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The New Urban Agenda: Where Is Population Health?

Posted on October 25, 2016

Just last week nearly 35,000 people came together in Quito, Ecuador to discuss the future of cities across the world. Participants included representatives of international organizations, governments, non- profits, civil society, indigenous groups and communities, the private sector, and the scientific and academic community. The meeting, formally the third United Nations Conference on Housing and Sustainable Urban Development (Habitat III for short) had as its goal the adoption of the future urban agenda for the planet. The last such meeting took place 20 years ago in Istanbul. 

Many of us may be skeptical of these global meetings. They can feel vacuous and bureaucratic, their proclamations simultaneously grandiose and technocratic. But at the same time there is something hopeful about people from around the planet and from so many diverse groups (from banks to indigenous communities) coming together to grapple with a challenge, and an opportunity, facing our world: how can we make cities more livable, healthier, and more equitable and environmentally sustainable? This is a critical question because, as noted by the Habitat III conveners “by 2050 the urban population will nearly double making urbanization one of the 21st century’s most transformative trends.”

There are many valuable elements to the urban agenda adopted in Quito. A guiding principle is the notion of “cities for all”, the idea that all persons regardless of class or background have a right to enjoy all the benefits that a city can offer. Sadly however, and as is abundantly clear from Philadelphia, our own city, the benefits of city living are very far from equitably distributed, even across neighborhoods in very short proximity to each other.

The Quito agenda also recognizes the importance of building inclusive urban economies but doing this in a way that minimizes environmental impacts. This implies using clean energy and above all promoting sustainable consumption and production patterns (which may effectively mean simply consuming less energy and less things). Of course this issue extends well beyond cities and links to the ways in which we live and organize society and our economy much more broadly. But the adverse consequences of not addressing these large-scale environmental consequences will hit cities especially hard because of their density, their physical characteristics (which can magnify heat impacts) and their often coastal locations.

The urban agenda adopted in Quito pays special attention to the challenges facing urban settlements in low and middle income countries. This is especially important given that a very large proportion of the growth of urban settlements over the next decades will occur in the cities of Asia and Africa. The agenda also calls out the critical importance of ending the discrimination faced by many groups including women and girls, children, indigenous peoples and local communities, slum and informal settlement dwellers, homeless people, and migrants, among others. It is evident from the news we read every day that prejudice and racism continue to be a major challenge here in our own city and around the world. Cities, because of their wonderful diversity, have a key responsibility and a key opportunity to eliminate racism in all its forms.

At this point you may we wondering, as was I, where is health? The document does allude to some critical health issues faced by cities: it specifically calls out the epidemics of AIDS, tuberculosis, and malaria and notes the need for better nutrition and food security. Certainly many of the challenges highlighted by the agenda (like the reduction of social inequalities and the promotion of social inclusion, and the need to promote the environmental quality of cities and ensure access to basic services and affordable housing) have health impacts.

But the agenda missed an opportunity to make a critical point: promoting population health and health equity is a key challenge but also a key opportunity for cities. The sheer density of city living makes it possible for policies to impact the environments and the health of many many people at once. Because they are home to enormous social and spatial inequalities, cities also have the obligation and the opportunity to act decisively to reduce health inequalities.  

A second critical point is that population health and environmental sustainability are inextricably linked. Policies that promote health, like active transportation and consuming less processed foods will have beneficial environmental impacts. And vice versa, policies to enhance the environmental quality and sustainability of cities will improve population health.

Improving population heath is thus a key justification for the new urban agenda, and a key pathway to achieving its goals, and many components of the urban agenda that may appear to be unrelated to health could have major health implications.

Fortunately cities all over the world are seeing these connections and beginning to act on them. What can we in Philadelphia do to embrace the urban agenda through our own population health and health equity lens? Can Philly be the standard-bearer of a health-focused new urban health agenda? Send me your ideas, I will share them with you all in future postings of this blog, and perhaps there are some that we as a School can work to make a reality….