The many positives of cities can sometimes mask the huge health inequalities that exist within them.
Our health can be shaped by where we grow up, live and work. For the majority of us, that’s now in cities and other urban areas.
Sitting at the centre of modern life, cities are engines of progress and innovation. But not all city residents experience or access these benefits equally. The many positives of cities and their momentum for advancement can sometimes mask the huge health inequalities that exist within them.
These inequalities track closely to income, race and gender. And while the pandemic may have exacerbated them, they are certainly not new. What the pandemic has done is to fast-forward a clock on patterns that were there all along.
Cities tackling health inequality
Fortunately, cities around the world are experimenting with new approaches to these challenges. We’ve been researching these at Impact on Urban Health, finding real-world solutions from cities that are providing fair and equal access to opportunities, while protecting their most disadvantaged communities from harmful health impacts.
London is developing a community research model to address the inherent inequalities built into traditional health research. By tapping into community knowledge, awareness and relationships, the research delivers nuanced insight that would be inaccessible through other methods.
Melbourne’s approach to improving the built environment has seen changes in infrastructure, from housing to transport to public landscaping, to help embed health outcomes in the development of cities. The city is experimenting with ideas like the “20-minute city” to promote active travel and more accessible health services.
And in Mexico City, a multidisciplinary approach has brought together experts to devise creative solutions to the city’s health challenges. Laboratorio para la Ciudad combined urban geographers, political scientists, AI experts and sociologists with writers, historians, philosophers, artists, filmmakers and architects to tackle issues like road safety and the health of indigenous communities.
In New York organizations like Queens Community House and Harlem Children’s Zone are focusing on the root causes of health inequalities. For example, having identified that a lack of access to fresh produce was contributing to the community’s overreliance on fast food, Queens Community House worked in partnership with residents to introduce an affordable farmers market.
Urban infrastructure often lacks input from people on what they need to be healthy. To address this, Paris is enabling residents to make decisions about how public money is spent to improve urban health. Between 2014 and 2020, the city committed 500 million euros of public money (about 5% of the city’s capital fund) to be spent on projects chosen by the city’s residents.
In Shanghai, the city has explored how cultural paradigms and unspoken rules affect the way that people interact with spaces and services. By understanding the stigmas around conditions like diabetes, the city has adapted community services to encourage people to come forward and talk about their health earlier and more openly.
In Toronto, for example, the city is exploring how social media can be used to identify and build an accurate picture of mental health. MAP Centre for Urban Health Solutions is analysing anonymised data from posts to identify areas of stress in local neighbourhoods. This data will then be used to inform the city where to prioritize support for communities.
How to unlock the potential for cities to be healthier
These examples, together with wider research findings, highlight examples of cities reshaping the built environment, devolving power, building cross-sector collaborations, centering the voice of urban communities, using new technologies, and tackling systemic issues of racial and economic segregation. Through these, we can start to paint a clear picture on how to unlock the potential for cities to be healthier.
First, cities need towork in wide partnerships that bring a range of perspectives. Complex health issues rarely have a single cause. Shaping our cities to improve urban health requires a collective effort which goes much wider than healthcare and public health authorities, and needs to include urban planners, civic institutions, investors, employers and, most importantly, communities.
Second, cities need toensure that the process of building health equity is equitable itself. This means investing time, rebalancing power and building trust so that those worst affected by health inequalities have the agency, voice and means to set the agenda for change. Without this, we risk building back to a society with wider disparities than before the pandemic.
Third, cities need tolearn together and be willing to take some risks. No one city is using all these approaches, but every city can adapt them to their own culture and circumstances. That takes leadership and time. In many of these examples, cities have taken an experimental approach — starting small, scouting for local solutions, and testing concepts before adopting them at scale.
Map of cities with key data and approach.
Image: Impact on Urban Health