The Civil City Framework for the Implementation of Nature-Based Smart Innovations: Right to a Healthy City Perspective

Abstract

This paper aims to expand the current debate concerning the implementation of health-related innovations by employing the rights-based approach. Specifically, we address the challenges related to the implementation of technological and Nature-Based Solutions (NBS) from the right to the city perspective. As a result, we present a comprehensive Civil City Framework that involves the synergic use of ICT tools and participation models to mobilize grassroots potential for building healthier cities, while ensuring equity and respect for diverse needs. We explain the participatory and technological aspects of implementing and monitoring innovative NBS, involving data gathering through environmental sensors, personal wristbands, and smartphone apps. Finally, we highlight opportunities and challenges stemming from the use of health- and environment-monitoring technologies. To build such a vision one needs to reconceive the city as commons, enabling collective action of city residents and cooperation between different local stakeholders. This can be achieved by embedding a pentahelix approach of multi-governance in urban planning, based on a close interaction between five key stakeholders, including public authorities, industry and business sector, academia, civil society organizations, and individual citizens.

1. Introduction

This contribution aims to address the specific phenomenon of technological and nature-based innovations in the field of urban planning, from the right to the city perspective [1]. To this end, we present a comprehensive Civil City Framework that involves the use of Information and Communications Technology (ICT) tools and participation models to mobilize grassroots energy for building healthier cities for all. At the same time, we underline that the existing market-based or tech-based approaches to greening the cities and reducing their carbon footprint are not enough to ensure the sustainable transformation of our cities [2]. It requires a strong civil component, based on co-production and grassroots engagement, to ensure equity and social sustainability.

Our response to this challenge is the civil-city approach, developed within the framework of the Right to the smart city project (funded by the Polish National Science Centre grant agreement no. 2018/30/E/HS6/00379) and tested in two European projects focused on implementing nature-based, smart innovations to enable positive changes in terms of urban health and social sustainability (euPOLIS and HEART, funded from Horizon 2020).

Right to the smart city: the impact of new technologies on quality of life, social relations and urban policy is a research project conducted by the interdisciplinary Civil City Lab research team, established at the Robert Zajonc Institute for Social Studies, University of Warsaw. Civil City Lab carries out research for the co-creation of better, democratic, and wisely managed cities and aims to investigate the consequences of digitalization and smart innovations in the context of urban life. We are particularly interested in how technology can influence the implementation of the principles of democracy, equality, and social justice expressed by the right to the city concept.

EuPOLIS project aims to create a methodology that will allow for designing and implementing Nature-Based Solutions (NBS), as well as the assessment of their direct and indirect (through economic, environmental, and social pathways) impacts on public health and wellbeing of the local community. Under the project, the consortium of 28 partners develops and tests the methodology in four demonstration locations in Europe: Belgrade (Serbia), Gladsaxe (Denmark), Piraeus (Greece), and Lodz (Poland). One of the fundamentals of euPOLIS methodology is a participatory process that should be employed for all decisions regarding the selection of NBS and the final design of the demo location. The direct and indirect health-related impacts of the interventions will be assessed based on the results of the longitudinal design studies, involving health monitoring wristbands and smartphone apps.

HEART project is a health-centered initiative that aims at investigating the benefits of regular visits to the green spaces enhanced by Nature-Based Solutions on the health and wellbeing of patients. Under the project, the consortium of 16 partners is testing the effects of such visits in four groups of patients with a medical history of cardiovascular, metabolic, neural, or respiratory diseases in three demonstration locations in Europe: Aarhus (Denmark), Athens (Greece), and Belgrade (Serbia). The participants health and wellbeing will be monitored through questionnaires, apps, and wristbands, and used for the assessment of the NBS impact on the individuals.

As a result, we address local environmental, health-related, and socio-economic challenges within one framework, directly related to United Nations Sustainable Development Goals 3 (Good health and wellbeing) and 11 (Sustainable cities and communities). Our work is also in line with European Commission priorities as described in the Green Deal policy [3] with the overarching aim of making the European Union climate neutral by 2050, as well as the recently developed New European Bauhaus initiative, which brings together citizens, experts, businesses, and institutions to ensure more sustainable living.

Importantly, the Civil City Framework allows for embedding the right to a healthy city approach in planning, which is especially relevant when implementing Nature-Based Solutions. We present both the participatory and technological aspects of those innovations, which involve gathering data through environmental sensors, personal wristbands, and smartphone apps on the local-community scale. Finally, we highlight opportunities and challenges stemming from the use of health- and environment-monitoring technologies. Based on our experience from the ongoing projects, we also analyze challenges relating to social and technological aspects of nature-based and sustainability-oriented initiatives.

This paper is an effort to expand the current debate concerning health-related planning interventions with a rights-based approach. To build such a vision, one needs to reconceive the city as commons [4], a shared resource managed through collective action and cooperation between different local stakeholders. This transformation can be facilitated by embedding a pentahelix approach in urban governance [5]. The pentahelix approach aims at integrating multi-governance in planning processes and is based on a close interaction between five key stakeholders’ groups, including public authorities, industry and business sector, academia, civil society organizations, and individual citizens (homeowners, residents, commuters).

We argue that applying the rights-based paradigm in the conceptualization of the city’s future is crucial in building an innovative human-based planning approach. We start with the literature review explaining the importance of nature in the cities in the context of the climate emergency and the potential of nature-based smart innovations in mitigating the impacts of the environmental crisis. Then we highlight the results from the existing studies, showcasing the links among the city environment, public health, and wellbeing. As we point out, there is a growing body of literature that underlines the importance of contact with nature in urban settings for the mental and physical wellbeing of the citizens.

In the subsequent parts, we define the right to the city approach and detail the right to a healthy city paradigm. We introduce the resulting health-oriented planning framework and potential use of smart innovations in ensuring the quality and accountability of the process. We describe some of the existing technological solutions that aim to ensure healthier living in the city. We also present the pentahelix stakeholder engagement model as a necessary foundation of all health-oriented planning initiatives.

We summarize our proposition with the definition of the main challenges that can be expected during the implementation of the Civil City Framework and the right to a healthy city approach. Those observations are based on our experiences from the ongoing projects conducted within the European Commission Horizon 2020 program: euPOLIS and HEART.

2. Urbanization and Nature-Based Solutions in the Context of the Climate Crisis

Although the urbanization rate has slowed down in recent years (from 3.1% in the 1950s to 1.9% in 2020) the population of cities is still growing [6] and is predicted to reach 70% of the world population by 2050. This trend is caused by a combination of a positive birth rate in cities, climate and economic migration from rural to urban areas, as well as urbanization of formerly rural areas (expansion of cities) [7]. The United Nations has identified urbanization, population growth, aging, and international migration, as four demographic mega-trends that shape the urban realm of today’s cities [6]. Achieving urban sustainability is therefore one of the key challenges we are facing today.

The expansion of urban areas not only affects people, but also has negative consequences for the natural ecosystems. That is because cities are great polluters, in terms of heat and CO₂ emission, and they undermine biodiversity through ecosystem degradation [8]. Moreover, urban areas often expand into zones of biodiversity significance [9], for example, coastal zones [8], which negatively affects their resilience to climate change [10]. Therefore, together with waste production and greenhouse gas emission, urbanization directly contributes to the global ecological footprint.

The loss of natural resilience to weather extremes, such as floods, heatwaves, windstorms, landslides, droughts, etc., and their frequency due to the climate emergency, has a negative effect on cities’ economies and citizens’ health and wellbeing [11,12]. Moreover, because of the climate emergency, many of today’s cities have become less sustainable and therefore in need of effective climate adaptation and disaster risk reduction strategies. One promising systemic solution to address these challenges has been bringing nature back to urban areas through so-called green regeneration and resilience thinking for planning [13].

The European Commission recognizes and supports such actions under an umbrella concept of Nature-Based Solutions (NBS). By definition, they ’are inspired and supported by nature, cost-effective, and simultaneously provide environmental, social and economic benefits to help build resilience’ ([14] p. 17). Nature-Based Solutions may take various forms, for example, pocket parks, green corridors, green bus stops, sustainable drainage systems, retention ponds, etc. As such, they address different climate-related hazards. Moreover, some of them include innovative technologies for monitoring the environment in real-time or even autonomous systems that adjust NBS’s functions to changing environmental conditions. Those so-called smart NBS allow for seasonal adjustments or immediate interventions based on the collected data. For example, in the Netherlands, a real-time monitoring system of soil moisture content notifies tree managers and workers when the trees require watering [15]. In the village of Geijsteren, such a system also sends messages to the citizens as part of a participatory tree maintenance program.

Based on the current trends in urban planning and environmental sciences one can predict that smart NBS will soon not only monitor and notify about such changes, but also make autonomous decisions on how the system should react [15]. For example, Open Storm, an open-source framework developed by Real-Time Water Systems Lab at the University of Michigan [16] allows for detecting flood hazards and real-time stormwater control that modifies discharges from stormwater facilities to improve water quality and reduce stream erosion.

The vast body of literature on smart NBS shows that actions targeted and tailored to specific conditions help to restore biodiversity [17], decrease temperature and pollutants concentration [18], reduce noise [19], and help to manage sewage/gray water [20]. However, very often, designers and planners focus only on tackling environmental challenges and, thereby, limit the multifunctional potential of NBS [21]. Nowadays, to show the direct benefits for the local community, NBS must be designed and implemented in a manner that matches the needs of citizens, while simultaneously building the climate resilience of cities [13].

As a result, NBS should, directly and indirectly, affect public health and wellbeing by creating a healthier environment for citizens. Research shows that the sole presence of green infrastructure has both indirect effects on the life of citizens via building climate resilience and directly affects their health and wellbeing [21]. In recent years, there has been a growing interest in measuring the impacts of urban blue-green spaces on the health of residents. The literature on the subject shows that living in areas with well-maintained parks decreases the risks of cardiovascular diseases [22,23], respiratory diseases [24], depression [25], and generally improves mental wellbeing [26,27].

3. Health and Nature in Urban Settings

As modern life becomes more and more fast-paced and stressful, the so-called diseases of civilization, such as heart diseases, different kinds of cancers, as well as mental-health problems, become more widespread and affect a significant portion of the global population. Meade [28] aptly notes in her review that in the past half-century, global health—whether understood as the health of the Earth ecosystem, the health of cities, or of diverse human populations—has changed in more ways than one could ever imagine. These major transformations include migration waves and aging of the urban population, climate change, as well as the arrival of digital innovations, the spreading of new infectious diseases, and unprecedented stresses on mental health fueled by new forms of addictions.

Indeed, in recent years, mental health problems have consistently been reported to affect a significant portion of the population and are associated with a severe burden on the functioning of people [29,30,31,32]. At the same time, a rising proportion of the population is moving to cities [7], where access to nature is limited.

There is a growing body of scientific literature showing the positive relationship between spending time in nature and wellbeing, both physical and mental. Studies show that nature has a positive influence on coping with stress and dealing with negative life events and negative emotional states [33,34,35,36]. Contact with nature is also associated with lower morbidity of various diseases, especially anxiety and depression [37,38,39]. Living in greener neighborhoods in cities is related to lower rates of antidepressant prescriptions [40]. Moreover, nature enhances functioning (such as mood and memory) in people with depression. Contact with nature also has numerous benefits for specific groups, for example, people 65+ who have frequent contact with nature are less often diagnosed with Alzheimer’s disease and experience reductions in symptoms of depression [41]. They also tend to have better physical health [42]. Additionally, in the case of children, greenery is a protective factor from the consequences of stressful events [43].

Moreover, urban nature encourages physical activities, which are beneficial for both physical and mental wellbeing. Exercising in green spaces is associated with greater enjoyment and feelings of revitalization and positive engagement, along with decreased tension, confusion, anger, and depression, as well as higher intent to repeat the activity [44].

The exact mechanisms behind the positive influence of natural spaces on physical and mental health are not fully understood. However, the role of cleaner air, lower noise levels, and spaces for relaxation and exercise seem to be key. Moreover, the blue and green spaces provide excellent settings for people to socialize and develop social bonds, which has also proven to play a major role in wellbeing [45]. Other mechanisms through which nature can support mental health, such as attention restoration, have been proposed as well [46,47]. The mere presence of greenery can be advantageous for the health of the citizens, and even the unintentional use of blue and green spaces seems to provide benefits [48,49]. Additionally, what became evident during the COVID-19-related restrictions was that people tend to seek contact with nature in difficult times, and research showed that the ways of using green spaces changed when the restrictions were imposed, to provide alternatives to activities that were otherwise unavailable [19,35,48].

It has been repeatedly proven that nature supports the prevention of a variety of health conditions, including somatic and mental. Given the growing expenses in public health [50], it seems perfectly rational to invest in preventive measures that would support the wellbeing of citizens, while, at the same time, indirectly helping to optimize healthcare expenditures and prevent disabilities related to the diseases of civilization.

Since the expansion of urban areas is further limiting the citizens’ access to natural spaces, it is of great importance that cities provide healthy spaces that support wellbeing. This can be achieved by introducing Nature-Based Solutions in public spaces and ensuring that people have a chance to benefit from them. However, such endeavors require joint efforts of various stakeholders in order to reach their full potential. The inclusion of citizens in the planning process increases their feelings of connectedness and agency, which apart from directly improving their wellbeing, ensures higher acceptance and long-term sustainability of such solutions. Moreover, various types of social participation, and social activities, in general, have been linked to lower mortality, better mental health, and greater odds of seeking professional mental healthcare when needed [51,52,53,54].

Participation and the capacity to exercise one’s rights is another important factor related to mental health. On the one hand, symptoms such as lack of energy, the feeling of social isolation, or low motivation may be negatively related to the ability to fully enjoy citizen rights. For example, people who are depressed are less likely to benefit from leisure time activities or seek social interactions. They are also often unable to work and tend to avoid involvement in civic activities. On the other hand, depriving community members of the opportunity to participate in decisions about their environment can increase negative sentiments and lead to frustration, anger or sadness.

Citizen participation in planning processes is important also because green infrastructure does not have the same benefits for all community members. A systematic review by Sreetheran and van den Bosch [55] showed that the fear of crime in green spaces is a function of personal demographics, along with the physical attributes of the space (i.e., lighting) or the time of the day. Gender is the most predictive determinant here, together with belonging to an ethnic minority. Therefore, the design of the space must take into consideration not only directly health-related effects for ’the average joe’ but also consider the needs of various groups of users whose voices are often marginalized, i.e., women, elders, minorities, migrants, and minors. That is especially important because access to well-maintained green spaces can help reduce the socio-economic inequalities in physical and mental health [56]. On top of the directly health-related effects, the well-maintained green infrastructure also affects social aspects such as perceived loneliness [57], visitors’ level of stress [58] and sense of community [59]. They may also play a role in increasing social cohesion by encouraging interactions of residents from different socio-economic backgrounds [60]. Last but not least, during the ongoing COVID-19 pandemic, local green areas became a valuable asset for many urban residents as they provided an opportunity to leave the house and socialize under social distancing rules introduced in many countries [61].

To summarize, while the implementation of NBS is mainly perceived as a way to build climate resilience, it can also have numerous community-level benefits. In this paper, we discuss the framework that would allow for the implementation of nature-based innovations that serve all citizens, while strengthening social relationships and solidarity among the members of the local community.

4. Urban Health and the Right to the City

Surprisingly, health is rarely mentioned in the literature concerning the right to the city, which tends to focus on housing shortages, access to public space and services as well as general democratization of the urban policy processes [62,63,64,65,66]. Meanwhile, health is more often assessed from the legal perspective, which focuses on the right to health as a basic human right [67].

Here, we want to underline that health is indeed a sine qua non condition of enjoying the right to the city and, as such, it is worth special attention in the context of the planning processes. We build our concept of a healthy city on the vision of caring cities [68], which proposes a new model of urban environments with people at the heart of decision-making, reflecting the diversity of users’ preferences and experiences, to ensure that spaces are adapted to meet people’s different needs, instead of making people adapt to the urban conditions. In this new paradigm, cities are seen as places that look after us, so groups and communities can take care of each other.

There are several dimensions that signify that the city is healthy and caring: its public spaces convey a sense of safety; its air, water, and earth are not polluted, and; urban planning is focused on ensuring that we live close to nature and are protected from the negative impact of weather-related conditions. Therefore, rethinking the city from a health and care perspective means designing environments that place a greater emphasis on people who use them, no longer creating spaces based on the strict economic or engineering rationale.

We believe that the right to the city approach embeds two important dimensions into the planning process. One is that the residents and city users should be treated as autonomous subjects, and the second is that all planning efforts should revolve around responding to their needs as well as respecting their rights as citizens. It means that health-related interventions should develop true opportunities for participation and empowerment, building communities resilience [69,70] and social sustainability [71,72] instead of focusing on the market- or power-driven interests.

As Figueiredo et al. [73] point out, the right to health intertwines with the right to the city because the guaranteed access to healthy urban spaces reduces inequities in the access to well-maintained spaces among the population. As a result, also the disadvantaged groups can enjoy positive urbanization effects. In this sense, the interconnection between the right to the city and the right to health promotes equity in urban planning.

5. Right to a Healthy City Framework

The right to the city concept has been growing in popularity in the last two decades [74,75], and was often adopted as a mobilizing frame by grassroots urban movements [66,76]. Following Harvey’s [77] interpretation of the original Lefebvre idea [1] we define it as both the individual liberty to access urban resources (including space, nature, services, and infrastructure) and the ability to exercise collective power to reshape the urbanization processes.

The original work of Lefebvre [1] was crucial in building the foundations for the contemporary understanding of the right to the city. In his famous book Le Droit à la Ville, he describes the right to the city as a conglomeration of various rights, including the right to information, access to services, to operating in urban space, and use of the city center [1]. Therefore, it expresses both protests of excluded groups (homeless, poor, hungry, or persecuted), and the aspirations of those better integrated, but not able to fully realize their potential (alienated representatives of middle and high classes, especially young people, small entrepreneurs, representatives of the intelligentsia, artists and officials).

Nowadays, the right to the city resurfaces in both activists’ and global policymakers’ narratives [78,79]. The former point out that because of the dominance of the global capitalism paradigm, our cities are places mainly geared towards revenue and productivity [80]. This means that they serve as great marketplaces, where goods and services are distributed and paid for, spaces for advertisement are plentiful, and where the workforce, ownership, and return on investment are the main concerns [81,82]. Meanwhile, our cities are a much less friendly environment for non-productive or free-of-charge activities, such as strolling in the green spaces, breathing clean air, having a good night’s sleep, or having fun without consuming. In the economy-oriented context, productive activities take precedence, and others are limited or even discouraged. When we treat citizens as individuals who contribute to productivity (managers, merchants, or employees), their subjective needs and characteristics are not considered when the city is planned, designed, and governed. As a result, cities undermine our rights to health, rest, or positive connections, denying the health-related and subjective dimensions of citizens’ wellbeing.

Moreover, the ability to exercise a right to healthy living is very much gender- and age-sensitive, and multicultural urban environments tend to sustain health inequalities related to ethnicity, nationality, and race, as well. For example, as women, historically, have performed many care-related tasks that were not ascribed a market value, this has generated a unique, but traditionally invisible, capital for local communities and cities as a whole. The health and care-related dimension of cities has remained similarly hidden and under-recognized for several decades. Only recently, with the recognition of the negative impact of an unhealthy environment on business, industry, and municipalities’ budgets, the value of a healthy city visibly increased [83].

However, the definition of a healthy environment is rather complex and it can address issues as diverse as health protection, access to recreation, rest satisfaction, the exercise of hygiene, opportunities for play and relaxation, and even the preservation of privacy. We posit that it should address what Papanek [84] calls ‘real needs’, while deprioritizing the ‘invented needs’ introduced by the consumerist agenda. Fulfilling such real needs require planning and design that increase biodiversity, facilitate maintaining a healthy body and mind, allow quality rest, encourage sharing of the space between users of different gender, age, and cultural background, promote fun and informality, socialize childcare, and intensify social gathering.

While putting forward the right to the city agenda, we believe that contribution to building a healthier and caring city, in the long run, brings benefits to all citizens. Health remains crucial to our happiness in different moments of life, facilitating work and life balance and promoting new forms of social organization that contribute to a more satisfactory urban life. We see it as an urgent task, because, if we continue to neglect health and care aspects of urbanization, our cities will increasingly deny the right to biological and mental wellbeing to the growing numbers of citizens. Moreover, we put forward the right to a healthy city agenda as perfectly aligned with the SDGs and European Green Deal policies and the adequate response to the challenges of climate emergency.

The civil city framework underlines the importance of the citizens’ engagement and responsibility for co-designing and planning the sustainable future of our cities [85]. While we recognize the crucial role of public and private stakeholders in shaping urban development, we underline the need for realigning those local policies with the concept of public health as a common good [86]. A healthy urban environment has clear long-term benefits for the majority of local actors and, as such, has the potential to become an axis of the pentahelix multi-stakeholder engagement.

The first step of implementing the civil city framework should therefore focus on building the right to a healthy city stakeholders’ coalition. This coalition should ensure that the process of developing and implementing pro-health interventions will be accompanied by the grassroots’ participatory engagement. As health risks remain high on the agenda of most urban residents, this should drive high participation in discussing the main health-related needs and problems encountered by the local community. Apart from in-person meetings and strategic workshops, different forms of data collection are necessary to enable better planning as well as impact assessment. Civil City Framework research tools include questionnaires, individual and group interview scenarios, observation guidelines, and spatial audit forms. Additionally, the data collected through health monitoring applications, wristbands, and other personal sensors, can be integrated with survey data to enable triangulation.

To summarize, to ensure the implementation of the right to a healthy city agenda, we propose employing the civil city framework consisting of:

(1)

Stakeholders’ engagement methodology to build a stakeholders’ coalition for the right to a healthy city (supported by tools for health-related grassroots participation);

(2)

ICT-enhanced health and healthy environment monitoring system (supported by social and medical surveys, smart sensors and apps).

6. Technologies for a Healthy City

In recent years, an increasing number of cities are initiating the transition into sensor-enhanced smart cities [87], as well as kinetic and responsive urban design [88]. The European Union actively supports such endeavors under the Climate Neutral and Smart Cities program, which recently announced the names of 100 European cities that by 2030 will become smart and climate-neutral cities [89]. This initiative is part of the European Green Deal [3] and its primary goal is to develop the implementation of ICT and the Internet of Things (IoT) focused on reduction of the CO₂ emission. It also aims, directly and indirectly, to create a healthier environment for citizens and urban-space users. On the one hand, climate-neutral cities will be healthier for their inhabitants. On the other hand, many smart solutions that are being implemented, directly target issues related to public health and wellbeing. At the same time, we observe the growing protests against increased surveillance and the way technology companies seek to reshape our cities [2,90,91,92]. This indicates growing concerns about who really benefits from technological innovations.

Still, many cities already use technology to provide better health-related services or create a healthy environment for urban-space users, even if the Climate Neutral and Smart Cities program set those goals for 2030 [89]. Kamel Boulos, et al. [93] described and discussed the vision of the ’Internet-connected web of citizens (people) and electronic sensors/devices (things)’ that serve to address health-related concerns. In many places, in recent years, this vision has become reality. For example, community-led air quality monitoring systems (Polish Smog Alert or Air Quality Egg App) allow citizens to track the pollution level in their neighborhoods in real-time. Moreover, these grassroots initiatives put pressure on local governments and authorities to implement regulations and actions that would diminish the pollution and therefore increase the air quality in urban areas. In the Polish city of Rybnik, authorities decided to use drones in the fight against air pollution. The unmanned flying vehicles are equipped with very precise PM2.5 and PM10 sensors that allow them to single out houses that burn wood or low-quality coal, recently banned in Poland. These monitoring activities and others similar, regardless of whether they are community-led or part of a more top-down political agenda, use technologies as tools for primarily raising awareness of pending environmental issues that might have a direct impact on public health. Therefore, they often require reinforcement from adequate legislation and actions from decision-makers. For example, the Polish smog monitoring drone system is administered by the police and is accompanied by a government policy that subsidizes the replacement of old furnaces.

In the civil-city approach, the technologies for monitoring the environment primarily serve for the identification of the pressing environmental issues that directly or indirectly impact the health and wellbeing of the local community, for example, high air-pollution levels, high levels of noise, or heat island effect, etc. Moreover, these systems are also used for the impact assessment of the intervention. Such a strategy is being implemented in the euPOLIS project. First, various monitoring systems are used to identify the environmental challenges in the demonstration locations. Second, the same systems are used for tracking and assessment of the functioning of Nature-Based Solutions and whether they managed to improve the identified environmental issues. Third, the human-centered civil-city approach is applied, which entails that the assessment of the implemented changes includes not only environmentally based indicators but also the perspective of the local community and how the intervention affects their health and wellbeing.

However, the usage of ICT and IoT in the urban-health context is not limited to monitoring systems. More and more often, these technologies are being used for the creation of health and care-related recommendations. For example, smart devices (bands, watches, or smartphones) might not only serve for monitoring our daily activities and various body functions but also make recommendations on how much we should walk or exercise to maintain good mental and physical health. The HEART project aims to build a case that combines monitoring technologies with medical doctors’ knowledge for the creation of recommendations that would enhance the treatment of such conditions as depression, metabolic, respiratory, and cardiovascular diseases. Moreover, medical chatbots [94], remote doctor consultations [95], AI-based health apps [96], and even simple temperature-measuring points already became crucial parts of the healthcare system that supported or in some cases replaced traditional solutions during the peaks of the COVID-19 pandemic [97]. For example, in San Francisco, the University of California Health introduced a chatbot that allowed for the screening of workers from the comfort of their couch [94]. This reduced the spread of the virus among the employees as there was no need for screening individuals who were at high risk of being infected with COVID-19 on the spot. Moreover, this solution delivered data on the availability of employees in real-time, which helped both in contact tracing and planning shifts.

Furthermore, medical chatbots equipped with sensors or simply autonomous medical assistants are predicted to play a pivotal role in providing healthcare for aging societies [98]. That is because they might facilitate remote monitoring of the home or urban environment and, in case of emergency, they can autonomously alert a medical facility and caregivers. Such solutions, although promising, might lead to exclusion of people for whom the entrance barriers cost-wise or technology-wise might be too high, as the introduction of remote doctors’ consultations proved during the peak of the COVID-19 pandemic [99]. Therefore, ICT and IoT-based systems and their implementation must take into account the diversity of communities and focus on serving people that do not have the skills and resources to use these new systems.

That is why, the civil-city approach emphasizes that a right to a healthy city is immanent for every citizen and urban-space user, regardless of their technological competences, socio-economic background, education level, gender, age, ethnicity, or religion. Therefore, solutions that aim to address urban-health issues must use technology not as an entrance barrier, but as tools that allow for empowerment and participation of people whose voices or needs would otherwise be marginalized. In the civil-city approach, this goal is tackled through an in-depth analysis of the specificity of the local community and groups of urban-space users. Based on the characteristics of these groups, it is possible to tailor the implementation of ICT to only those individuals who would benefit from it. For example, in the euPOLIS and HEART projects, although some workshops with stakeholders due to the COVID-19 restrictions or in some cases participants’ convenience were organized online, others are being held in person with the help of community leaders, and local hubs are being created to ensure open access. Only such a holistic approach allows for comprehensive mapping of the needs and inclusion of voices that tend to be marginalized.

Finally, the potential of ICT and IoT in tackling and managing the public health crisis became evident during the COVID-19 pandemic. The contact-tracing technologies were crucial in reducing the spread of the virus [100]. However, the mandatory usage of the contact-tracing apps introduced by some governments raised the questions of privacy and limits of surveillance [101,102]. Conversely, these technologies have the power to support grassroots initiatives and to provide unprecedented levels of citizen engagement and participation in the local and wider communities [93]. For example, San Remo mobile app PulsePoint notifies citizens trained in CPR (CardioPulmonary Resuscitation) when a cardiac arrest has been reported to emergency services nearby. However, Roszczyńska-Kurasińska and Domaradzka [103] argue that while some examples show that ICT and IoT might empower many positive processes and help in linking policymakers with citizens and vice versa, they may also contribute to the decrease in the quality of life and restriction of democratic freedoms.

Taken together, the civil-city approach identifies three main categories of how technologies might be used for the enhancement of a right to a healthy city:

(1)

Monitoring and identification of environmental challenges that have a direct and indirect impact on the health and wellbeing of citizens;

(2)

Making health recommendations based on real-time monitoring of citizens’ activities and body functions;

(3)

Empowering grassroots initiatives and building citizens’ engagement.

7. Participation and Stakeholders’ Engagement for Social Sustainability

The right to a healthy city approach is based on deep stakeholders’ engagement and citizens’ participation as key to successful planning, implementation as well as impact evaluation of Nature-Based Solutions. The civil-city stakeholder-engagement approach focuses on the co-creation and co-design of spatial interventions including NBS and smart innovations as enhancements to the public space. Stakeholders include institutions responsible for the project implementation, citizens directly influenced by the given intervention (community members and space users), as well as those who can support the local community in expressing its needs and preferences, turning the intervention into a co-creation process.

Stakeholders’ engagement allows for defining and negotiating between different needs and preferences and, as a result, to contribute to better urban health, while respecting diverse perspectives. It involves both traditional as well as new techniques enabling participation, including face-to-face interactions (workshops, site visits, focus groups), as well as dedicated smartphone apps and online surveys. Moreover, in HEART and euPOLIS, we also include a method of volunteer study based on wearable sensors to diversify possible forms of impact assessment. By wearing smart bands throughout the implementation process (including before and after the intervention), local participants will not only have a chance to observe their own bodies’ reactions to the NBS implementations, but also contribute to project-impact evaluation through data collection. This innovative form of participatory research will improve the community’s capacity to monitor other similar implementations in the future. This is in line with Irwin’s [104] concept of opening science and policy processes to the public. His citizen-science approach sought to develop scientific endeavors in a way responsive to citizens’ concerns and needs, in which citizens themselves produce reliable scientific knowledge. We apply the same logic to engaging residents in urban planning and impact assessment.

To further strengthen the formal participation processes, we aim to supplement them with informal processes of information exchange and cooperation, so that spatial interventions can be developed and put into practice with the grassroots involvement of local associations, clubs, and businesses. The main goal is to build a local stakeholders’ coalition for a right to a healthy city, which should lead the efforts to further engage the community members and other potential users of the site in the planning and designing processes. As a result, the stakeholders’ engagement should boost the long-term grassroots participation in local planning and monitoring activities.

The group of local stakeholders includes specific categories of institutions, organizations, groups, and individuals whose engagement will ensure the project meets its goals in the best possible way. We based our approach on the pentahelix multistakeholder model, which assumes five main categories of local actors. However, for the sake of practical implementation, we describe them in more detail as a list of ten groups of stakeholders from which the coalition members should be drawn:

• Residents from the local community (both individuals and families), where the Nature-Based Solutions are going to be implemented.
• Regular and potential users of the Nature-Based Solutions’ site (people working in the area, those who use local services or spend their free time in the area, visitors).
• Community groups, neighborhood initiatives, and urban movements active in the area (representing users’ needs, lobbying for the interests of the local residents, trade unions, sports clubs).
• Local organizations and charities specializing in supporting vulnerable members of the community: people with disabilities, those experiencing homelessness and poverty, refugees and migrants, women, elderly, youth, members of the LGBTQ+ community.
• Community-based organization(s) that will support the diagnosis of the local needs, recruitment, and coordination of study participants.
• Local businesses and employers, social enterprises (especially those responsible for gastronomy, creating meeting spaces or other sites that are magnets for visitors).
• Local public institutions including schools, universities, kindergartens, care homes, hospitals, health clinics, social assistance offices, police, city guard, post office, park authorities, etc.
• City planning authorities, e.g., the department of urban planning in the city office.
• Consultants and designers for the final planning and design of Nature-Based Solutions.
• Researchers and academics representing different disciplines relating to the quality of life, health, and environment.

Additionally, out of groups 1 and 2, we recruit the volunteers (participants) for a study that will monitor the Nature-Based Solutions’ impact on health through physiological data from wearables and qualitative and quantitative data from social surveys.

All stakeholders will be invited to workshops and meetings that will prepare them for future activities. Within local institutions, specific people need to be identified, preferably those who have experience in participatory processes. Often, different informal (built in the previous projects), or vertical contacts (outside of the hierarchical flow of documents), facilitate the process.

It is especially important to design participation activities in a way that includes groups that are marginalized or in danger of exclusion. An important factor in the proper process of involvement of residents is ensuring equal opportunities for participation for both women and men, younger and older members of the community, as well as minority groups. The dependencies between potential stakeholders must be explored and mapped to minimize power inequalities between different participants. If there is a risk of discrimination or power imbalance, it is worth considering creating additional opportunities for participation for those in need of protection.

Participation in planning can take various forms, with varying degrees of citizens’ involvement in the decision-making process. Arnstein’s [105] typology of citizens’ participation presents it as a metaphorical ladder, with each rung representing different levels of citizen agency, control, and power [105]. To enable high-quality stakeholders’ engagement, we employ different methods depending on the stage of planning:

(1)

Ensuring that citizens have access to information about planned activities and, thereby, have the opportunity to get involved,

(2)

Consultations in which citizens act as advisors and social experts, who are asked for their opinion on a specific matter,

(3)

Co-decision when citizens are trusted to have competencies and the right to be involved in the decision-making process and become co-responsible for the outcomes,

(4)

Citizen monitoring in which participants collect, analyze and share their health-related data with a group of independent researchers to assess impact.

Combining those four levels of participation ensures that the citizens have a real influence on the NBS implementations that affect them (directly or indirectly) and develop new skills in monitoring public and private interventions.

Within euPOLIS and HEART framework, we prepared a stakeholders’ engagement toolbox that describes a plethora of methods and how to best apply them in different local contexts. Two smart innovations worth highlighting include:

E-participation (aka digital or electronic participation) is understood as the use of ICT tools to inform the public about the planned operations or build support for the projects or policies, but also to engage citizens in participatory processes [106]. With the coronavirus pandemic in full swing, we put forward methods and tools that do not require physical presence from the participants, including smartphone apps with regular surveys and a health monitoring reporting system.

Wearable sensors: we equip volunteers with wearables (wristbands) that will gather physiological data. The devices will measure the heart rate of the participants and with the use of advanced machine-learning algorithms return the measure of wellbeing. Apart from the hardware, the participants will have access to multifunctional web applications and customer service, including online doctor appointments, which will analyze their results.

Wristbands themselves create an attractive incentive for citizens, which, in turn, might lead to further engagement in participatory processes and impact assessment. For example, in both euPOLIS and HEART projects, users will be required to wear wristbands until the end of the project and to participate in surveys through a dedicated app. The data gathered from the bands will be processed and managed in line with local data protection policy, and the analyses will be presented only in aggregate form. With the use of dedicated software, citizens will be able to assess their physical condition based on data from the wristbands in real-time.

However, the opportunities and challenges that ICT tools and methods bring to the table have to be critically assessed. One should be aware of the fact that while technological innovations might be of much use, they come at a certain cost. Therefore, one should diversify engagement tools also for those technologically excluded. For example, events should allow for access to community-owned computers or tablets, as well as for creating interacting points in the public space where the voices of citizens might be recorded both in digital and analog forms. Similarly, the tools should be inclusive in terms of the language used and accessibility, i.e., websites following WCAG guidelines, infographics with picture language, audio descriptions of images, and information distributed in sign language and the braille alphabet, for people with disabilities.

Engaging participants as partners in a co-design and co-creation process is crucial for the civil-city approach. Therefore, it is very important to plan and conduct real, ethical, and long-lasting processes of local stakeholders’ engagement in all pilot sites.

8. Challenges

In the following section, we discuss the challenges we encountered when applying the aforementioned Civil City Framework in practice. In both euPOLIS and HEART projects, we are in the initial phase of implementation and have not yet performed direct data collection to measure the impacts of NBS. However, we conducted desk research and initial participation activities, as well as defined the detailed impact assessment framework. We also developed stakeholder-engagement guidelines, as well as an ethical framework for the implementation of all projects’ activities.

In the initial stages of data collection, we realized that to make right to a healthy city tangible, we need specific contextual data to describe the structure of the local community, as well as the main challenges related to the site’s social, economic, and environmental/infrastructural conditions. At that stage, one of the main barriers was data availability. Although, in both projects, the representatives of pilot cities are among consortium partners, we still encountered issues with collecting relevant contextual indicators for the pilot sites. That is because data on a desired level of aggregation is in most cases very difficult to acquire, even for the municipality. Sometimes the information is not collected (e.g., on the racial, ethnic, and religious diversity of the local community), in other cases, it is not available at a desired level of aggregation (e.g., the number of families receiving social benefits, employment status, or sectors of employment). When obtained, the information was often outdated. Therefore, for example, age and gender structure, type of residency, or poverty had to be assessed based on the decade-old data.

In the case of euPOLIS, where the data based on desk research was crucial for constructing selection criteria for participants of the wristbands study, we opted for an alternative strategy. Instead of using outdated and not very precise existing data, we conducted a short panel study in which we tried to gather as much information as possible about the community using the space and living nearby. Although we did not manage to conduct a full-scale study that would allow for precise mapping of the local community, we succeeded with supplementing the census data with more up-to-date entries. Ideally, data gathered at this stage should allow for constructing the selection criteria for participants of the longitudinal study, as well as help to define and select measures for the assessment of the social impacts of NBS.

Another step of the proposed framework requires the selection of measures for the impact assessment. In both projects, participants will be asked to fill out a series of survey questionnaires before, during, and after the intervention. With many questions, the risk of response burden (it is often defined as the required effort to complete the questionnaire) increases [107] and, as a consequence, it may lead to sample attrition. That is why it was important to coordinate the selection of indicators and resulting survey questions through all areas of impact assessment. For example, in the case of the euPOLIS and HEART, it turned out that the initial list of social impact measures overlaps with those that assess the health aspects. Therefore, we were able to coordinate the selection with partners responsible for health measures and we reduced the number of questions that participants are going to be asked.

Another challenge relates to the sample design and selection criteria in all local studies. Both projects primarily aim at the assessment of the impacts of NBS on the health and wellbeing of either the local community (euPOLIS) or patients from the clinical study (HEART). While in HEART, the selection criteria for participants depends on their medical history, in euPOLIS, we recruit subjects from the community of space users. However, regardless of the project, it was crucial to understand the distinction between people who visit the space and residents living nearby. That is because their motivation and potential benefits from the visits may vary. Moreover, these two groups may have different needs that would relate to different required functions of the space [108]. Finally, the community-level variables, such as ’feeling of solidarity with the members of the local community’ would not be relevant to users who visit the site but live elsewhere. Therefore, controlling whether participants of the study belong to the local community or visit the space for other reasons was crucial for understanding the impacts of NBS on the local community.

Although the proposed framework assumes that the assessment measures will be selected based on the projects’ goals and results of the desk research, the methods for the assessment should also account for the specificity of the sample. That being said, the data should be collected in a manner that does not exclude participants because of their socio-economic background, age, or gender. On the contrary, the goal of the right to a healthy city approach is to guarantee access and voice to all people affected by the intervention. Therefore, it may be necessary to use different methods and tools for the impact assessment when addressing specific groups of participants, for example adding minority language to the survey [109] or using more traditional methods for less tech-savvy participants.

We also welcomed the challenge to develop our approach into a citizen-science exercise, allowing community members and other local stakeholders to actively participate and benefit from data collected in the project. Due to new data collection techniques enabled by the internet, smartphones, and social media, we could propose a form of crowd-sourced data collection, performed by members of the public. The inclusion of diverse audiences will therefore be of importance for creating real impact as well as ensuring the high quality of citizen-science data. By opening the process of data collection to the community members, we enrich the research findings by enabling the inclusion of local expertise in the impact assessment. As pointed out in the recent article by Tzilivakis [110], the main challenge is addressing the contrasting data needs and motivations of the different stakeholders: mainly researchers, citizens, policymakers, and business consultants. Reaching a common understanding of citizen-science benefits should increase trust between local stakeholders and allow for further citizens’ empowerment in line with the right to the city postulates.

What was also identified is a specific group of challenges related to the use of smart innovations, which include:

Digital reluctance: Although ICT tools might attract new participants, they might also discourage people who in other circumstances would be willing to express their opinions. For people who are not able or willing to use new technologies for participation or impact assessment, digitalizing project activities creates a high entry barrier. In the worst-case scenario, some members of the community may experience digital exclusion and be further marginalized during the implementation phase.

Low commitment, plug-in/plug-out engagement: Maintaining the commitment of citizens is always a challenging task, but even more so when using ICT tools, where there is a high risk of slacktivism or clicktivism that does not translate into meaningful engagement. Moreover, during the COVID-19 pandemic, a lot of people suffered from screen fatigue and asthenopia, which discouraged them from spending more time online.

Lack of physical contact: Although online meetings and e-participatory processes have many advantages, people tend to seek face-to-face contact with other humans, and much information is being conveyed in a non-verbal way. This notion is important not only regarding citizens, but also other stakeholders. With the coronavirus pandemic in full swing and citizens spending most of the time at home, the level of frustration and anxiety sky-rocketed, highlighting this need even further.

Data security policy: Using ICT tools in participation brings also to the table a very important notion of privacy and data security. While GDPR regulates data management in all EU countries, additional measures need to be in place if non-EU partners are involved. On the other hand, the GDPR regulations often serve as an excuse for not sharing data, even if there is no real threat to citizens’ privacy. It also adds a layer of bureaucracy to all participatory processes, which discourages both the municipalities as well as citizens themselves.

Privacy and surveillance concerns: All activities involving sharing of personal data, especially data concerning people’s health, emotional states, and other sensitive topics need to be highly protected against unauthorized use. Similarly, embedding sensors and other ICT tools in the public space creates opportunities for increased surveillance and privacy breaches.

Language incompatibility: Citizens less familiar with concepts of NBS and new technologies might find the language or concepts hard to understand without earlier explanations or a chance to observe real-life examples.

Addressing hearing and visual impairments: Although many modern ICT tools allow users with disabilities to access them, they also must adjust the conveyed messages to standards such as Web Content Accessibility Guidelines (WCAG).

Regarding the ethical concerns about the ICT tools used in participatory processes, we must ensure that they empower diverse participation and override social divisions. We are well aware that not only those who are familiar with the technology and use it on daily bases should be our focus, but also those who may be reluctant or new to this type of involvement should be included. Access to the Internet or smart devices should not be an entry barrier for any citizen; therefore, we strive to develop alternatives to ensure that no one is left behind.

Some other ways to overcome the shortcomings of ICT-fueled engagement and data collection are listed below:

• Ensure access to required ICT tools to all citizens, by making them as easy to use as possible, fun, and rewarding to engage with.
• Organize special events for those whose voice is often marginalized—urban poor, women, minorities, minors, and the elderly—to make sure they can express their preferences in a safe environment.
• Offer tangible incentives to participating citizens that could be enjoyed in the real world.
• Convey the process goals and information in a form and language as accessible as possible; not only the instruction needs to be clear, but also hardware and software must be understandable and intuitive.
• Offer participants diverse forms of social interactions and empowerment to make up for the lack of physical contact.
• Create information loops that ensure that citizens receive feedback on the information that they submit and the activities they perform.
• Pseudonymize all health data to ensure participants’ privacy, so that only depersonalized data is available for analysis and only aggregated results are shared.
• Perform data analysis in ways that are not focusing on the average impact measurements, but take into account the diversity of users and how they were affected.
• Cross-validate data from sensors with subjective evaluation measures collected among users to make sure that the objective improvements brought subjective benefits.

What seems to be the most difficult barrier to address in the case of our specific implementation sites are trust deficits often stemming from previous negative experiences in engaging with other local stakeholders. In places where the municipality is perceived as corrupt or over-bureaucratized, citizens’ motivation to participate is especially low. Another barrier lies on the side of the municipality, which often works on the specific schedule dictated by the local development strategies, policies, and other internal regulations. This means that there is often little time to organize stakeholders’ meetings and participation processes because political and bureaucratic goals take precedence.

9. Conclusions

The existing studies offer substantial evidence that the design of urban space strongly influences the behavior and wellbeing of users and nearby residents. Similarly, in the field of public health, a direct link between the urban environment and health risks or benefits can be made. We, therefore, know that protecting and upgrading urban green areas can help to mitigate the negative consequences of living in polluted, stressful, and climate-sensitive urban areas. This is because nature settings can meet multiple needs at the same time. They often enhance social interactions and help foster a sense of community, while, conversely, they can create a sense of calm and privacy in an outdoor space [111].

Therefore, it is not surprising that urban residents worldwide express a desire for contact with nature and each other, for living in environments that offer opportunities to recreate and play, and allow privacy as well as friendly spaces for spontaneous interactions. The quality-of-life demands goes hand in hand with the expectation to have a more active role in the design of their neighborhood, and a chance to develop a sense of community identity. Both can be seen as expressions of the right to the city agenda, which encompasses the cry for a decent life in the cities and the demand to become a subject, not an object of urban interventions [62].

However, in urban planning processes, conflicts often arise. In the process of planning for diverse and potentially conflicting needs and preferences, a balance must be sought through a well-designed process of participation and stakeholders’ engagement. As Matsuoka and Kaplan [111] demonstrate, people’s desire to participate in decisions that affect them is often expressed in the context of nature-based interventions. Because such settings are highly valued by users and residents alike, involving local groups early in the planning process is particularly important. In that way, the potential conflicts can be anticipated and addressed in the design solutions, and some new ideas developed together with participating citizens. A wider stakeholder engagement helps ensure that the planning outcomes respect the local culture and history of the community, foster the existing and help forge new community ties. The ways to address the citizens’ needs are diverse and therefore require sensitivity to local circumstances.

To make such a green and healthy city happen, we need a wide coalition of local stakeholders to negotiate optimal solutions and safeguard the citizens’ participation. If left alone, neither public authorities nor private investors can guarantee the implementation of the citizens’ right to the city. Therefore, a local coalition should involve incumbents as well as challengers in the local field of urban policy [112] in line with the pentahelix model, drawing from all sectors, including public and private actors, civil society, academia, and citizens. In our paper, we suggest that the right to a healthy city could become a platform for this type of coalition, as it highlights the importance of health as a basic human right and helps to create a concrete narrative [113] around planned interventions.

While this coalition should focus on the specific area and how to upgrade it to provide better living conditions, a much wider alliance on the global scale is needed to ensure that all can benefit from it. As Mayer [2] aptly points out, as researchers, we need to get involved in the emerging partnerships where planners, professionals, academics, organizers, and advocates collaborate with community networks and movement activists to transform our cities, not merely upgrade them.

This is what the civil-city approach strives to do, by presenting a holistic approach to preparing, conducting, and evaluating urban investments. In this, we employ frameworks and experiences from a growing number of research projects that range from studying smart cities from a right to the city perspective, through monitoring NBS implementation, to evaluating citizen science projects and operationalizing social sustainability measures. We critically observe smart-city implementations as those which could greatly benefit from the right to the city approach to correct the course of urban development, so it does not blindly implement technological novelties. Applying the right to a healthy city framework allows the same innovations to empower the citizens, while informing better planning and urban policies.

We believe that the complex challenges that the cities face right now require an analytical approach, based on a theory-driven empirical toolbox and value-driven implementation and evaluation framework. We call this Civil City Framework to underline the central role of citizens and civil society structures in ensuring that urban development takes a new course.