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Since coronavirus, Katrina, a former foster care kid, visits her elderly birth mother twice per week to provide in-home support and ensure that she is social distancing. These visitations are a part of a decade-long-journey toward reconciling their fractured relationship – an arrhythmic dance that began long before the pandemic. These days, Katrina’s walk from her basement apartment on a residential street two short blocks from her mother’s public housing apartment is filled with a new complication.

When Katrina approaches her mother’s building, she is greeted by bare-faced construction workers huddled together. A violent stairwell mugging prompted the housing provider to install a security system and replace a malfunctioning video camera, so she now uses a key FOB to enter the foyer. Too small for social distancing, the foyer is little more than a row of mailboxes on the left, and a couple of benches, now abandoned, on the right. Two of the three elevators are chronically out-of-service, and the sole operating lift is often sullied with urine and feces.

She takes it all the way to top of the building, where harsh fluorescent lights expose chipped walls and ageing brown laminate floors. Katrina slowly steps out, looks over her shoulder, then hurries down the hallway and enters the apartment. Her amma, a South Asian word for mother, greets her with an unhealed silence entangled in histories of war and displacement. The pair navigate the tiny apartment wordlessly, beneath a ceiling speckled with a yellowish popcorn pattern. Sometimes Katrina stares out a window that lets in rain and cold, at a condo across the street. She notices an array of sleek blinds instead of garbage bags and old bed sheets, shielding the dignity of its residents. Exhaling deeply, she wonders if the air is as heavy on the other side. 

It is this distance – not the street separating these two particular buildings, but a profound socio-spatial divide – where coronavirus health and density disparities are laid bare. And while there is a risk that highlighting this reality could fuel what award-winning writer Doug Saunders describes as “an atavistic deep-set fear of big cities as pits of disease,” negating this divide poses an even greater threat to the advancement of urban intensification. Instead of merely postulating about the desirability of density, it is necessary to define good urban density and confront the health challenges faced by individuals like Katrina and her mother. 

This begins by acknowledging what Roger Keil, an urban scholar and public intellectual, frames as the mixed and diverse densities that “manifest themselves at the peripheries.” His radical body of work establishes the foundation for casting our gaze beyond the gentrified density championed by mainstream urbanists to the multitude of dense typologies within cities themselves and across the globe. Building upon Keil’s discursive framework – which positions density as both pluralistic and decentralized – I’ve coined two terms for better understanding coronavirus related health risks faced by those from historically marginalized groups. 

First, there’s dominant density, designed by and for predominately white, middle-class urban dwellers living in high-priced condominiums within or adjacent to the city’s downtown core. My urbanist colleagues tend to depict these sites of density as a utopia of aspirational millennials and neat nuclear families with 1.5 children and a small hypoallergenic dog. An emphasis is placed on large parks, generous pedestrian infrastructure, proximity to jobs and chic gentrifying coffee shops. Aside from the latter, these neighbourhood amenities significantly contribute to improved public health. The problem is that dominant density propagated by mainstream urbanism fails to adequately address social determinants of health, like income, race and disability, which are proven to be deepening coronavirus related health and social inequality. While some urbanists are more inclusive in their approach, the vast majority do not imagine the kind of building Katrina’s mother lives in when thinking about density. 

The second term is forgotten densities. This form of density expands the dominant density discourse (and its myopic, privileged framework) and includes favelas, shanty towns, factory dormitories, seniors’ homes, tent cities, Indigenous reserves, prisons, mobile home parks, shelters and public housing. These types of densities extend into the peripheries Keil describes – including both the suburbs and density types in cities outside of North America, which is crucial in a global pandemic. 

These densities emerge from distinct histories and socio-political forces. However, they have common characteristics such as ageing infrastructure, over-policing, predatory enterprises like cheque-cashing businesses and liquor stores, inadequate transportation options, and sick buildings – structures that contribute to illness due to their poor design, materials and maintenance. The health of poor and racialized people has significantly been impeded by these issues – created and agitated by inequitable approaches to urban density.  

In addition to negating this correlation, mainstream urbanism fails to integrate a holistic approach to health and design. When discussing urban density in relation to the coronavirus, urbanists tend to reference dense cities that have been successful with flattening the curve. While counting the number of new cases is an important indicator, it isn’t the only one. The World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This definition of health allows us to consider the unwieldy range of health challenges faced by vulnerable groups during this time. 

While mainstream urbanists are loudly advocating to widen sidewalks and public parks – two important but narrow points of focus – individuals living in forgotten densities are pleading to have their urgent concerns heard. Black men, disproportionately profiled and murdered by police on streets, are weighing the risk of ignoring directives to wear a mask and possibly contracting the virus or wearing a mask and suffering the humiliation of being asked to leave stores when attempting to shop for essential supplies. Advocates for those experiencing homelessness warn that the deadly mix of crowding and a communicable disease will lead to catastrophic consequences. A petition has been started by those concerned about elders living in densely populated long-term facilities. Even in cities where the curve is flattening or hasn’t reached its deadly peak, communities living in forgotten densities – which tend to be disproportionately racialized and poor – are suffering in the margins.  

A quick scroll through any number of citizen-led community care groups further reveals the health concerns of those living in forgotten densities. These individuals are scared to leave their apartments for essential reasons because they can’t practice social distancing in cramped entranceways, elevators and laundry rooms. Those with underlying medical conditions are being placed at risk because families comprised of six people living in two-bedroom apartments do not have the space to quarantine within the home or the financial resources to quarantine elsewhere. 

Many individuals also lack access to balconies – and those who do are often left contending with toxic pigeon excrement. A deadly chorus of coughing and the uproar of domestic violence echoes off hallway walls and internal stairwells where some children, unable to find learning space within their living quarters, are doing their homework. Almost all of these individuals lack access to reliable public transit and can’t afford to have essential items delivered to their homes. Moreover, the naked vulnerability of those living rough on the streets has never been starker. 

These forgotten densities, and more egregiously forgotten people, were plagued with ageing infrastructure, poor design and negligible maintenance well before COVID-19. While overlooked, the data tells a complex story that mainstream urbanists seem intent on simplifying.  

In 2004, the Canadian Institute for Health Information published Housing and Population Health: The State of Current Research Knowledge, an exhaustive paper that clearly lays out an extensive list of density-related health challenges. “Individuals living in close proximity to each other will more easily spread infectious diseases,” it states. “This was a major impetus to public health action on housing over a hundred years ago. There are still examples in particular settings where this is of significant concern in Canada.” The paper also highlights that multiple studies have “found an association between multi-dwelling housing and adverse mental health,” which is partially explained by “social isolation in high-rise dwellings, lack of play space for children, fear of crime, and stigmatization related to building appearance.” In fact, “several studies have found an association between higher floor level and poorer mental health.” 

Notably, the paper also highlights that numerous studies have “examined the potential association between damp housing conditions and respiratory ailments in occupants.” This issue impacts 38 per cent of Canadian homes, including significant problems “in some First Nations communities due to a combination of inappropriate housing design, poor construction, inadequate maintenance, and poor ventilation.” While the First Nations communities referred to are located outside of urban areas, similar findings pertaining to increased occurrences of asthma and bronchitis have emerged from studies in densely populated inner-city neighbourhoods inhabited by other racialized groups. 

Another illuminating study, titled Housing and Health: Time Again for Public Health Action asserts:  

Features of substandard housing, including lack of safe drinking water, absence of hot water for washing, ineffective waste disposal, intrusion by disease vectors (e.g., insects and rats) and inadequate food storage have long been identified as contributing to the spread of infectious diseases. Crowding is associated with transmission of tuberculosis and respiratory infections. Lack of housing and the overcrowding found in temporary housing for the homeless also contribute to morbidity from respiratory infections and activation of tuberculosis.

These health issues are common in forgotten densities located in developing countries, and, shamefully, within affluent cities across North America. The data, while disturbing, doesn’t begin to capture the hardship caused by these density-related health issues on the ground. 

My placemaking practice is focused on urban design and social equity spanning North America. I regularly build bridges between mainstream urbanists and individuals from equity-seeking groups like women, residents living on low-incomes and racialized people. Occupying this in-between space is both professionally risky and laborious because urbanism professions, historically a technocracy, have failed to respond to the deeply personal dimensions of urban densification. 

Amid my less hectic schedule, I reflect on the privilege of owning a downtown Toronto loft with a window wall leading out to a generous balcony that overlooks a beautiful gated courtyard. My home isn’t lavish by any stretch of the imagination but I’m very comfortable. The only thing that overshadows my gratitude during this pandemic is my outrage that people living in forgotten densities cannot afford the luxury of health, and in some instances, life. Although it’s currently intensified, this realization is not new to me. 

I grew up in a poorly designed public housing high-rise that adversely impacted the quality of health in the community. It’s the kind of community that Thomas P. Costello, a former housing authority leader, critiqued as “geared to production, not to providing decent housing for poor people,” which “virtually guaranteed failure.”

By sharing research and personal experiences revealing long-standing and current coronavirus health disparities agitated by urban density, I’m not taking an anti-density stance. As urbanists, we should critique the things we feel most passionate about to achieve urban equity and design excellence – in that order. In addition to public health, urban density can contribute to land use efficiencies, economic opportunity and strong social networks. Even in forgotten densities, people consistently rise above discriminatory design practices and policies, to nurture the well-being of their communities. The value and necessity of urban density are undeniable. However, achieving good urban density for all is complex. 

In his paper Sustainable urbanism: towards a framework for quality and optimal density?, Steffen Lehmann, an architect, urban designer and professor at The University of Portsmouth, examines this complexity. “Density is one of the key issues in planning that can regularly create all kinds of misunderstandings and tensions, but is an essential driver of our urban futures,” Lehmann writes. We cannot fulfil this future without delving into the specificity of the misunderstandings and tensions. Most urgently, we need to make clear distinctions between desirable compact urban living and the other c-word urbanists tend to avoid: crowding. There is a fine yet highly contested line between the two. 

Psychologists tend to define crowding within the construct of desirability – and the emotions arising from a sense of spatial lack. A review of density intensity theory shows that dense environments elicit increased human responses to both positive and negative situations. Therefore, some of the negative health outcomes correlated with urban density – like aggression or lack of community cohesion – are not solely consequences of the built environment. This finding does not diminish well documented health conditions caused by some types of density. It compels us to be thorough – and confirms that factors such as violations of personal space, culture, trust and beliefs about the impacts of density also contribute to health outcomes. Psychologist Jonathan Freedman adds to this argument; he delineates the difference between physical crowding, defined as a lack of space, and perceived crowding, defined as a sensation or distinct feeling related to space. 

Mainstream urbanists have difficulty responding to these psychological nuances because the metrics used to measure urban density are floor area ratios, residential density and population density. These and other spatial metrics are relevant but woefully inadequate for addressing our human needs.

We’ve yet to fully explore how living in relatively small, spatially dispersed groups for the vast majority of human history may be contributing to something I refer to as collective urban density bias. This phenomenon helps to explain why, regardless of social or spatial realm, many people who live in cities have a negative perception of density. Namely, they fear that it will impinge on individual and community health: Urban dwellers with affluence resist density, arguing a fear of traffic congestion and loss of neighbourhood character – code for wanting to preserve racial and class homogeneity. Those aspiring to affluence resist density because they’ve bought into the fallacy of the single-family home and car as synonyms of success. And those struggling in the margins resist density because its disparities have hemmed them in or erased them. As urbanists, we cannot simply dismiss this collective resistance; we need to create space to unpack and address it. 

Most of us, urbanists and everyday folks, have a sense of the characteristics of density that contribute to our well-being. We know that the isolated urban typologies championed by Le Corbusier and Robert Moses directly contributed to segregation and the concentration of despair. We know that everyone thrives when they have access to green space and culturally responsive amenities, which is especially important as the footprint of individual living spaces continues to be reduced. We know that Toronto’s yellow belt – a term coined by urban planner Gil Meslin to describe low-rise residential areas where policy frameworks protect “stable physical character” over expanding accessibility – needs be unlocked to accommodate middle-to-lower income residents and diverse housing types. We know that transit-supportive densities create pathways to both physical destinations and possibility. We know that we’re facing a crisis of aging and sick building infrastructure that needs to be rehabilitated without displacing entire communities.  

Perhaps most importantly, despite the spirited defence of density, we know that failure to advance these and other progressive approaches have impeded the health of forgotten people living in forgotten densities. 

Moreover, communities are organizing and educating themselves about city-building processes. They refuse to be merely “consulted” about the growth of their cities; they expect to co-create their parks, housing developments, markets and streets. This emergent sense of something I refer to as healthy spatial entitlement is heartening. I am pleased to see a number of initiatives arising to combat complex challenges. The Association for Neighbourhood and Housing Development, a New York based non-profit membership organization developed an excellent Anti-Displacement Policy Toolkit that provides a wide range of policies and case studies to combat resident displacement. There is also an emergence of equitable development plans like the one produced for Wahsington, D.C.’s 11th Street Bridge Park. The plan is intended to increase affordable housing stock, create connections to the business corridors and provide construction and post-construction jobs for local residents. Closer to home, the City of Toronto’s RAC Zone is an initiative that successfully worked to replace outdated zoning restrictions – allowing for a range of small-scale businesses and community amenities, from pop-up markets and urban agriculture to health services and grocery stores.

Building on these and other good examples will require systemic interventions addressing architecture, urban design, planning legislation and social policy, while fostering respectful partnerships on the hyper-local level. We can no longer intensify cities using a site-by-site approach, vulnerable to political agendas and loud dissenting voices. 

Instead of being fearful of increased anti-density bias, we need to apply what we know toward a good urban density framework. This framework should be evidence-based and overlap with social determinants of health, such as food security, race, gender and poverty, while being anchored in a strong equity-based placemaking paradigm. It should be co-created through meaningful engagement with urbanists, public health professionals, community members and other stakeholders. Fully undertaking this scope of work is not possible during a pandemic. But we can certainly advance the process instead of diminishing the suffering of those experiencing density-related health challenges. If we’re successful in the long-term, perhaps we’ll find a way to mitigate the distance between the public housing apartment where Katrina’s mother lives and the condo on the other side of their misfortune.

Jay Pitter, MES, is an award-winning placemaker and author whose practice mitigates growing divides in cities across North America. She also shapes urgent city-building conversations through media and academic platforms. Jay has been named the John Bousfield Distinguished Visitor in Planning by the University of Toronto and her forthcoming book, Where We Live, will be published by McClelland & Stewart, Penguin Random House Canada.   

Urban Density: Confronting the Distance Between Desire and Disparity

Placemaker and author Jay Pitter argues for an equity-based understanding of urban density during the COVID-19 crisis and beyond.

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