It will come as no great surprise that city living presents enormous challenges for encouraging healthy behaviours.
Foods that are high in sugar, fat and salt and low in nutrients are available on seemingly every street corner. Achieving the necessary physical activity to support good health has become increasingly difficult. Parks and green spaces once available for free leisure activity by all ages are too often reduced to development opportunities for the next square of concrete jungle. Many cities continue to be designed so that using a private motor vehicle is the automatic choice to get from place to place.
Indeed, in developing countries in particular, walking or cycling pose real risks of injury or death. Outdoor air pollution is visible not only in the putrid smog that engulfs cities but also in the 3.7 million deaths that occur annually — in the same range as deaths from tobacco and alcohol.
Short-sighted definitions of progress are driving actions that sentence future generations to unhealthy, unprosperous, unsustainable lives. Despite the challenges that urbanisation presents to health, there are distinct opportunities to shape the environments in which we live, work and call home for the betterment of health.
Urbanisation is undeniably the future. But in the remaining weeks before the adoption of the New Urban Agenda — the global 20-year urbanisation vision that will be adopted this month at the Habitat III conference in Quito, Ecuador — it is critical to ensure that UN member states commit to a vision of sustainable and health-centred urbanisation.
The New Urban Agenda sets out commitments, principles and strategies to support nations and cities in their urban development planning. It also will impact significantly on development and funding priorities across the United Nations and multilateral systems, and holds the potential to change the way nations and cities engage with civil society and communities.
The New Urban Agenda, therefore, is a key opportunity to lay the foundations for cities that include local markets selling fresh produce in place of confectionary-laden corner shops and fast-food outlets, protected cycling routes that allow commuters to speed past gridlocked traffic, public parks where children can exercise and breathe fresh air, and infrastructure fuelled by energy that comes from sources with a fraction of the health risks of fossil fuels.
Health and Habitat III
Early in the Habitat III process, official discussions and documents had an unsatisfactory focus on health. While health and health-related priorities — walking and cycling, water and sanitation, air quality, and food and nutrition — were mentioned fleetingly across the technical “issue papers” and policy frameworks, any dedicated official discussion of health priorities for sustainable urbanisation was conspicuously absent.
Nonetheless, traction on health issues in the Habitat III process has grown, and the most recent drafts of the New Urban Agenda bear testament to advocacy by member states and civil society.
Since the agenda’s first draft was released in May, greater attention has been afforded to health overall, as well as to specific health-related issues and opportunities. Air quality and in particular air pollution are now mentioned throughout the document. (The New Urban Agenda’s final draft was released in early September.)
Specific language on road safety in particular has been strengthened considerably. The agenda now recognises the need to adopt, implement and enforce policies that link to broader health outcomes. This includes safe environments for walking and cycling, the unique needs of vulnerable populations, as well the prevention of injuries and non-communicable diseases.
However, the New Urban Agenda remains weak in highlighting how health is not only an outcome but also a prerequisite for sustainable human and economic development, worthy of investment across sectors. Health is one of the greatest assets of sustainable societies, ensuring a strong workforce and enabling progress. Yet too often, health and well-being are narrowly considered the domain of Ministries of Health and medical facilities.
While the provision of health services is essential to treat disease, an integrated approach across sectors will be crucial to reduce exposure to risk factors from poor sanitation to unhealthy foods, and therefore preventing avoidable disease and death.
The greatest opportunity to prevent disease lies not with the health authorities but rather beyond them: strategic decisions made in sectors including urban planning, transport, energy, agriculture, trade, labour and waste management have impacts on health and can accrue health benefits and savings — and in turn, sustainable social and economic gain.
Furthermore, many interventions to protect health offer clear environmental co-benefits. Promoting walking and cycling fosters physical activity, while also reducing greenhouse gas emissions. Diets low in meat and processed products but rich in locally sourced vegetables and fruits nourish populations, with a minimal carbon footprint. Transitioning to renewable energy at the city and household level reduces air pollution, with benefits for both human and planetary health.
Health is one of the greatest assets of sustainable societies, ensuring a strong workforce and enabling progress.
It is therefore crucial that health impacts are assessed during both the development of urban policies and plans, and when monitoring their impact.
Acknowledging the central importance of healthy populations in the New Urban Agenda, as well as encouraging the use of health frameworks such as health impact assessments in decision-making has the potential to achieve huge health gains that could not be made by the health sector alone.
However, the health sector has much to offer in terms of well-tested tools that can assist nation states and cities to objectively evaluate the potential health-related impacts of an intervention.
By acknowledging the importance of viewing urbanisation from a health lens, the New Urban Agenda could provide the catalyst necessary to implement a “whole of government” approach to health — a necessary approach, if true health gains are to be made.
A final recommendation
While health-related issues are now well integrated throughout the final draft of the New Urban Agenda, there is no direct recognition of either the opportunities or threats urbanisation poses for health. Nor is there direct recognition of the value of investing in interventions that will build healthy urban societies.
Recognising that the decisions made at a city level can either support or hinder people’s health would be a final and monumental step forward in promoting health for all.
Together with other partners, we strongly recommend incorporating a single consolidating paragraph outlining the aligned priorities to address health within sustainable urbanisation, in order to affirm the value of and recognise the means to ensure protection and promotion of public health:
“We commit to investing in public health, recognising health as both an indicator of and prerequisite for social and economic development. Health priorities are well aligned with those for sustainable urbanisation, and comprehensive approaches to disease prevention and control will contribute to resilient urban societies. We commit to strategic decision-making across sectors that can accrue both public health and environmental benefits, not least through health assessment of urban policies and investments, as an integral part of urban planning and investment decisions. We will work to reduce health inequalities to protect populations, especially those who are most vulnerable.”
Kristie Daniel is programme director of the Livable Cities programme for the HealthBridge Foundation of Canada, and Jess Beagley is policy research officer at NCDAlliance. This commentary has been adapted by the authors from a blog piece published prior to the Surabaya negotiations in late July, and has been republished from Citiscope.