At the Urban Transformation Summit hosted by the World Economic Forum on Tuesday 7 December 2021, GCHU Co-Director Professor Carl Heneghan presented a seminar on ‘Healthy People, Thriving City‘ which can be watched here. A synopsis of his presentation is published below.
The growth of urban populations is substantial: the proportion living in urban centres surpassed 50% in 2007 and is projected to rise to 68% by 2050.
Cities will continue to spread and grow, affecting the environment and the health and wellbeing of their populations. However, while growth is associated with many positive health outcomes, in areas with concentrated disadvantaged people – such as slums – health outcomes are often worse.
Safe drinking water, sanitation and drainage significantly contribute to health outcomes. Yet, 1 in 3 people globally does not have safe drinking water. In addition, roughly 670 million people don’t have access to sanitation. In 2012, 500,000 diarrhoea deaths were estimated to be caused by inadequate drinking water and 280,000 deaths by poor sanitation. Providing safe drinking water and sanitation requires a substantial increase to current progress to achieve universal coverage.
To avoid the unintended effects of growing global urbanisation, public health planners need to make health and wellbeing explicit goals in urban design.
For example, poor housing contributes substantially to poor health. In the UK, inadequate housing costs the NHS £1.4billion.
The inability to access and acquire nutritious food is also a significant issue. Food insecurity contributes considerably to premature mortality. The calorie-dense processed foods -the cheapest – are often the most available in poorly designed neighbourhoods.
Moreover, a better diet, reductions in obesity and increases in physical exercise can reduce premature mortality through reductions in NonCommunicable Diseases. Four main chronic diseases account for 60% of the global morbidity and mortality: diabetes, respiratory disease, cardiovascular diseases, and cancer.
Yet, a large proportion of the urban population do not have access to green spaces and consequently do not meet physical activity guidelines. In the UK, projections suggest increased physical activity could save a further £17 billion for the NHS.
Promotion of public transport, walking, and cycling can reduce dependence on fossil fuels and reduce the burden of NCDs; however, access to green spaces varies considerably. Safe, high-quality biking and walking infrastructure leads to more exercise: every kilometre you live nearer to green space infrastructure gives rise to roughly 15 minutes more exercise per week.
However, the potential benefits of extra exercise are often offset by air pollutants that cause a diverse range of adverse health effects. Four in ten Americans live with unhealthy air. In 2017, greater than 90% of the world’s population still lived in areas where ambient Particulate Matter 2.5 levels exceeded the WHO’s air quality guideline.
The social environment further influences health by increasing social support. Community organisations can act positively to improve living conditions. Furthermore, the availability of and access to health and social service is vital to wellbeing, as is transportation. Good transport networks increase access to employment and health services.
Because of these escalating global problems, the work of the Global Centre Healthcare Urbanisation (GCHU) has identified three priorities for improving health and wellbeing:
- Designing an urban environment that reduces the burden of Non-Communicable Diseases;
- Reducing the impact of environmental exposures on health and wellbeing;
- Enhancing the role of urban design in preventing the spread of infectious diseases.
To address these priorities, we are currently reviewing 320 systematic reviews led by Dr Georgia Richards for a commission in the UK on creating healthy cities.
The commission investigates the links between urban design and the risks to health and wellbeing. We aim to produce an evidence toolkit that should be available by the end of January 2022 that summarises the evidence to date of what works in what context for improving cities’ health and wellbeing.