Rethinking the urban physical environment for century-long lives: from age-friendly to longevity-ready cities

Abstract

In response to increasing life expectancies and urbanization, initiatives for age-friendly cities seek to facilitate active and healthy aging by strengthening supports and services for older people. While laudable, these efforts typically neglect early-life exposures that influence long-term well-being. With a focus on the urban physical environment, we argue that longevity-ready cities can accomplish more than initiatives focused solely on old age. We review features of cities that cumulatively influence healthy aging and longevity, discuss the need for proactive interventions in a changing climate, and highlight inequities in the ambient physical environment, especially those encountered at early ages, that powerfully contribute to disparities in later life stages. Compared with strategies aimed largely at accommodating older populations, longevity-ready cities would aim to reduce the sources of disadvantages across the life course and simultaneously improve the well-being of older people.

Fig. 1 |. Eight interconnected domains of the WHO’s age-friendly cities framework.

These domains reflect different aspects of urban physical environments, social environments, culture, and health and social services. Adapted from ref..

Fig. 2 |. Examples of factors (see definitions in Box 1) in the urban physical environment and their potential long-term impacts on healthy longevity throughout life.

The four examples of physical environmental components shown here are air pollutants, drinking contaminated water, heat stress, and access to green spaces. Health outcomes may be promoted or hindered across several life stages (for example, access to green spaces may promote physical and social activities for all life stages). Dashed lines represent statistical or causal relationships suggested by multiple lines of evidence (see main text).

Fig. 3 |. The influence of disparities in the urban physical environment on functional capacity that evolves across the life course.

The gray band represents the disability threshold for functional capacity. The solid gray curve represents the high functional capacity group, whereas the dashed curves in different colors represent groups with relatively lower functional capacity due to exposures at earlier life stages. Gaps between the solid curve and dashed ones are gaps in functional capacity induced by possible disparities that emerge at different life stages. Solid and dashed arrows represent gaps that would be eliminated by longevity-oriented urban planning and current age-friendly city initiatives, respectively, while the length of each arrow denotes the amount of effort needed. Adapted from ref..