The first stage of a medical examination is observation. Patients explain their symptoms to a doctor who uses their years of expertise to come to an initial conclusion. Only at that point does the patient move into the second stage in which an initial assessment is tested. 

Far from an exact science, medical diagnostics combines the intuitive reasoning of practitioners with partly subjective observation, before it is explored or tested further by a data collection process and analysis. This two-stage process helps professionals to make sense of the complex system of systems in the human body in the most efficient way possible. Skipping that first step and simply testing for every known ailment without a sense of a target would have general practitioner (GP) waiting times and lists stretching into days, even weeks.

For John Bryson, Professor of Enterprise and Economic Geography at the University of Birmingham, it inspired a new way of thinking about cities. This was a new way that led to one of the first RC-UK funded projects that received funding from every research council and Innovate UK. 

“City-regions, much like the human body, are a complex coming together of systems and interdependencies,” he explains. “But we have failed to properly read cities. We solve particular problems that have been politically defined, or answer a specific research question, but we overlook the city as a whole.”

“There would be so many issues with gathering data on every possible system within a city, not least having the time to do so. But if you treat the reading of cities like medical diagnostics you can observe, test and explore that web of connecting elements as a whole and really get to grips with the health of a city before focusing on the elements that really make a difference.”

Understanding the reality of city-regions and the challenges they face is a critical matter for our times. 

Global urbanisation is predicted to continue, with estimates that by 2030, 60 per cent of the world’s population will be living in cities. 

Cities can bring many benefits and opportunities as drivers of economic growth. But the confluence of diverse and interlocking forces acting on cities may also subject the population, or sections of it, to distress. The causes may be environmental, technological, economic, social or political, and act over timescales of days to decades.

“So many people depend on our city-regions,” says Professor Bryson. “It is essential that those many people; local authorities, planners, policymakers, urban design decision-makers, urban professionals, academics, businesses, financiers, residents and communities are able to work together to answer questions about the future of our cities, of their cities. Of course, the first step is asking the right questions, and an urban diagnostics approach will help them read their place or city.” 

Embracing complexity

Professor Bryson has focused on city-regions since 1985. In the early years of his academic career, he took a risk in tackling hyper complex issues, bucking the trend to restrict his research to one facet of cities.

“I came to the realisation that we actually knew very little about the flows of funds and finance in our cities,” he says. “We knew something about poverty, about deprivation, about how and why people buy houses – but next to nothing about how billions of pounds in finance flow into our cities and are then distributed.”

His 2017 paper in Cambridge Journal of Regions, Economy and Society outlined how financialisation, a relatively old process, works in Birmingham, UK. It highlights the importance of a systemic analysis of the financialisation of buildings and infrastructure, and the contribution this makes to path dependency and the shaping or transformation of cities and, in particular of Birmingham. This is an important paper for the University of Birmingham as it traces the long-term impacts of decisions made by Joseph Chamberlain, the first Chancellor of the University of Birmingham, on the form and structure of the UK’s second city.

“If you are to investigate those flows of finance, you have to develop a dialogue between business models, infrastructure, alterity and financialisation. Yes, it is incredibly complex, but anything short of a holistic approach means you are only looking at part of the picture. That principle has been at the heart of my work for over three decades. If you always focus on simplifying the problem, you are no longer addressing the true problem.”

From finance to knowledge-based businesses, then production and manufacturing, to infrastructure, alternative infrastructure, and more recently air quality and environmental pollution, the scope of Professor Bryson’s research grows year-to-year, embracing the hyper-complexity of city-regions. 

As such, the conventional methodologies for studying cities became less helpful as the questions became more complex. The need for a new approach was clear, and urban diagnostics was born. 

Asking the right questions

A holistic methodology makes sense. Instinctively, we think about our cities as a system of systems, though perhaps only when things are in a state of flux. 

Much as we discuss our symptoms when we are ill, we understand the knock-on effects of a systemic failure throughout all parts of a city. A worker strike or a snowstorm, for example, could disrupt transport links. We know from experience that such an event will impact on the commute, on accessibility to hospitals, on retail performance. We just ‘know’. It would be amiss to then not apply that instinctive understanding of interconnectedness to our analysis of cities, and in planning their future.

Harnessing that experiential knowledge is part of the first stage of urban diagnostics.

Conducting thorough explorative testing of one system within a city is painstakingly long work; to do the same across multiple connecting systems would be near impossible. Ergo, by defining the boundaries for research with an initial ‘reading’, the urban diagnostics method makes such a broad investigation manageable. Not only that, but it allows for alternative factors that may not have been considered by applying traditional city-reading techniques. As Professor Bryson puts it: “If you analyse what you've always analysed you will get the results you have always got.”  

“We start with a series of qualitative diagnostics of the city,” he explains. “It is crucial to combine a top-down view – that the research community has tended to lean too much on - with inputs from people across the city. So alongside a review of every possible policy document, we worked on alternative ways of engaging with citizens. In our work in Birmingham we developed a board game to discuss the issues facing the city rather than run conventional focus groups. We hired artist facilitators to work with residents over a number of months to help them convey their own experiences of the city. What is city life really like?”

In doing so, the research team could look beyond the presumed challenges facing the region; crime, social inequality, environmental degradation, economic deterioration and disjointed governance, and define the parameters that really drive the behaviour of the city and its citizens.

“The ultimate focus of any policy should be systemic. And yet, more often than not you see areas siloed off - health, social care, economy, transport, education, housing policy. Collaboration between them is rarely encouraged either politically or even academically. Cities become trapped in a cycle of looking at the same data, asking the same questions year on year. It goes against what we know, what we observe, and what citizens say. We know that these systems are linked.”

If the millions of incremental decisions made in a city are done so without consideration of the systemic nature of cities, ineffective and inefficient planning can hinder the development of a region. Furthermore, it leaves a city exposed to risk from shock events.

The 2008 global financial crisis tested the ability of cities to weather such an event.

“It was a shock to the system for so many, and it posed a number of questions. We often focus on the cities that saw systemic failure but there are cities that not only survived the crisis, but actually came out the other side stronger. Why is that? It has to be down to the resilience of their systems and preparedness to adapt. Decision makers should look to those examples to see how their own cities can manage shocks.”

Professor Bryson continues: “I apply an evolutionary approach to understanding economies. Economies and city-regions are not, and should not be, static. An overreliance on our past can often send us down a particular path which might not be appropriate, and a shock to the system can actually correct that course for the long-term benefits of a system. Here in the UK our systems were too financially orientated, and the 2008 crisis highlighted the need for change.”

“By the same measures you could consider Brexit as an opportunity to correct the system. But you can only do that if your cities are resilient enough in the first place, to adapt to the various forces and pressures they are exposed to. And to know if they are resilient enough, you need to be able to diagnose them correctly and get them prepared for shifting sands.”

Different problems, same methodology

Alongside colleagues from across the University of Birmingham, Professor Bryson supports the Resilient Cities workstream for the Institute of Global Innovation. It is designed to break down the boundaries between different disciplines and support decision makers in their quest for more resilient city-regions. 

In transitional city regions such as Nairobi and Sao Paulo, both involved in the research, a conventional ‘developed market economy’ framing of resilience is not appropriate. However, the flexibility of the urban diagnostics method helps local stakeholders to read their cities and reassess that understanding of resilience. 

“Resilience is more than just how cities respond to shock across these vast systems,” says Professor Bryson. “Resilience is individual, it is local, it is firms and sectors being adaptable too. This is where you start to see the similarities between cities. When a community is without the provision of a service, they are faced with a choice, to either accept the absence of private or public sector support, or to create. That is where innovative solutions come to the fore. Making choices by yourself, for yourself.”

Citizens are able to redefine themselves as innovators by plugging the gaps in the systems themselves.

“Sometimes their micro-systems will then be taken on and consumed into part of the city by public or private sector organisations. Whether they are or not, they make your city more resilient, and understanding their role is key to getting a true reading of the systems within a city,” he adds.

A 2018 paper in Geoforum, on which Professor Bryson was senior author, explored local infrastructure in the UK using such ‘alternative’ approaches to addressing infrastructure exclusion. In the case of one particular project - Broadband 4 the Rural North – the question was how broadband infrastructure could be provided when it had not met either a value-for-money calculation undertaken by the state, or the investment criteria required by capital markets.“

It is a really good example of how these ‘shadow’ activities often operate,” says Professor Bryson. “These rural residents needed broadband and were in what is called a ‘not-spot’. Connecting them was not seen as a priority for the public and private sector. Through their own endeavours, volunteering time and resources, residents created their own broadband service. Now what you have is a service that can be monetised, and people can be employed to manage the on-going delivery of this local broadband company. That benefits everyone and makes that community far more resilient.

“For policy makers it displays a need to move on from the idea that shadow activities should always be removed, which is often the way. We should re-imagine that relationship. Facilitating and supporting informal service providers alongside the formal systems can be a real asset. That sort of organisation and drive is at the heart of a resilient city and community.”

Urban diagnostics help to ‘read’ cities

Urban diagnostics can bridge the gaps in our reading of cities. It can show value in alternative service providers that may have been overlooked. It can identify pressure points and areas of strength, the very systems that will be in stark focus during shock events.

Perhaps it is no coincidence that a methodology borne from medical diagnostics has been so well received by Public Health England (PHE) – who have partnered with Professor Bryson and his team since 2018. Early outputs from the collaboration include an invited paper to the national PHE conference, a workshop targeted at trainee public health registers, and a day-long masterclass for PHE professionals.

For Professor Bryson, such partners represent a key way of driving change in how decisions are made. 

“Urban diagnostics is a threat politically, because a politician wants to be seen to be setting the agenda, making a difference and using those perceived successes as a reason for re-election,” he notes. “We believe that a diagnostic approach should be the first step in any policy prioritisation programme, but that simply is not how it has been done in the past.”

“But much like cities, and our bodies, decision making is the result of many inter-linked systems. By working with influential groups like Public Health England, we can help inform decision making that helps prepare our cities for future generations.”

To keep our cities in good health we need to change our approach to diagnosing them. It will contribute towards making decisions that move us towards more inclusive, sustainable, resilient city-regions. And, much as in medicine, prevention is far preferable to cure.

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