Mapping the urban and rural planning response paths to pandemics of infectious diseases

This paper investigates the role of urban and rural planning in addressing infectious diseases, highlighting the long-term neglect of this issue and the severe consequences. The COVID-19 pandemic serves as a recent reminder of this oversight, occurring within the typical 15-20 year cycle of comprehensive urban and rural planning. While modern urban and rural planning originated from concerns about epidemics (e.g., the 1848 Public Health Act in the UK), contemporary planning has shifted focus to other health issues, lacking effective strategies for infectious disease prevention. Current research often employs fragmented approaches (physical or technological determinism), leading to limited and sometimes conflicting conclusions. This study aims to overcome this limitation by adopting a more comprehensive perspective, building upon previous efforts that utilized concepts like the social smart city or focused on physical space policies related to social distancing. The study focuses on pandemics as they represent the highest prevalence of disease spread across geographic areas, encompassing the threats associated with endemic diseases.

The study reviewed 60 relevant studies focusing on infectious epidemics and the impact of globalization, urbanization, and agricultural development. These studies showed that different landscapes have varying impacts on infectious diseases, with urban areas often experiencing more outbreaks. Agricultural and urban development can reduce biodiversity, increase human-wildlife contact, and promote disease transmission. The feedback mechanisms are complex, involving both positive and negative interactions. For instance, while urban development can lead to improved medical standards, high density can also accelerate disease spread. The literature consistently highlights the need for comprehensive strategies to prevent outbreaks.

The study utilizes the concept of the chain of infection (reservoir, mode of transmission, host) to analyze the relationship between infectious disease outbreaks and urban and rural planning. A comprehensive atlas is developed to illustrate the complex relationships between 12 urban and rural planning issues (land expansion, population concentration, climate change, social inequality, healthcare capacity improvements, transportation improvements, built environment change, increased income, knowledge and education, increased food supply, increased agricultural inputs and irrigation, increased livestock farming) and the mechanisms of infectious disease outbreaks (occurrence and transmission). The atlas categorizes the impact of these planning issues, considering direct and intermediate effects on the probability of disease occurrence and transmission. The 12 issues are further categorized by their relevance to urban, rural, or both aspects of planning. The atlas maps the pathways between these issues and the key elements of disease outbreaks, highlighting the potential synergies and conflicts of various planning solutions. The study uses a higher-order interaction perspective extracting higher-order elements of epidemic transmission and urban/rural planning to reveal how planning might respond to a pandemic.

The atlas reveals several key pathways by which urban and rural planning decisions influence infectious disease outbreaks. Land expansion, for example, increases human-wildlife contact and reduces biodiversity, both promoting disease emergence. Population concentration increases the chance of pathogen contact and facilitates the spread of disease. Climate change affects both the reservoir and transmission aspects. Social inequality reduces access to healthcare and information, increasing vulnerability. Healthcare improvements, while reducing reservoirs, can also attract more people seeking treatment, potentially increasing transmission. Transportation improvements facilitate the spread of diseases via travel and trade. Changes in the built environment, both positive and negative, influence pathogen sources and transmission routes. Increased income, knowledge, and education generally reduce disease prevalence. However, increased food production, while improving nutrition, may also lead to new diseases due to human-animal interaction. Agricultural inputs and irrigation can damage biodiversity and increase pathogen resistance. Lastly, livestock farming increases human-pathogen contact and pathogen resistance. The atlas clearly shows the multifaceted and interconnected nature of these influences.

The findings challenge the traditional, fragmented approach to urban and rural planning in relation to infectious disease prevention. The atlas demonstrates the need for a more holistic and integrated approach, considering the complex interplay of various factors. The study emphasizes the crucial role of 'soft' issues, such as social equity and education, alongside 'hard' infrastructure improvements. The comprehensiveness of planning enables addressing infectious diseases at their source by acknowledging the numerous interacting factors. The study's key contribution lies in its comprehensive mapping of the relationships between planning decisions and infectious disease dynamics, offering valuable insights for policymakers and planners.

This research highlights the often-overlooked role of urban and rural planning in preventing infectious disease outbreaks. The generated atlas provides a valuable tool for evaluating the effectiveness of planning strategies in addressing pandemic threats. It emphasizes the need for a more comprehensive approach, considering both the physical and social aspects of urban and rural environments. While acknowledging limitations such as the lack of in-depth proof of planning's expanded conceptual boundaries and a lack of discussion on ideal physical spatial forms, the study provides crucial insights for future planning research and practice by highlighting the value of a holistic and integrated approach.

The study acknowledges two primary limitations. First, while proposing an expansion of the conceptual boundaries of planning, the study does not provide an in-depth proof of this expansion. Second, the study focuses on the comprehensive social aspect of planning and does not delve into specific ideal physical spatial forms for optimal epidemic response. These aspects require further investigation in future research.