Cities for global health

Abstract

The number of people, and proportion of the world population, living in cities has increased steadily, with 4.2 billion urban residents now accounting for 55% of the world’s population. That urban living influences health is well recognized and increasingly included in broader discussions about cities and sustainable human development. The general tone of such discourse, however, tends towards the negative aspects of infectious outbreaks, vehicular pollution, waste disposal, and unhealthy lifestyles rather than the “positive and progressive aspects of cities. recognised by historians, economists, and other social scientists.” Empirical evidence strongly points to urban residents having better health than their rural counterparts since at least the early to mid-20th century, in high income as well as low and middle income countries. The health advantages of urban living, however, are unevenly distributed in cities, with massive inequalities existing over short distances. Our urbanising world provides an opportunity, and an imperative, to not only further improve population health in cities but also to leverage cities as nodes in a natiotrafinal and global network to improve health in and across countries. Reducing inequalities is fundamental because population health suffers where inequalities are larger. The urban health literature commonly uses the “healthy city” concept to frame discussions. The idealised healthy city, although aspirational, can easily be disconnected from the complex dynamics of urban development, in which cities’ demographics and social, natural, built, and food environments are constantly changing through interactions between individual, corporate, and public actions. Limited attention has also been given to the essential role of urban services, including healthcare, childcare, and public safety. Thus the policy challenge for improving health in cities, first laid out a century ago by Chapin,16 remains—to identify and implement institutional and technical innovations in every sector that form transition pathways to better health, taking into account the contemporary local social, demographic, and economic conditions. We discuss a set of themes in which municipal governments and administrators (referred to as “cities” hereafter) can foster innovation in technology and practice and achieve economies of scale in services that improve the health of their own residents and benefit a wider geography, with emphasis on their role in reducing health inequalities.