From Zero Draft to (More Than) 60
After last month’s United Nations’ General Assembly in New York, with its inclusion of health and population topics such as the growing numbers of refugees and migrants internationally, and the mounting threat of anti-microbial resistance, we in global public health now turn our attention to the U.N. Habitat III conference in Quito, Ecuador beginning October 17, and specifically, the Agreed Draft of the New Urban Agenda, Habitat III’s central document-in-progress.
The “Zero Draft” as it was called until September, is the world’s urban planning guide to a near future when 70 percent of the global population is predicted to live in cities. It is our road map for sustainable cities, our declaration of interdependence for future metropolises. In the preparatory meetings over two years leading up to Quito, global health advocates have increased the presence of health considerations formally specified in the document, literally adding 14 new directives on “health” in August (raising the number to 28) and in particular, safeguards on air quality in six additional instances (raising the number to nine) and consideration given to road safety where there had been no mention before. These, along with 24 provisions on the environment and the commitment to meet WHO air quality guidelines, bolster the Draft with more than 60 directives that will safeguard and promote human health. These are important gains that will ensure the well being of city dwellers of the future if we act on them swiftly and correctly.
When I think about the potential impact of these health provisions in the coming decades by creating a shared agenda for public health in urban planning, I take heart in the fact that municipalities and public health have always been intertwined. Our earliest cities—those of the Greek and Roman Empires, or the Persians, Aztecs, and Incas—remind me that ancient human settlements fixed hygiene and sanitation as a priority. Doing otherwise meant potential high rates of sickness and death for city-dwelling populations, and also potential for urban-to-regional economic and political harm. These health considerations have followed us in to the modern era as we’ve understood the urban sources of and control measures for infectious disease—famously, John Snow’s plotting of the cholera outbreak in nineteenth century London, or New York City’s long push beginning at the turn of the twentieth century to ensure adequate light, air and sanitation in all residential dwellings, all the way to eliminating mosquito breeding grounds to contain Zika at the Summer Olympics in Rio de Janeiro and beyond in other cities throughout South, Central and North America. Scientific understanding of infectious disease has shaped our planning and behaviors in urban environments. With the right financing and implementation, I’m confident we have the means to manage infectious disease during this time of urban expansion.
My concern lies with our ability to anticipate and prevent non-communicable diseases (NCDs) in the world’s urban areas. The rising prevalence of obesity, the persistence of smoking, and the sources of air pollution, to name a few, simply have not been addressed by engineers and bureaucrats as fiercely and consistently as the threat of infectious disease. There are reasons for this: for one, we attribute NCDs to the consequences of human choice though we know that the built environment plays a significant role in behavior and the decline in physical activity; aggressive marketing of harmful products in consumption choices; and limited investment in infrastructure to polluting transit. What’s more, the tendency for rapid urbanization to outpace measures to provide adequate water, sanitation, housing and attention to air pollution and sprawl is reprising a history of unmanaged urbanization that has played out from the nineteenth century to the present day in many wealthy nations.
Make no mistake: we ignore the interconnectedness of public health and urban planning—including NCD risks—at our peril. Rapid growth in population, urban migration, and climate change will challenge us in ways that we haven’t yet imagined. A failure to act quickly and provide adequate resources to manage rapid urbanization in low- and middle-income countries could lock in to place unhealthy and unsustainable built environments for decades to come.
Now that these hard won health provisions are in place, our challenge will be to uphold them through implementation. As we do so, public health can provide the tools—for making good use of data on how many are ill and die; for prioritizing investments that can amplify health gains; for engaging the public to recognize the immediate and long term health impacts for millions of people in day-to-day decisions that will be made as the world urbanizes.
My organization and many others are ready to extend our work in tobacco control, road safety, obesity prevention and air pollution for example, in order to safeguard the health of urban dwellers in the years to come.
We must keep health at the heart of urban development, and act in ways that will ensure the well-being of city dwellers, through building improved green spaces, planning for healthy aging in place for older residents, investing in sustainable public transportation, advancing land-use policies that avoid urban sprawl, mandating cleaner fuels, vehicles and electric power generation, and restricting marketing of harmful products. We must translate the health provisions contained in the New Urban Agenda once it is ratified on October 20 into good policies and practices. Good health is what matters most to the people who live in the world’s cities. People like me. People like so many of you.