How to improve urban health: Lessons from cities around the world

 By: Kieron Boyle, CEO of Impact on Urban Health

Where we grow up, live and work significantly shapes our health. For the majority of us, that’s now in cities, with over four in five people already living in urban areas in the UK.

The many positive attributes of cities mask the inequalities that exist within them, especially when it comes to health. Living in urban areas carries distinct challenges which often start from a young age. These health impacts are not experienced equally — income, race and gender all play a part. The pandemic has brought these issues to the forefront of the health agenda, but they are certainly not new. What the pandemic has done is fast-forward the clock on patterns that were there all along.

Fortunately, cities around the world are testing and trialling new approaches to these challenges. At Impact on Urban Health, based in inner-city London, our aim is to find real-world solutions that work. We then share them to help improve the health of more people living in cities.

City spotlight

Here are some of the most promising examples we’ve identified from cities across the globe. These cities are providing fair and equal access to opportunities, while also protecting their most vulnerable communities from health inequalities.

Melbourne, for example, shares similar demographics with London. They have implemented several city-wide initiatives to improve the built environment, which have shown how changes in infrastructure, from housing to transport to public landscaping, can help embed health outcomes in the development of cities. The city is experimenting with ideas like the “20-minute city” to promote active travel and more accessible health services.

In Mexico City, a multidisciplinary approach – Laboratorio para la Ciudad (The Lab) – brought experts together to help tackle issues like road safety and the health of indigenous communities. The Lab provided a space in which local residents, urban geographers, AI experts, along with writers, historians, philosophers, artists, and filmmakers worked together to address some of the city’s most prominent issues. One of the outcomes was a framework for working with communities to create public space out of nothing and that work continues to be carried forward.

Urban infrastructure often lacks input from people on what they need to be healthy. To address this, Paris is devolving power to its residents, inviting them to make decisions about how public money is spent to improve urban health. Between 2014 and 2020, the city committed 500 million euros of public money (about five percent of the city’s capital fund) to be spent on projects chosen by the city’s residents. This resulted in the city supporting projects focused on health improvements, such as establishing a refuge shelter for migrants and new public gardens and pedestrian areas.

In New York, there is evidence of the vital role that anchor organisations – those with deep roots in local communities – play in tackling drivers of poor health in urban neighbourhoods. For example, organisations like Queens Community House identified that a lack of access to fresh produce was contributing to the community’s overreliance on fast food. It then worked in partnership with residents to introduce an affordable farmers market selling fresh produce, which has been running for over nine years. Queens Community House has also trained community chefs to run cooking classes on how to prepare and make healthy food.

Three steps for cities

These initiatives, together with wider research findings, highlight tangible examples of how reshaping the built environment, devolving power, building cross-sector collaborations, centring the voice of urban communities, using new technologies, and tackling systemic issues of racial and economic segregation can help to tackle health inequalities. Through these, we can start to better understand how to unlock the potential for cities to be healthier and there are three clear steps cities can take to begin moving in the right direction.

First, cities need to work in wide partnerships that bring a range of perspectives. Complex health issues rarely have a single cause. Shaping our cities to improve urban health requires a collective effort which goes much wider than healthcare and public health authorities, and needs to include urban planners, civic institutions, investors, employers and, most importantly, communities. For example, we are currently partnering with The Centre for Low Emission Construction at Imperial College London to work with the construction industry and its supply chain. Together we want to better understand the opportunities to reduce the sector’s impact on air pollution, as well as how to overcome barriers to increased uptake of low emission technologies.

Second, cities need to ensure that the process of building health equity is equitable itself. This means investing time, rebalancing power and building trust so that those worst affected by health inequalities have the agency, voice and means to set the agenda for change. Without this, we risk building back to a society with wider disparities than before the pandemic. For example, in London we’re partnering with community researchers at The Social Innovation Partnership to develop a community research model, which will address the inherent inequalities built into traditional health research. By tapping into community knowledge, awareness and relationships, the research delivers nuanced insight that would be inaccessible through other methods.

Third, cities need to learn together and be willing to take some risks. No one city is using all these approaches, but every city can adapt them to their own culture and circumstances. That takes leadership and time. In many of these examples, cities have taken an experimental approach — starting small, scouting for local solutions, and testing concepts before adopting them at scale.

The built environment is a major factor in why health inequalities can be so enduring. This impact is only set to increase, with nearly 70 percent of the world’s population estimated to be living in cities by 2050. If we get our cities right, there is a huge opportunity to create healthier societies.  Let’s not miss the opportunity.

Image: Jane Slack-Smith on Unsplash