Chair of the Salzburg Global program on Building Healthy, Equitable Communities: The Role of Inclusive Urban Development and Investment, Sharon Roerty writes for The BMJ on what can be done to make cities a more healthy place to live
This article is part of The BMJ's Building Healthy Communities collection.
Place is among the many social factors—including income, education, food security and early childcare and development—that contribute to health, both individually and collectively. Study after study have shown that how long and how well you can expect to live have much to do with where you reside.[1]
55% of the world’s population lives in urban areas; by 2050, that figure is expected to reach 68%.[2] Urban features such as housing density[3], public transport[4], sanitation[5] and green space[6] all have significant impacts on health.
Yet, in so many places all over the world, urban development and investment do not support opportunities for everyone to achieve optimal health—the definition of health equity. Instead, development and investment decisions have created deep-rooted barriers to good health. Faced with challenges like concentrated and entrenched poverty, substandard housing, pollution, poor public transportation and neglected and unsafe parks and streets, too many people start behind and stay behind.
In October 2018, at the Salzburg Global Seminar program on Building Healthy Equitable Communities supported by the Robert Wood Johnson Foundation, there was consensus that investors, planners, engineers and developers can and must hold themselves accountable for increasing opportunities for everyone to be healthier, especially people living in places where obstacles to a long, healthy life are greatest. Building on that discussion, a series of articles coming from that meeting explore a number of questions, including the following:
Part of the problem has been the failure to integrate health into urban planning and decision-making. Around the world, examples abound of more integrated and more conscious approaches to urban development and improvement. Being intentional about whom such improvements will benefit will result in opportunities for better health and well-being for everyone.
Bogatá, Columbia, pioneered the use of ciclovías, the regular closing of main streets to automobiles for runners, bicyclists, skaters and most importantly every kind of people, to use freely. This practice has expanded to cities around the world. Meanwhile, major cities in Spain have declared a war on cars—banning or limiting their use on designated streets. A new study estimates that Barcelona’s plan to limit cars and capture nearly 70 percent of street space for bikes and pedestrians could save 667 lives per year.[7]
Housing is another area of intense interest. In Nairobi, Kenya, where slums occupy about 2 percent of the land but house half the city’s population, the Muungano alliance has organised residents to save collectively, meet regularly and demand and help fund community improvements, including sanitation, water, housing and electricity. And in Delhi, India, a company called Micro Home Solutions takes an interdisciplinary design approach—drawing on the insights of sociologists, urban planners, architects, policymakers, and engineers—to create sound and sustainable housing for low-income dwellers.
As these and many other examples show, we can make the world’s cities healthier and more equitable by designing and building communities with the explicit goals of inclusion, health and opportunity for all. This will require leveraging the potential of the built environment to both prevent disease and promote health equity. The other articles in this collection provide details on how leaders working across sectors can achieve this.
Sharon Roerty, a senior program officer who joined the Robert Wood Johnson Foundation in 2011, is an urban alchemist who has spent a lot of time at the intersection of health and transportation. She served as the Chair of the Salzburg Global Seminar program on Building Healthy, Equitable Communities: The Role of Inclusive Urban Development and Investment in October 2018. The program was held in partnership with the Robert Wood Johnson Foundation.