Sometime in the latter half of the 2000s, cities around the globe became home to more than half of the human population (UNDESA, 2019). This demographic milestone, driven largely by rapid population growth in so-called secondary cities of 250,000 to 500,000 people in less developed countries, is important for many reasons. First, cities serve as the primary economic engines of the world—they generate 70 percent of the world’s gross domestic product—and often drive culture, art, innovation, and business in a given society. At the same time, cities occupy only 2 percent of the planet’s surface area, but they account for 70 percent of the world’s greenhouse gas emissions and more than 60 percent of global energy consumption. They also generate 70 percent of global solid waste and air pollution. “What happens in cities affects the state of global health and the ability to meet global health goals and the United Nations (UN) Sustainable Development Goals (SDGs),” said Jo Ivey Boufford, clinical professor of global public health at the New York University School of Global Public Health and co-chair of both the Forum on Public–Private Partnerships for Global Health and Safety and the planning committee for this workshop, in her introductory remarks to the Health-Focused Public–Private Partnerships in the Urban Context workshop sponsored by the forum at the National Academies of Sciences, Engineering, and Medicine (the National Academies).
Though more than half of the world’s population lives in cities, the international development community has largely concentrated on rural
populations, and UN agencies have remained focused predominately on national-level plans and programs. Recently, however, the UN and the international development community have acknowledged the importance of the urban context for policy and planning and for achieving national and global development goals for 2030 and beyond. In fact, Boufford said, cities have become interesting places for the international development community to work, and mayors have become important partners in achieving the SDGs. Mayors, after all, have close relationships with officials who lead government agencies as well as with leaders of civil society organizations and businesses in their cities. In addition, consortia of cities have actively joined climate change discussions and age-friendly and healthy cities networks throughout the world.
Working in the context of the broader urban environment represents a paradigm shift for the health sector, which, traditionally, has focused on the personal health care delivery system and has examined issues such as developing the health care workforce, providing essential medicines, and strengthening local health systems. As Boufford explained, however, “by introducing this broader notion of inter-sectoral engagement and working with other government agencies, we open up the possibility of looking at the role of urban planning, transportation, housing, and economic development as important forces for health, perhaps even more important than the health care sector.” Indeed, experts now know that achieving healthier urban communities worldwide requires taking a Health in All Policies approach that works to improve the natural, built, and social environments in which people live (see Figure 1-1). The key point of a Health in All Policies approach, said Boufford, is to recognize that the health and well-being of all citizens are essential for overall social and economic development; that virtually all government policies positively or negatively impact the determinants of health; and that inter-sectoral partnerships across agencies, and across government, civil society, and business, need to align for health in order to improve health.
To draw attention to health determinants and health inequities among populations that live in urban environments and to explore challenges faced in establishing urban population health, the Forum on Public–Private Partnerships for Global Health and Safety hosted a 1.5-day workshop on the role of health-focused public–private partnerships (PPPs) in the urban context. The workshop, held June 13–14, 2019, in Washington, DC, aimed to illuminate some of the intervention strategies that have been designed to attenuate these urban health issues and highlighted the importance of PPPs and urban-level governance in remediation efforts. By facilitating discussion among participants in both the public and private sectors, as well as among policy makers, the workshop served as a platform to share best practices on how to address health challenges through
interventions that target healthier urban populations. Presentations and discussions identified the role of cities in planetary health; the determinants of health and the health inequities found in urban environments; the transitions in global health that focus on the urban context; the evidence and challenges of urban health initiatives; the effects of urbanization and urban planning on health; the effects of food, agriculture, and transportation systems on urban population health; and the roles of digital technology and artificial intelligence (AI) in improving urban health.
The workshop was planned by an ad hoc committee with the following Statement of Task:
An ad hoc planning committee under the auspices of the National Academies of Sciences, Engineering, and Medicine will plan a 2-day public workshop to explore opportunities to improve the health of communities in urban settings, particularly in low- and middle-income countries. The workshop will apply a broad definition of health to address its multiple determinants and potential for inclusive multi-sectoral engagement. Workshop presentations and discussion topics will include approaches to and examples of multi-sectoral engagement at the city level for health promotion with an examination of governance structures, public- and private-sector participation and contributions, inclusion of stakeholders outside of the health care sector, and evaluation and assessment. Additional workshop presentations and discussion topics may include
- Impacts of urban health threats on the health and safety of employee populations and examples of how the private sector mitigates them;
- Opportunities for addressing urban inequality through city-level public–private partnerships for health; and
- Applications of digital and smart cities technology to address urban health and to promote multi-sectoral engagement.
The planning committee will develop the workshop agenda, select and invite speakers and discussants, and moderate the discussions. Experts will be drawn from the public and private sectors as well as from academic institutions to allow for multilateral, evidence-based discussions. A proceedings of the presentations and discussions at the workshop will be prepared by a designated rapporteur in accordance with institutional guidelines.
The workshop (see Appendix A for the workshop agenda) was organized by an independent planning committee in accordance with the National Academies’ procedures. This publication summarizes discussions that occurred throughout the workshop and highlights key lessons, practical strategies, and needs and opportunities that were presented for addressing health outcomes in cities by engaging directly with communities to shape and attend to their health priorities. Chapter 2 provides an overview of the relevance of urban issues in relation to planetary health and lists some of the determinants of urban health and health disparities. Chapter 3 examines evidence and challenges in urban health initiatives in international development, including the effects of urbanization and urban planning on health. Chapter 4 discusses work aimed at identifying
and addressing health inequities in urban settings, and Chapter 5 unpacks the effects of food, agriculture, and transportation systems on the health of urban populations. Chapter 6 explores how digital technologies and AI can contribute to improving urban health. Chapter 7 addresses the topic of political leadership and governance for PPPs in urban health and recounts discussions among a final panel of policy makers and elected officials about the role PPPs can play in improving urban health.
Conforming to the National Academies’ policies, the workshop did not attempt to establish conclusions or to develop recommendations about needs and future directions. Instead, it focused on issues the speakers and workshop participants identified and on potential solutions to those issues. In addition, the organizing committee’s role was limited to planning the workshop. This Proceedings of a Workshop was prepared by workshop rapporteurs Joe Alper, Liza Hamilton, and Claire Moerder as a factual summary of what occurred at the workshop.
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