Urban Futures

COVID-19 has comprehensively disrupted urban mobility systems. Public transport authorities are running skeleton services, while streets are less congested. In the midst of lockdown conditions, urban mobility systems look unrecognisable. Here, Dr Mike Hodson and Professor Andrew McMeekin reflect on how different areas have responded to the lockdown, and discuss key considerations that will shape post-pandemic transport.

Pre-COVID urban mobility

Our work on Greater Manchester’s existing transport system revealed long-standing challenges that are shared by many urban areas: over-dependence on cars, congestion at peak times, a privatised and fragmented public transport system of highly uneven and often very expensive (especially compared to London) provision, air pollution hotspots, unsustainable carbon emissions, and investment on infrastructure that focused on the city centre and strategically prioritised connections within the wider metropolitan area.

However, in the context of devolution, we have seen some progressive changes, including ambitious plans announced for a major new cycling and walking infrastructure and proposals for taking bus provision under municipal regulatory control. These developments were starting to address our call for a focus on the travel needs of all citizens, delivered under new governance arrangements of ‘civic futures’.

New, disruptive digital innovations have also reconfigured urban mobility systems. In pre-COVID transport systems, digital platform technologies – from the ride-hailing platform, Uber, to the mapping platform, Citymapper – were being experimented with by both private investors and via a renewed civic politics.

The challenge for existing forms of urban public transport, and for imagining the future role of digital platforms in urban mobility, is that they are predicated on mass, shared usage. Social distancing and lockdown, in the short-term, fundamentally challenges principles of shared ridership and shared usage and has stimulated a variety of responses.

Urban transport during the lockdown

Despite widespread disruption under lockdown conditions, a range of initiatives in different urban areas have been emerging that are starting to reimagine the fabric of urban transport. At the same time, evidence has been emerging about how empty streets during lockdown led to improved air quality and lower carbon dioxide emissions, renewing public debate about what future low-pollution, low-carbon urban mobility should look like.

It is within this context that cities have introduced new mobility initiatives: Milan has introduced measures to reduce car use and turn over 35km of city streets to cyclists and pedestrians; France has made €20million available for citizens to service bicycles to promote cycling, and Manchester has announced the pedestrianisation of Deansgate, one of its major thoroughfares. Greater engagement through various networks, such as the C40 group, has allowed cities to learn from each other. These networks should be developed to enable further sharing of key lessons.

Platform-based mobility providers have also been adapting, introducing in-vehicle segregation and no-contact deliveries. Also, in a new partnership with the World Economic Forum, German start-up Wunder Mobility has launched #WeAllMove, an open digital platform that connects essential services with mobility providers.

Similar open digital platforms could serve as a model for UK policymakers as lockdown restrictions are eased, but the need for distancing remains.

Some lockdown interventions – eg ‘temporary’ widening of cycle lanes – have been introduced as sticking plasters to cope with current circumstances.  But as people start to appreciate and experience them as the new normal, they may become permanent. On the other hand, some interventions, such as Paris mayor, Anne Hidalgo’s, plans for a more self-sufficient ‘15-Minute City’, have been much more openly directed towards experimenting for long-term change, with the lockdown seen as an opportunity to create more sustainable and effective mobility systems for the future.

Social distancing has meant the ‘sharing’ envisaged by ride-hailing companies has become problematic. This has created pressure to repurpose digital platforms for an era of social distancing. To do this effectively will require building new relationships between policymakers and platform expertise. This will be needed to develop mobility apps for processes of contact tracing and social distancing, which will likely become fundamental to monitoring and controlling urban movement.

With many nations easing lockdown measures, a key concern is how to get people moving in dense urban areas while maintaining social distancing measures. This risks favouring private cars over public transport. It also poses questions about which of these experimental interventions will solidify, which will be exposed as temporary and what this ultimately means for the organisation of urban transport systems.

Beyond COVID?

The lack of a vaccine means we don’t know when we will be ‘beyond COVID’, and predicting what urban mobility will look like is inevitably even more speculative than regular future gazing.

That said, current responses and interventions give us some clues. The reclaiming of streets for active travel in the absence of cars may become sufficiently popular to persist, especially in city centres. The end of rush hours could be facilitated by collective discussions about more genuinely flexible working patterns. This could involve solidifying home working and staggered commute times.

On the other hand, disruption to public transport, which is not well suited to social distancing, seems likely to continue for some time. In the period before buses, trains and trams return to full-scale operation, private mobility platforms may seize opportunities to fill the vacuum.

Policymakers must robustly protect the public interest over the possibilities for short-term profits for narrow social interests.

How this plays out is likely to be shaped by how the wider political and economic conditions of a post-COVID world shape future urban transport systems. The crisis has required a renewed reliance on a state that intervenes more deeply in the organisation of economic life and in securing the health of its citizens. A key question is whether this more interventionist state will be confined to responding to the immediate crisis before bouncing back to ‘business-as-usual’ or whether we are seeing the foundations of deep institutional and structural change? The answer likely rests on a combination of what the length, depth and scope of the COVID-19 crisis is, including the length of a global economic downturn, and the range of societally feasible political and experimental ideas that are available to draw on.

The fallout from COVID-19 is likely to intensify this political-economic struggle between the private investment opportunities provided by digital platforms in urban centres, and a new civic politics of digitally delivered provision that seeks to use platforms to bolster collective priorities via existing urban transport systems. How they are rebuilt, with which combinations of transport mode and under what arrangements of ownership and control, will shape the sustainability, resilience and effectiveness of future urban mobility systems.

Originally published 12 June 2020

Older people have borne the brunt of deaths from COVID-19, whether in hospital or in care homes. At the same time, the coronavirus emergency sits alongside a crisis in many of the communities in which older people live. Here, Chris Phillipson, Camilla Lewis, Tine Buffel, Patty Doran and Sophie Yarker examine how the pandemic will affect older people living in areas of multiple deprivation.

Where you live matters greatly for your quality of life in older age; it matters also for whether you are protected from COVID-19. The Marmot Review, examining changing health inequalities between 2010-2020, highlighted the increase in deprivation affecting many parts of England. Area deprivation is also associated with higher levels of social exclusion in later life, for example to services, participation in leisure activities, and relationships with friends and family. Quality of life will also be affected by housing conditions – especially important given restrictions imposed by social distancing.

Nearly three-quarters of a million people 75 and over live in what are termed ‘non-decent homes’ – a higher proportion than any other age group. The most common reason is the presence of a serious hazard posing a risk to the occupants’ health or safety, such as inadequate heating or a fall hazard. Over a million over- 55s are living in a home with at least one such problem. It is hardly surprising that the Office for National Statistics (ONS) has reported that those living in the poorest parts of England and Wales are dying at twice the rate from COVID-19 compared with those in more affluent areas.

Figure 2. Deaths in the most deprived areas are considerably higher than in more wealthy neighbourhoods

Double lockdown

As the impact of coronavirus grows, older populations who are social distancing may be doubly locked down – suffering the effects of social isolation whilst living in places affected by substantial cuts to public services. This challenges us to ask fundamental questions about the changing nature of our communities, and the responses necessary to assist older people during the pandemic. With the likely continuation of social distancing rules in some form, the implications for neighbourhood support requires urgent attention. The danger at the present time is that the pressures facing communities are being over- simplified through two competing narratives:

The first portrays a romanticised view of neighbourhoods coming together against a ‘common enemy’, symbolised by the weekly applause for NHS workers, along with the deployment of an army of volunteers stepping forward to support vulnerable groups.

The second highlights reports of outbreaks of unrest caused by the constraints of the lockdown, suspicion of neighbours flouting the guidelines, and selfish behaviour in supermarkets.

It is certainly the case that many social groups have emerged to provide support for those whose isolation has been compounded by COVID-19. In some cases, this builds upon existing voluntary and mutual aid organisations which have replaced services from the local welfare state. But it is important not to ignore evidence about the long-term changes affecting communities. Roughly at the same time as COVID-19 started to spread across the country, the Office of National Statistics (ONS) provided an update on its review of trends in social capital in the UK. The results highlighted significant developments over the past decade, with evidence of less positive engagement with neighbours, less help being given to groups such as older people, and a reduced sense of belonging to the communities in which we live.

The findings from the ONS should not come as a surprise: the last ten years has seen an upsurge in inequalities within and between neighbourhoods in the UK, with zones of affluence and poverty existing side by side. But the majority of attention has focused on growing disparities between income groups, rather than the impact on relationships in everyday life. COVID-19 and measures such as social distancing, will ‘stress test’ the ability of communities to work together to protect vulnerable groups. The pandemic underlines the degree to which social processes relating to inequality, discrimination and racism contribute to the distribution of illness and deaths caused by COVID-19. Social interventions in marginalised communities are now urgently required to strengthen defences against subsequent waves of the virus.

Community development policy

We would argue for a new community development policy to assist the most deprived neighbourhoods in the UK. The policy will need to comprise:

Funding:  Disinvestment in social infrastructure has resulted in the closure of libraries, day care and community centres. Such resources are essential for providing informal spaces for people to meet, and both support and empower vulnerable groups. Deep cuts to local authorities over the past decade have resulted in significant financial pressures on all public services. Local authorities suffered a 49.1% real terms reduction in central government funding from 2010 to 2018.

Areas of multiple deprivation must be prioritised in future government spending. Such funding will need to be complemented by a national strategy to tackle health inequalities, drawing on lessons from the Marmot Review, and studies showing the detrimental impact of neighbourhood deprivation on older people’s quality of life. Targeting older people at risk of isolation, by focusing resources on socially excluded places, must be an essential part of the government’s recovery strategy.

Locally based partnerships: Interventions which have the most impact are those designed to meet the specific needs of communities, in situ. A one-size-fits-all approach to community must be rejected, in favour of tailored support to meet the needs of different groups through encouraging dialogue between local residents, voluntary organisations and the public sector.

Local authorities need to give urgent attention to developing new models of neighbourhood working as part of their recovery strategies from the pandemic.  Such ways of working will encompass a variety of approaches, for example: advocacy, befriending, counselling, and organising social activities. These types of support have become essential in the current crisis and need to be strengthened over the longer-term. However, given the extent of the crisis affecting communities, a broader range of activities at a neighbourhood level should be encouraged, including: providing food co-ops, home repair services, financial advice, and protecting people from various forms of abuse.

Challenging discrimination: Coronavirus is disproportionally affecting groups based on age, ethnicity, gender, disability, and sexual orientation. Continued social distancing is likely to reinforce ageism and age-based divisions within communities. The number of deaths (direct and indirect) in care homes from COVID-19, and the delay in recognising the extent of the disaster, illustrates the extent of the crisis in social attitudes towards ageing. Older people are increasingly presented as a  burden in relation to the economy, pensions and social care – an issue which needs to be tackled at all levels of society.

We support the call from the British Society of Gerontology and the Centre for Ageing Better for a fundamental culture shift to challenge negative attitudes towards older people. Given the risk for greater age segregation occurring as a result of COVID-19, it is essential to foster contact between generations, challenge ageist stereotypes, and highlight the diversity of experiences in later life. We also urge the government to work with national and local equalities organisations to support older people who are facing intersecting pressures relating to ageism, racism, and sexism.

Originally published on 1st June 2020

In a recent clip widely shared on social media, Newsnight’s Emily Maitlis highlighted the inequalities at the heart of the current COVID-19 emergency, describing it as “a public health issue with huge ramifications for social welfare and a social welfare issue with huge ramifications for public health”. Dr Bella Starling, Professor Arpana Verma and Nasima Begum outline how COVID-19 can disproportionately affect those who are already impacted by social, ethnic and gender inequalities.

Prevalence and risk

Emerging data show that nearly 35% of people who are critically ill with coronavirus are from Black and Asian backgrounds. This is higher than the 13% of the UK population who identify as from Black, Asian and ethnic communities in the last Census. While some factors might explain this higher proportion – for example, COVID-19 has primarily affected urban areas, including local authority wards with large, ethnically diverse populations – based on this current data, Black people are significantly more likely to be critically ill with COVID-19 when taking account of local demography.

Those with ‘underlying health conditions’ have been shown to be at risk of more severe cases of COVID-19. BBC News have reported that nine out of ten COVID-19 deaths recorded by the ONS so far have featured underlying health conditions. In this context, it is imperative to recall that ‘underlying health conditions’ are often associated with those that are already marginalised or living with protected characteristics. For example, diabetes is associated with higher risk of COVID-19. At the same time, people of South Asian origin are up to six times more likely to develop Type 2 diabetes than the general population in the UK. Such correlations may account for some of the greater numbers of hospitalisations being seen in ethnic communities, though further evidence and analyses are required.

There is also increasing evidence of a gendered aspect to COVID-19 risk. Men are more severely affected than women, according to mortality data. In this case, it is important that this disparity, occurring as it does along the lines of a protected characteristic, are taken into account when creating policy responses and the development of clinical practice.

Access to care and treatment

Evidence shows that in some conditions people present differently for care. LGBT communities, for example, are less likely to access healthcare. In cancer, Black, Asian and ethnic communities present later, at a more advanced stage of disease. Awareness and help seeking behaviour is low across all ethnic groups, with the lowest awareness in the Black African group. Access to screening, and the location of COVID-19 screening facilities, is therefore vital and needs to be inclusive of areas where different communities are located.

Great strides have been made in supporting the move to remote healthcare consultations and online interactions during the coronavirus outbreak. However, access to technology is unequal. Those in manual occupations and the unemployed have lower rates of smartphone use: 67% in lower (eg. DE) socioeconomic groups and 86% in higher (eg. AB) socioeconomic groups (in 2018). In addition, little is known about attitudes and acceptance of telehealth methods amongst diverse groups. Take diabetes again, for instance; low participation rates of ethnic diabetes patients have been reported in systematic reviews focusing on telehealth interventions, and the ethnic composition of studies is often unreported.

Workforce(s)

Those in public services and the service industry, who work with large numbers of the general public, are at greater risk of exposure to COVID-19. Their numbers include high rates of Black, Asian, and working class members. According to a recent report, BME individuals account for 21% of all NHS staff; 20% of nursing and support staff and 44% of medical staff. Tragically, as of 22^nd April, they also account for 63%, 64% and % of deaths in the same staff groups. In addition, 50% of health and social care workers who have died were born outside the UK, compared to a reported 18% of NHS staff.

The same report highlights that women are in higher numbers in this dataset (contrasting with the dominance of men infected or admitted to intensive care). Taken together, these data might suggest that the burden of, and risks associated with formal care during the outbreak (and perhaps also the burdens of informal care: community volunteering, homeworking and home-schooling) fall more to women, ethnic and migrant groups, reinforcing societal inequalities.

Society and communication

In the early stages of the outbreak, an Ipsos MORI poll showed that casual racism was becoming apparent: 14% of those surveyed would avoid people of Chinese appearance. Should any prejudice arise against those who have had COVID-19 (once testing is more firmly underway), how can we guard against such prejudice being experienced by people with protected characteristics, if COVID-19 incidence remains higher among these groups?

People with limited financial and social resources are more likely to have limited health literacy, and we know that people from different backgrounds and protected characteristics seek health information through a variety of different and culturally specific media. The majority of mainstream health reporting is dominated by White voices, which may be a ‘turn-off’ for some communities seeking information about coronavirus, and social media can often provide incorrect information.

More widely, outside of the regulated systems of NHS patient and professional interactions, the wider move to increased online communication during this pandemic needs to be conscious of accessibility and language, as well as historical and recent targeting of people with protected characteristics online.

Finally, the language around COVID-19 and ‘underlying health conditions’ can be damaging. Language, and all its nuances, has power that goes beyond the speaker. It can guide our thinking and behaviour, providing a backdrop to what might be considered ‘normal’ or acceptable. So, when, probably through no ill-intention, narratives emphasise the serious risk of dying from COVID-19 ‘mainly’ amongst those with ‘underlying health conditions’, these can lead to the consideration that there are members of society who are considered to be more disposable than others. A recent editorial commented how labelling causes stigmatisation and public health should focus on reducing the stigma associated with COVID-19 to “inform immediate and long-term strategies to build empathy and social justice in current and future pandemics”.

Keeping inequalities central to the COVID-19 response

So, in Emily’s words, how do we stop inequalities becoming even starker because of coronavirus? Nationally, research is massively mobilising, including in Greater Manchester.

It is clear that COVID-19 is exacerbated by social inequalities, with marginalised groups often at most risk of contacting the illness and their illness more likely to be severe. Research, policy and practice needs to quickly adapt to this fact, and put social, gender, racial and access inequalities front-and-centre in our response.

With that in mind, we propose the following steps to help in this effort to ensure that we leave no-one behind;

Better understanding of the patient experience of COVID-19 in those with protected characteristics, and investigations into the biological, medical, or sociological factors. NIHR and UKRI have responded to the emerging data with a funding call to explore the association between ethnicity, COVID-19 incidence, and adverse health outcomes. This is to be applauded, demonstrating agility and flexibility in signalling the importance of this research as quickly as possible. Interdisciplinary research could further strengthen the evidence base.

Coronavirus research (including research priorities, planning, design and implementation) must be inclusive of people and patients including those with protected characteristics. NIHR has demonstrated leadership through its commitment to working in partnership in research with patients, communities and the public (public involvement, engagement and participation) during the pandemic in line with the UK Public Involvement Standards.

COVID-19 related research needs to capture as much data as possible so as to be able to carry out subset analyses. There is an important role for ethics committees in ensuring that this can be carried out.

Engagement with COVID-19 and related research, whilst supporting vital public health messages, needs to be imaginative, creative and inclusive in its reach, with appropriate translations as a minimum. Learning from how science communicates and listens to less well heard communities might be helpful here, as is keeping online safeguarding high on the agenda.

Learning from existing good practice that places health inequalities at the heart of translational research. For example,

·      The Health Inequalities Steering Group supports the Manchester Biomedical Research Centre and Clinical Research Facilities to be conscious of, and address, health inequalities through its research

·      Applying the Health Inequalities Assessment Toolkit to translational research

·      Research advisory groups that focus on those with protected characteristics – e.g. The Public Programmes Team’s: Black Asian Minority Ethnic and Refugee research advisory group, Voice Up (Young People’s Research Advisory Group), and Deaf Experts by Experience

·      Programmes of work focused on health inequalities including (but not limited to) the Manchester Urban Collaborative on Health, i3HS Hub, Division of Population Health, GM ARC, Health Innovation Manchester, GM Patient Safety Translational Research Centre, the Manchester Biomedical Research Centre and Manchester Clinical Research facility.

Finally, we look forward to the results of the Parliamentary inquiry into COVID-19 impacts on those with protected characteristics, to which we have submitted evidence, and hope that these lessons can be learned in time to mitigate the risks and ensure we leave no-one behind.

Originally published 28 April 2020

With special thanks to our contributors:

Nasima Begum is a poet, producer and creative practitioner. She is a trustee of Young Identity, Manchester's most exciting collective of writers, musicians and artists who are currently resident artists at HOME. She is currently the Youth Project Coordinator at Ananna, an organisation for women and girls to enable positive change within their community. In her role she works with marginalised young people to access opportunities and reach their potential through creative workshops and 1-1 work. Nasima is also a member of BRAG (BAMER Research Advisory Group).

Tine Buffel is a Senior Lecturer at The University of Manchester, where she directs the Manchester Urban Ageing Research Group (MUARG). She has published widely in the field of ageing, with a particular focus on issues relating to urban change and social exclusion in later life.

Juan Manuel del Nido is a social anthropologist and economist. His research interests include examining how everyday residents understand the political and that which transcends it; and labour and economic relations in Argentina.

Patty Doran is a Research Associate for the UK Data Service based in the Cathie Marsh Institute for Social Research at The University of Manchester. Patty’s research has focused on ageing, inequalities, social support and the life course, and using mixed methods to address complex research questions.

Francesca Gains is a Professor of Public Policy and academic co-director of Policy@Manchester. Before becoming an academic she worked in local government & the probation service, and has both government funded and Parliamentary research experience. She is a Fellow of the Academy of Social Sciences and on the editorial board of the Journal of Public Policy, Local Government Studies and the International Review of Administrative Sciences.

Graham Haughton is Professor of Urban and Environmental Planning at The University of Manchester. Graham's research interests include sustainable urban development, urban regeneration, regional development, and water conflicts.

Mike Hodson is Senior Research Fellow in the Sustainable Consumption Institute. His research focuses on the shape of future sustainable cities and understanding the role of urban infrastructure in this.

Camilla Lewis is a Senior Lecturer in Ageing and Urban Studies at Newcastle University. She joined in July 2019 from The University of Manchester, where she led an ESRC-funded project about ageing in place. She is a social anthropologist interested in interdisciplinary approaches.

Yaron Matras is Professor of Linguistics at The University of Manchester School of Arts, Languages and Cultures. He specialises in the study of multilingual societies and the documentation of various languages including Romani, Kurdish, and Arabic dialects. He is the founder of the Multilingual Manchester research unit.

Andrew McMeekin is Professor of Innovation at Manchester Business School and Research Director of the Sustainable Consumption Institute. Until recently he was co-director of the Economic and Social Research Council (ESRC), Scottish Government and Defra funded Sustainable Practices Research Group (2011-2014). His current research looks at how persistent sustainability problems can be addressed through long-term socio-technical system innovation, especially in energy, mobility and housing.

Chris Phillipson is Professor of Sociology and Social Gerontology in the School of Sciences at The University of Manchester. He has published extensively on issues relating to ageing in cities, and issues relating to the transition from work to retirement.

Nuno Pinto is Lecturer in Urban Planning and Urban Design at The University of Manchester. His research interests focus on the use of quantitative methods in urban planning and their integration in decision-making processes.

Marianne Sensier is a Research Fellow in Economics and the Alliance Business School at The University of Manchester. Marianne’s main research focus is on the application of econometric methods to macroeconomic problems.

Bella Starling is a Wellcome Trust Engagement Fellow and Director of the Public Programmes team at Manchester University NHS Foundation Trust. Her career has spanned neuroscience, genetics and stem cell research, science writing, biomedical ethics, public engagement, patient involvement and science policy, as a practitioner, action researcher, strategic adviser and funder. She is passionate about inclusion in, and democratisation of, research; her Fellowship explores how public engagement with research acts as a catalyst for social change.

Elvira Uyarra is Reader in Innovation Policy and Strategy at the Alliance Manchester Business School and Director of the Manchester Institute of Innovation Research. Elvira is also adjunct professor at the Mohn Center of Innovation and Regional Development at the University of Western Norway and visiting fellow at the Centre for Innovation Management Research (CIMR) of Birkbeck, University of London. She teaches and conducts research on science and innovation policy and management and on regional innovation. She is fellow of the Regional Studies Association (RSA) and Chair of the North West of England branch of the RSA.

Arpana Verma is Head of the Division of Population Health, Health Services Research and Primary Care. She is Director of Manchester Urban Collaboration on Health (MUCH) a WHO Collaborating Centre and honorary Consultant in Public Health at PHE.

Iain White is Professor of Environmental Planning at the University of Waikato. He researches issues connected to the interface between science and decision-making.

Sophie Yarker is a Research Fellow at the Manchester Institute for Collaborative Research on Ageing (MICRA). She has a background in human geography and sociology with research interests in community, belonging and civil society.

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The opinions and views expressed in this publication are those of the respective authors and do not necessarily reflect the views of The University of Manchester.

August 2020

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