Global perspectives on urban health

Overview

Cities sit at the centre of modern life. They act as engines driving society, and their ability to generate wealth and opportunity shapes our health.  Furthermore, they have the potential and resources to provide positive benefits to people of all ages. For example, access to education, jobs, health services, supportive communities and transport. However, not all city residents experience or can access these benefits equally. Many positive attributes of cities mask the inequalities that exist within them.

Living in urban areas, like inner-city London, carries distinct health challenges. Many of these start early in life and are influenced by the wider determinants of health and wellbeing. For example, if you live in an inner-city area in the UK, you are more likely to have low-paid employment or be unemployed, be exposed to high levels of air pollution and live with multiple long-term health conditions from an earlier age.

These health inequalities are not unique to London. So we began to look at similar cities and neighbourhoods to ours around the world. We started by identifying comparable cities with a view to understanding what urban health equity (or lack thereof) looked like globally. Health challenges associated with density of population, overcrowded housing, poor air quality, social isolation, ethnic and cultural diversity, precarious employment and income inequality are present in the majority of urban communities. This shared context means we believe there is huge potential for cities across the world to learn from each other.

By focusing our attention on understanding health in urban areas, looking at what works and what creative ideas can be used to tackle what doesn’t, we gain valuable insight which can then be applied in other places. Moreover, by sharing our knowledge, expertise and vision with others, nationally and internationally, we can begin to remove the barriers to achieving health equity.

Together, we can build an understanding of the barriers to living healthier lives and how to collectively remove them, reducing health inequalities. Of course, what is most important is that health equity cannot be achieved by one organisation or sector alone. Solutions must be multifaceted. Though improved health may be the end goal, they do not always need to start with healthcare.

Our [now Former] Chief Executive, Kieron Boyle, comments: “This report explores how cities around the world are addressing health inequalities. It finds real-world solutions in how they are shaping the built environment, devolving power, building cross-sector collaborations, centring the voice of urban communities, using new data and technologies, and tackling systemic issues of racial and economic segregation. Through these examples, we can see a clear picture of how to unlock the potential for cities to be healthier.”

This data analysis gave us a list of ten cities from across the world, each undertaking interesting urban health initiatives. Some were close comparators to London, others specifically to our home in Lambeth and Southwark. Though not an exhaustive list, we identified initiatives designed to have a positive impact on urban health in each city.

Click on the cities below to explore how they approach urban health.

Overall, three consistent themes emerged as we explored each city:

1. Urban health is about far more than healthcare

Complex health issues rarely have a single cause. Often, these are driven by many interconnected factors. Through different cultural and political contexts, we’ve explored the commonalities between health and the places people grow up, live and work. This has helped deepen our understanding of what drives positive health outcomes for all. Shaping our cities to improve urban health requires a collective effort. This goes much wider than the healthcare system, clinical interventions and public health authorities. And it includes urban planners, civic institutions, investors, employers and residents.

Our commitment: a dedicated taskforce

In 2021, we are creating an urban health taskforce. This two-year project will convene a broad spectrum of voices from urban communities, academia, business, statutory and third sector organisations. Thus driving the urban health debate in the UK. The taskforce will focus on evidence gathering and consultation to establish the key challenges around urban health and to develop recommendations that can be implemented to improve health in our cities. We will use this platform to help to raise the profile of urban health in the UK and to influence key thinkers working in this space.

2. Tackling health inequalities will depend on cross-sector collaboration and collective responsibility

Whilst collaborative working is happening in many places it is seldom cross-sector. We need to look at how to encourage and incentivise different sectors to recognise their own influence on health and measure the health impacts of their work. This is particularly important now as we see the impact COVID-19 has had on economies all over the world.

The most impactful collective health initiatives connect local community leaders with decision makers, all of whom need to be willing to commit time to building trusted relationships and to be open to experimenting with new ways of working together.  For example, in Detroit, the Michigan Health Endowment Fund recognises that many parts of the system are doing great work. However, poor communication can lead to duplication and unhelpful competition. Therefore, the Fund takes a whole-system view, producing a services map which they analyse for gaps. Then, once identified, it seeks out grant partners who can fill those gaps, usually drawn from the community level. Also, it is beginning to bring together leaders from different sectors to leverage the work each are doing and address urban health issues, such as food insecurity, at a systemic level.

Our commitment: sharing what we learn

The COVID-19 pandemic has taught us now, more than ever, that we live in a globally connected community; that there is much we can learn and achieve by working together.

Truly understanding what works in improving health in inner cities is key to achieving impact. For instance, learning rooted in practice is our contribution to the growing body of evidence around urban health. We’re committed to sharing what we learn about what works and what doesn’t with other global cities.

We’ll continue to work with decision makers, community leaders, businesses, investors, and others to build health equity. We’ll do this here in the UK, and internationally – to build on this research and take practical action.

We’ll also continue to work with organisations and people from all sectors, from community groups to large commercial enterprises. Our collaborations with anchor organisations allow us to research issues, develop new methods, test ideas on the ground, share knowledge and evaluate the effectiveness of projects. We will continue to support anchor organisations in Lambeth and Southwark, working with them to test solutions to some of the biggest urban health challenges we face.

3. The process of building health equity must be equitable

We can only achieve health equity through an equitable process that invests time, rebalances power and builds trust. This is critical in ensuring that a genuinely collective voice advocates for better health. Taking the time to fully understand the experiences of people living and working in cities, will keep the process of engagement, involvement and delivering action centred on the perspectives of urban communities.

We believe that community organisations can play a pivotal role in driving positive change in health. They can act as anchor organisations, offering stability and a trusted reference point for community knowledge. Our research also showed that they were best placed to build personal and collective resilience in neighbourhoods, offering trusted support for residents most at risk from poor health outcomes. But they are also flexible and willing to adapt, exploring opportunities to support communities to grow and thrive in response to changing needs.  One example of this is the way Queens Community House in New York City improved local people’s access to fresh, nutritious produce by establishing a farmers’ market with and for the community.

Our commitment: Strengthening our approach to community research and engagement

We recognise that for too long, communities experiencing the negative consequences of inequality have been the subjects of research programmes. Conversely, as demonstrated by numerous examples in this report, improvements in health which have been driven from the ground up rely on communities instead becoming partners in the design and implementation of research and active agents in developing solutions.

Therefore, Impact on Urban Health has invested in developing a Community Research approach, with our strategic partner, The Social Innovation Partnership, built upon principles of community leadership and co-ownership. It ensures that people who are living in a place and are experiencing the challenges that organisations are trying to solve are more involved in local research, and the projects and interventions that come out of that research. As a result, the Community Research team leverage their knowledge, awareness and relationships in communities in Lambeth and Southwark to deliver nuanced insight that would be inaccessible through traditional research methods.