Does the New Urban Agenda boost efforts at achieving healthy cities?
The Habitat III strategy is being adopted as global recognition is picking up that health should be at the heart of city development strategies.
QUITO, Ecuador — Here is the paradox: Cities are driving economic growth in many countries, but rapid and unplanned growth also has triggered air pollution, contaminated water and created mounds of waste, not all of which is processed. The result has been a steep rise in respiratory, cardiovascular and vector-borne diseases, and growing numbers of sickly city dwellers.
One telling statistic comes from a recent World Health Organization analysis of data from 3,000 cities across the world. Of those, air quality in more than 80 percent did not meet WHO standards, on a yearly average.
The most important asset of any city is the health of its citizens. Sickly people do not make productive workers nor resilient and vibrant communities; ill health saps mobility, wears down family budgets and hampers social interaction. It also further marginalizes vulnerable populations. To health advocates, it is all too obvious that health is a prerequisite for sustainable human and economic development, and should be at the heart of city development strategies. The reality, however, is a lot more complex.
It has taken years of passionate advocacy backed up by scientific evidence to convince urban planners and municipalities that this is the case. And even now, a lot more persuading is needed.
Undermining quality of life
Advocates are making this case prominently at this week’s Habitat III summit on urbanization, where national governments will adopt a 20-year global strategy on sustainable cities. That document, known as the New Urban Agenda, is seen as a key opportunity to reorient the international policy discussion on urban health.
“A huge chunk of the disease burden in cities is due to the urban environment. The World Health Organization played a proactive role in the Habitat III preparatory process, trying to mainstream health in the New Urban Agenda,” said Anumita Roychowdhury, head of the air pollution and clean transportation programme at the Centre for Science and Environment in India, a country that is home to some of the world’s most polluted cities.
“As we have seen, air pollution and other types of pollution are undermining the quality of life of city dwellers and concerted efforts by many people have ensured that health has now come into the urban debate,” she said. “In India, the Health Ministry has recommended an health impact assessment of all policies and projects.”
Delhi has been ravaged by dengue and chikungunya, for instance, both of which can be traced to water and sanitation problems in the city. Meanwhile, air pollution is worsening cardiovascular and respiratory diseases in Indian cities, half of which are considered to have “critical” air quality, particularly with regard to particulate matter, Roychowdhury said.
“These are serious health risks. All this means that the non-communicable disease burden is going up,” she continued. “If we don’t reduce our environmental risks through better urban planning and design, we will pay a very steep price.”
She pointed particularly to the need for policymakers to promote cycling and walking, particularly as a way to get people out of cars and cut down on related pollution.
“Habitat III offers a platform,” Roychowdhury said. “The New Urban Agenda offers guidelines, but the real work is in sensitizing governments and implementation strategies.”
On Monday, the World Health Organization, in collaboration the Norwegian government and the Climate and Clean Air Coalition, launched a new global initiative here aimed at reducing short-lived climate pollutants. The Breathe Life campaign invites urban leaders to commit to promoting awareness and taking steps to reduce air pollution to reach WHO air-quality goals. Ten mayors and ministers of health and housing from Latin America and Asia were present on the occasion.
Many of these concerns resonated in a panel discussion on Sunday, just ahead of the formal start of Habitat III. The event drew attention to a new 43-page report from the WHO, “Health as the Pulse of the New Urban Agenda”, which emphasizes that health can act as a powerful “accelerator” and a measure of overall progress on the New Urban Agenda.
“Healthy cities are environmentally sustainable and resilient,” the report states. “Cities with clean air, energy-efficient infrastructure and widely accessible green spaces can attract more investment and businesses, create more jobs and offer more opportunity to people from all walks of life. Healthy cities are socially inclusive.”
“Focusing on health can unlock progress, reduce inequalities in urban areas and expand access to services and opportunities,” it noted.
The WHO’s Carlos Dora smiles when asked whether health has been mainstreamed into the new global urban dialogue.
“You need patience and a sense of humour — it takes time. Changing mindsets is never easy,” said Dora, who coordinates the agency’s Interventions for Healthy Environments unit.
That includes in the New Urban Agenda, a document that went through four major iterations during the course of four months of political negotiation at the United Nations over the summer. Its final draft was released in early September.
“But look at this way,” Dora said. “Till March 2016, there was no mention of health in the New Urban Agenda. But after [July], things started changing. Now, health is mentioned 25 times.”
Dora says the biggest challenge in mainstreaming health in urban development strategies is to get all sectors that impact health to understand the linkages. Health advocates have to be strategic in how they reach out to other sectors.
“It pays to find commonalities. If I am trying to influence the transport crowd, I must first find out what is their big issue. They say congestion. Then I come in with how traffic congestion affects health.”
He said he sees “promising signs”, noting that “Many cities now do health impact assessments.”
Still, others express disappointment with where the New Urban Agenda ended up, seeing it, at least in part, as a missed opportunity at a critical point.
“Health and health care get mentioned a lot in the text of the draft New Urban Agenda, but usually in a long list of things,” said David Satterthwaite, a senior fellow at the International Institute for Environment and Development (IIED).
“But there is no mention of emergency services; no mention of diarrhoea or of acute respiratory infections, often the main causes of infant and child death; no mention of the social determinants of health,” he said.
The bigger gap in the New Urban Agenda is a lack of attention to what is needed to address environmental and public health in urban areas, Satterthwaite said, pointing particularly to informal settlements. There’s “no real understanding of the health problems faced by those living in informal settlements and the impacts on them in terms of costs, work days lost, premature death.”
He emphasized the need for stronger, better resourced, more accountable urban governments, in addition to well-organized groups of urban poor — such as the federations of slum and shack dwellers currently operating in over 30 countries.
Satterthwaite’s suggestions include reviving the “healthy cities” movement, especially in low- and middle-income nations. He also says there is need for strong support from the international community to support city governments in making their own commitments to addressing new mandates around urban development, including from last year’s Sustainable Development Goals and Paris climate agreement.
Gap on informality
The good news is that notable action is already happening at the city level. The WHO report draws attention to the city of Rajshahi in Bangladesh, which had dangerously high levels of what’s known as PM10 — airborne particulate matter less than 10 micrometers in diameter. But since 2014, it has managed to slash these concentrations by two-thirds, the largest observed reduction achieved by any city in the world.
How did Rajshahi do this? There was no single solution, but one key strategy was to replace old brick kilns with cleaner, more efficient brick-making ovens. City officials also launched battery-powered autorickshaws and planned new green spaces. And they paved sidewalks to reduce dust, and more generally promoted new pedestrian areas.
These strategies proved powerful in Rajshahi as a whole, but part of the discussion here at Habitat III is seeking to emphasize the importance of monitoring and data that is even more granular. “Neighbourhood differences exist,” Aletha Maybank, deputy commissioner for health in New York City, said Sunday. Many cities see residential segregation by race, and health indicators often vary significantly between rich and poor neighbourhoods in the same city.
Data is particularly poor on informal settlements, where health indicators for millions often remain invisible in mainstream policy discussions.
“Slums are part of the city. We don’t have toilets, electricity, water, sanitation — even streets sometimes. This impacts our health,” said Sandra Nandudu from Uganda’s Slum Dwellers International branch. “We are now collecting our own data, since no one else seems to be bothered.”
Satterthwaite says this is a key gap that the New Urban Agenda does not address, and which will thus require additional priority in coming years. “It is vital that there is more attention to documenting the scale and nature of ill health, injury and premature death in informal settlements,” he said. “There is very little detailed data on this.”