Introduction

What role should urban and rural planning play in dealing with infectious diseases? How should planners link the vision of epidemic prevention and control with specific actions? This seems to be an important issue in urban and rural planning. The word “important” does not mean that the current COVID-19 pandemic “exaggerates” the importance of the above issues. In contrast, COVID-19 is another reminder to the world of the long-term neglect of infectious diseases in urban and rural planning and of the serious negative consequences of this neglect.

Fewer than 20 years elapsed between the COVID-19 pandemic, the acute respiratory infectious disease caused by SARS-CoV-2, and the first international outbreak of SARS in 2002–2003. Surprisingly, this coincides with the completion cycle of comprehensive urban and rural planning (generally 15–20 years). Looking back at the timing of major pandemics, at least seven have occurred since 1950 (Piret and Boivin 2021). From a global perspective, pandemics are far more common than previously thought. For instance, at least four pandemics have occurred since 2000, including the swine flu (2009–2010) and MERS (2015-present), in addition to the two SARS pandemics mentioned above. This suggests that when planners start to develop a new comprehensive urban and rural plan, pandemic issues are very likely a hidden threat to the built environment for which the plan is to be launched. Therefore, pandemics should be given more attention and consideration in urban and rural planning.

Although modern urban and rural planning originated from concern about epidemic infectious diseases, contemporary planning has faced an embarrassing situation with regard to this issue. The 1848 Public Health Act in the UK set the precedent for modern urban and rural planning to prevent infectious diseases by improving urban infrastructure. Subsequently, a series of modern urban and rural planning theories proposed in the early 20th century continued the logic of solving urban public health problems by improving the urban physical environment. However, this idea seems to have reached its limit in recent decades. Contemporary urban and rural planning focuses on accidental injuries and chronic and mental health issues instead of infectious diseases (Kochtitzky and Frumkin et al. 2006; Harris and Harris-Roxas et al. 2022). This focus stems from the inability to treat epidemic infectious diseases rather than active choice. Although academics have claimed that the prevention of infectious diseases is a key issue in urban planning, planning practitioners have no coping strategies to reference for infectious diseases (Kochtitzky and Frumkin et al. 2006). It is not surprising that previous studies (Lennon 2023), (Bereitschaft and Scheller 2020), (Maturana et al. 2021), identify protecting cities from future infectious diseases as “an emerging strand of research” triggered by the epidemic.

Since 2020, most discussions among urban and rural planning scholars on epidemic response have focused on physical determinism or technological determinism guided by social distancing. This replicates the long-standing mechanistic thinking that urban and rural planning problems can be decomposed into several parts that are studied separately and finally assembled to form an understanding of urban and rural planning. This methodology allows us to draw certain conclusions that hold true under specific conditions at a lower cost. However, this research often leads to seemingly irreconcilable debates because the assembled machinery is not equal to the disassembled parts. In contemporary times, this kind of research has grown to a stage where it is possible to conduct research that is closer to reality by starting from the planning itself (the machinery as whole). Due to dissatisfaction with the drawbacks of mechanistic thinking, some scholars have also attempted to adopt a relatively comprehensive perspective to discuss the response of urban planning to epidemics. A previous study (Alizadeh and Sharifi 2023) attempted to use the concept of the social smart city to reconcile the contradictions of physical determinism and technological determinism, two representatives of fragmented thinking, with the ideological system of urban planning. Another study (Bereitschaft and Scheller 2020) attempted to establish a comprehensive perspective on responses to the epidemic, although a large part of this research focused on the concretization of social distancing concepts in physical space policies. Therefore, the focus on the “planning landscape” can more likely be regarded as an expanded version of the assembly of the planning parts. Martínez and Short (2021) adopted a comprehensive perspective that provided several possible measures for urban and rural planning in the face of the epidemic. During this pandemic, there has been a rapid increase in research on infodemic issues. This represents the extension of a comprehensive perspective on the digital environment. Research on epidemic prevention and control is breaking through the dimensional wall between the digital and physical worlds. Ball and Maxmen (2020) noted the problem of rampant infodemics during the early stages of this pandemic. Cai and Luo et al. (2023) discussed the transmission of false information on social media to provide a basis for the emergency management of information during unexpected events (such as epidemics). Zhang and Guo et al. (2022) discussed how to correct misinformation to prevent the spread of infodemics. Häusler and Baraghith (2023) proposed a method of immunizing individuals to infodemics through “preeducation”. These studies reflect the increasing interest in the academic community in a comprehensive perspective to respond to the pandemic, especially in the era of information technology.

In summary, current research is embedded in the scenario of what to do during an epidemic. Infectious epidemics require several necessary conditions, from the occurrence of individual cases to the local epidemic stage and then to the pandemic stage. There is almost no systematic analysis of the relationship between these necessary conditions and urban and rural planning. Starting from these necessary conditions, discussing the response of urban and rural planning to an epidemic can lead to the development of a comprehensive scenario for –planners that reflects what urban and rural planning can do during a pandemic. These achievements are operational in practice. At the same time, the comprehensive perspective used to construct this scenario at the theoretical level is itself an optimization of the traditional fragmented urban planning research approach. This allows us to construct urban planning theory in a more practical way rather than dividing urban planning into several competing theoretical clusters that cannot easily reflect the overall planning. Although the number of ideas presented in this study is still relatively low, these ideas have already begun to approach the unified theory of planning.

A pandemic represents the highest prevalence of a certain epidemic disease that spreads across geographic areas, while an endemic disease refers to the prevalence of an epidemic within a geographic area. From the perspective of urban planning, the significance of pandemics is not limited to describing their prevalence. A pandemic is a potential exogenous threat to cities caused by an epidemic disease that is supported by social and economic connections between cities and even countries. This potential threat is an issue that urban planners must consider. Moreover, because a pandemic has greater prevalence than an endemic state, concerns about the threats associated with pandemics will naturally encompass those associated with endemics. Therefore, this study focused on pandemic-level infectious diseases.

In this study, we analyzed the occurrence and epidemic chain of infectious pandemic diseases and evaluated the feedback mechanism between urban and rural development actions and the occurrence and epidemic process of infectious pandemic diseases. A map of the path for urban and rural planning to address the epidemic caused by infectious diseases was produced. The purpose of this map is to construct a large picture that clarifies the planning approach used to address issues associated with infectious disease prevention. Maps are also useful tools for urban planners to understand the complicated relationships between urban development outcomes and some common infectious diseases. The study illustrated the conflicts or synergies of various planning solutions for infectious diseases. Therefore, maps can be helpful tools for supporting urban and rural policy-makers in reviewing their proposed urban and rural plans and policy sets.

The aim of this study is to summarize the relationship between pandemics caused by infectious diseases and urban development and construction behaviors through an literature search. Therefore, in “Chain of infection and urban and rural planning”, the article first discusses the relationship between the chain of infection and urban and rural planning characteristics (Fig. 1). In “Literature and Atlas”, the literature collection is described, and we present the relationship between the occurrence of infectious diseases and the results of urban and rural planning with the use of an atlas. In “Planning enlightenment”, we discuss the direction of urban and rural planning innovation based on this atlas. In “Conclusion”, we summarize and highlight the shortcomings of this study.

Fig. 1: The combined chain of infection and urban and rural planning.
figure 1

(Source: drawn by Haozhe Zhang, based on the chain of infection (Dicker and Coronado et al. 2006)). This figure shows that the physical environment affects the establishment of the chain of infection by influencing the possibility of agent, transmission pathways, and whether a host can convert into reserves or agent, thereby affecting the epidemic status of infectious diseases.

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Chain of infection and urban and rural planning

Chain of infection

The chain of infection is an important concept in epidemiology to describe the general process of how a pathogen causes human disease (Dicker and Coronado et al. 2006). The chain of infection includes three elements: the reservoir, the mode of transmission, and the host. A reservoir is a living or nonliving object that allows pathogens to parasitize. Reservoirs are generally divided into human, animal and environmental reservoirs. The mode of transmission is the way the pathogen reaches the host from the reservoir and can be divided into direct and indirect modes. The host is a person invaded by pathogens, generally symptomatic patients and asymptomatic carriers. After the pathogen is excreted from the host, a new cycle of infection can occur through the abovementioned pathways. If this process continues, an infectious disease will eventually lead to an outbreak. However, if any of the above three elements are missing, a pandemic will not occur or spread. Hence, efficiently managing these three elements is the fundamental strategy for controlling the spread of infectious diseases (R. Bonita and Kjellstrom 1996).

We can draw the following conclusions from the chain of infection: (1) whether the pathogen can be successfully and sustainably transmitted in the chain of infection depends on the nature of the outbreak of an infectious disease; (2) the probability of each of the three elements existing defines the probability of an outbreak of an infectious disease; (3) for the direct mode, patients’ or carriers’ ability to travel may cause a widespread epidemic of an infectious disease; (4) for the indirect mode, the spread of disease-carrying media may lead to a widespread epidemic of an infectious disease; (5) the pathogens excreted by the human host can enter the retransmission chain, and this repeated process will eventually cause an epidemic of an infectious disease, with the human host playing the role of the reservoir in the new infection chain; and (6) the generation and retransmission of an infectious disease are closely related, and their interaction leads to the prevalence of infectious diseases.

Physical environment: the junction between infectious diseases and planning

The definition of infection chains in Principles of Epidemiology in Public Health Practice: an Introduction to Applied Epidemiology and Biostatistics (Dicker and Coronado et al. 2006) and Basic Epidemiology (R. Bonita and Kjellstrom 1996) provides the basic logic that an epidemic of infectious disease requires two necessary conditions: the occurrence and the spread of an infectious disease. Based on this idea, we connected urban and rural planning and the chain of infection (Fig. 2). By adjusting the physical and social characteristics of the built environment, urban and rural planning can affect the emergence and prevalence of infectious diseases at three junction points: (1) the impact on the possibility of the infectious agent, (2) the impact on the transmission route, and (3) the impact on the possibility of the human host turning into a reservoir in the new circle of the chain of infection. The first two factors affect the possibility of occurrence of infectious disease cases or pathogen carriers, and the third factor affects the possibility of infectious diseases becoming epidemics.

Fig. 2: Atlas of planning responding to infectious diseases.
figure 2

(Source: drawn by Haozhe Zhang, Jinyi Li). This figure indicates that issues involved in urban and rural planning can be addressed and prevented by setting reasonable goals for the spread of infectious diseases. Although the relationship between issues involved in urban and rural planning and the prevalence of infectious diseases seems complex, the impact path is relatively clear.

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The physical environment and the social characteristics hidden behind it play crucial roles in the establishment and circulation of the infection chain. Contemporary urban and rural planning includes not only the study of the physical characteristics of the physical environment (location, scale, shape, etc.) but also the social characteristics (population, industry, public utilities, etc.) of different physical environments. Researchers have noted the complexity of these impact processes (McMichael 2004; MillenniumEcosystemAssessment 2005; Jones and Patel et al. 2008; Hassell and Begon et al. 2017). The physical environment provides a material basis for the spread of pathogens. Moreover, the ways in which humans use space directly affect the probability of human exposure to pathogens, which in turn has an important impact on the emergence and prevalence of infectious diseases. Hassell and Begon et al. (2017) noted that different types of landscapes (cities, suburbs, farmlands, forests, grasslands, etc.) have different effects on infectious diseases. Urbanized areas are related increasing epidemics, while farmland landscapes, such as forestland and grassland, show a trend of diversification in response to epidemics. In the final analysis, the influence of the physical environment on the prevalence of infectious diseases is determined by its influence on the possibility of the occurrence of infectious diseases and the possibility of transmission.

Literature and Atlas

Collection and summary of relevant literature

In this study, 60 relevant studies were screened and collected from SpringerLink, IEEE, ScienceDirect, Nature, CNKI (Chinese) and other databases. These documents had the following characteristics: (1) they considered the generation and mechanism of infectious epidemics, and (2) they examined the impact of globalization, urbanization, and agricultural development on infectious epidemics. These studies discuss the correlation and causation between changes in the material and social characteristics of the physical environment and the spread of certain epidemic-related infectious diseases and propose corresponding suggestions. However, the common limitation of these studies is that none of them presented a comprehensive solution to address the outbreak of epidemic infectious diseases from the perspective of managing the physical environment.

Overall, these studies reach a consensus on the following aspects:

  1. (1)

    Different types of landscapes (cities, suburbs, farmlands, forests, grasslands, etc.) have different impacts on the emergence and development of infectious diseases (Fischer and Reperant et al. 2005; Geue and Partecke 2008; Friggens and Beier 2010; Lehrer and Fredebaugh et al. 2010). Cholera, pestis, dengue fever, SARS, and COVID-19 usually emerge in densely populated urban areas, while there have been few large-scale outbreaks of infectious diseases in rural areas. Patz and Confalonieri (2004) argued that agricultural development and urbanization are both important influencing factors for emerging infectious diseases. Farming and urban construction can reduce biodiversity, release potentially pathogenic organic matter (e.g., feed, household waste) into the natural environment, and increase the temporal and spatial connections of individuals in the landscape (Gunderson and Holling 2002). All of these factors promote the generation, transmission, and prevalence of infectious diseases.

  2. (2)

    The feedback mechanisms of various influencing factors and functions that cause outbreaks of infectious diseases are complex and involve both positive and negative feedback. Intellectual agglomeration through urban development may lead to better medical standards, but a high-density urban environment may also lead to the rapid spread of infectious diseases. Urban construction and expansion follow the “ecological conception” and enclose a large number of natural lands. On the one hand, this introduces more natural environments into the city; on the other hand, this development creates more intersections between humans and wildlife, facilitating the occurrence of some zoonotic diseases. Jones and Patel et al. (2008) analyzed 335 emerging infectious disease (EID) events from 1940 to 2004 and found that the majority (60.3%) were zoonotic, and the majority (71.8%) of pathogens (e.g., SARS and Ebola) originated from wild animals and plants. Rohr and Barrett et al. (2019) revealed that agricultural production not only improved human nutritional status and enhanced individual immunity but also triggered new infectious diseases due to the large number of livestock and poultry raised (e.g., Avian influenza, swine influenza, Middle East respiratory syndrome).

Thus, the means to prevent outbreaks and epidemics of infectious diseases should be comprehensive.

Atlas

Although there is little literature on this topic, the ‘duality’ of urban and rural planning is the basis for thinking about the relationship between this planning and disease prevention. The original intention of planning was to implement certain actions to promote urban and rural development. Therefore, we assume that a plan must be implemented. Current urban and rural construction can be considered the result of previous planning implementation, while the current plan can be considered an adjustment to and revision of previous planning implementation. The term “planning” here has two meanings: human construction behavior and a predetermined action plan for achieving specific goals. Thus, the real results of urban and rural development and the possible outcomes of urban and rural planning are included in the study of the impact of urban and rural planning on infectious diseases. When considering planning and responses to the spread of infectious diseases, we attempt to determine the path through which urban‒rural development affects the spread of infectious diseases and the channels by which urban and rural planning affect the spread of infectious diseases.

When formulating urban and rural planning policies, the hope is that policies can address target issues (such as epidemic prevention and control). However, after the implementation of a planning policy, implementation may effectively prevent epidemic problems but may also promote outbreaks. For example, to shape a healthy life, cities often establish more routes to country parks for clean air and physical exercise opportunities. However, these planning policies may lead to the emergence of zoonoses due to increased contact between people and wild animals (such as pestis). This phenomenon can be attributed to the following two reasons:

  1. (1)

    Patients may have an incomplete understanding of the epidemic and urban‒rural planning, such as when few planners realize that close external connections may lead to a widespread epidemic;

  2. (2)

    Components should be made with certain considerations, such as increasing urban density while attempting to reduce carbon emissions, although this may increase the difficulty of epidemic prevention during an outbreak.

The purpose of the atlas generated in this study is to clarify the relationship between the epidemic and policies for planners and policy-makers while allowing them to make smarter compromises for this dilemma.

Urban and rural planning each include several specific issues. We categorize the impacts of changes to the physical environment on outbreaks of infectious diseases, drawn from the collected literature, into 12 issues: land expansion, population concentration, climate change, social inequality, health care capacity improvements, transportation improvements, built environment change, increased income, knowledge and education, increased food supply, increased agricultural inputs and irrigation, and increased livestock farming. Most of these issues (e.g., land expansion, climate change) are related to urban and rural factors. For example, increased agricultural inputs and irrigation belong to the rural aspect, while social inequality is considered an urban-related theme.

We established a comprehensive atlas to describe the possible related effects of different land use types in urban and rural areas and how these effects influence outbreaks of infectious diseases. The atlas includes the following four parts: aspects, issues, intermediate effects, and mechanisms of outbreaks. Planning involves both urban and rural aspects, and there are several common issues related to the emergence and prevalence of infectious diseases. The actions involved in these issues may directly affect the mechanism of outbreaks or may generate certain intermediate effects that can affect the mechanism of outbreaks.

The mechanism of outbreaks involves two links, occurrence and transmission, each of which has several direct causes. The possibility of an outbreak of an infectious disease is determined by both the probability of occurrence and its transmission. Increased contact between humans and pathogens and increased pathogen drug resistance are 2 key direct causes of infectious disease occurrence. Reservoir and transmission modes, host reservoirs, travel, and trading are 4 key direct causes of infectious disease transmission. Reservoirs and transmission modes as well as travel modes also contribute to possible contact between humans and pathogens, and increased pathogen drug resistance contributes to disease transmission. Additionally, increased pathogen drug resistance contributes to the possibility of transmission.

Intermediate effects imply more complex or implicit connections between certain issues in planning and the mechanism of disease outbreaks. The intermediate effects are determined and summarized from the collected literature. Health status involves the capacity to cure, medical attraction, lower diversity, field trips, the deterioration of the physical environment, the improvement of the physical environment, individual protection ability, and personal immunity.

Land expansion

Land expansion issue is concerned by both of urban and rural aspects in planning. It triggers the following two paths to promote the outbreaks of infectious diseases: increasing human contact with wildlife and lowering diversity.

  1. (1)

    Increased contact between humans and the wildlife. Land expansion by urban and rural development results in more intersections between human activities (such as residence, leisure, production, grazing, etc.) and wild animal and plant habitats (Friggens and Beier 2010), and thus leading to more exposure to pathogens carried by wild animals (Neiderud 2015). Many common wild animals are also hosts of zoonotic diseases (Taylor and Latham et al. 2001). About 60% to 80% of infectious diseases are zoonotic, of which at least 70% come from wild animals and plants (Jones and Patel et al. 2008; Karesh and Dobson et al. 2012; Rohr and Barrett et al. 2019). Wild animal aggregation caused by habitat shrinking may increase pathogen invasion to human beings and long-term epidemic through frequent contact between humans and the wildlife, which is supposed to exacerbate epidemic of zoonosis.

  2. (2)

    Lower diversity. Both urban and rural land expansion may lead to a sharp decline in biodiversity (Green and Cornell et al. 2005; Crist and Mora et al. 2017). The decrease in species diversity may lead to an increase in the number of wildlife hosts for pathogens, leading to an increase in the abundance of certain pathogen-carrying species, therefore contributing to The emergence of infectious diseases (Faeth and Warren et al. 2005; Dobson and Cattadori et al. 2006; Grimm and Faeth et al. 2008; Plowright and Sokolow et al. 2008; Smith and Acevedo Whitehouse et al. 2009; Keesing and Belden et al. 2010; Brearley and Rhodes et al. 2013; Jones and Grace et al. 2013; Galbraith and Beggs et al. 2015; Cohen and Civitello et al. 2016; Murray and Sánchez et al. 2019). For example, expansion of suburban into woodlands, having resulted in fewer predators for white-footed mice and the increase in the mice, is thought to contribute to the spread of Lyme disease in the United States in 1976 (Bradley and Altizer 2007); while forest fragmentation caused by farmland expansion lead to microbial imbalances, has made a huge contribution to diseases such as diarrheal disease and acute respiratory infection in Cambodia (Whitmee and Haines et al. 2015; Pienkowski and Dickens et al. 2017).

Population concentration

Population concentration is manifested as population mobility and high density, which can be attributed to the consequences of urban development. Population concentration promotes the occurrence of infectious diseases by increasing the chance of contact between people and pathogens, and makes it easy for patients or pathogen carriers to become potential pathogenic reservoir leading to further spread of virus (Yuan and Lu et al. 2018). Some researchers argued that the average number of susceptible individuals, infected individuals, and recovered individuals was positively correlated with the population growth rate (Zhang and Atkinson et al. 2008). In particular, respiratory infectious diseases such as viral pneumonia and measles are more likely to cause pandemics in cities with high population density (Arif and Sengupta 2021; Yin and Sun et al. 2021).

Climate change

Both urban and rural overdevelopment can cause climate change, hence we see climate change because of urban aspect, as well as the rural aspect. Climate change mainly contributes to the increased reservoir and transmission possibilities. The increased reservoir and transmission routes can not only contribute the occurrence by increasing the contact opportunities between people and pathogens, but also directly lead to the further spread of infectious diseases. On the one hand, climate change may provide better living conditions for some infectious disease hosts, which leads to an increase in pathogenic reservoir and transmission routes. On the other hand, climate change may reduce biodiversity, lead to fewer natural enemies of infectious disease hosts, and increase the number of hosts, thereby increasing reservoir and transmission routes. For example, the El Niño event in 1991-1992 greatly promoted the reproduction of local rodent populations, and rodents in farmland rapidly spread Hantaan virus (Glass and Schwartz et al. 1995; Washer 2010).

Social inequality

Social inequality is considered more of a city-related issue, so we consider it an issue of the aspect of urban development. Social inequality reduces the ability of some citizen to obtain information and materials necessary for survival. This phenomenon will contribute to the occurrence of diseases, and promote the further spread of diseases as well. The social attributes of a person such as socioeconomic status, housing, gender, and education contributes to health inequalities, as researchers observed globally (Bradley and Altizer 2007; Alirol and Getaz et al. 2011). Some urban migrants are at a disadvantage in terms of employment, income, and social welfare, which makes it difficult for them to access to the city’s convenient medical system and other public services. The inequity of education often also makes some populations have lower awareness of health risks, and thus have more opportunities to be infected with diseases. Social inequality is detrimental to the effectiveness of infectious disease responses, thereby promoting the recurrence and spread of infectious diseases. Studies have shown that low income, unemployment, and deprivation are associated with increased risk of dengue, schistosomiasis, and leptospirosis in selected Brazilian cities (Ximenes and Southgate et al. 2003; Siqueira and Martelli et al. 2004; de Mattos Almeida and Caiaffa et al. 2007). Social inequality also makes herd immunity strategies less effective (Dicker and Coronado et al. 2006).

Healthcare improvements

The healthcare improvement issue is mainly related to the urban aspect. The effects of healthcare improvement on the occurrence and spread of infectious diseases and the mechanisms by which these effects are exerted are complex and diverse. The improvement of a region’s healthcare will promote its capacity of curing diseases and increase its medical attractiveness. But the results of increased capacity of curing and medical attractiveness are complex. Improvements in curing capability clearly reduce the number of human reservoir and lessen the spread of disease (Nuzzo and Meyer et al. 2019; Shuvo and Molokwu et al. 2020). It, however, may also be accompanied by the abuse of drugs, which will promote the emergence of new pathogenic variants and eventually lead to the emergence of infectious diseases. The improvement of medical attractiveness in a certain area may attract more people to come to seek better medical treatment, increasing opportunity of pathogen transmission. At the same time, medical facilities themselves are also important places where people contact with pathogens. Many researchers argue the “Hospital Acquired Infections (HAIs)” has a clear relationship with medical attractiveness (Gan and Lim et al. 2020). However, the distribution of healing medical facilities is uneven between urban and rural areas. Compared with small cities and villages, large cities have higher quality medical resources, but they are also more likely to attract medical tourists, which in turn will cause the prevalence of infectious diseases in these large cities.

Transportation improvements

The transportation improvements issue is also mainly related to the urban aspect. The transportation improvements increase the frequency of people’s activities in the wild for leisure, which causes more chances of contacting with wildlife reservoir, amplifying the possibility of infectious diseases; on the other hand, the improvements in transportation promote travel and trade. It accelerates the mobility of goods, capital, people across regions, implying more probability of the spread of infectious diseases. Transportation hub cities and port cities are more likely to become centers of disease outbreaks. For example, cholera is mainly commercially transmitted between Asia and Europe (Lashley and Durham 2007), and dengue virus enters Africa and the Americas through export trade (McMichael 2004; Neiderud 2015). There is also evidences that the construction of new roads has affected the transmission of diarrheal disease by altering the opportunities of contact among people, as well as people and contaminated water sources (Eisenberg and Cevallos et al. 2006).

Built environment change

The built environment change issue impacts on the emergence and prevalence of infectious diseases more within cities than in rural areas. Thus, it is mainly classified into the urban aspect. This issue includes two directions: the deterioration of the built environment and the improvement of the built environment.

The deterioration of the built environment is supposed to raise more animal and environmental pathogenic reservoir and transmission routes. The declines of infrastructure (water supply sanitation, sewage and waste management capacity decline), food storage conditions and the quality of housing conditions (crowded housing, aging building materials and ventilation systems), might cause infectious diseases prevail. This effect is mainly through the increase of animal mosquitoes, rodents) and environmental (soil, water) pathogenic sources, which in turn increases the chance of human contact with pathogens, thereby promoting the emergence and prevalence of infectious diseases. For example: lack of urban waste management, improper accumulation of waste, and imperfect sewage management lead to soil, air, and water pollution, and promote the reproduction of hosts such as rodents and Aedes mosquitoes (Ko and Reis et al. 1999; De and Varaiya et al. 2002; Hayes and García-Rivera et al. 2003; Ramos and Mohammed et al. 2008), and increased incidence of diarrhea that may increase intestinal parasite infection (Guevart and Noeske et al. 2006; Moraes 2007). Poor housing built with unsanitary and low-quality materials can lead to the occurrence of insect-borne diseases (Levy and Bowman et al. 2006). Buildings lacking efficient fuel and ventilation systems can lead to soil-borne helminth infections, as well as inappropriate food storage also contributes the spread of disease (Neiderud 2015).

On the other hand, with the population influx into cities, the gathering of technology, capital, and labor force also improve of urban built environment. Therefore, the updated environment will also curb the survival of many animal and environment pathogenic sources, which, thereby, inhibits the generation of infectious diseases (Perdue and Stone et al. 2003; Pinter-Wollman and Jelić et al. 2018; Spencer and Finucane et al. 2020).

Income

The increased income issue belongs to both urban and rural aspects. The improvement of income means more opportunities for individuals to receive better education, to participate in social activities benefiting themselves. These enhance their abilities to protect themselves from diseases. Thereby, the improvement of income reduces the occurrence and spread of infectious diseases. There is a negative correlation between income levels and the incidence and prevalence of infectious diseases (Scarbrough and Holt et al. 2019). For example, conditions such as income levels in cities are generally better than those in rural areas, which makes urban prevention and control capability is higher than in rural areas (UNDP and TheChinaInstituteforReformandDevelopment 2008; Alirol and Getaz et al. 2011). At the same time, this difference greatly affects the way people coping with the disease. Studies suggest that the proportion of patients who do not actively take treatment increases sequentially from large cities, small cities to rural areas (Liu and Rao et al. 2003).

Knowledge and education

The knowledge and education issue are of concern by in both urban and rural aspects. Education, bringing lifestyle changes, is positively correlated with health status (Hoare and Hoare et al. 1999; Albert and Davia 2011; Lu and Tang et al. 2015). Compared with cities, rural residents have less publicity and personal awareness of infectious disease prevention and control. A study in Punjab province, Pakistan, found that residents in urban areas access to more knowledge, by systematic or occasional education, about the prevention of infectious diseases than rural residents, therefore it is more likely for urban residents to seek diagnosis and treatment at the very early stage when they feel unwell. To a certain extent, the more knowledge gain by education reduces the possibility of the emergence and prevalence of infectious diseases in urban area (Neiderud 2015).

The infodemic issues have emerging during this pandemic also indirectly demonstrated the importance of education and knowledge in fighting against viruses. Infodemic refers to the widespread phenomenon of too much pandemic related information, including false information (WHO 2023). The information overload leads people to misunderstandings about the severity, treatment methods, and prevention measures of diseases, which seriously hinders the prevention and control of diseases and promotes the spread of diseases to a certain extent. Better education and more diverse ways of acquiring knowledge may help individuals better recognize the truth and truly helpful information in the fog of information, thereby having a better resistance to infodemic in digital environment and improving their ability to prevent real infectious diseases in physical environment (Häusler and Baraghith 2023). Education and knowledge are the key to authenticity of information for individuals, and at least prevent themselves from being at a worse risk of infection.

Food supply

Farming is the origin of food supply capacity, so food supply issue more belongs to the rural aspect than urban aspect. Increased food production and supply can improve social nutrition wellness, thereby contributing to individual resistance to infectious diseases (Becker and Hall 2014; Roberts 2017; Civitello and Allman et al. 2018; Farhadi and Ovchinnikov 2018). With the advantages by efficient food supply, agricultural activities, however, may cause side effects. Some researchers observed a positive association between increased agricultural activitivities and the emergence and prevalence of over 50% zoonotic infectious diseases (Rohr and Barrett et al. 2019).

Agricultural inputs and irrigation

Rural development means the increase in agricultural inputs (fertilizers, pesticides) and irrigation. The issue of increasing agricultural inputs and irrigation mainly belongs to the rural aspect. Increases in agricultural inputs and irrigation operations may harm species diversity, increase pathogen resistance, or lead to the accumulation of certain animal hosts, thereby promoting the emergence and prevalence of infectious diseases. Excessive use of farming inputs such as pesticides and fertilizers has endangered the health of wildlife and contributed to the emergence of certain zoonotic diseases (Dobson and Foufopoulos 2001; Tilman and Fargione et al. 2001; Tilman and Cassman et al. 2002; Foley and Ramankutty et al. 2011; Sheahan and Barrett et al. 2017; Rohr and Barrett et al. 2019). Heavy metals and other pollutants caused by agricultural production can further aggravate the aggregation of wild animals and pathogen invasion by affecting the immune function of biological populations (Padgett and Glaser 2003). Large increases in agriculture-related reservoirs and irrigation networks may lead to the emergence of water-borne infectious diseases such as malaria and mosquito-borne lymphatic filariasis (Rohr and Barrett et al. 2019).

Livestock farming

Livestock farming, another rural aspect issue, is also one of the factors that induce zoonotic infectious diseases. This issue may increase the chance of contact between humans and pathogens, and may lead to increased resistance of pathogens, thereby increasing the incidence of infectious diseases. The development of the livestock farming industry also provides humans with a better source of nutrition, which in turn has an inhibitory effect on the spread of infectious diseases. The increase in the scale of agricultural production and grazing lead to an increase in the contact rate between humans and livestock and wild animals, increasing the possibility of infection, such as avian influenza, swine influenza, and Middle East respiratory syndrome (Rohr and Barrett et al. 2019). Poultry farming was one of the main sources of H7N9 infection in urban and rural areas of Zhejiang Province from 2013 to 2017 (Chen and Wang et al. 2018). According to a United Nations study, “approximately 60% of human infectious diseases originate in animals” (UNESCAP and CSAM 2020). The abuse of pesticides is also the main way for many current disease antigens to acquire drug resistance, which will make it more difficult to treat zoonotic infectious diseases and may lead to the spread of emerging infectious diseases (Shea 2003; Gilchrist and Greko et al. 2007; Van Boeckel and Glennon et al. 2017; Iwu and Korsten et al. 2020; Malagón-Rojas and Barrera et al. 2020).

Summary of the Atlas

The information in Fig. 2 can be summarized as follows. From the issue to the infectious disease response, planning goals need to be transmitted. The issues involved in urban and rural planning have a seemingly complicated relationship with the prevention of infectious diseases, but this relationship can be summarized in several clear paths. Opportunities for contact between humans and pathogens and pathogen drug resistance are the key interfaces that lead to the emergence of infectious diseases. The establishment of pathogenic sources or transmission routes, human infection sources, travel activities and trade activities are the key interfaces that lead to the spread of infectious diseases.

Land expansion, population concentration, agricultural breeding, and increases in pathogenic sources or transmission routes may directly increase the likelihood of human-to-pathogen contact, which is also easy to observe in traditional planning work. Medical attractiveness, field trips, individual preparedness, and travel are also associated with changes in human exposure to pathogens. It is important to consider their possible consequences when formulating planning policies in relation to the risk of infectious disease.

Medical healing, agricultural inputs and irrigation are associated with increased pathogen resistance, which increases the likelihood of infectious disease. Climate change, agricultural inputs and irrigation, a reduction in species diversity, and deterioration of the built environment may lead to an increase in pathogenic sources or transmission routes, while improvements in the built environment may reduce pathogenic sources or transmission routes. Population aggregation may promote the transformation of pathogen carriers into new sources of infection and promote the spread of infectious diseases. Improvements in healing ability, individual defense ability and individual physical fitness reduce the number of human infection sources. An increase in the attractiveness of medical care may attract more people who are urgently seeking medical treatment, which in turn exacerbates the spread of infectious diseases. Improving transportation facilities may increase trade activities and aggravate the spread of infectious diseases.

Planning enlightenment

The relationships among humans, land, and microorganisms have undergone tremendous changes in recent decades, which has led to greater requirements for urban and rural planning in the new era. The early model of simply improving a certain urban physical system (such as infrastructure) to prevent infectious diseases is no longer suitable for the current state of urban and rural development. The prevention and control of infectious diseases should be carried out under the concept of multidimensional synergy. Table 1 summarizes the key issues involved in urban and rural planning, and points out which issues belong to urban concerns, which issues belong to rural concerns, and which issues are of common concerns to both rural and urban areas. Figure 2 depicts the transmission mechanism underlying the various effects of urban construction and epidemics. These mechanisms can help to identify current urban and rural planning work. For urban and rural planning, the paths presented in the atlas also suggest what should be done and how to organize knowledge and ability to respond to infectious disease prevention).

Table 1 Issues and corresponding aspects in planning.
Full size table

Most existing research on planning responses to epidemics has focused on how to adjust a certain system in a city to cope with the impact of an epidemic. Epidemic response should be accomplished by mobilizing overall social resources. Therefore, existing research has overlooked the most valuable and capable aspect of planning: comprehensiveness. This study aimed to provide a clearer understanding of how to utilize the advantages and comprehensiveness of planning to respond to epidemics through path maps. Based on a comparison with the existing research, the following four aspects illustrate future directions for planning research and practice. This is the inspiration we intend to bring to planning research and practice.

Bridging the knowledge gap with a more comprehensive view

Although urban and rural planning have a long history of physical space planning, society requires urban and rural planning to address planning issues from a more comprehensive and integrated perspective. In the current era, urban and rural planning is constantly required to go beyond the physical environment and incorporate related events, which represent almost the entire human society, into its vision. The development of IT presented planners with more possibilities and confidence to translate other professional knowledge into comprehensive planning policy. This is the technical preparation for urban and rural planning to broaden its professional vision in the era of decentralization. Planning practitioners and researchers should be acutely aware of these conditions and take advantage of them.

The traditional concept of urban and rural planning oriented by physical space needs to be redefined. This definition should not be limited to academic discussions but should permeate into government decision-making and system construction. Physical space provides apparent feedback on social structure, government actions, and urban and rural development; thus, it contributes to an in-depth understanding of the motivations behind urban problems. According to the paths depicted in Fig. 2, the root cause of epidemic-related infectious diseases is contact between people and pathogens, which is the key to controlling infectious diseases through urban and rural planning. Education, poverty, social inequality, the development of the health care industry and other issues should be included in urban and rural planning in relation to infectious disease prevention.

Understanding the effects of various “soft” issues

Soft issues such as ecology, social equity, and education have not received as much attention in urban and rural planning as hard issues such as physical space (land use, housing, infrastructure, and urban design). Compared with “hard” issues, soft issues and residents have more indirect and potential relationships. Therefore, planners and the government tend to overlook their importance. This study demonstrated the close relationship between soft issues and hard issues that are explicitly related to human life. For example, the destruction of the ecological environment is directly related to the prevalence of infectious diseases. The loss of social equality often leads to certain vulnerable groups being the first to be crushed by disease, which in turn leads to the spread of infectious diseases (Lori and Patrick et al. 2007; DeBruin and Liaschenko et al. 2012; Liz 2020). Resources and time to solve urban and rural problems are always in short supply, but they should not be used only to solve immediate and obvious problems. Urban and rural planning involve weighing various issues, but only by deeply understanding the real value of each issue can we make better decisions.

Cooperation, self-sufficiency and the risks of industrial development

Urban and rural development tends to place “high-tech” industry as the primary development goal while neglecting or even depriving some common industries of development space. However, many common industries are closely related to the basic security of cities or regions. The significance of these long-neglected industries may be seen only in specific periods. For example, in the early stage of the COVID-19 epidemic, due to long-term dependence on external imports, many countries and cities experienced serious shortages of alcohol and masks, which worsened the epidemic. Therefore, examining the composition of urban and rural industries in planning and highlighting the survival of the emergency industry will guarantee the prosperity of cities and the stability of the country.

Tourism and trade are industries that are considered elegant and popular among global and local governments. However, the risk of the rapid spread of infectious diseases brought about by trade and travel cannot be ignored. Local governments should be warned that when they attempt to attract visitors with higher GDPs, they should also pay attention to the risk of disease transmission hidden behind the prosperity of these industries.

Similarly, agricultural development has both positive and negative impacts on infectious disease prevention. Pollution and ecological damage caused by farming activities contribute to the emergence of infectious diseases. Ensuring food security and solving the problems of poverty through farming have immediate and positive impacts on the control of infectious diseases at the source. However, the current urban and rural planning system is doing little work on agricultural development and food issues. Planners should prioritize these issues.

Population, awareness, education and land

A dense population may increase the risk of infectious disease transmission, but density is not a necessary condition for ensuring the prevalence of infectious diseases. During the COVID-19 pandemic, although the incidence of disease was related to population density, it is difficult to say that population density was a determinant of the prevalence of this infectious disease. Moreover, the population density of cities and regions cannot be reduced rapidly in a short period of time. A reduction in urban population density will inevitably lead to land sprawl, which will increase the risk of epidemics. Establishing appropriate awareness of prevention and control among the population through education and formulating appropriate management measures are less costly and more effective approaches. Improving the level of education and promoting a healthier lifestyle should also be the focus of urban and rural planning.

Conclusion

The comprehensiveness of urban and rural planning allows us to prevent and control urban infectious diseases at the source. However, because it involves many professional fields, values and conflicts, it is difficult for us to see the logical network of urban and rural problems. Sometimes we know the causes of certain urban problems from theory or experience, but due to the “overall balance” of the development of the urban giant system, some factors must be ignored, especially invisible ones. The prevalence of COVID-19 in cities is well known. Time and time again, neglecting seemingly insignificant issues that lack economic benefits but are important for controlling the source of infectious diseases eventually leads to global disaster.

This study highlights the issue of epidemic prevention and control, which has been frequently overlooked in the field of planning. In this study, the complex relationship between the pandemic and planning is summarized in several aspects. The atlas provided in this study shows that planners need to rethink and examine planning strategies from key perspectives, such as pathogen exposure opportunities, pathogen resistance, hosts, travel, and trade, to evaluate whether planning solutions can effectively address pandemic issues. It is undeniable that planning is only one of the many ways that society responds to epidemic problems. This study demonstrates that planning is feasible for addressing infectious epidemic problems and provides specific response ideas. This represents an important inspiration for contemporary and future planning provided by this study.

Modern urban planning has struggled to address infectious diseases by adding a tangible physical system to the city. From the establishment of the value system to the improvement of refined facilities to the coordination of physical and nonphysical measures, urban and rural planning has become the only way to address the risk of infectious diseases. This research summarizes relevant research and maps the relationship between the emergence and spread of infectious diseases and the effects of urban and rural development. This research is the first attempt to help urban and rural planning develop in a more comprehensive and refined way.

Researchers always hope to explore the reasons behind these phenomena. Currently, the high-order interaction of research methodology has penetrated contemporary research fields, including the natural sciences, humanities and social sciences (Battiston and Amico et al. 2021). Cities and their issues are often affected by a complex combination of hidden factors. Understanding visible urban problems from a high-order interaction perspective may reveal the underlying causes of many urban issues. The methodology we used in this study involved extracting the higher-order elements of epidemic transmission (the chain of infection) and the higher-order elements of urban and rural planning work (the 12 issues) and subsequently constructing a higher-order interaction between the two to reveal how urban and rural planning might respond to a pandemic. We hope this approach can inspire future planning research.

This study has several limitations. First, we attempted to expand the conceptual boundaries of planning but did not prove this in depth. In the era of significantly improved information processing capabilities, this expansion, in our opinion, is part of the demand for the next generation of urban planning theory and practice. We have not fully demonstrated this expansion in this article. Second, we paid less attention to the ideal urban physical pattern for this epidemic. We position planning as a comprehensive social practice where achieving goals relies on much more than physical spatial form. In fact, the reasonable adjustment of value orientation and the comprehensive application of various measures can contribute to an effective response to epidemics. Therefore, we do not discuss what physical spatial form can best respond to the epidemic. These issues may require additional follow-up work.