Play as a Public Health Intervention in Cities

[This article has been published in Catalan in the"Espai Salut" newsletter of the Diputació de Barcelona]

When adults are asked to reflect on a happy moment of their childhood, they often remember playing outdoors, generally without their parents’ supervision. However, over the last 50 years, playing outdoors has decreased drastically in countries with medium and high income.

Especially in cities, play is becoming more and more restricted by the lack of independent mobility of children, by greater supervision by their parents and by the limited availability of public green spaces. Thus, although play is an activity associated to childhood, modern urban environments limit children’s opportunities more than ever. Instead, children are much more likely to spend their free time indoors and to use screen-based technology.

Especially in cities, play is becoming more and more restricted by the lack of independent mobility of children, by greater supervision by their parents and by the limited availability of public green spaces

The results for health can be seen in the increase in child obesity, attention disorders and mental health problems, such as anxiety, depression or aggressive conduct. Furthermore, the lack of play and the associated reduction in physical activity mean that children become physically weaker, to the point that even when their body mass stays the same, their muscular strength declines.

In article 31 of the Convention on the Rights of the Child, the United Nations recognizes the right to play as the “specific human right of children and young people”. It is widely recognized in literature on child psychological development that play is fundamental for physical and emotional development. However, public policies to support play in public spaces are few in number, while priority is given to motor vehicles and commercial activities in these same spaces.

In some towns and cities in Catalonia, the prohibition of playing ballgames in public squares is a clear example. In the United Kingdom and the USA, there are also numerous cases in which children’s play activities, such as climbing trees or drawing with chalk, in urban public spaces, have been prohibited or even criminalized.

How does play benefit health?

Play is the main form of learning in childhood. As children grow older, play continues in many ways to be critical to their health and wellbeing. As explained by P. Gray, play promotes mental health, as it is “the major means by which children develop intrinsic interests and competencies; learn how to make decisions, solve problems, exert self-control and follow rules; learn to regulate their emotions; make friends and learn to get along with others as equals; and experience joy”. It also helps to develop fine motor skills, co-ordination, sensory abilities, agility and strength.

Play is the main form of learning in childhood. As children grow older, play continues in many ways to be critical to their health and wellbeing

Play can promote creativity, alleviate stress and contribute to general wellbeing. Outdoor play in natural or green spaces and play with other children without supervision are especially important for healthy development and can improve self-awareness, capacity to reason, perception and the feeling of independence.

The risk of injury is often mentioned as a barrier or limiting factor. Curiously, although most statistics show that child safety has remained stable or has improved in many towns and cities, our collective tolerance of possible play-related injuries has decreased.

A systematic review of the relationship between outdoor play involving risk and children’s health revealed general positive effects of risky outdoor play in a variety of health indicators, among which the most frequent was physical activity, as well as the positive effects on social health and social behaviour, injuries and aggressive conduct. Tim Gill, an expert on matters relating to childhood and play, offers a detailed discussion of the evidence and controversy and defends the need for autonomous play and for exposure, through play, to risk levels that are appropriate for each age.

What can we do?

Playing outdoors, being able to move around the city without needing an adult and having contact with nature are very useful indicators about the quality of life of a town or city, both for children and for all generations.

In order to recover play as a fundamental part of childhood, we have to provide suitable environments for the different stages of development. This includes the creation of physical infrastructures, such as safe and attractive green areas that are accessible by children without necessarily having to be accompanied by adults. The infrastructure should not just be defined as children’s parks with play equipment but should include natural elements such as earth, sand and trees, irregular surfaces and areas to climb. Opportunities for play may be dispersed all around the town or city at smaller scales, at the same time as larger spaces are created for sport and exploration.

Policies are needed that recognize and protect the rights of children to use and enjoy public spaces. An intersectorial action of the administrations is also required to improve mobility in towns and cities so that children can get around safely using active or public transport.

Policies are needed that recognize and protect the rights of children to use and enjoy public spaces

Play-friendly cities are gaining ground at international level, not only to create better options for active play, but also to include children in urban design processes, actively involving and empowering them. Cities such as Boulder Colorado have created specific programmes to achieve this, and platforms such as Child in the City offer resources to take a different approach in considering play in city planning and management.

School playgrounds offer a key area for intervention. Traditional yards with cement grounds where areas to play football or basketball take up most of the space offer few types of play. Eliminating concrete and placing tree trunks, tunnels and vegetation could be low-cost ways of facilitating play.

School yards may also serve as learning areas, to provide new synergies between the acquisition of knowledge and play. For example, the city of Ghent created the GRAS programme -Green Adventurous Schools- to reform the yards of primary and secondary schools. The head teachers of the schools observed that injuries and bullying decreased, while attention and concentration increased with yard designs that encouraged more active play and green elements.

School playgrounds offer a key area for intervention (...). Eliminating concrete and placing tree trunks, tunnels and vegetation could be low-cost ways of facilitating play

Copenhagen has used the “play along the road” philosophy to bring leisure activities to all areas of the city, such as junctions, school yards and the waterfront promenade. Instead of just designated children’s parks, a diversity of places are offered for taking part in sport, cycling, jumping and swinging while gong about everyday activities.

Locally, in February 2019 Barcelona City Council and the Childhood and Adolescent Institute presented the first Public space play plan, an initiative that places playing and physical activity as the key tools to achieve a better city to live in. The plan values the wide-ranging benefits of play, both for the development and wellbeing of children and young people and for the health and community life and co-existence of all citizens. Among other things, it defines seven criteria for the design of a “playable” city.

Barcelona City Council and the Childhood and Adolescent Institute presented the first Public space play plan, an initiative that places playing and physical activity as the key tools to achieve a better city to live in

The city of Pontevedra, which has been recognized internationally for its policies to recover public space, remarks that one of its main indicators of success is the increase in the number of children and families who play in the streets. Therefore, play is much more than free time and fun. Play is a right, but also a powerful means of promoting healthier, happier and more inclusive cities.