Urbanization: a challenge for public health
Urbanization is associated with many health challenges related to water, environment, violence and injury, noncommunicable diseases (NCDs) and their risk factors like tobacco use, unhealthy diets, physical inactivity, harmful use of alcohol as well as the risks associated with disease outbreaks. Of the six WHO Regions, the Western Pacific experiences the biggest number of natural hazards, and rapid urbanization increase human vulnerability to disaster.
Virtually all population growth over the next 30 years will be in urban areas.
The rapid increase of people living in cities will be among the most important global health issues of the 21st century. Almost 50% of people in the Western Pacific Region live in urban areas. The rapid rate of urbanization has brought about in recent years changes in physical and social determinants of health. By 2030, six out of every 10 people will be city dwellers, with 60% of the increase in the global population in the Asia Pacific. In many cases, especially in the developing world, the speed of urbanization has outpaced the ability of governments to build essential infrastructure. Unplanned urbanization can intensify an existing humanitarian crisis and has consequences for the health security and safety of all citizens in cities.
The urban poor suffer disproportionately from a wide range of diseases and other health problems.
It is estimated that half a billion people live in informal settlements and slums in Asia. Five out of six newly poor are in cities. While overall, the highest densities of urban slums are found in Africa, the biggest proportion are in the Asia Pacific. Health data is usually aggregated to provide an average of all urban residents - blurring differences between the rich and the poor. It thus masks the health conditions of the urban poor. More than one billion people – one third of the urban population – live in urban slums. World Bank estimates that by 2035, cities will become the predominant sites of poverty. Health problems of the urban poor include an increased risk for violence, chronic disease, and for some communicable diseases such as tuberculosis, HIV/AIDS and food/water-borne diseases.
The major drivers of health in urban settings are beyond the health sector.
Urbanization is not inherently positive or negative. Underlying drivers – also referred to as social determinants – converge in urban settings which strongly influence health status and other outcomes. These determinants include physical infrastructure, access to social and health services, local governance, and the distribution of income and educational opportunities. Communicable diseases such as HIV/AIDS and tuberculosis, chronic diseases such as heart disease and diabetes, mental disorders, and deaths due to violence and road traffic injuries are all driven by these underlying social determinants.
Actions and solutions exist to tackle the root causes of urban health challenges.
Urban planning can promote healthy behaviours and safety through investment in active transport, designing areas to promote physical activity and passing regulatory controls on tobacco and food safety. Improving urban living conditions in the areas of housing, water and sanitation will go a long way to mitigating health risks. Building inclusive cities that are accessible and age-friendly will benefit all urban residents. Such actions do not necessarily require additional funding, but commitment to redirect resources to priority interventions, thereby achieving greater efficiency.
Build partnerships with multiple sectors of society to make cities healthier.
Health is a human right for all citizens. It is the role and responsibility of individuals, civil society, and governments to uphold this principle. Platforms where municipalities, civil society and individuals come together must be encouraged to protect the right to health of current and future generations of urban dwellers. By bringing multiple sectors of society together to actively engage in developing policies, more sustainable health outcomes will be achieved. We are at a clear turning point in which we are moving towards an increasingly urbanized world and with it, the need to embrace the consequences this can have for health – both the benefits and the challenges. Rather than look back fifty years from now at what could have been done, we can take action now to ensure that growing cities are healthy cities.