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UCL-Lancet Commission: Shaping Cities for Health

By news editor, on 6 June 2012

Jessica Lowrie, UCL Communications & Marketing intern.

By 2030, globally, three in five people will live in cities. Despite the perception that city living provides an ‘urban advantage’ over those who live in rural areas, those who live in poor urban areas can often have worse health outcomes than wealthier city residents, but also in comparison to rural dwellers.

Urban and economic growth will not automatically create an ‘urban advantage’ – public policy is needed to maintain and improve conditions to allow for such an advantage to exist.

Healthy cities
This concept was the foundation for an event held by the UCL-Lancet Commission on 30 May to launch their high-profile report on Healthy Cities, published on the same day.

The report was the second from the UCL-Lancet Commission, recognising the valued commitment from both organisations to UCL’s Grand Challenges (Global Health, Sustainable Cities, Intercultural Interaction and Human Wellbeing).

The well-organised and insightful event began with introductions from Professor David Price (UCL Vice-Provost – Research) and Professor Richard Horton (Editor, the Lancet).

Professor Yvonne Rydin (UCL Bartlett School of Planning), lead author of the report, then embarked on a comprehensive overview of the report and its main findings.

Professor Rydin explained that the report aimed “to understand how better health outcomes can be delivered through interventions in urban environments in cities across the world”.

Certain components of a healthy city seem obvious: good water and sanitation infrastructures, clean air, uncontaminated land, safe homes, opportunities for safe and active mobility and effective green infrastructure.

Delivery problems

Yet, in reality, these are not implemented. Professor Rydin commented that the problem is with delivery, and mentioned the Healthy Cities movement, which has suffered from a lack of action in the 30 years since its conception.

The reasons for this were alluded to, and a call for a new way of planning for urban health was issued. The importance of working with urban health stakeholders as well as involving and supporting local communities was recognised.

The Commission authors understand that cities are both complex and interactive, recognising that changes in one part of the system can affect others. The report includes case studies of city level interventions to illustrate important themes for healthy cities. Specific examples are from cities as diverse as London, Bogota, Mumbai and Toronto.

Urban heat
One theme that seemed to receive a lot of media attention related to the concept of urban heat islands – the disparity in temperature between city centres and the surrounding regions. Suggestions of wearing shorts to the office, taking siestas and installing swimming pools seemed to be popular in the press!

However, this was just one aspect of the comprehensive report: issues such as water and sanitation infrastructures, usage of household energy, urban agriculture and transport were also explored.

In particular, one of the encouraging case studies featured was an innovative transportation initiative in Bogota, Colombia, which bans cars in the city centre, one day a week, to encourage physical activity.

Another inspiring case study was the community-led sanitation infrastructure programmes being introduced in the slums of Mumbai, India. This example also stressed the importance of cultural context, emphasising the need for tailored solutions for each city.

Co-authors, Professor Paul Wilkinson (London School of Hygiene & Tropical Medicine) and Professor Nora Groce (UCL Leonard Cheshire Chair of Disability & Inclusive Development) both stressed the lack of a single solution due to contextual variations and levels of complexity. Despite this, there are common principles, which can be utilised globally.

Professor Groce went on to emphasise that solutions should be evidence-based, and that there needs to be collaboration between disciplines, additionally solutions will be changeable over time and will require constant vigilance and adaptability.

Phil Nedin and Professor Sir Andrew Haines were both given the opportunity to respond to the report, and both offered very complimentary appraisals.

Holistic thinking
Phil Nedin explained that he considered the true strength of the report to be in its holistic approach. This focus on the increasing need for interdisciplinary research in future resonated throughout the question and answer session, which followed the formal panel presentations.

Professor David Price mentioned in his introduction his belief that a “university should be greater than the sum of its parts”, and how the Grand Challenges are a major step in the right direction.

The existence of such an inspiring report and, indeed, the progressive research behind it, demonstrates the great strength of UCL’s Grand Challenges in addressing major societal issues of global relevance – and provides support for a focus on interdisciplinary research in the future.

Image: ‘Bucket-latrine’ public toilet in Old Fadama, Accra, Ghana (Credit: Julio Davila)

Watch videos of the full event and Q&A session below:

UCL Grand Challenges
UCL-Lancet Commission on Healthy Cities (website)
UCL news feature and multimedia

One Response to “UCL-Lancet Commission: Shaping Cities for Health”

  • 1
    Evelyne de Leeuw wrote on 20 June 2012:

    Cities are made by people, and cities make people. Natural features such as a ford in the river or a natural harbor increase the likelihood of human settlement and urban growth. But people make choices to band together to plan and design (either purposively, instinctively or creatively ) to enhance such features to suit human purpose.
    Urban development, throughout history, has had every connection with human development, health and well-being. More often than not this connection has had a profound political component that expressed a struggle between haves, and have-nots. This is not just a post-hoc assessment of the times of Edwin Chadwick and other 19th century hygienists , or earlier efforts to design cities and their environs in sanitarily sound ways. The protection and development of urban health, and Healthy Cities, remain intrinsically high-stakes political exercises . This is, in fact, expressly confirmed in the stated objective of the Healthy Cities movement, namely, ‘to put health high on social and political agendas’ .
    ‘Healthy Cities’ as a recent movement has always been a strongly value-driven process rather than a technical exercise in urban planning for health. When Trevor Hancock and Len Duhl reviewed the history of urban planning for health and came up with eleven qualities of a Healthy City, they knew that the ambition to create, for instance, ‘a stable ecosystem’ or a ‘non-exploitive community’ had very little to do with the hardware of urban planning, and everything with politics and community dynamics. In fact, Jason Corburn continues Duhl’s work at UC Berkeley very much focusing on the people and the politics of urban planning .
    It is a significant moment in the life of Healthy Cities that The Lancet, not the least of international peer-reviewed journals, has commissioned a comprehensive review of the accomplishments of that very movement . But this milestone suffers somewhat from the same ailments that have challenged the establishment of evidence of effectiveness of health promotion more generally; in adopting a pathogenic -albeit at times more social than clinical- model of health and disease the data collection and analyses have acquired an inherent bias toward a pathology of disease in urban settings, rather than a sociology of health: politicians, sociologists and political scientists interestingly lack from the review authorship line-up.
    A sociological view of urban health and Healthy Cities would have included the role of people in Healthy City efforts, both at the level of ‘those affected’ as well as in terms of political theory explaining the mechanisms and processes that drive and determine ‘who gets what’ . And let us not forget, as Hessel recently proposed in what has become the foundation statement of a new global resistance movement: nous aurons le levain pour que la pâte lève (we will be the yeast that makes the bread rise) : be it as communities or politicians, people drive change.
    It is obvious that the urban environment is a complex one. But by focusing on the technical rather than social complexities of urban planning (cf. p. 6 “…how urban planning could shape the physical aspects of an urban environment to promote health”) the piece arrives at rather redundant recommendations. A new generation of activist scholars has already moved away from the type of analysis presented6. They argue for a more rigorous, and community-based, application of an already existing scholarly and interpretive toolbox which more Healthy Cities students and practitioners should embrace .
    After the exceedingly valuable and detailed four case studies which focus, as said, on hardware (structures, toxins, pathologies, etc.) more than software (people and their sociological institutions) the authors oddly arrive at recommendations much more commensurate with a power perspective than with the physics of urban planning: Healthy Cities should embrace evolutionary experimentation, assessment of urban performance should be a negotiated zone, everyone should recognise that policy (interventions) are value-laden, and to that purpose, we need to self-reflect. Unfortunately, these are not such novel ideas. In fact, in sociology and political science the ‘standard normal’ model has, with vigour, left the stages heuristic (where processes could be described as sequential and linear) and has adopted multi-level, networked, negotiated and highly iterative interactions which extend far beyond traditional urban planning stakeholders. Unfortunately, several authors have recently demonstrated that such perspectives, although ‘de rigueur’ in social science for decades now, have yet to be adopted in the health sciences , .
    We have argued elsewhere that the deliberate and conscientious application of political theory to complex issues in health promotion and urban health would generate precisely the insights the Healthy Cities review yearns for13, : who plays which game with whom? For what purpose? What is the role of ‘those affected’ – the communities that feel disempowered by intangible structures and institutions, or communities that have the potential and opportunity to be truly engaged? What arguments, which evidence, shaped by whom, enters the policy discourse at which point for what reasons?
    These may look exciting new questions, opening up new vistas beyond ‘stakeholder self-reflection’, as advocated in the review. Lamentably, they are not new. They have been among the standard repertoire of social scientists since the early 1990s. Perhaps the first complexity to address is that of even better communicating, equitably, across disciplines and practice areas. This will, we feel, contribute to shaping Healthy Cities more than anything else.

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