What actions today can boost future health in our cities?

Work with all stakeholders to change children’s environments

“Looking back in history, major public health epidemics have always been tackled by acting at both the individual and collective level. There is overwhelming evidence that excessive childhood weight is connected to more than just lifestyle behaviours. 

It’s also linked to wider factors such as deprivation, diversity, the obesogenic environment and the resilience of family systems. Acting on these key modifiable influences seems essential, but is at the moment far from commonplace.

In Amsterdam, we work together with stakeholders to make healthy the new normal in our children’s urban environment. In a perfect world, we would agree and implement measures today at a local, national and international level to create a healthier food environment. These measures include a sugar tax, a ban on advertising unhealthy foods to children, tax reductions on fruit and vegetables and healthy zones around school buildings. 

These would jump-start an even healthier life for our children, especially those living in the most deprived parts of cities, and thus our future generations.”

Karen den Hertog, Manager, Amsterdam Healthy Weight Programme

Improve data collection and recognise systems of power

“We must change the system of gathering, reporting, analysing, and acting upon the data collected. It is important to use both quantitative methodologies and the qualitative measures that provide us with bold and dynamic ways of acting upon data. 

Recognising that living in cities is based on an individual’s history and identity, data must be layered for those intersections of people’s identities. It can’t just be split, for example, by gender, such as women who have multiple long-term chronic conditions but looking at for example immigrant trans women of colour.

Root causes of quality and quantity of life are being recognised more and more. But often, we are acting on how to shift that root cause towards wholeness for everyone, without recognising and acting upon the systems of power, the systemic biases, or the policies and cultural practices and assumptions that created the social differences. For an equitable and thriving community, it is going to take all of us working together. Not only sharing the approaches from our systems and sectors, but a change in the language where marginalised is no longer in our vocabulary, where everyone embraces that another world is possible.”

Dr Brandy Kelly Pryor, Senior Director of Programmes from the Humana Foundation and Assistant Professor at the University of Louisville in the US

Study how structures impact individual and community health systems

“Health and disease share close quarters in urban environments. Studying the myriad ways that structures of society, economy, and politics impact health can reveal innovative solutions to seemingly intractable problems. 

For example, we see that people who live in New York City neighbourhoods with high socioeconomic deprivation develop chronic conditions like type 1 diabetes, hypertension, and cardiovascular disease more frequently, with greater severity, and earlier in life than those who live in wealthier neighbourhoods.

At the Arnhold Institute for Global Health, we work to strengthen community health systems. We believe that building strong relationships between residents, healthcare providers, community organisations and healthcare systems is critical to designing and maintaining healthy and equitable cities.”

Sandeep Kishore, Founding Director and Erica Levine, Associate Director, Chronic Disease Action Center, Arnhold Institute for Global Health

Face up to social determinants and engage residents in electoral politics

“Many of the actions needed in the US are applicable in other countries. One thing we need to do is to face the problem of social determinants square in the face. We must improve social conditions, recognising and directly confronting difficult issues like marginalisation and racism. The second is engaging residents of cities in electoral politics. We must make sure that elected officials reflect the needs of their population, genuine civic engagement.

In both the US and the UK, there is a disconnect between the people and the national government. Things are achievable – with civic engagement and collaboration – at the city or municipal level that might not be possible through national politics. Because residents are closer to local governance, cities can be innovators. And we see that in devolution policies in the UK, for example in Manchester.”

Alonzo Plough, Chief Science Officer and Vice President of Research, Evaluation and Learning at Robert Wood Johnson Foundation

Invest in all people in the city and address people’s basic needs

“We must find a way to make sure we’re investing in all the parts and all the people in the city in a meaningful, useful way. People are being deprived of the capacity to participate in their own lives, communities or cities they live in. To avoid exclusion, we have to find ways to invest in those parts we have neglected or dropped with economic changes. We need to invest in both the built environment and people, individually and collectively as groups.

We should learn more and more about how to address the basic human needs of people. Loneliness, isolation, conflict resolution between groups and within groups, supporting those in different positions (for example families in poverty with children) and getting resources to them. Another is about mental health, finding a better way to help individuals, families and communities sort through a range of challenging emotions and feelings, particularly as a result of trauma. We have to help them find ways to imagine a better place – the hope they need to make the place they live a better place.”

Kenneth Thompson, Medical Director, Pennsylvania Psychiatric Leadership Council