Opinion: The future of public health lies in cities

By Margaret Chan 01 December 2016

In cities, a wide range of actions can be taken to promote improved health and sustainable futures for their inhabitants, who number more than 50 percent of the world’s population. This was made clear in the Healthy Cities Consensus, released during the 9th Global Conference on Health Promotion held Nov. 21-24, 2016. Photo by: WHO China

Public health was born in cities. In the 19th century, sanitation revealed how city planning affected citizen health. This recognition of the link between people’s health and the places they lived led to dramatic changes in the way health policy was created.

In a world where over half the population now lives in towns and cities, it is time for us to revisit this link and remember why it matters.

On Nov. 21, more than 100 mayors from around the world issued the “Healthy Cities Consensus” during the 9th Global Conference on Health Promotion in Shanghai, China. Conference delegates, including around 40 government ministers and several heads of United Nations agencies, also released the “Shanghai Declaration on Health Promotion.”

Both documents recognize the critical role cities play in promoting health and sustainable development. The consensus says: “Health is created at the local level, in the settings of everyday life.”

This acknowledges that while income levels in cities are increasing, rapid urbanization is also pressuring the cities’ own resources. As a result, we are seeing huge and unacceptable disparities in life expectancy between different communities in the same city. The life expectancy of poorer people can be 20 years less than that of richer people.

Improving lives of communities

A mayor is the first citizen of a town or city. It is, therefore, a mayor’s responsibility to improve the lives of their communities. A number of progressive mayors are introducing changes to make their towns and cities healthier, safer and more sustainable.

In the lead-up to the Shanghai conference, the city followed Beijing’s lead, introducing new regulations banning smoking in airports, trains and hotels. They will come into effect next March. Then, during the conference, the national government demonstrated its commitment to promoting health, announcing its plans to push forward new anti-smoking regulations to come into force in cities and all other areas nationwide by the end of 2016.

These proposed measures would prohibit smoking in a variety of places, including workplaces, on trains and buses, stadiums and school grounds. And they would be aimed at curbing the enormous toll from exposure to secondhand smoke, which kills around 100,000 people in China each year.

Expand access to healthier and safer lifestyles

Opinion: Leading from the top to promote health and sustainable development

Legislative and fiscal measures are among the most effective approaches to promote health and foster sustainable development, but often face stiff and well-funded resistance from industry. Strong leadership will be required to make sure they are introduced and implemented, asserts WHO Director General Dr. Margaret Chan in this guest column.

Cities are also becoming healthier by introducing measures that make it easier to eat healthier foods and live more active lifestyles. In 2013, Mexico City became the first city in the world to levy a tax on sugary drinks, which are known to contribute to diabetes and obesity. London and Paris were two of the first cities to offer free bicycles for the public, to reduce pollution and make exercise easier and more accessible. In Kuwait City, salt content in bread has been reduced, helping to decrease the incidence of high blood pressure among its citizens.

City roads are becoming safer too. In Sao Paulo, Bogota and Accra measures are being introduced to reduce road traffic accidents. Beijing has on-off driving days to decrease the amount of pollution in the air. Street-lighting introduced in New Delhi has led to less violence, and safer streets for all its citizens.

Smarter cities, smarter health care

With people in cities living in close quarters, there is a heightened risk of disease outbreaks. In 2015, an outbreak of Middle East respiratory syndrome, or MERS, in a hospital in Seoul caused initial alarm: this was dealt with quickly through effective early response systems that successfully prevented a full-scale outbreak.

A host of “smart cities” are showing the world how internet, mobile phones and wearable technology can be used to improve their citizens’ access to urban health care. Barcelona’s interconnected, data-driven urban infrastructure allows residents immediate access a greater range of social and health care services, including 24-hour care for the elderly and disabled.

The World Health Organization’s own “Healthy Cities” project emphasizes how cities can be gateways for change for the rest of a country, and encourages cities to learn from each other.  

Huge change can begin with a single mayor. One hundred mayors is a strong start. I urge other mayors and leaders across the world to sign up to the Shanghai Consensus and, in doing so, to show their commitment to the future of their cities and to their people.

Join the Devex community and access more in-depth analysis, breaking news and business advice — and a host of other services — on international development, humanitarian aid and global health.

About the author

Dr mchan86title rgb en v
Margaret Chan

Dr. Margaret Chan has been director general of WHO since November 2006, beginning a second five-year term in July 2012. Before being elected director general, she was WHO assistant director general for communicable diseases as well as representative of the director general for pandemic influenza.


Join the Discussion