cities health

8/17/2019 Cities Health

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Why urban health matters


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© World Health Organization 2010. All rights reserved.

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T e boundaries and names shown and the designation used on maps do not imply the expression of any opinion whatsoever on the part of the World Health Organizationconcerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dot ed lines on mapsrepresent approximate border lines for which there may not yet be full agreement.T e mention of specic companies or of certain manufacturers’ products does not implythat they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions exceptedthe names of proprietary products are distinguished by initial capital let ers. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied.T e responsibility for the interpretation and use of the material lies with the reader. In no eventshall the World Health Organization be liable for damages arising from its use.

Photo credits: IRIN; ONASIA (L. Duggleby); Rotary International; UN; WHO (AFRO, SEARO, N. Alexander, M. Decker, V. Dithajohn, O. Häkämies, A. Kari)

WHO/WKC/WHD/2010.1


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Why urban health matters


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CONTENTS – Why urban health matters

2010: A year-long focus on urbanization and health......................................................................................................................................................................................................................................1

Director-General’s statement..................................................................................................................................................................................................................................................................................................................................2

I. Introduction......................................................................................................................................................................................................................................................................................................................................................................6

II. What are the issues?..............................................................................................................................................................................................................................................................................................................................................8

1. Urbanization impacts population health ...................................................................................................................................................................................................................................................................8 2. Urban set ings are a health determinant ......................................................................................................................................................................................................................................................................9 3.T ere are unfair di ff erences in the health of city dwellers .........................................................................................................................................................................................14

III. What can be done: calls to action...............................................................................................................................................................................................................................................................................................15

1. Promote urban planning for healthy behaviours and safety ...........................................................................................................................................................................16 2. Improve urban living conditions.....................................................................................................................................................................................................................................................................................................16 3. Ensure participatory urban governance ....................................................................................................................................................................................................................................................................17 4. Build inclusive cities that are accessible and age- f iendly.........................................................................................................................................................................................18 5. Make urban areas resilient to emergencies and disasters..........................................................................................................................................................................................18

Annex: A role for all – who can do what?.................................................................................................................................................................................................................................................................................19

References.........................................................................................................................................................................................................................................................................................................................................................................................

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To ensure sustained action on the topic of urbanization and health throughout 2010, a series of events are planned to highlight the health risks in urban set ings and the actions and policy options that can be takento improve health in cities.

1. World Health Day 2010

T e aim of World Health Day 2010 is to draw at ention to urbanization and health, recognizing that inan increasingly urbanized world, health issues present new challenges that go far beyond the health sectorand require action at the global, national, community, and individual levels. World Health Day 2010 isnot seen as an event in and of itself, but as the launch of the year-long focus on the issue.

2. A joint WHO/UN-HABITAT Global Report on urban health inequities

T e report, to be published later in the year, will expose the extent to which the urban poor su ff erdisproportionately f om a wide range of diseases and health problems. It will provide evidence-basedinformation to help municipal and health authorities reduce health inequities in their cities.

3. Global Forum, Kobe

T e Forum will bring together mayors, municipal leaders and national ministers across multiple sectors for a declaration of action to reduce health inequities in cities.T e Forum will be held in Kobe, Japan,

15–17 November 2010.

2010: A year-long focus on urbanization and health


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For a growing proportion of the world’s population,prospects for a bet er future are tied to livingconditions in cities.

Cities concentrate people, opportunities, andservices, including those for health and education.In a well-known trend, cities house the most andthe best hospitals and they at ract the most talenteddoctors, nurses and other health care staff . Whencities are planned, managed, and governed well, lifeourishes and health outcomes surpass those seen

in rural areas.

But cities also concentrate risks and hazards forhealth.T ey magnify some long-standing threatsto health and introduce others. When largenumbers of people are linked together in space andconnected by shared services, the consequences ofadverse events – like contamination of the food or water supply, high levels of air or noise pollution,a chemical spill, a disease outbreak or a naturaldisaster – are vastly amplied.

Given the current scale of urbanization, it comes as

no surprise that cities themselves contribute to twoglobal trends of direct concern to health: climatechange and the rise of chronic diseases. According

to the latest estimates, cities contribute directlyto more than 60% of greenhouse gas emissions.T ey account for 75% of energy consumptionand a similar proportion of all wastes. At the same

time, city dwellers are especially vulnerable to theconsequences of climate change, whether expressedas heat waves, water scarcity, increasing levels of airpollution, or rising sea levels in coastal areas.

Cities also tend to promote unhealthy lifestyles, like“convenient” diets that depend on processed foods,sedentary behaviour, smoking, and the harmfuluse of alcohol and other substances.T ese lifestylechoices are directly linked to obesity and the rise of

conditions like heart disease, stroke, some cancers,and diabetes. And these conditions are increasinglyconcentrated in the urban poor.Perhaps most alarming, the growth of urban centresin the 21stcentury is being accompanied by asecond, distinctly ominous trend. Poverty, whichin previous centuries was greatest in scat ered ruralareas, is now heavily concentrated in cities. In manycountries, urbanization has outpaced the ability of

governments to build essential infrastructures andenact and enforce the legislation that make life incities safe, rewarding, and healthy.

Director-general’s statement

Urban health mat ers,in critical ways, for moreand more people.

For the rst time inhistory, more people

are now living in urbanset ings than in ruralareas. By the year 2030,an estimated six out ofevery ten people will beliving in towns or cities,with the most explosive growth expected in Asiaand A f ica.


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Today, around one third of urban dwellers,

amounting to nearly one billion people, live in urbanslums, informal set ings, or sidewalk tents. Whilethe vast majority of urban slums – more than 90% –are located in the developing world, nearly everycity everywhere has pockets of extreme deprivationtogether with extreme wealth.T ey have people who over-consume health care and people whoforego the most basic and essential care fornancialand other reasons. In every corner of the world,

certain city dwellers suff er disproportionately frompoor health, and these inequities can be traced backto diff erences in their social and living conditions.

On this World Health Day, the World Health

Organization (WHO) is calling on a wide range ofgroups – from municipal authorities and the privatesector, to concerned citizens, nongovernmentalorganizations, and advocates for healthy living – totake a close look at health inequities in cities andtake action.

Why should inequities in urban health and livingstandards mat er? Most obviously, the consequences

of poverty and ill health, including mental health,are contagious in a city set ing.T ey are detrimentalto all city dwellers. Urban poverty and squalor are


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strongly linked to social unrest, mental disorders,crime, violence, and outbreaks of disease associated with crowding andlth.T ese threats can easilyspread beyond a single neighbourhood or district to

endanger all citizens and taint a city’s reputation.Municipal authorities know what this means interms of at racting tourists and new businessesand winning the next election. City dwellers know what this means in terms of social cohesion, safety,security, and the quality of life.

In addition, health inequities are an excellent socialaccountant.T ey are a reliable way to measure how well a city is meeting the needs of its residents. Poorhealth, including mental health, is one of the most visible and measurable expressions of urban harm.Health inequities can also be a rallying point forpublic demands for change that compel politicalleaders to take action.

Urban health mat ers and urban health governancemat ers most especially. For example, in developingcountries, the best urban governance can help

produce 75 years or more of life expectancy. Withpoor urban governance, life expectancy can be aslow as 35 years.

Good urban health governance helps ensure thatopportunities and advantages are more evenlydistributed, and that access to health care is fair andaff ordable. Abundant evidence has identied the

root causes of urban health inequities and shownhow they can be tackled.

While most of these root causes lie beyond thedirect control of the health sector, local leadershave direct inuence over a wide range of urbanhealth determinants, from housing and transportpolicies, to social services, to smoking regulationsand the policies that govern food marketing andsales. Local leaders are well-positioned to inuenceland use, building standards, water and sanitationsystems, and the enactment and enforcement ofhealth-promoting legislation. Moreover, actingin the name of health can rally stakeholders fromdiverse backgrounds and interests and build politicalpressure on issues that are important to every citydweller. Health is valued universally as an essentialprerequisite for a fullling and productive life.

Making cities good for health takes time, but asabundant examples from all around the world show,it can be done.

Director-general’s statement


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Urban health mat ers, in critical ways, for more andmore people. And WHO will be doing more, todayand well into the future, to support these eff orts.

1. Promote urban planning for healthybehaviours and safety

2. Improve urban living conditions

3. Ensure participatory urban governance

4. Build inclusive cities that are accessibleand age- f iendly

5. Make urban areas resilient to emergenciesand disasters

Later in the year, WHO and UN-HABITAT will be launching a report on urban health inequitiesand how to address them. TitledHidden cities , thereport is aimed at unmasking and overcoming health

inequities in urban set

ings, and includes abundantpractical examples and policy advice on specic,evidence-based interventions.

In November 2010, a global forum on urbanizationand health, to be held in Kobe, Japan, will bringtogether municipal authorities and decision-makersacross multiple sectors with the aim of promoting

intersectoral action to reduce urban healthinequities.

In a dedicated programme, WHO and its sixregional offi ces will work with specic cities andnational authorities to assess urban health inequitiesand identify appropriate actions to reduce them.

To maintain momentum, urban health advocates are being identi ed and successful city experiences will

be shared as menus of policy options and models ofgood practice.

WHO will help municipal authorities in assessingthe health impact of planning options in othersectors, such as urban transportation and the safetyof roads for both vehicles and pedestrians.

Dr Margaret ChanDirector-General of the World Health Organization 5


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T e year 2007 saw, for therst time, themajority of human beings living in urban areas.T is trend will continue with 6 in 10 peopleliving in towns and cities by 2030. In recenttimes, the growth of urban areas in low-incomecountries has been four times faster than thegrowth in high-income countries.T is trend,too, is expected to continue in coming years.

Urban areas provide great opportunities forindividuals and families to prosper and canprovide a healthy living environment throughenhanced access to services, culture andrecreation. However, city dwellers continue toface health hazards and new health challengeshave emerged. While the characteristics of each city vary

by local context, common urban health andsocial challenges include: overcrowding; airpollution; rising levels of risk factors like

I. Introduction

Where people live a ff ects their health and opportunities for leadinglives to their full potential.

tobacco use, unhealthy diet, physical inactivityand the harmful use of alcohol; road trafficinjuries; inadequate infrastructure, transportfacilities and solid waste management systems,and insufficient access to health facilities inslum areas.

World Health Day in 2010 off ers anopportunity to take a closer look at theconditions that determine health outcomesfor the majority of the world’s population,the issues that need to be addressed, and theactions that can be taken. By understandingthese issues, limited resources can be allocatedto more targeted interventions, and achieve bet er health outcomes.T

e focus on urbanization and health as atheme for World Health Day 2010 is timely andhighly relevant for the following reasons.


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F , with the majority of the world’spopulation now living in urban areas andthis proportion expected to grow, urbanhealth should become a major focus of global

public health policy. Whilst urbanizationand the growth of cities may be associated with increasing prosperity and good healthat an aggregate level, urban populationsdemonstrate the world’s most obvious healthdisparities – in both low- and high-incomecountries. Rapid migration from rural areas as well as natural population growth are put ingfurther pressure on limited resources in cities,

especially in low-income countries.

S , much of the natural and migrationgrowth in urban population is among thepoor. More than one billion people – onethird of the urban population – live inovercrowded and life-threatening conditionsin urban slums and informal set lements. If

cities fail to deliver on the perceived promiseof economic opportunities for the poor, largeconcentrations of unemployed young people

may threaten social stability, security andthe health of communities as a consequence.In low-income countries, in particular,disparities will increase, as the combination

of in-migration, natural growth and scarcityof resources results in cities being unable toprovide the services needed by those whocome to live in them.

T , there is evidence that rapid,unplanned urbanization can have negativeconsequences for the health and safety ofpeople.

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Virtually all population growth over thenext 30 years will be in urban areas (1) .

By 2030, 6 out of every 10 people will becity dwellers, rising to seven out of 10 people by 2050(2) .

Key points to consider on urban growthand its impact on health

Most of the world’s population growthis expected in urban areas in low- andmiddle-income countries (Figure 1).

Urbanization trends vary across diff erentparts of the world. Some cities and regionsare experiencing rapid growth, whereas othercities and regions are in population decline.However, the world’s urban population in the

less developed regions is projected to increasefrom 1.9 billion people living in cities in 2000to 3.9 billion in 2030(3).

Growth will be primarily in small andmid-sized cities

Urbanization and its health impacts are not just an issue for megacities – cities with over10 million residents. In fact, much of theurban population growth will occur in small andmid-sized cities. While large cities of developingcountries will account for 20% of the increase inthe world’s population between 2000 and 2015,small and mid-size cities (less than 5 million) will account for 45% of this increase(4).

Urbanization involves migration,reclassi cation and natural growth

In addition to migration, cities add populationthrough reclassication, when they expandhorizontally and absorb hamlets and towns.Migration and reclassication account for

40% of urban growth, with the remaining60% coming from natural growth of existingpopulations(5).

II. What are the issues?

1. Urbanization impacts population health

FIGURE 1

Distribution of worldpopulation Growth, 1950-2030

Source: Cohen B. Urban Growth

in Developing Countries. WorldDevelopment. Vol. 32, No. 1, pp. 23–51, 2004.Data source: UNDESA. World urbanizationprospects: the 2001 revision.

Mean years of education

Urban – high-income countries

1950–1975

2500

2000

1500

1000

500

0 P o p u l

a t i o

n i

n c r e

a s e

, i n

t h

o u

s a n d

s

1975–2000

time frames

2000–2030

Urban – Middle-and-low income countries

Rural – High and Middle-and-low income


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Cities are growing horizontallyT e trend for the past 50 years is for cities to

grow horizontally in the form of urban sprawl, whether as suburbs in the developed world orperi-urban expansion in the developing world.T is has implications for the effi ciency ofurban services, including delivery of water andsanitation, provision of public transport, as wellas for access to jobs, education, food and healthservices.

Speed of growth can outpacein f astructure requirements

In many cases, especially in the developing world, the speed of urbanization has outpacedthe ability of governments to build essentialinfrastructure. Failure to plan for continued

growth results in inadequate health services, water, sanitation, education, and essentialinfrastructure.

Many cities are currently burdened and will be confronted by a triple threat:

o Infectious diseases exacerbated by poorliving conditions;o Noncommunicable diseases – such as

heart disease, cancers and diabetes –and conditions fuelled by tobacco use,unhealthy diets, physical inactivity, andharmful use of alcohol; and

o Accidents, injuries, road accidents, violence

and crime.T ese are the result a complex interactionof various determinants of health, includinginsuffi cient infrastructure and services thatparticularly impact the health of the poor andslum dwellers. Living and working conditions vary widely within and between cities acrossthe world and are the “causes of the causes”of ill-health.

2. Urban set ings are a health determinant

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Housing, land tenure and security

Most, but not all, urban poor live in slums andsquat er set lements. T ese set ings tend to be

unregulated, precarious, overcrowded, and areof en exposed to hazards, such as steep hillsidessubject to landslides, riverbanks and water basin locations subject to ooding, or sites nearindustrial hazards. Inadequate, overcrowded ordeteriorating housing in informal set lements,especially where tenure is insecure, increasesthe health risks from environmental hazards, violence and crime, and is associated with

injuries, respiratory problems, infectiousdiseases, and mental health problems(6) .

Water

Approximately 5.9 billion people – 87% of the world’s population – are now using safe drinking- water sources, according to the new WHO/

UNICEF Joint Monitoring Programme report onsanitation and drinking-water (7) . Although 94%of urban residents in developing countries use

“improved” drinking-water sources (that is, theavailability of at least 20 litres per person per dayfrom a source within 1 km of the user’s dwelling),grave risks of water contamination still exist dueto the unreliability of supplies and related waterstorage practices (8) .

Sanitation

Although the vast majority without access to water and sanitation live in rural areas(7) ,some 807 million city dwellers (24% globallyand 32% in developing cities) lack access to what WHO de nes as “improved sanitation” –household latrines or ush toilets that areconnected to sewer, septic, compost or coveredpit – hygienically separating excreta from humancontact. Of these, more than 170 million urbanresidents do not have access to even the simplestlatrine and are forced to defecate in the open. About 500 million urban dwellers worldwideshare sanitation facilities with other households

(8) . Globally, an estimated 3% of all deaths arethe result of diarrhoeal diseases caused by unsafedrinking-water, sanitation and hygiene(9) .


Housing land tenureand security

Most, but not all, urban poor live in slums andsqua er se lements. ese se ings tend to be

unregulated, precarious, overcrowded, and are

Water

Approximately 5.9 billion people – 87 of theworld’s population – are now using safe drinking-water sources, according to the new WHO/

Sanitation

Although the vast majority without access towater and sanitation live in rural areassome 807 million city dwellers (24 globallyand 32 in developing cities) lack access to

2. Urban set ings are a health determinant (continued)


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Food

Another health determinant in cities is access tosafe and quality food, and in suffi cient quantity(10) . Inadequate diet reduces resistance todisease, especially for slum dwellers, becausethey live in the constant presence of pathogenicmicro-organisms (11) . Urban poor populationsin the developed and developing world of en relyon street food, fast food, processed and cheapfood, leading to nutritional problems such as vitamin/mineral de ciencies, dental problemsand obesity, which in turn is associated withdiabetes and cardiovascular problems.

Urban transport

Public transport, walking and cycling – assuredthrough good land use and transit planning –are the major travel modes in some large citiesof Europe, Asia and the Americas. But in manydeveloped and fast-developing cities, trends are

moving in the opposite direction. As people become more affl uent, the lack of publictransport infrastructure and services or good

networks for cycling and walking along withat raction to a more affl uent lifestyle has spurreda rapid transition to cars or motorcycles leadingto enormous increases in traffi c, along withtraffi c-related pollution, injury risks topedestrians and cyclists, and a reduction inphysical activity.

Physical inactivity is a major risk factor forcardiovascular disease, diabetes and certaincancers. While everyone in a city may beaff ected by a lack of transport options, poorneighbourhoods of en lose out the most, asthey lack good public transport access to healthcentres, grocery stores, schools, and jobs(9, 12, 13) .

Road traffi c injuries also stand out as animportant and growing transport-related publichealth problem, with most deaths occurring inlow- and middle-income countries. Globally,road traffi c injuries constitute the ninth leading

cause of death and ill-health, and will rise to thethird position by 2030 unless immediate andsustained action is taken(14) .

Food

Another health determinant in cities is access tosafe and quality food, and in suffi cient quantity10 . Inadequate diet reduces resistance to

Urban transport

Public transport, walking and cycling – assuredthrough good land use and transit planning –are the major travel modes in some large cities

Noise exposure

Noise, a common urbanproblem, is a consequenceof transportation and

construction. Intense andcontinuous exposure may be associated with hearingimpairment, high bloodpressure and cardiovasculardisease (15) .

Noise exposure

Noise, a common urbanproblem, is a consequenceof transportation and

construction. Intense and


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Outdoor and indoor air pollution

In 2004, outdoor urban air pollution killed some1.2 million people worldwide (9) . WHO estimates

that 1.5 billion urban dwellers face levels ofoutdoor air pollution that are above the maximumrecommended limits (16) .

Of urban air pollutants, ne particulate mat er,mostly from vehicle and industrial fuel combustion,has the greatest eff ect on human health. Worldwide,

ne particulate mat er is estimated to cause about8% of lung cancer deaths, 5% of cardiopulmonarydeaths and about 3% of respiratory infection deaths(9) .

About 25% of city dwellers in developingcountries and 70% of city dwellers in leastdeveloped countries use solid fuels for householdheating and cooking. In 2004, exposure to indoorpollution was estimated to cause about 2 milliondeaths worldwide, mostly from pneumonia,chronic lung disease and cancer. As poor

households tend to be more dependent on solidfuel for heating and cooking, they are thus mostexposed to indoor pollution (17) .

UAP deaths/1 million population

0–50

50–150

150–250

250–400

> 400

Data not available Source: WHO Global health risks, 2009


FIGURE 2

Deaths attributable to urban air pollution, 2004

Outdoor and indoorair pollution

In 2004, outdoor urban air pollution killed some1.2 million people worldwide

that 1.5 billion urban dwellers face levels of

2. Urban set ings are a health determinant (continued)


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Climate change

Climate change has major environmental healthimpacts in the cities of the developing world, which can be generally more vulnerable to the

impacts of climate change. Key vulnerabilityfactors include coastal location and exposureto the urban heat-island eff ect, whereby urbantemperatures may be as much as 5–11 °C higherthan in surrounding rural areas due to the greaterheat absorption of dense urban built spacesand lowered capacity for evaporative cooling(18) . Urban areas concentrate both emit ers ofgreenhouse gases and people at risk from climate

change.T

e potential health impacts of climatechange range from direct (e.g. ill-health fromheat exposure) to highly indirect (e.g. spreadof infectious diseases to new locations throughecological changes)(19) .

Social environment

A city’s social environment can support ordamage health (20) . Positive urban featuresinclude higher levels of social support. 333

Climate change

Climate change has major environmental healthimpacts in the cities of the developing world,which can be generally more vulnerable to the

Social environment

A city’s social environment can support ordamage healthinclude higher levels of social support.

Problematic characteristics of the urban socialenvironment may include social pressure for health-damaging behaviour like drug abuse and violenceand high levels of social stressors such as socialisolation and extreme poverty(21) . Interpersonal violence is fast becoming a major security and publichealth issue(22) . Violence tends to be greater infaster-growing and larger cities. In urban areas, young people aged 15 to 24 commit the largestnumber of violent acts and are also the principal victims of violence.T e lives and health of citydwellers are at risk during wars and conicts.

Health and social services

Cities are frequently characterized as having a richarray of health and social services in comparisonto rural areas. Yet for low- and middle-incomecountries in particular, the story is more complex. Access to services for the urban poor may belimited by ability to pay, even in the context freehealth services where medications and suppliesare not free, location or hours of operation is

inconvenient, and care is of poor quality.T

eresult is low utilization of even the most basicpreventative and curative health services.

Health and social services

Cities are frequently characterized as having a richarray of health and social services in comparisonto rural areas. Yet for low- and middle-income


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Figure 3 shows a map of community districtsin New York City by measures of concentrateddisadvantage including for education.

Figure 4 shows the same map for HIV/AIDS.In both gures, the darkest areas are the mostdisadvantaged and have the highest rate of poorhealth outcomes.T ese diff erences in healthoutcomes within urban areas disaggregated byabsolute or relative poverty are seen aroundthe world.T is highlights the need for detailedintra-urban data in cities to show where

interventions can have the most eff ect.

Health inequities are the result of acombination of poor social policiesand programmes, and unfaireconomic and social arrangements. Put ing right these inequities, aboveall, is a mat er of social justice.

3. T ere are unfair di ff erences in the health of city dwellers

Health inequities are a concern in all cities.For example, in Glasgow, Scotland, malelife expectancy in Calton ward is 54 yearsin contrast to 82 years in Lenzie, EastDunbartonshire, a nearby ward in the same city(23). A child who lives in a slum in Kenya isfar more likely to die before the age of 5 thanhis or her compatriot living in another moreaffl uent part of the city, or even in rural Kenya.In the Embakasi slum in Nairobi, the under-5mortality rate per 1000 children is 254 whilethe average for Nairobi is 62(24).Intra-urban diff erences are seen for more thanlife expectancy and under- ve mortality.

FIGURE 3

average educational attainment

FIGURE 4

Age-adjusted HIV/AIDS rate

Source: Vlahov, D et al. Knowledge Network

on Urban Settings Thematic Paper 1.

WHO Centre for Health Development 2008.(Available at http://www.who.or.jp/CHP/

thematic_papers/KNUS_ThematicPaper01.pdf)

FIGURE 4

10 20 30 4050 Miles

HIV/AIDS rate

0–11

12–23

24–37

38–64

65–126

FIGURE 3

Miles

Mean years of education

10.06–10.90

10.90–11.93

11.93–12.85

12.85–14.43

14.43–16.10

0 10 20 30 405

Intra-urban di ff erences in New York City, 2000



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On World Health Day 2010, WHOrecommends the following ve calls toaction to build a healthy and safe urbanenvironment:

Promote urban planning forhealthy behaviours and safety

Improve urban living conditions

Ensure participatory urbangovernance

Build inclusive cities that areaccessible and age!friendly

Make urban areas resilient toemergencies and disasters

III. What can be done:calls to action

We are at a clear turning point at which we aremoving towards an

increasingly urbanizedworld. We need toappreciate the positive andnegative impact on healthdue to urbanization andtake appropriate actionsto address them.T ere is

a pressing need for actionnow to ensure that growingcities are healthy cities.

T ese ve calls to action donot necessarily requireadditional funding, butpolitical commitment is vitalto redirect resources topriority interventions, therebyachieving greater effi ciency.


1 !

Improve urban living conditions 2!

Ensure participatory urbangovernance

Ensure participatory urban 3 !

uild inclusive cities that areaccessible and age friendly

4 !

Make urban areas resilient toemergencies and disasters

5 !

555


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III. What can be done: calls to action


Urban planning can promote healthy behaviours and safety in many diff erent ways,applicable both to existing and new areas.T ese would include design for physicalactivity in cities, where healthy food isavailable, safe, accessible and aff ordable, where health services for all are providedand where roads are safe.

Concrete and feasible actions that can betaken include: Design cities to promote physical activity Make healthy food available, safe, and

aff ordable Provide adequate health services for all Improve road safety

Improve urban livingconditions

Improvements in housing and housingconditions, control of pollution andimprovement in water and sanitation go a long way to mitigating health risks. Land securityand tenure is a foundation on which health can be built. Squat er set lements are of en illegal but generally represent the only option opento poor people, migrant or local, in searchof shelter. Informal set lements are rarelyprovided with basic social services.

Concrete and feasible actions that can betaken include: Locate houses in safe places Improve housing conditions Control indoor and outdoor pollution Ensure safe water and improved sanitation


Improve urban livingconditions

1 ! 2 !


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Ensure participatory urban governance

Local participatory governance mechanismsshould be established that enable communitiesand local governments to partner in building healthier and safer cities. Goodurban governance means paying at entionto concerns and planning horizons thatextend beyond current needs(25). In manydeveloping nations, present urban problemsare only the beginning. Cities need a longerterm strategy in order to turn urbanization’spotential into reality. Action and successful implementation requirefour preconditions for change: politicalcommitment at the highest level where health,equity and sustainable development are core values in a city’s policies and vision; shared vision, understanding and commitment toa comprehensive and systematic approach

for urban health; organizational structuresand processes to coordinate, manage andsupport change and to facilitate intersectoralaction and active citizen involvement; andopportunities for partnership-building andnetworking with statutory and non-statutory bodies and community groups(26).

Concrete and feasible actions that can betaken include: Share information about city planning

for health Encourage public dialogue Involve communities in decision-making Create opportunities for participation

Ensure participatory urban governance

3 !

777


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III. What can be done: calls to action

Build inclusive cities that are accessible and age-friendly

Globally, populations are rapidly ageing,leading to more older persons, many of whom will experience mobility and sensoryimpairments. WHO has developed a guidethat is aimed primarily at urban planners tomonitor progress towards more age-friendlycities in general(27).

Concrete and feasible actions that can betaken include: Make public transport accessible to disabled

people Develop safe walkways for those with

special needs Build public places and buildings for easy

access Promote active city life and sports for all

Make urban areas resilient to emergencies and disasters

Urban set ings face complex emergencies,including natural and human-made disasters.Local governments can play a crucial rolein urban disaster risk reduction, emergencypreparedness, and assessment and responsein coordination with other emergencymanagement mechanisms at the global,regional and national levels.

Concrete and feasible actions that can betaken: Locate health facilities in safe areas Build more resilient health facilities to withstand known dangers

Strengthen community preparedness andresponse capacity

Improve disease surveillance

In summary, for the rsttime in history, we are livingin a predominantly urbanworld. Urbanization iscontinuing, and local and

national governments aswell as communities are facing many challengesas more people are livingin cities. It is our collectiveresponsibility to take actionnow to make sure that cities

are healthy for all people atall times.

Build inclusive cities that are accessible and age friendly

Make urban areas resilient to emergencies and disasters

4 ! 5 !


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999

Ministries of health

o Become more informed about thesocial determinants of health, and howurban policy choices impact health anddevelopment.

o Engage other sectors proactively indialogue, including housing, transport,industry, water and sanitation, education,environment and nance agencies.

o Lead by example bysupportinghealthier and more livable cities.

o Support health and environmentalimpact assessment for urban plans andpolicies.

Local governments

o Show leadership by providing rolemodels and by set ing an example.Champion walking, cycling, activelifestyles and community designs thatsupport these activities.

o Foster collaboration within localgovernment through forums for city

departments (such as transport, health,public safety, parks and recreation andeducation) to discuss the developmentof an integrated urban health strategy.Encourage public health and urbanplanners to work closely together.

o Partner with voluntary organizations,professionals and communityorganizations and establish a mechanismthat will give health professionalsthe opportunity to provide input onplanning and transport plans.

o Share information and set upmechanisms for sharing data on activeliving, for example on the health costs

of inactivity and pedestrian travel andsafety pat erns, across governmentdepartments and with civil society andthe community.

o Encourage and enable communityparticipation by engaging thenongovernmental, private and publicsectors as well as citizens of all ages inplanning and implementing initiativesto encourage active living and physicalactivity.

Civil society

o Ensure that people are fully engaged inshaping the policies and programmesthat aff ect their lives.

o Include residents of informalset lements in formal processes by set ing up groups, associationsand federations. Large or small,organizations of the urban poor shouldcome together to identify the socialand economic conditions that theyface; to nd practical solutions tothese problems; to struggle againstmarginalization; and to ensure accessto the goods and services to whichthey are entitled.

o Work with governments onparticipatory planning and budgeting to allocate a greaterportion of the municipal investment budget to priorities determined byneighbourhoods and communitygroups.

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Researchers

o Generate and systematize knowledgeto address the many existinginformation gaps, including:

urbanization and urban growth;

disaggregated by intra-urban area;

approaches to deal with healthinequity in cities; and

citizens in the decisions that aff ecttheir habitat and their health.

Urban planners

o Use zoning and land use regulations as a way to prevent exposure of citydwellers to pollution emissions andhazards from industrial activities, waste and chemicals, and well astransport.

o Develop/adopt building practicesthat protect health among buildingusers regarding indoor airenvironment, safety, noise, water,sanitation and waste management,among several other healthdeterminants in urban set ings.

o Build compact cities, where dwellershave easy access to green areas, publictransport, cycle paths and health,education and other fundamentalsocial services.

o Incorporate Health Impact Assessment (HIA) into theconsideration of alternative planningchoices and policies.

International agencies

o Promote and support policies topromote healthy environments.

o Disseminate lessons learned from onepart of the world to other.

o Support women’s rights, povertyreduction and equity-promoting strategies and programmes.

o Encourage policy-makers togenerate and use sociodemographic information to make bet er decisionsregarding the urban future.

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