REPLENISH - REimagining PLaces and ENgineering Infrastructure Systems for Health

The infrastructure systems that support our urban systems and serve citizens, society and cities, have developed over centuries. They have been variously superseded, extended and supplemented as populations have grown, technology has developed and contexts have changed. This presents challenges of maintenance (keeping the older parts going) and integration (of the new with the old) as expectations of ever better service inexorably rise.
REPLENISH is focusing on the 'urban metabolism' - the flows of resources, goods and people into, around and out of cities. When the infrastructure systems underpinning this 'urban metabolism' work uninterrupted and unencumbered by excessive demand or lack of affordability, they work well and citizens are happy. This is the expectation. However there several factors combine to compromise the efficacy of these systems and materially damage citizen mental and physical health and wellbeing (H&WB):

- Many infrastructure systems are not run primarily for the benefit of the citizenry they serve. Where (e.g. many utility) services are provided by private companies, their primary responsibility is to their shareholders and profit is an overriding imperative. Regulation is a mechanism for acting for the common good, but can only be invoked using incontrovertible evidence.
- Our infrastructure systems are highly interdependent - a failure or need for major intervention in one will often have significant adverse consequences on many others.
- Rapidly-growing demand often outstrips supply, with effects most keenly felt in mobility systems. Congestion, delays, uncertainty of travel times and plotting of routes to 'beat the competition' lead to angst and stress ('commuter rage', cf. 'road rage', in the extreme) and compromised mental health.
- Infrastructure systems deteriorate with age, repeated use and due to environmental factors. Maintenance, refurbishment and replacement fails to keep pace with system-wide deterioration, causing failures and emergency repairs, and often major disruption. Disruption to the urban metabolism due to streetworks, arising from the physical interdependency of multiple buried pipes and cables beneath roads, is a prime example.
- Serious side effects of current mobility systems include engine exhaust emission and airborne particulates from vehicle breaks and tyres.
- Wealthier citizens can sometimes avoid such problems by using some of their wealth, whereas poorer citizens cannot. This results in H&WB inequalities.

Moreover, the solution to some of these 'urban metabolism' problems offer potential for physical exercise. Non-communicable diseases (NCDs), including heart disease, stroke, cancer, diabetes and chronic lung disease, are collectively responsible for almost 70% of all deaths worldwide. Radical changes to the quality of the urban environment and the way we move around cities would manifestly improve this situation.
Our infrastructure systems, as currently constituted, are therefore one of the major upstream determinants of NCDs and compromised mental H&WB, and contribute hugely to direct costs (e.g. to the NHS) and indirect costs (e.g. loss of productivity) to the UK's economy.

REPLENISH contends that if our infrastructure systems and their associated cityscapes were designed with positive H&WB outcomes as the primary design criterion, huge social and economic benefits would result. REPLENISH therefore proposes, by adopting systems thinking and systems engineering (or 'doing'), to:

- create the evidence base to prove the extent of the damage to citizen H&WB and the benefits of change,
- rethink and redesign our engineered infrastructure systems and cityscapes,
- create alternative business models that would prove the value of investment in making such change, and amended forms of governance that control their efficacy,
- prove the concepts via demonstrator projects in association with the Design Council, Sustrans and other user partners.

REPLENISH's vision is to transform:
- Cities into places that positively contribute to the health and wellbeing (H&WB) of its people.
- Those who shape and govern cities by understanding the health and wellbeing implications of the decisions and interventions they make.
- The research team (the academics, user and project partners) by developing transdisciplinarity practices.

REPLENISH's ambition is to create a new form of city engineering that embeds H&WB as the principal components in decision-making, specifically addressing the upstream causes of Non-Communicable Diseases, which to date has eluded current infrastructure and urban systems design.

REPLENISH will assess H&WB outcomes throughout the conception, design, trialling, implementation, monitoring and adaptation stages of radical urban interventions that combine:
- Reengineered 'urban metabolism' - the movement of people, raw materials and goods, and the removal of waste - using systems methodologies.
- Synthesis with urban systems. Radical urban interventions have the potential to address multiple problems and yield multiple benefits via a whole-systems approach. We will use highly-detailed, complex and comprehensive system mapping to reveal urban system interdependencies and all consequences, positive and negative, of iteratively-designed interventions. We will formulate alternative business models to facilitate their implementation in practice, and ensure (recommending change where necessary) that all systems of governance are in alignment.
- Reimagined urban places so that they synthesise with these transformed engineered systems and respond to future likely urban change. A truly smart, multiply-sensed, place would meet citizens' aspirations and deliver on cities' sustainability, resilience, liveability, health and wellbeing agendas.

REPLENISH will disseminate its findings widely and embed its methodologies in national and local policy and practice to deliver the transformation.

This grant is funded by the UK Prevention Research Partnership (UKPRP) which is administered by the Medical Research Council on behalf of the UKPRP's 12 funding partners: British Heart Foundation; Cancer Research UK; Chief Scientist Office of the Scottish Government Health and Social Care Directorates; Engineering and Physical Sciences Research Council; Economic and Social Research Council; Health and Social Care Research and Development Division, Welsh Government; Health and Social Care Public Health Agency, Northern Ireland; Medical Research Council; Natural Environment Research Council; National Institute for Health Research; The Health Foundation; The Wellcome Trust.