Can high-rise homes make you ill?

HEALTH AND WELLBEING: Are you in heaven or are you in hell? Are towers good for you? asks Create Street’s Nicholas Boys Smith.

Frothy coffees. Funky spaces. Great neighbours. Green roofs. Walking to everything. Watching the sun go down from your exclusive eyrie. To read the PR patter of a hundred sales brochures right now is to realise that high-rise heaven is round the corner and up the lift-shaft. We have learnt, proclaim sleek developers and confident architects, from the mistakes of the past. This time people will be happy and the windows will clean themselves.

Are they right? Some market signals are hopeful. There is a market for top end residential flats high in towers. In modern, high-end, well-managed London developments with a reliable lift, each floor is typically worth 1.5% more. Some robust sociological studies show that middle income or wealthy residents can be very satisfied with their homes as long as the blocks are well managed. And recent city-wide data shows that crime, particularly burglary, can now be lower in high-rise buildings compared to other housing. With more prosperous residents, controlled access, more expensive management and street locations, high-rises can be very safe places to live.

However, take the long view and the data is more disturbing. What is the evidence of the experience of living in high-rise or large blocks on wellbeing and correlated factors such as children’s progress, physical activity and social interconnectivity levels? Clearly people can be happy in towers and miserable in houses and vice versa. However, our study, Heart in the Right Street, has reviewed 85 peer-reviewed academic studies which contrasted socio-economically comparable groups living in high and low-rise accommodation. Sixty-seven (79%) found that high-rise residence was negatively associated with some aspect of wellbeing. Nine (11%) found no association either way. And nine (11%) found a positive association between high-rise residency and wellbeing. Living in large high-rise buildings is less popular for most, associated with higher levels of stress and mental depression (particularly for women in families), is normally inimical to effective child-rearing and seems to be normally associated with lower levels of social capital. Nor does very recent research suggest this is changing. One very recent study (though imperfectly controlled) found that Vancouver high-rise residents were less likely than those living in detached homes to know their neighbours’ names, to have done them a favour, to trust them or to believe that their wallet would be returned if lost locally.

Why is this? Three reasons stand out. Firstly, it often seems to be much harder to bring up children in large blocks of flats. Children go outside less when they live in high-rises. They spend more time playing alone or in restricted play. This is not without consequences. One controlled study, compared mothers of under fives in the Newcastle estate of Cruddas Park. Some 62% of mothers living on the sixth floor or above reported difficulties with the ‘play, health [or] personality’ of their children; 53% of mothers in high-rise below the sixth-floor reported issues. However only 3% of mothers in houses reported issues.

Secondly, when the internal scale of a large building matches their external scale, towers can “atomise” and dehumanise by taking away from residents control over who they will meet as they travel between their flat and the public realm. The can increase withdrawal and anonymity and decrease friendships. Residents may meet more people but they will know fewer of them. Research suggests that “the richest social environments are those in which we feel free to edge closer together or move apart as we wish”. However, living in large buildings can undermines these bonds of social interdependence. And society needs these bonds. Professor Robert Gifford has cited a very wide range of controlled studies that make this point emphatically. In one study, those with garden flats had three times as many friends in the building as those on high floors. In another study residents of low-rise buildings had 50% more local friends than residents of high-rise buildings.

Thirdly, bigger more complex buildings cost much more to manage. A 2012 Cambridge study found that service charges rose as densities increased. One very experienced architect concluded that “it is inevitable that tall buildings have much higher management costs”. This seems to be particularly the case as high-rise buildings age. Service charges in the Barbican Centre’s Shakespeare Tower are £8,000 a year. This is fine if residents or owners can afford it. But if they can’t, the communal area can become pretty unpleasant. This was what happened following the last high-rise boom. What is the long-term outlook for luxury towers in a post-Brexit outer London?

Flats in ultra-high density buildings have their place in the modern city. The platonic ideal of the high-rise resident will usually be a male, prosperous, childless, second-home owner. Towers can work. But they are clearly, statistically, not for everyone.  Sip carefully because the coffee isn’t as frothy as it seems.

Design matters in affordable housing

Create Streets’ recent book Heart in the Right Street, examined the available research on connections between wellbeing and the built environment.

Here is a summary of the key findings:


  • At least 10 studies have now shown a link between regularly looking out at an attractive green environment and mood, stress, recovery from mental fatigue and wellbeing.
  • Most strikingly, patients who look out at an attractive environment require less medication and recover more quickly than those who do not.
  • However, greenery needs to be done in the right way. It can be expensive to maintain and therefore susceptible to budget changes in the future. There is evidence that green space is degrading into hard paving for reasons of economy in the UK right now.
  • Likewise, green space that is too big and too far away tends to not make a difference to people’s everyday life. UK focus group research by MORI also shows that, given the choice, most people would rather have access to modest private gardens which they can use effortlessly every day and which seem to work better in managing family stress and wellbeing.

Homes and height

  • People want to live in homes rather than tower blocks. A recent IPSOS Mori Poll, has shown that terraced houses (24%) and low-rise purpose built flats (21%) are thought by the public to be the most suitable buildings to meet the needs of Londoners. Only 8% support towers.
  • There are numerous wellbeing indicators associated with homes and buildings at human scale height and form. The most comprehensive literature review Create Street was able to find concluded: “The literature suggests that high-rises are less satisfactory than other housing forms for most people, that they are not optimal for children, that social relations are more impersonal and helping behaviour is less than in other housing forms, that crime and fear of crime are greater, and that they may independently account for some suicides.”
  • This is not to say that towers are always bad. Indeed, consistently around 10% of the population prefer them. But they tend to be far more popular amongst the rich and the childless. The rich can certainly cope with their higher management costs.
  • Clearly people can be happy in towers and miserable in houses and vice versa but an analysis of a total of at least 85 peer-reviewed academic studies which contrasted socio-economically comparable groups living in high and low-rise accommodation, 67 (or 79%) found that high rise residence was negatively associated with some aspect of wellbeing.
  • Living in high-rise building is associated with higher levels of stress and mental depression (particularly for women in families), is normally inimical to effective child-rearing and seems to be normally associated with lower levels of social capital.
  • This goes hand in hand with density. Developments should be dense enough to be walkable and to provide walkable shops and offices. But not too dense as to be overwhelming or to be creating problems of urban form or long-term maintenance costs. Between 50 and 220 homes per hectare is perfect.

Connectivity and streets

  • Streets that “plug into” the surrounding city are associated with numerous positive wellbeing outcomes. A well connected, highly walkable, traditional street grid of differing natures and sizes with multiple junctions and route choices. Some streets should be pedestrian or bicycle only but most would be mixed use with generous pavements wherever possible.
  • If larger residential buildings really are felt to be essential existing research indicates that for most people inside and outside the building the best thing is to design them as if they were smaller buildings. If their external facades are “broken up” vertically they will promote more pro-social behaviour among passers by.
  • Active facades help makes cities work: a Copenhagen Study calculated that there was around seven times as much activity on front of active facades as the passive. Activity brings all sorts of wellbeing, economic and crime-reducing benefits. Other studies in Madrid, Melbourne and Stockholm had similar findings. Mixed use developments, with residential, commercial and retail use, helps to bring about this crucial activity.
  • Walkability is vital: studies have shown that residents of the most walkable neighbourhoods (ones which plug into city-wide connectivity) were nearly two and a half times more likely to get sufficient physical activity than residents of the least walkable.

Beauty and design

  • Beauty really does matter – any development that most people don’t aesthetically like is missing a key trick and is not maximising the wellbeing or happiness of residents. Environmental psychologists have shown that alongside green space and soft edges we enjoy gentle surprises and pleasant memories. We dislike sharp edges, darkness, sudden loud noises. What this means is that the strong preferences that most of us show for a more locationally and historically referenced architecture is therefore psychologically credible, even sensible.
  • There is measurable emotional attachment to beautiful places – a 2011 US survey found stronger correlations between a place’s physical beauty and people’s satisfaction with their communities than any other attributes. 2008-2010 Gallup survey of 43,000 people in 26 cities agreed. It found that residents’ ratings of the aesthetic attraction of their cities and green spaces correlated significantly with residents’ attachment to their city. This in turn correlated with GDP growth.

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Nicholas Boys Smith is the director of Create Streets, a non-partisan social enterprise and independent research institute focusing on the built environment. He is a research fellow of urban design at the University of Buckingham