According to the United Nations over half of the world’s people live in urban areas, a figure that will reach nearly 70% by 2050. One challenge of urban growth is to ensure cities are healthy and sustainable places where people can thrive. But how can that best be achieved?
In the London boroughs of Lambeth and Southwark urban health foundation Guy’s and St Thomas’ Charity, where I’m currently doing my On Purpose Associate Programme placement, is exploring how city life impacts on health and wellbeing.
Together with the King’s Fund think tank, the charity recently hosted a conference on improving health in urban communities. Speakers from around the world shared their experiences and discussed the challenges of achieving good urban health. Here are three of my conference takeaways.
1. Health is not just about healthcare
Some health perspectives focus only on what is needed to get better when we become ill such as access to doctors and hospitals. But, as all the speakers highlighted, the many social determinants that impact whether we fall ill in the first place are equally important and in need of our attention. So, what are some of these determinants and how can they be improved?
Dr Katie Hunter, a public health specialist at the Greater London Authority, described how our experience of the urban environment itself can influence health. She highlighted how London’s Healthy Streets scheme designs public spaces to promote walking, cycling and public transport over car use. As well as more physical activity and better air quality, people-friendly streets encourage greater social interaction as a way of tackling urban isolation.
Other health drivers, as flagged by Dr Brandy Kelly Pryor from the US-based Humana Foundation, include food security and post-secondary school success in the labour market. People’s ability to do meaningful work and earn a decent salary can greatly impact their health outcomes.
The same is true of the physical circumstances in which people live, pointing to the need for affordable housing. These themes were picked up by Alonzo Plough of the Robert Wood Johnson Foundation who also challenged the narrative that poor health is simply the result of unwise personal choices. He stressed that it is instead rooted in larger systemic issues that are both intricate and interconnected.
2. Systems thinking is vital for creating healthy cities
Reflecting on her work around reducing childhood obesity in Amsterdam, Karen den Hertog spoke of the need to engage with the complex systems driving urban health — a key theme of the conference. Many speakers underlined the struggle of adopting a systems thinking approach. So how can this challenge be overcome?
Karen highlighted how small local actions can collectively drive power and change upwards to the broader policy landscape. She urged us to get comfortable with the ‘muddle’ involved in delivering this change and remember to keep galvanising all actors whether they are teachers, parents, planners or administrators.
London’s Deputy Mayor for Environment and Energy, Shirley Rodrigues, built on Karen’s thinking by sharing the joined-up policy approach taken by the Mayor’s Office. She explained how a ‘health filter’ is applied to policy areas as broad as the environment, housing and social justice to ensure determinants of health are always factored into decision-making.
Paul Lindley of the London Child Obesity Taskforce described the group’s engagement with 20 different sectors across the city, from schools to supermarkets. The goal here is to understand the obesogenic environment children navigate each day so that all levers in the system can be utilised with the aim of improving health.
3. Communities can drive their own change
The importance of statistical data in understanding health determinants and outcomes was discussed by many speakers. Several also spoke of the value of learning from lived experience when thinking about how to improve urban health. But as Radhika Bynon from the Young Foundation described, public health interventions are instead often ‘implemented’ or ‘done to’ groups of beneficiaries without listening to what they feel they need. On a similar note, Jacqui Dyer MBE, Chair of Black Thrive, talked of how service delivery can be misaligned with the needs of the people it aims to benefit.
But what happens when community voices are elevated and citizens are given agency to formulate and deliver solutions?
Radhika gave the example of a citizen-led project in the London borough of Tower Hamlets where the community took the lead. Supported by the Young Foundation, a group of residents identified that proficiency in English was a barrier to parents engaging with their children’s teachers. They formed a project to train local residents as coaches who could run courses for parents. The scheme’s positive effects on wellbeing included reduced social isolation, and, crucially, better communication between teachers and parents about children’s education.
There is always hope
After immersing myself in this day of discussions, I left the conference feeling optimistic about our ability to create good urban health. As Kenneth Thompson of Pennsylvania Psychiatric Leadership Council said in reference to post-industrial Pittsburgh’s journey to a healthy future, it is about “finding hope in the city”. It is with this vision of hope and in recognition of the power of community, that I think we have the capacity to build healthier and stronger future cities.
Find out more about Guy’s and St Thomas’ Charity’s work exploring how living in cities impacts on people’s health and wellbeing.