Putting health at the heart of the urban policy agenda
Dr Margaret Chan
Director-General of the World Health Organization
Excellencies, honourable ministers, distinguished delegates, ladies and gentlemen,
Half of humanity lives in an urban setting. Nearly a billion people live in slums, shantytowns, on sidewalks, under the bridges, or next to the railroad tracks. Disadvantage and disease go together. The rapid increase of people living in cities will be among the most important global health issues of the 21st century.
Imagine the consequences when rapid urbanization converges with other trends, like the continuing rise of lifestyle-related chronic diseases and climate change. We are heading towards some very troubling times.
For a large and growing number of people, prospects for a better future are tied to living conditions in cities. The work done during the Forum can improve those prospects considerably, and I thank you for what you have achieved.
Cities concentrate people and opportunities, and they also concentrate threats to health. As your deliberations made clear, cities can be planned, designed, and administered in ways that promote health and protect people from these threats.
The most important determinants of urban health lie beyond the direct control of the health sector. These determinants are social and political in nature, and they can be shaped by policies, in multiple sectors.
We can be proud of what has been achieved in just these past three days. Your achievements build on the awareness, and the engagement of more than 1,500 cities, in this year’s World Health Day event, and on many other activities jointly undertaken by WHO and UN-HABITAT.
These achievements come at a time when cities are under the spotlight. The World Expo in Shanghai, with its theme of Better City, Better Life, showcased the innovations being used to improve city life.
This was a largely smoke-free event. With up to one million people attending the Expo daily, this is far more than a symbolic gesture. This was a policy decision, and I congratulate the Shanghai authorities on setting a precedent.
A smoke-free city is a better city, with a better, and a longer, life for its residents.
Ladies and gentlemen,
Let me thank the chairs, panellists, and moderators of the thematic and plenary sessions for managing their tasks with excellence. We have just heard the outcome, as presented by three mayors. In essence the Kobe Call for Action asks governments to put health at the heart of the urban policy agenda.
As noted, better data are needed to get a grip on health problems within cities, and to see where specific problems and needs are concentrated. Policymakers need to make full use of urban planning expertise, and get civil society, community groups, and businesses to shape these plans. After all, these are the people who will be living with the results.
Above all, the Kobe declaration calls for the more systematic use of tools for assessing health inequities. These data provide the foundation for an effective response. As you have agreed, ongoing systems are needed for regular data collection and analysis based on disaggregated data.
Otherwise, health problems linked to poverty and disadvantaged populations will remain statistically hidden. Averages hide a lot of problems.
Urban inequities and the plight of the poor have been a particular focus of the Forum, and most appropriately so. Ultimately, these inequities are detrimental to all city dwellers. Urban poverty and squalor are strongly linked to disease outbreaks, social unrest, crime and violence.
In a city setting, these threats can be highly contagious, rapidly spreading from a single neighbourhood to endanger all citizens and taint a city’s reputation.
We have heard about ways to address these problems. By measuring health status and health outcomes, urban inequities can be unmasked and addressed.
This is the focus of a new UN-HABITAT/WHO report on Hidden cities: unmasking and overcoming health inequities in urban settings. We will be launching this report later today.
I have been especially pleased by the engagement of so many governors, mayors, and other high-level officials from all over the world, and by support from experts in urban planning. I have also been impressed by the emphasis given to visionary leadership, and by the experiences and many success stories these leaders have reported.
Good urban health governance makes all the difference in the world. The best urban governance can produce 75 years or more of life expectancy. With poor urban governance, life expectancy can be as low as 35 years.
As I said, most root causes of urban health problems lie beyond the direct control of the health sector. But using health as an entry point and a rallying point has many advantages. Poor health, including mental health, is one of the most visible and measurable expressions of urban harm.
Municipal leaders have direct influence over a wide range of health determinants, from housing and transport policies, to social services, smoking regulations, the policies that govern food marketing and sales, and decisions about what foods and beverages are available in schools.
The Call for Action stresses the importance of urban planning as an opportunity to promote health. Municipal leaders are well-positioned to influence land use, building standards, water and sanitation systems, and the enactment and enforcement of health-promoting legislation.
Moreover, acting in the name of health can rally stakeholders from diverse backgrounds and interests and build political pressure on issues that are important to every city dweller. Health is valued universally as an essential prerequisite for a fulfilling and productive life.
Good urban health governance helps ensure that opportunities and advantages are more evenly distributed, and that access to health care is fair and affordable.
Ladies and gentlemen,
Let me illustrate the importance of your work at the policy level, articulated in the Call for Action by the principle of mainstreaming health in all urban polices. Let me do so by drawing your attention to a recent trend, closely linked to rapid urbanization.
Studies show that obesity and type 2 diabetes, both strongly associated with unhealthy diets, have reached epidemic proportions in parts of Asia. Some experts view Asia as the new epicentre for the diabetes epidemic.
The trend is alarming. The pattern seen in this part of the world is different than that experienced elsewhere. The epidemic in Asia has grown faster over a much shorter time. And it is being fuelled by rapid urbanization.
In Asia, people are developing diabetes at a younger age, in greater numbers, and often after much smaller weight gain than is seen with diabetes in Europe and North America. Asian diabetics suffer longer from complications, and they die sooner.
Diabetes is an especially costly disease: costly for societies, costly in terms of chronic care, and extremely costly in terms of hospital bills for well-known complications. This situation dramatically underscores the importance of health-promoting urban polices in multiple sectors.
This is a health problem, but it is even more a political, social, and economic issue. The costs of managing patients with a disease like diabetes can overwhelm insurance schemes and unravel safety nets for social protection.
As for many other urban health issues, the health sector can drive the thinking, drive the data, drive the concern. But the health sector cannot formulate the policies or enact and enforce the legislation that creates a health-promoting environment, an environment that makes healthy choices the easy choices.
Ladies and gentlemen,
I thank you for the rich diversity of debates, ideas, experiences and practical, often ingenious solutions. Making cities good for health takes time. But this Forum tells us it can be done. This, too, is an achievement we can be proud of.
You have raised the profile of urban health, and most especially, the importance of addressing urban health inequities. I believe that the attention that is now being given to these issues puts us on the right track for the future.