wh d 2010 background

7/27/2019 Wh d 2010 Background

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Why urban health matters


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World Healh Organizaion 2010. All righs reserved.

Te designaions employed and he presenaion o he maerial in his publicaion do no imply he expression o any opinion whasoever on he par o he World HealhOrganizaion concerning he legal saus o any counry, erriory, ciy or area or o is auhoriies, or concerning he delimiaions o i s roniers or boundaries.Te boundaries and names shown and he designaion used on maps do no imply he expression o any opinion whasoever on he par o he World Healh Organizaionconcerning he legal saus o any counry, erriory, ciy or area or o is auhoriies, or concerning he delimiaion o is roniers or boundaries. Doted lines on mapsrepresen approximae border lines or which here may no ye be ull agreemen. Te menion o specic companies or o cerain manuacurers producs does no implyha hey are endorsed or recommended by he World Healh Organizaion in preerence o ohers o a similar naure ha are no menioned. Errors and omissions exceped,he names o proprieary producs are disinguished by iniial capial leters.All reasonable precauions have been aken by he World Healh Organizaion o veriy he inormaion conained in his publicaion. However, he published maerial isbeing disribued wihou warrany o any kind, eiher expressed or implied. Te responsibiliy or he inerpreaion and use o he maerial lies wih he reader. In no evenshall he World Healh Organizaion be liable or damages arising rom is use.

Phoo credis: IRIN; ONA SIA (L. Duggleby); Roary Inernaional; UN; WHO (AFRO, SEARO, N. Alexander, M. Decker, V. Dihajohn, O. Hkmies, A. K ari)

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 ocus on urbanizaion and healh ......................................................................................................................................................................................................................................1

Direcor-Generals saemen ...................................................................................................................................................................................................................................................................................................................................................2

I. Inroducion ...........................................................................................................................................................................................................................................................................................................................................................................................................6

II. Wha are he issues? ......................................................................................................................................................................................................................................................................................................................................................................8

1. Urbanizaion impacs populaion healh ...................................................................................................................................................................................................................................................................8

2. Urban setings are a healh deerminan ......................................................................................................................................................................................................................................................................9

3. Tere are unair dierences in he healh o ciy dwellers.........................................................................................................................................................................................14

III. Wha can be done: calls o acion ...............................................................................................................................................................................................................................................................................................15

1. Promoe urban planning or healhy behaviours and saey ...........................................................................................................................................................................16

2. Improve urban living condiions .....................................................................................................................................................................................................................................................................................................16

3. Ensure paricipaory urban governance....................................................................................................................................................................................................................................................................17

4. Build inclusive ciies ha are accessible and age-fiendly .........................................................................................................................................................................................18

5. Make urban areas resilien o emergencies and disasers ..........................................................................................................................................................................................18

Annex: A role or all who can do wha? .................................................................................................................................................................................................................................................................................19

Reerences....................................................................................................................................................................................................................................................................................................................................................................................................................................

21


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o ensure susained acion on he opic o urbanizaion and healh hroughou 2010, a series o evens areplanned o highligh he healh risks in urban setings and he acions and policy opions ha can be akeno improve healh in ciies.

1. World Health Day 2010

Te aim o World Healh Day 2010 is o draw atenion o urbanizaion and healh, recognizing ha inan increasingly urbanized world, healh issues presen new challenges ha go ar beyond he healh secorand require acion a he global, naional, communiy, and individual levels. World Healh Day 2010 isno seen as an even in and o isel, bu as he launch o he year-long ocus on he issue.

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

Te repor, o be published laer in he year, will expose he exen o which he urban poor suerdisproporionaely om a wide range o diseases and healh problems. I will provide evidence-basedinormaion o help municipal and healh auhoriies reduce healh inequiies in heir ciies.

3. Global Forum, Kobe

Te Forum will bring ogeher mayors, municipal leaders and naional minisers across muliple secorsor a declaraion o acion o reduce healh inequiies in ciies. Te Forum will be held in Kobe, Japan,

1517 November 2010.

2010: A year-long focus on urbanization and health


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For a growing proporion o he worlds populaion,prospecs or a beter uure are ied o livingcondiions in ciies.

Ciies concenrae people, opporuniies, and

services, including hose or healh and educaion.In a well-known rend, ciies house he mos andhe bes hospials and hey atrac he mos aleneddocors, nurses and oher healh care sa. Whenciies are planned, managed, and governed well, lieourishes and healh oucomes surpass hose seenin rural areas.

Bu ciies also concenrae risks and hazards orhealh. Tey magniy some long-sanding hreaso healh and inroduce ohers. When largenumbers o people are linked ogeher in space andconneced by shared services, he consequences oadverse evens like conaminaion o he ood or

waer supply, high levels o air or noise polluion,a chemical spill, a disease oubreak or a nauraldisaser are vasly amplied.

Given he curren scale o urbanizaion, i comes as

no surprise ha ciies hemselves conribue o woglobal rends o direc concern o healh: climaechange and he rise o chronic diseases. According

o he laes esimaes, ciies conribue direclyo more han 60% o greenhouse gas emissions.Tey accoun or 75% o energy consumpionand a similar proporion o all wases. A he same

ime, ciy dwellers are especially vulnerable o heconsequences o climae change, wheher expressedas hea waves, waer scarciy, increasing levels o airpolluion, or rising sea levels in coasal areas.

Ciies also end o promoe unhealhy liesyles, likeconvenien dies ha depend on processed oods,sedenary behaviour, smoking, and he harmuluse o alcohol and oher subsances. Tese liesylechoices are direcly linked o obesiy and he rise o

condiions like hear disease, sroke, some cancers,and diabees. And hese condiions are increasinglyconcenraed in he urban poor.

Perhaps mos alarming, he growh o urban cenresin he 21s cenury is being accompanied by asecond, disincly ominous rend. Povery, whichin previous cenuries was greaes in scatered ruralareas, is now heavily concenraed in ciies. In manycounries, urbanizaion has oupaced he abiliy o

governmens o build essenial inrasrucures andenac and enorce he legislaion ha make lie inciies sae, rewarding, and healhy.

Director-generals statement

Urban healh maters,in criical ways, or moreand more people.

For he frs ime inhisory, more people

are now living in urbansetings han in ruralareas. By he year 2030,an esimaed six ou oevery en people will beliving in owns or ciies,wih he mos explosive

growh expeced in Asiaand Aica.


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oday, around one hird o urban dwellers,

amouning o nearly one billion people, live in urbanslums, inormal setings, or sidewalk ens. Whilehe vas majoriy o urban slums more han 90% are locaed in he developing world, nearly everyciy everywhere has pockes o exreme deprivaionogeher wih exreme wealh. Tey have people

who over-consume healh care and people whoorego he mos basic and essenial care or nancialand oher reasons. In every corner o he world,

cerain ciy dwellers suer disproporionaely rompoor healh, and hese inequiies can be raced backo dierences in heir social and living condiions.

On his World Healh Day, he World Healh

Organizaion (WHO) is calling on a wide range ogroups rom municipal auhoriies and he privae

secor, o concerned ciizens, nongovernmenal

organizaions, and advocaes or healhy living o

ake a close look a healh inequiies in ciies and

ake acion.

Why should inequiies in urban healh and living

sandards mater? Mos obviously, he consequences

o povery and ill healh, including menal healh,are conagious in a ciy seting. Tey are derimenal

o all ciy dwellers. Urban povery and squalor are


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srongly linked o social unres, menal disorders,crime, violence, and oubreaks o disease associaed

wih crowding and lh. Tese hreas can easilyspread beyond a single neighbourhood or disric o

endanger all ciizens and ain a ciys repuaion.Municipal auhoriies know wha his means inerms o atracing ouriss and new businessesand winning he nex elecion. Ciy dwellers know

wha his means in erms o social cohesion, saey,securiy, and he qualiy o lie.

In addiion, healh inequiies are an excellen socialaccounan. Tey are a reliable way o measure how

well a ciy is meeing he needs o is residens. Poorhealh, including menal healh, is one o he mos

visible and measurable expressions o urban harm.Healh inequiies can also be a rallying poin orpublic demands or change ha compel poliicalleaders o ake acion.

Urban healh maters and urban healh governancematers mos especially. For example, in developingcounries, he bes urban governance can help

produce 75 years or more o lie expecancy. Wihpoor urban governance, lie expecancy can be aslow as 35 years.

Good urban healh governance helps ensure haopporuniies and advanages are more evenlydisribued, and ha access o healh care is air andaordable. Abundan evidence has idenied he

roo causes o urban healh inequiies and shownhow hey can be ackled.

While mos o hese roo causes lie beyond hedirec conrol o he healh secor, local leadershave direc inuence over a wide range o urbanhealh deerminans, rom housing and ransporpolicies, o social services, o smoking regulaionsand he policies ha govern ood markeing andsales. Local leaders are well-posiioned o inuence

land use, building sandards, waer and saniaionsysems, and he enacmen and enorcemen ohealh-promoing legislaion. Moreover, acingin he name o healh can rally sakeholders romdiverse backgrounds and ineress and build poliicalpressure on issues ha are imporan o every ciydweller. Healh is valued universally as an essenialprerequisie or a ullling and producive lie.

Making ciies good or healh akes ime, bu asabundan examples rom all around he world show,i can be done.

Director-generals statement


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Urban healh maters, in criical ways, or more andmore people. And WHO will be doing more, odayand well ino he uure, o suppor hese eors.

1. Promoe urban planning or healhybehaviours and saey

2. Improve urban living condiions

3. Ensure paricipaory urban governance

4. Build inclusive ciies ha are accessibleand age-iendly

5. Make urban areas resilien o emergenciesand disasers

Laer in he year, WHO and UN-HABIA willbe launching a repor on urban healh inequiiesand how o address hem. iled Hidden ciies, herepor is aimed a unmasking and overcoming healh

inequiies in urban setings, and includes abundanpracical examples and policy advice on specic,evidence-based inervenions.

In November 2010, a global orum on urbanizaionand healh, o be held in Kobe, Japan, will bringogeher municipal auhoriies and decision-makersacross muliple secors wih he aim o promoing

inersecoral acion o reduce urban healhinequiies.

In a dedicaed programme, WHO and is sixregional o ces will work wih specic ciies andnaional auhoriies o assess urban healh inequiiesand ideniy appropriae acions o reduce hem.

o mainain momenum, urban healh advocaes arebeing idenied and successul ciy experiences will

be shared as menus o policy opions and models ogood pracice.

WHO will help municipal auhoriies in assessinghe healh impac o planning opions in ohersecors, such as urban ransporaion and he saeyo roads or boh vehicles and pedesrians.

Dr Margare ChanDirecor-General o he World Healh Organizaion


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Te year 2007 saw, or he rs ime, hemajoriy o human beings living in urban areas.Tis rend will coninue wih 6 in 10 peopleliving in owns and ciies by 2030. In recenimes, he growh o urban areas in low-incomecounries has been our imes aser han hegrowh in high-income counries. Tis rend,oo, is expeced o coninue in coming years.

Urban areas provide grea opporuniies orindividuals and amilies o prosper and canprovide a healhy living environmen hroughenhanced access o services, culure andrecreaion. However, ciy dwellers coninue oace healh hazards and new healh challengeshave emerged.

While he characerisics o each ciy vary

by local conex, common urban healh andsocial challenges include: overcrowding; airpolluion; rising levels o risk acors like

I. Introduction

Where people live aecs heir healh and opporuniies or leadinglives o heir ull poenial.

obacco use, unhealhy die, physical inaciviyand he harmul use o alcohol; road racinjuries; inadequae inrasrucure, ransporaciliies and solid wase managemen sysems,and insucien access o healh aciliies inslum areas.

World Healh Day in 2010 oers anopporuniy o ake a closer look a hecondiions ha deermine healh oucomesor he majoriy o he worlds populaion,he issues ha need o be addressed, and heacions ha can be aken. By undersandinghese issues, limied resources can be allocaedo more argeed inervenions, and achievebeter healh oucomes.

Te ocus on urbanizaion and healh as aheme or World Healh Day 2010 is imely andhighly relevan or he ollowing reasons.


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F,wih he majoriy o he worldspopulaion now living in urban areas andhis proporion expeced o grow, urbanhealh should become a major ocus o global

public healh policy. Whils urbanizaionand he growh o ciies may be associaedwih increasing prosperiy and good healha an aggregae level, urban populaionsdemonsrae he worlds mos obvious healhdispariies in boh low- and high-incomecounries. Rapid migraion rom rural areas aswell as naural populaion growh are putingurher pressure on limied resources in ciies,

especially in low-income counries.

S, much o he naural and migraiongrowh in urban populaion is among hepoor. More han one billion people onehird o he urban populaion live inovercrowded and lie-hreaening condiionsin urban slums and inormal setlemens. I

ciies ail o deliver on he perceived promiseo economic opporuniies or he poor, largeconcenraions o unemployed young people

may hreaen social sabiliy, securiy andhe healh o communiies as a consequence.In low-income counries, in paricular,dispariies will increase, as he combinaion

o in-migraion, naural growh and scarciyo resources resuls in ciies being unable oprovide he services needed by hose whocome o live in hem.

T, here is evidence ha rapid,unplanned urbanizaion can have negaiveconsequences or he healh and saey opeople.


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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 peopleby 2050 (2).

Key poins o consider on urban growhand is impac on healh

Mos o he worlds populaion growhis expeced in urban areas in low- andmiddle-income counries (Figure 1).

Urbanizaion rends vary across dierenpars o he world. Some ciies and regionsare experiencing rapid growh, whereas oherciies and regions are in populaion decline.However, he worlds urban populaion in he

less developed regions is projeced o increaserom 1.9 billion people living in ciies in 2000o 3.9 billion in 2030 (3).

Growh will be primarily in small andmid-sized ciies

Urbanizaion and is healh impacs are nojus an issue or megaciies ciies wih over10 million residens. In ac, much o heurban populaion growh will occur in small andmid-sized ciies. While large ciies o developingcounries will accoun or 20% o he increase inhe worlds populaion beween 2000 and 2015,small and mid-size ciies (less han 5 million)will accoun or 45% o his increase (4).

Urbanizaion involves migraion,reclassicaion and naural growh

In addiion o migraion, ciies add populaionhrough reclassicaion, when hey expandhorizonally and absorb hamles and owns.Migraion and reclassicaion accoun or

40% o urban growh, wih he remaining60% coming rom naural growh o exisingpopulaions (5).

II. What are the issues?

1. Urbanizaion impacs populaion healh

FIGURE 1

Distribution of world

population Growth, 1950-2030

Source: Cohen B. Urban Growth

in Developing Countries. WorldDevelopment. Vol. 32, No. 1, pp. 2351, 2004.

Data source: UNDESA. World urbanization

prospects: the 2001 revision.

Mean years of education

Urban high-income countries

19501975

2500

2000

1500

1000

500

0Populationi

ncrease,in

thousands

19752000

time frames

20002030

Urban Middle-and-low income countries

Rural High and Middle-and-low income


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Ciies are growing horizonally

Te rend or he pas 50 years is or ciies o

grow horizonally in he orm o urban sprawl,wheher as suburbs in he developed world orperi-urban expansion in he developing world.

Tis has implicaions or he e ciency ourban services, including delivery o waer andsaniaion, provision o public ranspor, as wellas or access o jobs, educaion, ood and healhservices.

Speed o growh can oupaceinfasrucure requiremens

In many cases, especially in he developingworld, he speed o urbanizaion has oupacedhe abiliy o governmens o build essenialinrasrucure. Failure o plan or coninued

growh resuls in inadequae healh services,waer, saniaion, educaion, and essenialinrasrucure.

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

o Inecious diseases exacerbaed by poorliving condiions;

o Noncommunicable diseases such ashear disease, cancers and diabees and condiions uelled by obacco use,unhealhy dies, physical inaciviy, andharmul use o alcohol; and

o Accidens, injuries, road accidens, violence

and crime.Tese are he resul a complex ineraciono various deerminans o healh, includinginsu cien inrasrucure and services haparicularly impac he healh o he poor andslum dwellers. Living and working condiionsvary widely wihin and beween ciies acrosshe world and are he causes o he causeso ill-healh.

2. Urban setings are a healh deerminan


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Housing, land tenureand security

Most, but not all, urban poor live in slums andsquaer selements. ese seings tend to be

unregulated, precarious, overcrowded, and areoen exposed to hazards, such as steep hillsidessubject to landslides, riverbanks and waterbasin locations subject to ooding, or sites nearindustrial hazards. Inadequate, overcrowded ordeteriorating housing in informal selements,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 theworlds 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 users 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 towater and sanitation live in rural areas (7),some 807 million city dwellers (24% globallyand 32% in developing cities) lack access to

what WHO denes 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).


2. Urban setings are a healh deerminan(coninued)


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Food

Another health determinant in cities is access tosafe and quality food, and in su cient quantity(10). Inadequate diet reduces resistance to

disease, especially for slum dwellers, becausethey live in the constant presence of pathogenicmicro-organisms (11). Urban poor populationsin the developed and developing world oen relyon street food, fast food, processed and cheapfood, leading to nutritional problems such asvitamin/mineral deciencies, 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 peoplebecome more a uent, the lack of publictransport infrastructure and services or good

networks for cycling and walking along witharaction to a more a uent lifestyle has spurreda rapid transition to cars or motorcycles leading

to enormous increases in tra c, along withtra c-related pollution, injur y 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 beaected by a lack of transport options, poorneighbourhoods oen lose out the most, asthey lack good public transport access to healthcentres, grocery stores, schools, and jobs(9, 12, 13).

Road tra c injuries also stand out as animportant and growing transport-related publichealth problem, with most deaths occurring inlow- and middle-income countries. Globally,road tra 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).

Noise exposure

Noise, a common urbanproblem, is a consequenceof transportation and

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


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Outdoor and indoorair 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 maer,mostly from vehicle and industrial fuel combustion,has the greatest eect on human health. Worldwide,ne particulate maer 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

050

50150

150250

250400

> 400

Data not available Source: WHO Global health risks, 2009


FIGURE 2

Deaths attributable to urban air pollution, 2004

2. Urban setings are a healh deerminan(coninued)


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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 eect, whereby urbantemperatures may be as much as 511 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 emiers ofgreenhouse gases and people at risk from climate

change. 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 citys social environment can support ordamage health (20). Positive urban featuresinclude 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 principalvictims of violence. 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. eresult is low utilization of even the most basicpreventative and curative health services.


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Figure 3 shows a map o communiy disricsin New York Ciy by measures o concenraeddisadvanage including or educaion.

Figure 4 shows he same map or HIV/AIDS.In boh gures, he darkes areas are he mosdisadvanaged and have he highes rae o poorhealh oucomes. Tese dierences in healhoucomes wihin urban areas disaggregaed byabsolue or relaive povery are seen aroundhe world. Tis highlighs he need or deailedinra-urban daa in ciies o show where

inervenions can have he mos eec.

Healh inequiies are he resul o acombinaion o poor social policiesand programmes, and unaireconomic and social arrangemens.

Puting righ hese inequiies, aboveall, is a mater o social jusice.

3. Tere are unair differences in he healh o ciy dwellers

Healh inequiies are a concern in all ciies.For example, in Glasgow, Scoland, malelie expecancy in Calon ward is 54 yearsin conras o 82 years in Lenzie, EasDunbaronshire, a nearby ward in he same ciy(23). A child who lives in a slum in Kenya isar more likely o die beore he age o 5 hanhis or her compario living in anoher moreaffl uen par o he ciy, or even in rural Kenya.In he Embakasi slum in Nairobi, he under-5moraliy rae per 1000 children is 254 whilehe average or Nairobi is 62 (24).

Inra-urban dierences are seen or more hanlie expecancy and under-ve moraliy.

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)

10 20 30 4050 Miles

HIV/AIDS rate

011

1223

2437

3864

65126

Miles

Mean years of education

10.0610.90

10.9011.93

11.9312.85

12.8514.43

14.4316.10

0 10 20 30 405

Intra-urban dierences in New York City, 2000



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On World Health Day 2010, WHO

recommends the following ve calls to

action to build a healthy and safe urban

environment:

Promote urban planning forhealthy behaviours and safety

Improve urban living conditions

Ensure participatory urban

governance

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 a a clear urningpoin a which we aremoving owards an

increasingly urbanizedworld. We need oappreciae he posiive andnegaive impac on healhdue o urbanizaion andake appropriae acionso address hem. Tere is

a pressing need or acionnow o ensure ha growingciies are healhy ciies. ese ve calls to action do

not necessarily requireadditional funding, butpolitical commitment is vitalto redirect resources topriority interventions, therebyachieving greater e ciency.

1!

2!

3!

4!

5!


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III. What can be done: calls to action

Promote urban planning forhealthy behaviours and safety

Urban planning can promoe healhybehaviours and saey in many dieren ways,

applicable boh o exising and new areas.Tese would include design or physicalaciviy in ciies, where healhy ood isavailable, sae, accessible and aordable,where healh services or all are providedand where roads are sae.

Concrete and feasible actions that can be

taken include: Design ciies o promoe physical aciviy

Make healhy ood available, sae, andaordable

Provide adequae healh services or all

Improve road saey

Improve urban livingconditions

Improvemens in housing and housingcondiions, conrol o polluion and

improvemen in waer and saniaion go a longway o miigaing healh risks. Land securiyand enure is a oundaion on which healh canbe buil. Squater setlemens are ofen illegalbu generally represen he only opion openo poor people, migran or local, in searcho sheler. Inormal setlemens are rarelyprovided wih basic social services.

Concrete and feasible actions that can betaken include:

Locae houses in sae places

Improve housing condiions

Conrol indoor and oudoor polluion

Ensure sae waer and improved saniaion

1! 2!


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Ensure participatory urbangovernance

Local paricipaory governance mechanismsshould be esablished ha enable communiies

and local governmens o parner inbuilding healhier and saer ciies. Goodurban governance means paying ateniono concerns and planning horizons haexend beyond curren needs (25). In manydeveloping naions, presen urban problemsare only he beginning. Ciies need a longererm sraegy in order o urn urbanizaionspoenial ino realiy.

Acion and success ul implemenaion requireour precondiions or change: poliicalcommimen a he highes level where healh,equiy and susainable developmen are corevalues in a ciys policies and vision; sharedvision, undersanding and commimen oa comprehensive and sysemaic approach

or urban healh; organizaional srucuresand processes o coordinae, manage and

suppor change and o aciliae inersecoralacion and acive ciizen involvemen; andopporuniies or parnership-building andneworking wih sauory and non-sauorybodies and communiy groups (26).


Share inormaion abou ciy planningor healh

Encourage public dialogue

Involve communiies in decision-making

Creae opporuniies or paricipaion

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III. What can be done: calls to action

Build inclusive cities that areaccessible and age-friendly

Globally, populaions are rapidly ageing,leading o more older persons, many o

whom will experience mobiliy and sensoryimpairmens. WHO has developed a guideha is aimed primarily a urban planners omonior progress owards more age-riendlyciies in general (27).


Make public ranspor accessible o disabledpeople

Develop sae walkways or hose wihspecial needs

Build public places and buildings or easyaccess

Promoe acive ciy lie and spors or all

Make urban areas resilient toemergencies and disasters

Urban setings ace complex emergencies,including naural and human-made disasers.

Local governmens can play a crucial rolein urban disaser risk reducion, emergencypreparedness, and assessmen and responsein coordinaion wih oher emergencymanagemen mechanisms a he global,regional and naional levels.

Concrete and feasible actions that can be

taken: Locae healh aciliies in sae areas

Build more resilien healh aciliies owihsand known dangers

Srenghen communiy preparedness andresponse capaciy

Improve disease surveillance

In summary, or he frsime in hisory, we are livingin a predominanly urbanworld. Urbanizaion isconinuing, and local and

naional governmens aswell as communiies areacing many challengesas more people are livingin ciies. I is our colleciveresponsibiliy o ake acionnow o make sure ha ciies

are healhy or all people aall imes.

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Ministries of health

o Become more informed abou hesocial deerminans o healh, and howurban policy choices impac healh anddevelopmen.

o Engage oher secors proacively in

dialogue, including housing, ranspor,indusry, waer and saniaion, educaion,environmen and nance agencies.

o Lead by examplebysupporinghealhier and more livable ciies.

o Suppor healh and environmenalimpac assessmen or urban plans andpolicies.

Local governments

o Show leadership by providing rolemodels and by seting an example.Champion walking, cycling, aciveliesyles and communiy designs hasuppor hese aciviies.

o Foser collaboraion wihin localgovernmen hrough orums or ciy

deparmens (such as ranspor, healh,public saey, parks and recreaion andeducaion) o discuss he developmeno an inegraed urban healh sraegy.Encourage public healh and urbanplanners o work closely ogeher.

o Parner wih volunary organizaions,professionals and communiyorganizaions and esablish a mechanismha will give healh proessionalshe opporuniy o provide inpu onplanning and ranspor plans.

o Share informaion and se upmechanisms or sharing daa on aciveliving, or example on he healh coss

o inaciviy and pedesrian ravel andsaey paterns, across governmendeparmens and wih civil sociey andhe communiy.

o Encourage and enable communiyparicipaionby engaging henongovernmenal, privae and publicsecors as well as ciizens o all ages inplanning and implemening iniiaiveso encourage acive living and physicalaciviy.

Civil society

o Ensure ha people are fully engaged inshaping he policies and programmesha aec heir lives.

o Include residens of informalsetlemens in ormal processes

by seting up groups, associaionsand ederaions. Large or small,organizaions o he urban poor shouldcome ogeher o ideniy he socialand economic condiions ha heyace; o nd pracical soluions ohese problems; o sruggle againsmarginalizaion; and o ensure accesso he goods and services o which

hey are eniled.

o Work wih governmens onparicipaory planning and

budgeingo allocae a greaerporion o he municipal invesmenbudge o prioriies deermined byneighbourhoods and communiygroups.

Annex:A role for all who can do what?


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Researchers

o Generae and sysemaize knowledgeo address he many exisinginformaion gaps, including:

potentialadvantagesofurbanizaion and urban growh;

theinequitiesofhealthdisaggregaed by inra-urban area;

theeectivenessofproactiveapproaches o deal wih healhinequiy in ciies; and

theimportanceofinvolvingallciizens in he decisions ha aecheir habia and heir healh.

Urban planners

o Use zoning and land use regulaionsas a way o preven exposure o ciydwellers o polluion emissions andhazards rom indusrial aciviies,wase and chemicals, and well as

ranspor.o Develop/adop building pracices

ha proec healh among buildingusers regarding indoor airenvironmen, saey, noise, waer,saniaion and wase managemen,among several oher healhdeerminans in urban setings.

o Build compac ciies,where dwellershave easy access o green areas, publicranspor, cycle pahs and healh,educaion and oher undamenalsocial services.

o Incorporae Healh Impac

Assessmen (HIA) ino heconsideraion o alernaive planning

choices and policies.

International agencies

o Promoe and suppor policies opromoe healhy environmens.

o Disseminae lessons learnedrom onepar o he world o oher.

o Suppor womens righs, poveryreducion and equiy-promoingsraegies and programmes.

o Encourage policy-makers ogenerae and use sociodemographicinormaion o make beter decisionsregarding he urban uure.

Annex: A role for all who can do what?


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wh d 2010 background

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