Future cities must prioritize mental health of young people

More than 70% of the world’s children will live in cities by the year 2050, UNICEF predicts. Between now and then, urban areas will be a magnet for people 25 and under who seek work, education and housing. 

While cities offer a range of services and opportunities, they also have a demonstrated negative impact on the mental health of children, adolescents and young adults.

A new survey of experts and young people from 50 countries recognizes this global cultural shift and offers suggestions about how to make cities safer and more welcoming for this population. The paper, published Feb. 21 in Nature, emphasizes that young people must play a role in designing that future.

“One of the most important points in the paper is we have to give young people a voice,” said Jürgen Unützer, chair of the University of Washington School of Medicine’s Department of Psychiatry and Behavioral Sciences. He is one of more than 30 contributors to the paper.

“This population shift is a big, big change. The people who make decisions about how cities spend their money, how they do things? None of them are young. They're all older people, right? So we have this huge disconnect between who lives there and who is deciding what we’ll be doing with the resources in our cities.”  

Pamela Collins, chair of the Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health, was the paper’s lead author. She conducted much of the work while at UW Medicine, with the assistance of graduate student Tessa Concepcion, then a global mental health research coordinator.

Working with the nonprofit citiesRISE, the investigators created a series of surveys that were unique in their global reach and inclusion of young people. The idea was to find and incorporate suggestions to improve city planning by prioritizing the well-being of this demographic. They surveyed a multidisciplinary group of researchers, practitioners and advocates that included younger respondents, as well.

“I like to use the question that Sandro Galea posed more than a decade ago as a jumping-off point for this work: ‘Can we improve mental health if we improve cities?’” Collins said. “Our study participants highlighted the importance of supporting and promoting healthy social connection for young people, and they underscored the value of reducing inequalities in urban environments. Whatever action cities take, young people need to be centrally involved.” 

Unützer said the paper provides both a call to action and a starting point for an important conversation. Each city must decide its needs, and regional and national governments must help them achieve those needs. The authors acknowledged that this will be a complicated conversation because no one-size-fits-all approach exists.

“There are themes that come across, however,” Unützer said. “A space that’s safe — that's huge. Everybody said that. Whether it was rich or poor, they said, ‘We need a space where we can hang out.’ So anybody who is doing city planning could consider where is the safe space? Where can people go and feel like they don't have to worry about things here in Seattle or Tacoma. And how would that be different for a city like Lagos, Nigeria?”

Concepcion said differences in opinion emerged, with younger and older survey respondents agreeing only about 30% of the time. For instance, young respondents were far more interested in ways to avoid discrimination and marginalization and removing barriers to equality. 

The researchers purposely weighted the opinions of young respondents to get a clearer picture. Concepcion leaned heavily on a youth advisory council assembled by citiesRISE during the survey process.  

“We wanted to ensure that the top characteristics of a mental health-friendly city from young people were selected, even if older people didn't also select those,” Concepcion said. “That was a way to elevate their voices and make sure that the things that young people thought were priorities made it through to the next round of the survey.”

Download broadcast-ready video and audio assets with Tessa Concepcion discussing mental health friendly cities.

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