Health and urban development: a centuries-old connection

A concept as old as the Romans
The ancient Greeks and Romans were already well aware of the deep connection between our surroundings and our health. The Roman architect Vitruvius, in his landmark treatise De Architectura (c. 80–70 BC), championed a healthy living environment built on the principles of utilitas, firmitas, and venustas. A building was expected to be more than just functional and durable; it had to be beautiful and contribute to the health of people.

Following the fall of the Roman Empire in the 5th century AD, Vitruvius’s work fell into obscurity for a long time, until it was rediscovered during the Renaissance (15th–17th centuries). Vitruvius’s ideas on healthy living environments inspired famous architects such as Niccoli, Brunelleschi and Leonardo da Vinci.

Population growth puts health on the agenda
European population growth took off during the Renaissance, but it was the Industrial Revolution, which began in 18th-century Britain, that sent numbers soaring.

The Low Countries were no exception. There too, cities began bursting at the seams. Working-class families lived crammed together in small, unhygienic shacks: “musty, damp rooms cause diseases of all kinds”¹. Growing societal concerns about unhealthy housing sparked a new social policy in the mid-19th century.

In 1852, the first housing association in the Netherlands was founded: the Vereeniging ten behoeve der Arbeidersklasse (Association for the benefit of the working class). Just a few years later, the Dutch Royal Institute of Engineers highlighted the connection between substandard housing and poor public health in its 1854 Report to the King on the Requirements and Layout of Workers’ Dwellings. As one of the first official institutions to address the issue, the institute assessed the living conditions of workers and drew up guidelines to improve housing hygiene in Dutch cities.

Healthy housing becomes law
From that point onward, the debate on housing hygiene intensified. In 1895, the issue ranks high on the agenda of the Congress for Public Health Regulations, a public-private collaboration of politicians, civil servants, physicians, and engineers.

The congress concludes that a ‘national law addressing the most pressing demands of housing hygiene’ is necessary. This leads to the Housing Act of 1901, a milestone in Dutch housing policy. A key instrument within the Public Health Act of 1901, which oversees public health in general, the Housing Act laid down practical regulations to put an end to unhealthy housing.

By the early 20th century, the Dutch state had become convinced that active legislation was essential to ensure a healthier living environment for its citizens.

From healthy housing to healthy area development
The post-World War II baby boom and rapid economic expansion triggered a new wave of urbanisation. To ensure that the growth of cities proceeded in a structured manner, a spatial planning memorandum (‘Nota inzake de ruimtelijke ordening’) was adopted in the Netherlands in 1960. At the same time, the first Housing Act of 1901 was replaced by the Housing Act 1962 (which came into force in 1965).

Since then, these spatial policy documents have been regularly revised, with the most recent version being the ‘Ontwerp Nota Ruimte’ of 2025. Over the 125 years since the Housing Act took effect, the focus has expanded from tackling unhealthy housing to enhancing the quality of the broader living environment. This is crucial because while growing wealth has raised life expectancy – from an average of 71 years in 1950 to 82 years in 2025 – the number of years spent in poor health is also rising. People are living longer lives, but they are also living longer with an illness or impairment.

Health as an integral part of area development
While economic prosperity continues to climb, social well-being is increasingly under strain. Looking ahead, our primary challenge will be extending the years that people live in good health.

Area developers can play a big role in this by making health a core part of how they design neighbourhoods. Things like strengthening social cohesion in the neighbourhood, encouraging people to exercise, and ensuring access to sufficient green spaces deserve a permanent place on the agenda.

This is in addition to delivering high-quality, healthy housing. In this regard, we can learn from the old masters. To return to Vitruvius: “The central areas, bounded by porticoes, should be decorated with greenery. This is because walking in the open air is very healthy”².

_Sources

_{[1] This quote comes from a letter sent in 1851 by three prominent residents of Amsterdam to concerned fellow citizens. The aim was to raise funds for the establishment of the Netherlands’ first social housing association, to provide working-class families with good and healthy housing. Source: Beekers (2012).}

_{[2] Source: Vitruvius, De Architectura, section 5.9.5; in: Andrew Fox (2026).}

_{Beekers, W.P. (2012), Het bewoonbare land. Geschiedenis van de volkshuisvestingsbeweging in Nederland. Vrije Universiteit Amsterdam: https://research.vu.nl/ws/portalfiles/portal/42109893/complete%20dissertation.pdf.}

_{Binnenlands Bestuur (2019), Wonen en zorg: gescheiden maar onlosmakelijk verbonden. Binnenlands Bestuur: https://www.binnenlandsbestuur.nl/ruimte-en-milieu/verkiezingen/wonen-en-zorg-gescheiden-maar-onlosmakelijk-verbonden.}

_{CBS (2024), Geschiedenis van het sociale zekerheidsstelsel in beeld. CBS: https://www.cbs.nl/nl-nl/corporate/2024/39/geschiedenis-van-het-sociale-zekerheidsstelsel-in-beeld.}

_{CBS (2025), Tijdlijn Woningvoorraad. CBS: https://www.cbs.nl/nl-nl/longread/diversen/2025/tijdlijn-woningvoorraad.}

_{Dijkman, R. (2024), Een onderzoek naar het effect van een gezonde leefomgeving op woningprijzen in steden uit de G40 gelegen in Noordoost Nederland. ASRE: https://files.vastgoedbibliotheek.nl/Server/getfile.aspx?file=docs/MSRE/24_2/Dijkman_RJ.pdf.}

_{Fox, A. (2026), Blog #121: Healthy Living in Rome’s Green Spaces with Andrew Fox. Peopling the Past: Blog #121: Healthy Living in Rome’s Green Spaces with Andrew Fox – Peopling the Past.}

_{Galen, R. van (2026), Bijdrage op LinkedIn: https://www.linkedin.com/posts/rubenvangaalen_vanochtend-op-de-npo-radio-1-naar-aanleiding-share-7485567919490334720--aCQ/?utm.}

_{HCSW, Canon Volkshuisvesting: 1854 Verslag aan den Koning over de vereischten en inrigting van arbeiderswoningen. HCSW: https://canonsociaalwerk.eu/nl_vhv/detail/475.}

_{HCSW, Canon Volkshuisvesting: 1901 De Woningwet ‘Zaak van het Rijk, taak van gemeenten’. HCSW: https://canonsociaalwerk.eu/nl_vhv/detail/265.}

_{KU Leuven, Vitruvius: voedingsbodem voor renaissance-architectuur. Publicatieplatform UB: https://expo.bib.kuleuven.be/exhibits/show/renaissance-architectuur/vitruvius.}

_{Ministerie van Binnenlandse Zaken en Volkshuisvesting, Vitruviuswaarden. Ministerie van BZK: https://www.ruimtelijkeordening.nl/onderwerpen/ruimtelijke-kwaliteit/ruimtelijke-kwaliteitsaanpak/vitruviuswaarden.}