For many, a city is a double-edged sword. It creates new wealth and opportunities for many but also results in myriad concerns around adequate job opportunities, hygiene, cost of living, security and quality of life.
Urban waste and pollution have also contributed significantly to global warming, with some 70 per cent of carbon emissions coming from cities, according to the United Nations. This has not only affected crop yields and food security but, increasingly, posed higher risks to susceptibility to new communicable diseases such as the Zika virus, which the World Health Organization has declared an international public health emergency.
Here in Malaysia, we experienced a 50 percent rise in deaths from dengue fever — like Zika, a tropical disease transmitted by the Aedes mosquito — last year compared with the previous year. According to the Health Ministry, that’s the biggest such jump ever recorded.
Medical experts point to rapid urbanization alongside poor planning as a key cause of the spread of new and existing diseases in cities, a factor that is being exacerbated by global warming. An important tool in responding, then, is to bolster the systems offered by the city and its communities.
In Malaysia, for instance, transparency is central to timely responses in curbing infectious and vector-borne diseases commonly found in cities, such as dengue. To this end, the Health Ministry produces a weekly update on reported dengue cases and deaths, informing the public about dengue breeding hotspots.
“This ensures accountability, whereby the public knows that the Health Ministry is constantly monitoring high-risk areas and taking necessary action to curb mosquito-breeding hotspots, as well as encourage civic participation in ensuring their neighbourhoods are free from mosquito breeding sites,” Noor Hisham Abdullah, director-general of Malaysia’s Health Ministry, said in an email.
He said the ministry is taking an additional step this year by rolling out a database that will help increase information-sharing among key stakeholders in the health industry. The hope is that this will help not only in the delivery of health services but also in the quick response to urban infectious diseases.
“The Ministry of Health is then allowed to have an evidence-based planning and accurate projection and forecasting so that good decisions can be made, within a climate of a changing health landscape (disease patterns, resource allocation, demands, delivery challenges, etc.) and to facilitate development of environment for informed persons to make better health choices,” he said.
Transcending the health sector
The policymaking challenge of reconnecting urban planning with public health was a central point made in a set of stakeholder recommendations for sustainable urbanization released this month, called “The City We Need 2.0”. The report, the result of more than two-dozen public events that took place around the globe over the past half-year, puts forth 10 key “principles” for a new vision of sustainable urbanisation.
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The New Urban Agenda should recognise that good health requires solutions that transcend the health sector and recommend improved inter-sectoral communication and coordination for health.
One of those principles looks specifically at the evolving recognition of the importance of recognizing the urban component in fostering health as well as a broader sense of well-being. Not only does this future vision feature a city that promotes safety, “a culture of peace” and accessible green space, but it also “must address the rising tide of non-communicable diseases”, including by guaranteeing access to good food.
Such recommendations are now being offered as official input to a global effort to come up with a new UN strategy on sustainable urbanization, known as the New Urban Agenda. That strategy, a first draft of which should be made public in early May, is to be finalized and agreed upon by UN member states at a conference in October in Quito, called Habitat III.
The stakeholder recommendations urge that the New Urban Agenda goes beyond typical health-related concerns to also consider well-being more broadly. Indeed, this is a key addition to the original health-related principle included in the first iteration of the “City We Need” document, from 2014, which noted simply that “The City We Need is a healthy city.”
“The New Urban Agenda should recognise that good health requires solutions that transcend the health sector and recommend improved inter-sectoral communication and coordination for health,” the new document states. “The … impacts on health of actions in all urban sectors should be explicitly considered.”
Several of these recommendations and priorities came out of a meeting held in Malaysia in January, part of a series of events known as Urban Thinkers Campuses, an initiative of the World Urban Campaign to prepare for Habitat III.
“The key outcome of the event is a call to recognise that health is a fundamental aim of development,” said Uta Dietrich, a research fellow at the United Nations University’s International Institute for Global Health in Kuala Lumpur and an organiser of the event.
The Urban Thinkers Campus took place in Kuching, the capital of Sarawak, a state in East Malaysia known for its lush rainforests and diverse ecosystem. Since 1994, Kuching has also been deemed a “Healthy City” by the WHO and is a member of the Alliance for Healthy Cities. The campus drew civil society, health and architecture representatives from 28 countries, Dietrich said, seeking to address links between sustainable urban development, human health and environmental well-being.
Following days’ of discussion, the participants offered a suite of 16 recommendations. These range from concerns over the use of antibiotics (reduce their use in animal husbandry and improve surveillance for antimicrobial resistance) to a priority on pedestrian infrastructure (given its co-benefits for health in encouraging active lifestyles and reducing air pollution from motorised vehicles) to identifying and preserving traditional knowledge and even incorporating this into formal decision-making processes.
The recommendations place particular emphasis on bolstering systems around urban planning and monitoring. “Much of the urban disease burden arises from failure to plan and manage cities for human beings. Development must be human-centered, address inequalities and promote social justice,” the campus’s final report notes.
“There is a pressing need for more quantitative and qualitative data on health and its underlying determinants, disaggregated at all geographic scales and by socioeconomic groupings,” it states. “To provide a basis for informed action, data collection and regular monitoring systems should be established that exploit new technologies, focus on variables implicated in multiple urban systems, and encompass not only capitals and mega-cities, but the small- and medium-sized cities where most urban growth occurs.”
Participatory approach
With “The City We Need 2.0” now out, participants in the Kuching campus say a push for participatory approaches will be key to building healthy cities. Building a health city cannot be left up to government or any single organization, they note.
“Recognising that one sector alone cannot create a healthy city, they establish participatory approaches to find and embrace common purpose,” said Trevor Hancock, a scholar at the University of Victoria’s School of Public Health and Social Policy, in Canada. “They bring together citizens, public, private and non-profit institutions, private business, labour and faith organizations and other key sectors to manage the affairs of the city in an open and transparent manner.”
One such initiative is Public Bike Share, a company that works with state governments throughout Malaysia to develop a bike-sharing system in cities across the country, following on the success of similar programmes in places such as London and Melbourne. The company has been commissioned by the governments of Penang and Malacca, two UN World Heritage Cities, to develop, operate and maintain bike-sharing systems — a first for such an initiative in Southeast Asia.
Public Bike Share’s founder, Hubert Fong, said participatory approaches are challenging given a large number of stakeholders, the intricacies of integrated decision-making and problems on reaching group consensus. Nonetheless, he said local governments and city councils are increasingly taking an interest in implementing bike paths as an alternative form of urban commuting.
“With the proliferation of mobile communications, Internet connectivity and smartphone penetration, it is now easier to manage such initiatives on a large scale,” he said. “There is great potential to harness this over time to shape the planning and development of our cities.”
Hancock, too, noted that building healthy cities that put people, planet and participation at the heart of governance is not necessarily a distant dream. Many such models are already being implemented today in communities around the world. Together, they add up to real progress, supporters say.
For instance, Hancock pointed to the US city of Dubuque, Iowa, which in January won a USD 31.5 million federal grant in part to flood-proof around 320 houses. Yet the city is also using a large chunk of this money to undertake work aimed at preventing water-borne diseases caused by bad sewage systems.
Dubuque hopes to use the project as a model for larger cities in the United States. In recent years, it has also added new sidewalks, pedestrian bridges and parks, part of a broader attempt to connect urban planning with healthy and sustainable living.
Hancock said that while no single city has yet put all such elements in place, “Our challenge is to put it all together.”
Citiscope is a nonprofit news outlet that covers innovations in cities around the world. More at Citiscope. org.
