Cities will determine the health and wellbeing of populations in the 21st century: Threat or opportunity?

Building a case for action

The environment in which we move, work, learn, play, and eat determines our potential to achieve good health. Concrete jungles, food desserts, roads which resemble car parking lots, overpowering air and noise pollution, obesogenic environments, and isolation among density are not uncommon features of urban living – all of which predispose to physical and psychological ailments. Urbanisation, most notably mega, rapid or unplanned, currently poses a huge threat to human and environmental health, but is equally an unprecedented opportunity for action.

In 2016, over 50 percent of the global population were urban dwellers. By 2050, it is estimated that up to 70 percent of the 10 billion people living on earth will reside in cities, with 90 percent of this growth occurring in low- and middle-income countries. In this rapidly urbanising landscape, understanding and communicating how urbanisation impacts health is essential in tackling the rise in non-communicable diseases (NCDs), more commonly known as lifestyle diseases.

Designing solutions

Megacities bring mega-issues, and designing our way out of these industrial-scale problems can be overwhelming. Don’t stress, you can comfort yourself with food. Food connects health, climate change, and social inequity. As such, it is an incredibly powerful, and often overlooked, design tool. If cities are designed around healthy, sustainable food systems – the co-benefits for other health and social issues will follow. Community gardens, for example, have been shown to increase physical activity, mental wellbeing, social connectedness, and local food production. At scale, across cities, this simple intervention could also contribute to the greenification of urban centres, reducing air pollution and improving climate change outcomes.

Yes, it’s essential to understand the complexity of urban health issues in order to implement appropriate and effective interventions without creating or exacerbating other issues in the process – but it’s equally important not to get bogged down in this complexity. Seeking bold, simple solutions with multiple co-benefits is the best way forward – and if we truly want to build healthy cities, we need to focus on food.

The road to recovery

Civilizations past and present have built the ideal conditions for disease, but the road to recovery doesn’t necessarily necessitate a do-over.

Three key steps will pave the way to a healthier future:

1. Take the road less travelled

Less developed countries can leapfrog the unhealthy design of established cities in more developed countries. A pertinent example of successful leapfrogging is the rapid adoption of mobile phone technology, whereby developing countries bypassed landline technology – which in turn negated the need for expensive and unnecessary infrastructure without compromising connectivity and communication. The same idea can be applied to urbanisation. We know what makes an unhealthy city. For countries yet to build, or build big, a cleaner, healthy way to plan and build cities is available. The 20-minute neighbourhood project provides an example of an ideal we can work (and walk) towards.

2. Renovate

It might be too late to level existing unhealthy cities and start again, but no one said we couldn’t renovate! Whether it’s turning a skyscraper into an urban jungle, finding a suitable rooftop to plant a garden, increasing access to healthy food outlets or decreasing exposure to unhealthy food marketing, the menu of solutions available is ever increasing.

3. Construct collaborations

Ultimately, no matter what stage of development we find ourselves in, we need to actively promote and invest in healthy design. Architects, planners, and designers need to exploit choice architecture to reduce the current resistance created by urban environments to achieving healthy lifestyles. In our rapidly expanding and dynamic world, we need to take a moment of pause, and look beyond tomorrow. What does your healthy city look like? What actions can we take to build this vision? Who is responsible for change?  As much as this is a public health issue, health professionals don’t build cities. We need to identify the people and organisations involved in healthy place-making, and ensure they’re equipped with appropriate support and resources – including a shared vision for healthy place-making. Who will lead the charge? It seems City Mayors are stepping up. C40 Cities and the Milan Urban Food Policy Pact have demonstrated the power and commitment of local change-makers to lead us toward a healthier future.

The general principles for good health: clean air, healthy diet, sleep, exercise, and emotional wellbeing have not changed for centuries (thank you Hippocrates). The current problem with which we are faced is not identifying the issue, nor the solutions, but rather how to get the job done. What’s the key message here? We can build the healthy, sustainable, beautiful future we want with the solutions available today. How can your research, organisation, or government contribute to this change?

This post was written by Jess and is also published on PLOS Blogs.

Jessica Renzella is Events & Campaign Coordinator at NCDFREE. She holds a Bachelor of Biomedicine and recently graduated from the Master of Public Health at Australia’s Melbourne University, focusing her studies on the intersection between food, health and climate change. After an internship with the World Health Organization earlier in 2016, Jess is back in Europe undertaking a DPhil in Population Health at Oxford University, concentrating her time and efforts on the impact of urban environments on nutrition.