Health-Focused Public–Private Partnerships in the Urban Context Proceedings of a Workshop (2020) / Chapter Skim
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2 Cities and Planetary Health: Why Urban Issues Matter
2 Cities and Planetary Health: Why Urban Issues Matter
Pages 7-28
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From page 7... ...
. • Climate change remediation interventions in cities could include establish ing early heat-warning systems and interventions; implementing flood protec tions that use nature-based solutions such as restored coastal ecosystems; decarbonzing the urban economy and expanding sustainable mobility options; i and adequately retrofitting urban housing stock to eliminate greenhouse gas emissions (Haines)
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The opening session provided a foundation for the rest of the workshop by introducing the role of cities in planetary health and the determinants of urban health and health inequities. The three speakers in this session were Sir Andy Haines, professor of environmental change and public health at the London School of Hygiene & Tropical Health; David Vlahov, associate dean for research and professor at the Yale University School of Nursing and professor of epidemiology at the Yale University School of Public Health; and Ana Diez-Roux, dean and distinguished university professor of epidemiology at the Drexel University Dornsife School of Public Health and director of the Drexel University Urban Health Collaborative.
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From page 9... ...
According to Haines, with increasing urbanization of the human population, the future of planetary health and the interaction between environmental change and human health will depend substantially on policies enacted in cities. Haines explained that "cities are the engines of economic activity, responsible for the bulk of global economic activity and about three-quarters of the global energy-related greenhouse gas emissions." Transportation is one major source of urban emissions, and a strong relationship exists between urban density and transport-related emissions.
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This connection offers a two-for-one opportunity because decarbonizing the economy reduces air pollution. Haines said a general relationship exists between development and greenhouse gas emissions; however, there is no absolute reason why a city could not transition from a low- or middle-income status to a higher-income status along a low air pollution, low greenhouse gas trajectory.
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He also noted that cities and their residents would realize significant health benefits by expanding sustainable mobility options such as public transport systems and car-free zones; increasing walkability, car-sharing, and bike-sharing schemes; and creating low-emission zones.
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Haines said that adequately retrofitting urban-housing stock would eliminate millions of tons of greenhouse gas emissions and would reduce premature deaths (Wilkinson et al., 2009)
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. A systematic review has shown that promoting healthy, more environmentally sustainable diets -- those with increased consumption of fruit and vegetables and decreased consumption of animal products, particularly ruminant meat -- would reduce the use of land and water and cut greenhouse gas emissions by 20–30 percent medians for these indicators across all studies (Aleksandrowicz et al., 2016)
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and extreme poverty -- all components of how people engage and interact with one another. Finally, the resource environment comprises health services, social services, food availability and access, education, and work.
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One lesson learned from these early projects was that urban renewal requires both physical infrastructure improvements and opportunities for residents to become integrated citizens of society. In other words, developing economic opportunities for residents may be an advisable complement to physically redeveloping neighborhoods.
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As cities grow and expand over the next 50 years, PPPs can contribute innovations that include sustainable technologies. The conventional economy of take-make-waste and construction waste generates about 535 million tons of debris each year as well as 60 million tons of food waste.
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From page 17... ...
Vlahov also noted that a number of NGOs have worked with individual communities and with the private sector to incrementally upgrade informal settlements and slums and to build local enterprise capacity and resilience within the community. The iShack Project in South Africa, for example, is using solar electricity to demonstrate how green technologies can jump-start redevelopment of informal settlements and slums.
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This heterogeneity leads to a third reason to care about urban health: The health consequences of city living are not the same for everyone. Diez-Roux said, "It is important to remember that cities are characterized by large social and health inequalities." In the United States and internationally, for example, income inequality in large cities exceeds that of rural areas, and income inequality is linked to health inequalities and to differences in life expectancy.
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FIGURE 2-3 Historical and projected trajectories for the urbanization of humanity. SOURCES: As presented by Ana Diez-Roux, June 13, 2019.
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FIGURE 2-4 Avoidable mortalities in small areas of 15 European cities. NOTES: The box plots show the range of mortality between areas with the lowest and highest mortality.
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Diez-Roux noted that economic policies, social inclusion, mobility, food policy, urban development, and other drivers shape local and proximal determinants of health, and each driver offers opportunities for multi-sector interventions. Diez-Roux also discussed a fifth reason to be concerned about urban health: Cities are already enacting policies, but little is known about the effects of urban policies on health or health equity.
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The first features more sprawl, more energy consumption and greenhouse gas emissions, higher levels of air pollution, more dependence on automobiles, increased consumption of processed foods and meat, less physical activity, and increased social consequences such as isolation, violence, and mental health concerns. The alternative option features compact, energy-efficient development with active public transportation, sustainable food, reduced air pollution and greenhouse gas emissions, more physical activity, increased consumption of fruits and vegetables compared to meat, and reduced impact on biodiversity, biomass, and croplands due to a smaller urban footprint.
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From page 23... ...
. So far, Diez-Roux and her collaborators have identified nearly 400 cities for which they are working to compile data and have pinpointed four thematic policy areas that have been implemented in Latin America: mobility and emissions control, social inclusion, comprehensive urban development, and health behavior promotion.
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Haines said, "We probably have not capitalized enough on those opportunities." He added that he has seen emerging private-sector interest in bringing renewable energy options and food production options such as hydroponics and aquaponics to urban environments. He suggested mapping emerging areas in the private sector to see how the sector could best be engaged in these efforts.
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Nor have they really studied whether mass media and social media can play roles in reducing disparities. Haines noted that social media use is expanding greatly in low-income countries, where many people have mobile phones before they have settled accommodations, and health communications could make an impact in those areas.
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He said, "We need people that can bridge that gap between academia and the frontline decision makers at the urban level, and we need to think about how we can strengthen the capacity to envelop more human resources, more people with those mixed experiences." Haines also said that when he and his collaborators tried to link health and environmental data from 250 randomly selected cities around the world, they found substantial data gaps -- particularly from smaller, rapidly growing cities in Africa and Asia. Given that these cities will likely grow most over future decades, investment in data capture needs to occur for at least a range of these cities so that cities can be followed as they develop and expand.
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From page 27... ...
WHO and its partners have some city-level activities, such as the Healthy Cities Network and the Global Network for Age-friendly Cities and Communities, but Singer noted he has not yet seen an entity pull all of the activities together across schematics and sectors in order to use the platform of cities to deliver health. He saw an opportunity to look more systematically at a health issue, such as aging, noncommunicable diseases, air pollution, or obesity, at the municipal level.
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