that people can make decisions among competing behavioral choices. Yet, achieving this degree of legibility requires attention not just to how neighborhoods can be redesigned to encourage physical activity, but to how residents will then value and understand them as active, healthy citizens. These broader social questions are important as ``neighbourhoods are arenas in which people make social comparisons which can affect their sense of well-being, often in a context where the fortunes of others are all too evident. Housing, planning, health and social policies need to take this message on board whilst acquiring a better understanding of the role of the neighborhood in people's social lives and perceptions of the self '' (Ellaway et al, 2001, page 2315).

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As a recent CABE (Centre for Architecture and the Built Environment) report notes, there may be ``increasing recognition of how the design and maintenance of the built environment impacts on activity levels ... [but] currently little incentive to make the connection meaningful'' (2006, page 5). Without meaningful connections between the built environment and the uses expected of it by policy makers, there can be little hope that these instrumental uses will occurespecially given the manifold governmental agendas and realms across which these issues cut. Hence, it must be asserted that, rather than instrumentality, the intrinsic value(s) of space need instead to be researched, understood, and, where possible, cultivated. Sadly for policy makers, this involves the far more nebulous, intangible qualities of meaning, value, pride, community, inclusion, respect, loyalty, and a raft of other aspirational indicators that are inherently problematic to quantify, let alone measure accurately. These indicators, closely linked to quality of life, are central to individual and group well-being and are thus crucial precursors to the motivation, confidence, and capacity to use space instrumentally for purposes such as physical activity. These upstream measures demand attention if the reworking of the built environment is to be greeted with the kind of success that the promised Olympic legacy will demand. At root, some people will always be active wherever they live whether through self-selection in `fit' neighborhoods or through behavioral habit. Others, however, will remain inactive in even the most `fit' environment, a situation in which design guidelines alone will not remove the need for behavioral interventions ``delivered either at the level of the individual or household or through group-based approaches'' (Ogilvie et al, 2007, page 1204). The urban is a maelstrom of human life and such variety is a vital constituent of this. There is little doubt that active lifestyles have clear health benefits (Anderson, 2007), but an appreciation of the intrinsic value of space might also generate that sense of personal ownership or control over life and health that is so crucial to both physical and mental well-being. 5 Conclusion In this paper I have suggested that current governmental policy attention to the potential role of the built environment in encouraging physical activity marks out some potentially valuable areas of urban geographic research. Indeed, while `ecologic' approaches to public health are gaining in popularity and `ecologies' (political and not so political) of the city have assumed importance in urban geography (Heynen et al, 2006; Robbins et al, 2001), an opportunity remains to meld the two in order to critically explore the urban ecologies of health and illness fostered by the schisms in people ^ city interactions made increasingly explicit through the concerted governmental focus on deprivation and social inclusion (DCLG, 2006; 2007b; ODPM, 2004; PM Strategy Unit, 2005). This need might be addressed at a number of scales, ranging from micro studies of the household, to the neighborhood (especially given that policy work conceptualizing the urban environment and its causative role in health outcomes is most often framed at this scale), the city, the region, and the nation. While this undoubtedly leaves the research field wide open, the potential range of scalar approaches also demonstrates the interconnections between the geographic scales at which environment ^ health behavior relationships are formed. These range from the tools and strategies used to decide on sporting amenity location at a national scale, to the ways in which individual household members might interact with immediate and distant natural and built environmental features in the pursuit of being physically active or in composing rationales for not being active. It is thus clear that, although the research field concerning the relationships between the environment and health behavior is already a busy one, there is a definitive need to think beyond the instrumental

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realms of causality and into the far more murky worlds of engagement and how these might be framed, politicized, and used to create new readings of urban environments and the potential consequences of these. To return once more to the guidelines explored in this paper, it is interesting that NICE recognizes the need for environments to be ``welcoming, attractive, interesting and even inspirational'' (2008, page 17) to encourage physical activity. Yet no further elaboration is given of how such qualities might be engineered or cultivated, despite the fact that these should evidently be at the heart of the proposed `culture shift' to a more physically active society. Given that `inspiration' is perhaps the crux of encouraging people to change ingrained habits, it seems curious that these somewhat problematic adjectives are left hanging. Yet, the fact that they are left on the sidelines again marks out an arena in which further work is very much needed. Indeed, to make spaces `welcoming' means going beyond simply signposting staircases or using ``innovative playground design'' (NICE, 2008). It also requires thinking in far more lateral and multidimensional ways than are possible in ``prioritizing cyclists and pedestrians in planning'' (NICE, 2008). It means thinking about people not through a service-delivery lens as abstracted staircase, bike, or playground users, but as authors of their own and others' environmental scripts. Being active is one particular storyline which can and does change at willa state of affairs rarely predictable in or by the nature of the built form. What needs to be taken forward, then, is that a `culture shift' is not just a shift in how we use the environment, but also in our attitudes towards the places in which we livein many respects, regardless of whether or not we choose to be physically active. Indeed, while demonstrable improvements in physical activity rates might well be the focus of government attention, this should not sanction a turn away from the broader questions of well-being that also indelibly mark our perceptions of place and, therefore, our health outcomes. In recent years, physical activity seems to have become a panacea for an increasingly wide array of social ills and sport is now firmly included within the Labour Party's social inclusion agenda (Sport England, 2007b; 2007c; 2007d). Yet the potential domains across which physical activity uptake is being suggested to have an influence extend far beyond public health or social inclusion alone, and into the arenas of neighborhood renewal, public safety, and urban regeneration. Despite its comprehensive nature, this trend seems to have passed largely unremarked and without thought for the potentially disparate consequences encapsulated within its rationale. While this shift in the instrumental value accorded to physical activity has clearly emerged mainly from overriding concern with the anticipated long-term health and economic costs of obesity, the justification for this rests on a false and misguided assumption that the English have become indelibly lazy (Stamatakis and Choudhurty, 2008). By extension, it also assumes that by reversing this assumed descent, sport and activity can once again become a vehicle for both the kind of moral vigor and the bodily improvement needed to realize the UK government's host of ambitious PSA targets. I started this paper from the proposition that not only could urban geographers have much to say about this, but that this agenda means that greater attention needs to be paid to the multiple ways in which cities, in particular, are now being read by many policy makers as compartmentalized spaces that can be engineered and augmented to induce the behavioral outcomes necessary to achieve an increasingly wide array of public health, social, and economic targets. However, meeting governmental targets for physical activity uptake represents only one among many possible readings of the built form and its inhabitants. There therefore needs to be some recognition and acceptance that there may always be a disjuncture between the aspirations of instrumentality and the reality that the intrinsic values and understandings which tend to

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guide behavioral choice may well exist beyond external influence. As a consequence, accepting this disjuncture should also be central to the aspirations and politics of an inclusive public health.
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