How could cities improve health for all?

In the pursuit of creating thriving and resilient communities, cities play a pivotal role in shaping the health and well-being of their residents. The design and policies implemented within urban environments significantly impact various facets of public health, from physical fitness to mental well-being. As our world undergoes rapid urbanization, the need for cities to prioritize and implement strategies that foster health for all becomes increasingly crucial. From accessible healthcare services to green spaces, affordable housing, and community engagement, a holistic approach is essential to create environments that support the diverse needs of residents. This introductory paragraph sets the stage for a comprehensive exploration of the multifaceted ways in which cities can improve health outcomes for their populations, promoting inclusivity, sustainability, and a higher quality of life.

Building Healthy Cities for All: Navigating Urbanization Challenges and Fostering Sustainable Well-being

The mandate for healthy cities is more pressing than ever as global urbanization continues to rise, with over half of the world's population residing in urban areas. While cities offer opportunities for improved services and economic advancement, they also present unique health challenges. Overcrowding, inadequate sanitation, and social determinants contribute to the prevalence of infectious diseases and elevated rates of noncommunicable diseases, violence, and mental health issues in urban settings. Recognizing the pivotal role of urbanization in 21st-century public health challenges, the World Health Organization (WHO) emphasizes the need for strategic management and planning to ensure that cities promote health and health equity.

As the world's population is projected to be 70 percent urban by 2050, the importance of creating healthy and livable cities becomes paramount. The Ottawa Charter for Health Promotion, formulated three decades ago, underscores the necessity of fostering healthier and sustainable environments where people live, work, study, and play. This vision aligns with the 2030 Agenda for Sustainable Development, a comprehensive global plan that emphasizes social justice, equity, and the interconnectedness of social, economic, and environmental goals. The 9th Global Conference on Health Promotion emphasizes the role of health promotion in achieving the Sustainable Development Goals (SDGs), with a focus on making cities inclusive, safe, resilient, and sustainable (SDG 11).

The WHO Healthy Cities programs, with thousands of cities worldwide participating, have become instrumental in driving innovations addressing social determinants of health and advocating for Health in All Policies. The Healthy Cities approach, rooted in political leadership and participatory governance, is transformative for health and health equity. By addressing environmental degradation, climate change, aging, migration, growing inequalities, and social isolation, this approach seeks to create urban environments that are conducive to the well-being of all residents. Importantly, it aims to rectify major health inequities that persist globally, particularly within cities, where marginalized groups face greater health challenges due to harmful environments and limited access to services. A commitment to a healthy cities approach not only advances health goals but also contributes to the broader agenda of sustainable development, ensuring that no one is left behind in the pursuit of "Health for All and All for Health."

Promoting Sustainable Development and Global Well-Being: The Integral Role of Healthy Cities in Achieving the SDGs

The pursuit of healthy cities is intricately intertwined with the achievement of several Sustainable Development Goals (SDGs), demonstrating the profound impact urban environments can have on global well-being. From ensuring zero hunger to fostering climate action and promoting peace, justice, and strong institutions, a healthy cities approach emerges as a pivotal strategy in advancing holistic and sustainable urban development.

In addressing zero hunger, healthy cities adopt innovative policy measures to enhance the food environment. This involves increasing access to healthy options through initiatives like green markets, empowering individuals with transparent information for healthier choices, and implementing measures to limit the availability of unhealthy foods. Furthermore, a commitment to end malnutrition includes targeted delivery of nutrient-dense meals to vulnerable populations.

Clean water and sanitation are fundamental components of a healthy cities’ agenda. Urbanization's promises of efficiency and improved infrastructure must prioritize increased access to safe drinking water, improved sanitation, proper waste disposal, and pollution management. This approach extends its focus to both formal and informal settlements, recognizing the importance of adequate sanitation standards for all.

Sustainable cities and communities are at the heart of a healthy cities approach, emphasizing better housing, reduced overcrowding, and upgraded slums as public health priorities. Improved urban planning, including increased access to safe transport systems, green spaces, and emergency responses, contributes to reduced road traffic deaths, enhanced air quality, increased physical activity, and resilience against natural disasters.

The linkage between responsible consumption and production and health is underscored in healthy cities. Unsustainable practices that harm the environment also impact health through pollutants, contaminated water, and food losses. Healthy cities advocate for sustainable practices, urging both corporations and individuals to adopt measures beneficial to both the planet and its inhabitants.

Recognizing the profound influence of climate on health, a healthy cities approach prioritizes climate action. Extreme weather events are acknowledged for their impact on food supply chains, the spread of waterborne illnesses, uprooting and migration, and physical injuries. By reducing carbon emissions, healthy cities simultaneously improve air quality and promote physical activity, positioning themselves as significant contributors to climate change mitigation.

Peace, justice, and strong institutions find roots in healthy cities that foster inclusivity and eliminate violence. Providing safe spaces for living, working, and recreation, healthy cities serve as catalysts for effective, transparent, and accountable intersectoral governance. They not only advance health but also contribute to achieving universal health coverage and progress in various SDGs.

As cities increasingly concentrate diverse populations, including marginalized groups, a healthy cities approach emerges as a crucial pathway toward mitigating climate change, fostering sustainable development, and advancing global well-being. Initiatives like WHO’s Healthy Cities project and UNDP’s ART initiative underline the importance of multi-actor, multi-sector, and multi-level governance structures to strengthen local governance and development in the pursuit of healthier, more sustainable cities.

Building Healthy Cities: A Smoke-Free Initiative and the Crucial Role of Governance

Introduction: The journey toward healthy cities not only demands comprehensive approaches but also underscores the critical role that city leaders play in safeguarding the well-being of their residents. A significant aspect of this commitment lies in creating smoke-free environments, acknowledging the detrimental health effects of tobacco smoke. While national laws are instrumental, city leaders, irrespective of the size of their jurisdictions, possess a unique opportunity to spearhead initiatives that shield citizens from the harms associated with smoking. This perspective aligns with the WHO Framework Convention on Tobacco Control (WHO FCTC) and resonates with the Sustainable Development Goals (SDGs).

Smoke-Free Cities as Catalysts for Change: City-level action to combat tobacco smoke exposure not only protects local populations but can also serve as a catalyst for broader national transformation. By implementing measures such as increasing access to healthy alternatives, providing clear information for informed choices, and discouraging the availability of unhealthy products, cities can contribute significantly to SDG 3 on health. This approach also aligns with other SDGs, fostering safe working environments (SDG 8) and creating inclusive green spaces (SDG 11).

Learning from Successful Models: Drawing lessons from globally recognized smoke-free cities like Beijing, Mexico City, New York, and São Paulo, it becomes evident that political leadership is the linchpin against challenges and skepticism. Examining the transformation of New York into a smoke-free city under Mayor Michael Bloomberg's leadership showcases the power of clear messaging, public support, and evidence-backed policies. The city's success debunked industry-propagated concerns about economic repercussions, demonstrating that health protection and economic prosperity can go hand in hand.

Governance for Healthy Cities: Effective governance is essential for the success of healthy city programs. While strong leadership from mayors is crucial, a holistic approach involves organizational structures, capacity-building, healthy public policies, city planning, systematic monitoring, and partnerships. WHO's European Healthy Cities Project serves as a testament to the significance of multi-dimensional governance. Incentive mechanisms, such as designation and accreditation, enhance city commitment and accountability to the Healthy Cities value system.

Intersectoral Coordination and Community Empowerment: Intersectoral coordination, often facilitated by interdisciplinary steering committees, ensures that diverse aspects like health, urban planning, housing, sanitation, environment, and transport align for a common goal. The notion that "health is the business of all sectors" underscores the collaborative nature of healthy cities. Health officials lead not by taking over other sectors but by fostering collaboration, ensuring effective and equitable multisectoral policies and programs. Civil society engagement and community empowerment are integral, driving the planning and implementation of healthy cities initiatives.

Local Monitoring Driving Change: Real-world examples, such as Maputo, Mozambique, highlight the impact of local monitoring in driving positive behavioral change. Empowering local leaders to gather information and mobilize communities led to significant improvements in sanitation facilities. This low-cost methodology showcases the potential of mapping problems and community involvement in addressing health challenges in cities.

In essence, a governance-centric approach is indispensable for building and sustaining healthy cities, where smoke-free initiatives become emblematic of a broader commitment to well-being, economic vitality, and equitable development.

Conclusion: Cultivating Healthy Cities for Sustainable Well-Being

In the pursuit of healthy cities, the imperative to create smoke-free environments stands as a beacon of commitment to the health and prosperity of urban populations. City leaders, armed with a unique opportunity and responsibility, can wield their influence to protect citizens from the multifaceted harms associated with tobacco smoke. This not only aligns with global initiatives like the WHO Framework Convention on Tobacco Control and the Sustainable Development Goals (SDGs) but also positions cities as pioneers capable of sparking national transformation.

The success stories of globally recognized smoke-free cities, from Beijing to New York, underscore the transformative power of political leadership, clear messaging, and evidence-backed policies. Despite initial skepticism, these cities have demonstrated that health protection and economic vibrancy are not mutually exclusive but rather complementary facets of a thriving urban landscape.

Effective governance emerges as a linchpin in the trajectory toward healthy cities. The WHO's European Healthy Cities Project serves as a testament to the multifaceted approach needed, encompassing organizational structures, capacity-building, policy formulation, city planning, and systematic monitoring. Governance extends beyond the corridors of power to foster intersectoral coordination, acknowledging that the health of a city is a collective responsibility cutting across various sectors.

Interdisciplinary steering committees, empowered by strong governance, ensure that health considerations integrate seamlessly with urban planning, housing, sanitation, environment, and transportation. The collaborative ethos is grounded in the understanding that "health is the business of all sectors," emphasizing collaboration rather than dominance.

Real-world examples, like Maputo in Mozambique, showcase the impact of local monitoring and community engagement in driving positive change. Empowering local leaders and communities can lead to tangible improvements in public health indicators, demonstrating the feasibility of grassroots efforts in building healthier cities.

As we draw conclusions from these insights, it becomes evident that the journey toward healthy cities extends beyond mere rhetoric. It demands visionary leadership, effective governance structures, and community empowerment. Smoke-free initiatives serve as symbolic gateways to broader commitments to health, environmental sustainability, economic resilience, and social equity. In fostering healthy cities, we not only protect current generations but lay the foundation for a sustainable and vibrant urban future where well-being is paramount, and no citizen is left behind.