Making the ‘Urban’ Better: Planetary health conversations on building healthy sustainable cities in the era of COVID-19 and beyond…

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“The greatest threat to positive societal reset is not the challenges of the present but a stagnant mindset of impossibility”.

The world has witnessed unprecedented collaboration as part of the pandemic response, between different government ministries, between community groups and the public sector, and between public and private sectors. These previously considered improbable or unlikely intersectoral action for health challenge our perceived limits of what is possible. Our challenge is to harness this momentum to accelerate societal re-imagination of a different future, and to catalyse action to address health, social and planetary inequalities.

The inaugural Making the #UrbanBetter conversation, a joint event of University of Cambridge Wolfson College’s Global Health and Sustainability and Conservation hubs, was convened on the 14th September to do just that.

Hosted by Tolullah, UrbanBetter founder and Wolfson College Fellow, we had over 120 registered participants from 30 countries in Africa, Europe, Asia, North America and Latin America and the Caribbean. Our conversation, with global partners whose work impacts the built environment, population health and sustainability, was live interpreted into French and we had discussions captured as a graphic illustration in real time!

The conversation kicked off with framing of the challenge and making the links between global health, conservation and sustainability and a call to action to “colour outside the lines” with a provocation to look beyond the normal system boundaries. What if, for example, we considered how industries could create health?

We asked registered participants before the event, what questions we should be asking now to shape a healthy sustainable future in cities worldwide to prevent (infectious and non-communicable) disease and future epidemics. Over the course of the event, some of these questions were posed to speakers and discussants.

“We should be questioning everything. From the types of food we consume and how we produce them, to how we build our homes and more”

This was the response from one participant, illustrating the need for foundational disruptions that will need us to work across silos and collaborate to address these complex challenges. The emergent themes and examples of questions asked by other participants are summarised below.

What questions should we be asking now to shape a healthy sustainable future in cities worldwide to prevent (infectious and non-communicable) disease and future epidemics?


Urban design and planning

  • How can we better equip built environment professionals with the capability to ensure performance measurements of human health?
  • What ubiquitous, outdated designs make us prone to global pandemics?
  • What is the role of public space in creating health in cities?

Planetary health and resilience

  • How do we ensure biodiversity in urban landscapes?
  • What is the role, evidence and opportunity for green space in improving mental and physical health and reducing CO2 emissions?
  • In the urban poor context, what are existing points of resilience that may be harnessed to better address disease outbreaks?

Intersectoral collaboration and participation

  • Are we intentional in cultivating collaborations between sectors that contribute in the creation of healthy sustainable cities?
  • Which stakeholders are excluded from current public health discussions? Whose voices are not heard?
  • What effective tools are out there to coordinate actions and work together to overcome pandemics?

Inequality in access to services and work

  • Do people need to live in an urban environment to be able to get good work?
  • How can we ensure the access to healthcare and vaccines for both documented and undocumented migrants and climate refugees?

Consumption and waste

  • How do we effect behaviour change to encourage communities to produce less waste, reduce littering and pollution?
  • How to get governments and business on board with reducing unnecessary consumption?

Funding

  • How can cities finance the changes that are needed when local tax revenues have plummeted?
  • How do we make the economic and political case for what the evidence shows is the way forward for health of people and planet?

Demography

  • How should city and national governments be responding to the increasing urban populations, especially in Africa?

Measurement

  • How clean and unpolluted are our cities?
  • What is the current climate risk and vulnerability at city level? What adaptation / mitigation measures can be put in place?

We also explored global, regional and local approaches to integrating health into urban planning and development.

“Mayors are the new Ministries of Health”

In making this remark, one of our speakers highlighted the transformative role that dynamic cities can play in accelerating progress towards the healthier, greener, safer, more inclusive and resilient future set out in the Sustainable Development Goals.

To explore the opportunities for integrating planetary health foresight into urban development, speakers shared experiences from Cape Town, South Africa, Douala, Cameroon, Accra, Ghana, Lagos, Nigeria, and Essex, UK of intersectoral action before and during the pandemic and examples of ongoing and planned urban built environment interventions.

For example, the transdisciplinary research team of academics and government representatives in the health and human settlements sectors shared their experiences conducting research on integrating health into human settlements policy as part of a LIRA-funded project.

Speakers from Lagos and Accra shared their experiences of building a resilience plan to address planetary health challenges in their respective cities, and we also heard about the Livewell scheme, integrating well-being into urban development in Essex.

The experiences shared were complemented by participants’ responses to the pre-event survey question: What types of interventions are needed to jointly and equitably address sustainability/conservation and global health? One participant called for “Bold, long-term interventions backed by science and a modular approach which enables learning from mistakes.”

What types of interventions are needed to jointly and equitably address sustainability/conservation and global health?


Built environment

  • Better open space.
  • Make ‘health’ considerations a more central pillar of planning decision making.
  • Genuinely affordable housing for those on the lowest incomes.
  • Urban governance that put health in the centre beyond disease management.

Intersectoral collaboration

  • Involvement of all major operational stakeholders of the built environment.
  • One Health – balance between preservation of the environment and health of the people.
  • Pooled open data that is genuinely accessible.

Finance and resource allocation

  • Joint budgeting and agenda setting.
  • Financing economic incentives.

Participation, empowerment, transparency

  • Interventions aiming to empower individuals & groups to manage stress in complex environments where goals inevitable conflict.
  • Interdisciplinary interventions that seek to incorporate bottom-up approaches to empower urban poor communities.
  • Education on impact of pollution on public and environmental health.
  • Collective responsibility and accountability across all of society.

Systems approach

  • We need to seamlessly and benignly bio-integrate all our activities and technologies with nature.
  • Interventions should be mutually supportive, proactive, resilient and systemic. We often already know what we need to do.

Disruptive policies

  • Active travel and healthy food environments.
  • Skills development for these policies.

Politics and leadership

  • A dramatic increase in political will.
  • Coordinated leadership at all levels of development that are truly interdisciplinary and inclusive.

Equity

  • Interventions that centre the most vulnerable and marginalized.
  • Reduce inequality, promote more accessible and better information to inform individual choices and policy decisions.

Technology

  • The use of Artificial Intelligence to optimize global health solutions.

“Young people need to be at the heart of how we find ways forward…are we ready to value youth voices?”

By 2035, half of Africa’s population will be living in cities and urban areas; and the vast majority of them will be young people. What do they think? What do they want? What choices will they make? What actions will they take? We often don’t know because the perspectives of young people are rarely privileged in decision-making spaces. In considering the potential for policy-relevant action on planetary health beyond the COVID-19 pandemic, a discussant highlighted the critical importance of ensuring that any planned initiatives work directly with young people from the beginning, sharing an example from the Africa Voices Foundation of how integrating young people’s voices into strategic planning and implementation can work in practice.

These fundamental changes in how we think about cities and urban development requires political will and leadership as noted by one participant in this quote:

“Health leading the design of cities is being proved [necessary] by COVID-19.  But is everyone listening and acting?”

These required changes also clearly have cost implications. So, we also interrogated how healthy sustainable urban development can be financed. In this section, speakers urged that we first need to change our mindset with respect to the role of cities towards cities as places on wellness not just production. Of note, we were challenged to consider the dissonance in language between academics / practitioners and the finance and investment community, with the need for those language siloes to be broken for more effective partnership.

Lastly, we considered the role of universities and research in effectively contributing to addressing planetary health challenges. Key points noted by the speakers and participants are summarised below.

What do you see as the role of academia and research partnerships in responding to urban and planetary health challenges?


Shape new norms

  • Articulate the benefits of healthy sustainable urban development.
  • Re-shape the narrative and re-define cities and the aspirations of urban living.
  • Bridge interdisciplinary gaps between health, environmental, economics and urban design.
  • Integrate the art and science of cities and the way forward.
  • Set aspirations that illustrate what equality looks like with accessible data to show the way to better solutions.
  • Serve as the hub (nucleus) that unveils and seeks solutions for problems related to health and well-being.

Inform policies and action

  • Understand decision-making and impact of urban design.
  • Monitor and evaluate the impact of behaviour change on public and environmental health.
  • Identify what incentives are effective (possibly cost-effective) at creating healthy cities.
  • Enable synergy in problem solving.

Inspire and train of the next generation of leaders

  • Train the next generation to address the specific challenges faced in their cities.
  • Curriculum should include planetary health, history and socio-environmental determinants of health. 
  • Ensure the next generation are skilled in systems thinking, intersectoral action for health, equity, communication and listening.
  • Equip the next generation with tools to understand the links between science and policy and how to influence/inform policy.

Promote equitable transnational cooperation and transdisciplinary collaboration

  • Bridging the gap between research’s specific approach and local authorities’ general approach to health in cities.
  • Building transnational cooperation, understanding, and knowledge sharing.
  • More open and participatory research paradigms that empower citizens to understand and contribute to the issues at stake.
  • Support North/South partnerships are essential.
  • Provide incentives for transdisciplinary research.

Support shared learning and knowledge exchange

  • Share good practices on integrating health in non-health sectors.
  • Getting the facts, finding policies that work, identify good examples and champions (then share and disseminate).
  • Provide the best available data and case studies.
  • promote data sharing especially with local experts.

Well, we’ve got our work cut out for us, and we will certainly need all hands on deck! But these are just snippets from a really engaging conversation. Listen to the dialogue in full.

You can also find all the resources mentioned during the conversation and the graphic illustration summarising the discussion here.

This event marks the first of a new Making the #UrbanBetter conversation series on health foresight in Africa’s cities in collaboration with different partners. This conversation series will be feeding into ongoing efforts to integrate health foresight into Africa’s cities for human and planetary health, so stay tuned!!

Follow us on Twitter, Facebook and Instagram for updates on the next conversation and join our mission to make the #UrbanBetter.

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