The Imperative Intersection between Climate and Health - Interview with Agnès Patuano

By Theresa Konova & Tobias Arends

Figure 1: An urban green space comprising smart, fair and healthy urban greening strategies, Parc de Bruxelles. Photo: João Cortesão, 2024. In: Reporting the Delta. NAI010 Publishers.

TOPOS was invited to the publication event of ‘Reporting the Delta’ by nai010 publishers. Following the event, we’ve asked Agnès Patuano, WUR teacher and researcher about the article she wrote together with João Cortesão – a former WUR colleague and urbanist who currently works as senior advisor for innovation and EU collaboration at the municipality of Utrecht. The article ‘Climate & Health: A Shared Prescription for a Better Future’ talks about the intersection between climate resilience and public health and how we could design integrated solutions to improve both, particularly in vulnerable delta regions.

Climate and health are often discussed separately. Why did you feel it was important to bring them together?

AP:

João and I wrote this article to explore the link between public health and urban climate. I’m not a climate expert myself, but I’ve noticed that climate research tends to treat climate as a primarily biophysical issue, something we can measure and model through temperature, evaporation, or surface materials. Health, on the other hand, is seen as far more subjective, personal, experiential, and shaped by daily life. Yet at its core, everything we do in spatial design is about health. Design is never intended to harm people; it is always meant to support wellbeing in some way. And when we’re looking  at climate resilience through that lens, suddenly things become much less quantifiable. It’s no longer just about how many trees you plant or how much shade you create, but about whether people can actually use those spaces. A shaded area that is inaccessible or unsafe does very little for public health.

What we wanted to do in the chapter was to bring those perspectives together, to look at the synergies, but also the trade-offs, between climate measures and health outcomes. Not to prescribe solutions, but to slightly shift how people think about urban resilience.

Your chapter also draws on the concept of “One Health.” What does that add to the discussion?

AP:

‘One Health’ is still an emerging framework. It partly resulted from the COVID crisis, and it is based on the idea that health is the result of complex interactions within a socio-ecological system. So, it's not just focussing on human health or environmental health but rather considering health as a combination of the two. Human health, animal health, plant health, and environmental conditions are all interconnected. The concept is not well defined yet, so there's still a lot of work being done on what that means in practice. But, for landscape architects and spatial planners, it is extremely relevant. It means we can fully consider landscapes and urban environments as public health resources. It puts spatial design at the same level as other ‘big topics’, meaning there's more funding available and that there's more room for us to really come up with innovative solutions.

For example, when looking at heatwaves, we're not just looking at them from a biophysical perspective: how do we get shading into the cities? How do we lower temperatures? With a ‘One Health’ perspective, we're also considering how people actually experience heat stress in their daily lives, how it affects mobility, social interaction, or vulnerability. We are considering ‘how can we relieve people from heat stress?’ In essence it encourages a more integrated vision.

It is also a particularly relevant concept when looking at Delta regions. There, you cannot  separate the health of inhabitants from the state of the environment, but instead you have to look at the system as a whole. Water management and flood safety are no longer purely technical challenges but are increasingly tied to public health. This creates space to explore both the synergies and trade‑offs of design decisions for the daily life of residents of these regions.

TA:

You're treating health as an interdisciplinary theme that can encompass a lot of different issues that we have. Given that, the changes in the public space can vary a lot between different regions. How would the life of the people living in urban delta cities change if we would plan or design for the ‘One Health’ concept?

AP:

Yes, this framework gives us a bit more room to argue for more integrated solutions, to make the cities more comfortable and cooler for daily life while also being better prepared for extreme weather and flooding events.

That might mean a more extensive and connected green-blue network, for example, that would encourage people to be active in a safe and comfortable way. There could be also other flexible design solutions that combine water storage with space for recreation and physical activity. What’s crucial is that these solutions are conceived as an integrated part of the urban fabric, rather than treated as isolated interventions.

For delta regions especially, the contact with water would become central. Currently, water is still mostly seen as an ‘enemy’, something to control or keep out. How do we shift this view towards a more symbiotic relationship with water? If we start treating it as an integral part of everyday life, it can also become a valuable resource for health. That might include more opportunities for contact with water, for example, by creating safe swimming areas, accessible waterfronts and spaces where people can engage with water in various meaningful ways.

Figure 2: Blue and green infrastructure can help create healthy urban environments for everyday life, Utrecht. Photo: João Cortesão, 2024. In: Reporting the Delta. NAI010 Publishers.

TK:

Speaking about the integral part of water in our lives: do you think that water environments and their species would be more integrated in the human lifestyle if we let the water reclaim more space? If we have more different and dynamic habitats, for both water and humans?

AP:

In The Netherlands, there is an extremely rich and powerful history of keeping the water away and reclaiming land from it. But working with it can be much more powerful, not just technically, but psychologically. When people live with water, when it is visible, accessible, and part of their daily life, they tend to develop a sense of stewardship. They become more understanding of it, more protective, and more aware of its dynamics. That relationship is important for real resilience. 

But like in many cases, there is a trade-off to this. You might want to have permeable surfaces everywhere, but those can be difficult to navigate for people using wheelchairs or mobility aids. And often, human infrastructure and access to healthcare facilities like hospitals and care centres must be prioritized over more climate-focused solutions. I don’t think there is ever a one-size-fits-all solution. The challenge lies in balancing these needs, often through spatial and temporal layering, allowing places to serve different functions throughout the seasons or at different times.

TA:

Sometimes I feel like many different places share the same design solutions, the green-blue network for example. In a world that needs to adapt, how do you keep the spatial identity of a place, even when the challenges might be similar?

AP:

Again, there is never a one-size-fits-all solution. Even though we sometimes wish there was, with the creation of design principles and guidelines, in the hope of producing knowledge that is generalizable. But everything we do is context dependent. It’s about cultural heritage, local identity, and everyday practices.  Participation plays a key role here. And meaningful participation is very difficult, but the more you integrate people into the design process, the more likely you are to create solutions that are targeted to local needs.

TA:

Is there a hierarchy within the ‘One Health’ concept?

AP:

I think the concept can be very powerful as a discussion tool to leverage funding and influence policy. But philosophically, it’s not very robust, because there is an embedded hierarchy indeed.

I once spoke with researchers working on Lyme disease. Strictly speaking, the ‘One Health’ concept would treat tick’s health and human health equally. In practice, of course, we prioritize human health, and that’s not something we should deny.  Nature itself is hierarchical. There are apex predators and species lower down the food chain. Pretending everything is equal doesn’t reflect reality.

But for the application of the concept, we could look at how we can keep ticks out of cities and create other areas for them to thrive. Of course, then you face the question of whether we can create successful ‘rewilded’ places and pockets of nature, but that is a whole different topic. So, the concept is promising, but its implementation is still evolving.

TA:

Earlier, you briefly mentioned the importance of participation. Most times, participation is very human focused. And even though participation for nature exists, it’s maybe less prioritized currently?

AP:

I’m no expert on more-than-human participation. But I’ve seen examples  where people are advocating for other species, like shrimps for example. And I find that it often involves a large amount of anthropomorphism. Although I like the idea in theory, in practice I find it a bit disrespectful to the shrimps to put words in their mouths and pretend that we know what they want.

But, of course, it’s essential to involve ecological experts to weigh in on these kinds of topics and help assess the effects a spatial intervention might have on ecosystems. That knowledge, allows us to make choices. And inherent to those choices are trade-offs, because you can never design in a way that is good for absolutely everyone or benefits everyone equally.

TK:

Given that trade-offs are inherent to the choice-making process, how can you avoid creating new inequalities that didn’t exist before?

AP:

There are tools available to help us anticipate the impact of our interventions, like participation, health impact assessment and ecological impact assessment. Modelling techniques have also improved significantly in recent years.

But beyond evaluating the impact of design, you will need to make decisions. Take the issue of allergies for example, which is a very relevant topic when looking at the overlap between climate and health. Because we know that a changing climate means that pollen seasons are longer and more intense. In the BENIGN project, which is also mentioned in the chapter, we’re looking at which trees and plants not to plant, to avoid allergies. There are already a lot of guidelines available so we don’t create allergy-prone areas. At the same time, we need to strive for a balance here, because we also want to create opportunities for children to develop a stronger immune system so that they don’t develop allergies later on. Exposure to these allergenic species is important for kids to develop a resistance to it.

It is important to have a good idea of the vulnerable populations likely to be impacted by the design before you start. What are their needs, and wishes, where do they go, where don’t they go, etc. And what you consider to be a vulnerable population will change depending on the context. And sadly, there is never going to be a ‘best possible’ intervention that won’t create negative long-term effects of any kind. What matters is to be as mindful as we can and be aware of which population is being disadvantaged.

TA:

So, it’s a two-sided coin. We should try to be the best informed possible before starting to design, through participation, expert knowledge, and possibly modelling. But afterwards, we should also monitor whether the design is having the desired effect.

AP:

Indeed. We need much more post-occupancy evaluations to see how green spaces are being used 10 or 20 years down the line. And there is a real disconnect here between the scale of our lifetime and the scale of projects, research funding, and politics.

Most research projects last around five years, which is a standard length. It’s aligned with PhD timelines and election cycles. This is important because municipalities can change their policies throughout a project, which can affect their involvement and sometimes our access to populations. But to measure the effects of an intervention within five years is nothing. The effects of spatial interventions, particularly on health and climate, often take decades to become visible. Their impact occurs on such large scales that it’s almost impossible to measure in that short timeframe.

TA:

In public space design generally, are there any topics or groups currently that are undervalued and benefit the least, or are even negatively affected?

AP:

There is still a tendency to design green space primarily for decorative reasons. It’s only important for them to look pretty and there is less focus on the optimisation for health or climate. One of the benefits of the ‘One Health’ concept is to highlight the role that urban green spaces can have for both human and animal health.

Even though it is by no means a neglected topic, we should talk more about ageing. The world population is getting older, humans live longer, and the places we live in don’t necessarily have great quality for these stages of our lives. We need to give more attention to making all spaces accessible for people with physical disabilities. This also means designing green areas that feel welcoming for those who may not be comfortable in nature, by creating a gradual transition between built and natural spaces.

And finally, safety. It’s so important and yet still poorly understood. Just like ‘health’, safety is both objective and measurable, but also deeply subjective and individual. It can change throughout your lifestyle, your lifetime and even through the time of day.

Figure 3: Example of urban greening by the incrementation of vegetation

in urban areas, at both the public space and building levels. These actions

can excel when backed up by green standards. Tokyo, Japan. Photo: João

Cortesão, 2023. In: Reporting the Delta. NAI010 Publishers.

‘Do you have any concluding remarks?’

What João and I ultimately argue in our chapter is that climate-resilient design should never be an end in itself. Climate adaptation measures are a means, not the goal. The goal is the health and wellbeing of people, now and in the future. Without healthy people using and inhabiting public space, the public realm loses its meaning, and so does the purpose of spatial design.

By mapping the intersections between urban climate resilience and public health, we wanted to make visible what is often addressed implicitly or in isolation. Climate risks, spatial measures, and health outcomes are deeply intertwined, especially in delta regions where water, land, and everyday life are inseparable. Recognizing these intersections allows us to move towards more systemic forms of urban resilience, similar to what is advocated with the ‘One Health’ approach.

Ultimately, integrating climate and health represents a shift in how we think about urban resilience: from protecting systems and infrastructure alone, to safeguarding the everyday life and wellbeing of people. This shift is particularly urgent in delta regions, but its relevance extends far beyond them.

Figure 4: overview of the main intersections of urban climate resilience and public health. João Cortesão and Agnès Patuano, 2024. In: Reporting the Delta. NAI010 Publishers.