Introduction

Sensible, healthy citizens require an environment conducive to the exercise of appropriately sensible and healthy behavioural choices. However, the interplay between individual behaviour, environmental/structural attributes and health outcomes is extraordinarily intricate. As a result, identifying causal relationships between these factors is fraught with methodological difficulties. This is further complicated by the current trend within social policy of conflating the health costs and long-term effects of chronic diseases induced by lifestyle choices with a broader critique of an ‘urban condition’ characterised by decline, inequality and congenital irresponsibility (Peterson and Lupton 1996). Yet, despite recognition of the distinctive relationships between the urban form and health outcomes, public health and urban planning have been remarkably slow to amalgamate their means and ends in order to address these social and structural determinants of health (Corburn 2004). This is particularly curious given the well-documented historical co-emergence of public health and urban planning through a shared dream of sanitising the city to eradicate infectious disease (Hamlin and Sheard 1998). Despite this entwined history, we have recently been told of an ‘emerging field’ of the built environment in health (Jackson 2005: 218). In this iteration, the built environment is being cast as a tool for meeting specific public health goals (Curtis et al 2002; Cummins 2003; Foster and Hillsdon 2004) as part of a wider range of urban policies and objectives. Therefore, it is increasingly the case that to explore the problematisations of public health is also to explore the problematisations of the urban environment and, by extension, the urban condition in far broader terms. In other words, constituting sensible behaviour in relation to acceptable levels of risk opens up new sites of urban governance in order to flip the built environment from a cause of poor health to the solution for optimal health.

The emergence of what have been described as ‘epidemics’ of chronic, lifestyle diseases has been instrumental in refashioning attitudes towards the value and utility of the built environment in health. It is for this reason that this chapter turns first to an extended discussion of the three empirical examples that drive this book – obesity, drinking and physical (in)activity – in order to highlight why, how and where they have become such a significant component of everyday, lived experiences and the political machinery.