7 Take-Home Messages on Urban Health

Urban populations are growing and will continue to do so. By 2050, 70% of the world's population will live in cities. Urban life brings its own benefits and challenges, and the benefits can be enhanced through informed urban and transport planning that uses a multi-sectoral approach with people and wellbeing at the center. Here are 7 key messages from urban health researchers on how to promote health in cities.

[Researchers from ISGlobal, CHORUS, ARISE and APHRC came together to identify key messages on Urban Health. This text has been co-written by Amanda Fernandes, Helen Elsey, Kate Hawkins, Deepa Barua, Chinyere Okeke, Deepak Joshi, Noemia Siqueira-Filha, Linda Oloo, Neele Wiltgen-Georgi, Ivy Chumo, Sushil Baral, Caroline Kabira, Blessing Mberu, Evelise Pereira Barboza and Carolyn Daher during the 18th International Conference on Urban Health - held in Valencia Spain]

1. Building healthy places is fundamental to health in cities. Recognising that urban health systems extend well beyond the health care system is critical to creating healthy cities. Within urban areas, there is a need to focus on 'place' for analysis and strategic action, understanding how all residents live, interact, work and travel in the city on a daily basis.
2. Inclusivity, accountability and equity must be considered at every step in urban health. There are many examples of programmes that improve overall health but have unintended consequences that undermine the health of the poorest and most vulnerable. Understanding changing gender norms, racism and discrimination in cities is a prerequisite for healthy urban development. To achieve real change, all voices need to be heard and language barriers overcome, leading to health equity in all decision levels.
3. Urban health is political. Local governments may be led and influenced by politicians, private companies and property developers. This can undermine long-term planning and sustainability. Finding community-level responses is vital and can be powerful at the city level, for example passing bylaws to protect and promote health without leaving the most vulnerable behind.
4. A multi-sectoral approach to improving urban health is essential. The greatest improvements in health will come from changes in the wider determinants such as mobility, public space, housing and urban design. This is particularly important given the ongoing fuel and climate crises that affect all our cities.
5. Understanding and responding to informality is key to improving urban health. The informal nature of economy, housing as well as informality of health providers defines the lives and health of urban poor residents. We should not forget the often-invisible urban informal settlements that are out of sight, and mind for the rest of the city.
6. Extend the depth and breadth of data to drive urban change for all. A data revolution is underway. Cities and citizens are producing more and more data. We need to democratise and harmonised the data, so that we can collectively discuss problems, design interventions and hold the public, private and government sectors to account. To guide action, we need better data of informal and illegal settlements and households, whether in large communities or small pockets rather than making assumptions through aggregate data.
7. Human resources for health need to flex in response to the specific needs of cities. Health providers and public health teams need additional skills, particularly 'soft skills' to negotiate and influence across sectors, to use systems thinking to understand problems and change processes, and to identify creative and sustainable solutions and how to monitor and evaluate them, that respond to the diverse and changing contexts of places within cities.

In short, to paraphrase Dr Thiago Hérick de Sá - WHO, we need to bring together actors and alliances to "remove the fence” (i.e., eliminate inequities) for all, with people together, with data and knowledge, street by street, in all the cities and communities of the world!

We need to support city dwellers to be at the forefront of creating healthy cities. Photo: BRAC University JPG School of Public Health, Bangladesh.

More on Urban Health

International Society for Urban Health

Global Network for Age-friendly Cities and Communities

CHORUS Research on urban health

ARISE consortium

African Population and Health Research Center