We are at an unprecedented moment in human development as the greatest migration in history unfolds around us. Less than a decade ago a majority of humankind still lived in the countryside, yet today a clear majority live in urban areas. By the deadline of the new Sustainable Development Goals (SDGs) in 2030, 60% of all people will reside in cities, proportionally twice that of 1950. For most of us from now on, life and death will be an urban affair.
In 2010, at the dawn of this urban world, we published our first joint global report on urban health titled Hidden cities: unmasking and overcoming health inequities in urban settings. The global community was not only waking up to this new demographic reality and the consequent implications for health, society, and economic and political affairs, but also to a host of new opportunities as humans shape and are shaped by an urban future. Apart from the impact of urbanization on human health, the report used new statistics to demonstrate that the growth of prosperity in cities leaves behind significant ‘hidden’ urban areas and populations. Indeed, many of today’s urban poor are not only much worse off than their wealthier fellow citizens, they even lag behind rural populations. Urban inequity is obviously unjust, but certainly also hindered national and global achievement of the Millennium Development Goals (MDGs).
This new report coincides with the advent of the new SDGs and development paradigm. Equity, inclusiveness, and accountability in health and development are core principles and themes of the SDGs, as well as for the Third United Nations Conference on Housing and Sustainable Urban Development in Quito in October 2016. The commitment to universal health coverage, as well as to the New Urban Agenda that will emerge from Quito, is intrinsically linked to improving the living conditions and health of all city dwellers. A healthy population is essential for creating economically competitive and inclusive cities. Health and its various determinants, cities and inequality, are all represented by individual goals in the SDGs and the solutions are interdependent. City leaders are broadening their responsibilities to take on global health and demographic issues such as pollution, slum upgrading, noncommunicable diseases, communicable disease such as HIV/AIDS and tuberculosis, as well as population ageing and migration.
Similarly, cities are increasingly focusing on measuring and challenging inequities. At least 102 cities in 53 countries use the WHO’s Urban Health Equity Assessment and Response Tool (Urban HEART) to analyse and plan for more equitable health outcomes. International organizations have also focused on urban health equity in recent years, publishing flagship reports such as UNICEF’s State of the World’s Children 2012: Children in an Urban World; UNAIDS’ 2014 The Cities report; and Save the Children’s 2015 State of the World’s Mothers: the Urban Disadvantage, to name just a few. Practical, proven solutions exist to tackle these 21st century challenges. This report presents evidence that in cities, progress in health depends not only on the strength of health systems, but also on shaping urban environments. Capitalizing on such intrinsically linked factors leads to efficiency, synergies and co-benefits, and is essential to the attainment of the SDGs.
The report presents examples of effective actions by cities and nations around the world and subsequent successes. At the same time, it underscores the persistence of inequity and how its root causes must fundamentally be addressed in order to achieve meaningful progress. As the global community transitions hopefully into a new era of sustainable development, committed leadership is needed to create healthier, more equitable cities. This report should serve as a starting point for identifying the health challenge faced by hundreds of millions of vulnerable people currently living in cities around the world, as well as for crafting policies and actions for sustainable urban development for the majority of humanity who will reside in the cities of the future.
Full report available via WHO (free download).
Photo credit: Xavier Donat
|Author(s)||World Health Organisation (WHO) and UN-Habitat|