Sharon Roerty from the Robert Wood Johnson Foundation tells us more about the Salzburg Global Seminar on Building Healthy Equitable Communities, and what can be done to make cities a more healthy place to live. This article is part of the 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 sanitation⁵ and green space⁶ 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 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:

• How can investments in urban revitalization and infrastructure advance health, equity and the public good?
• What are the key policy strategies and practices that address the roots of inequality and support healthier and more inclusive housing, transportation, utilities and open space systems? 
• How can cities foster a shared sense of community to build infrastructure that serves the public interest? 
• How can citizen science and data be used to promote equitable development and community-driven solutions?

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 Z. Roerty, MCRP/AICP, Robert Wood Johnson Foundation, USA. 

Competing interests: none declared.

 

1. Marmot M. “Social determinants of health inequalities.” The Lancet, March 19, 2005, 365 (9464) 1099-1104.
2. United Nations Department of Economic and Social Affairs. “68% of the world population projected to live in urban areas by 2050, says UN.” May 16, 2018. Available at: https://www.un.org/development/desa/en/news/population/2018-revision-of-world-urbanization-prospects.html.
3. Braveman P, Dekker M, Egerter S, Sadegh-Nobari T and Pollack C. “An examination of the many ways in which housing can influence health and strategies to improve health through emphasis on healthier homes.” The Robert Wood Johnson Foundation, May 1, 2011. Available at: https://www.rwjf.org/en/library/research/2011/05/housing-and-health.html.
4. Frank LD, Andresen MA and Schmid TL. “Obesity relationships with community design, physical activity, and time spent in cars.” American Journal of Preventive Medicine, 27 (2) Aug. 2004: 87-96.
5. WHO Commission on Social Determinants of Health. “Globalization, water and health.” Globalization and Health Knowledge Network, May 2007. Available at: https://www.who.int/social_determinants/resources/gkn_wilson.pdf?ua=1.
6. Braubach M, Egoroy A, Pierpaolo M, Wolf T, Ward Thompson C and Martuzzi M. “Effects of urban green space on environmental health, equity and resilience.” Theory and Practice of Urban Sustainability Transitions. Springer, September 2017. Available at: https://link.springer.com/chapter/10.1007/978-3-319-56091-5_11. 
7. Bliss L. “The Life-Saving Benefits of Barcelona’s Car-Free Superblocks.” City Lab, September 9, 2019. Available at: https://www.citylab.com/transportation/2019/09/barcelona-superblock-car-free-streets-cities-urban-design/597484/.