Dr Catriona Waddington, Mott MacDonald health economist
A thriving urban economy has obvious advantages for the health of city-dwellers – it affects everything from diet and access to medical care, to air quality, sanitation and worker safety.
The relationship between city governments and business is a crucial one. City leaders must be aware of potential tensions between the pursuit of short-term profit and long-term improvements in health, for example pollution from industry and vehicles, unsafe working environments, poor sanitation and mental stress. The following illustrations give more detail.
1. Stand firm against vested interests
Tobacco growing, manufacture and sales can be major sources of employment and taxation revenue, and many people enjoy smoking. But tobacco kills more than 7M people each year; half of those who use tobacco die of it. A UK local government Declaration on Tobacco Control commits councils to “protect our tobacco control work from the commercial and vested interests of the tobacco industry by not accepting any partnerships (or) payments.”
2. Challenge the status quo
Car use tends to increase with economic growth, as people become more affluent. However, in most cities that monitor air quality, pollution exceeds World Health Organisation (WHO) thresholds for safety. Half the urban population being monitored is exposed to air pollution at least 2.5 times higher than the recommended maximum, putting people at added risk of chronic health problems. Contributing factors include social aspirations to car ownership, transport and planning policies oriented around use of private cars, and economic reliance on fossil fuels.
City leaders have significant control over transport and can contribute to reducing pollution by implementing integrated rapid public transport to take cars off the road. In many locations the automotive industry is a major employer; mayors can play a part in sustaining this while reducing pollution by promoting travel by autonomous electric vehicles and working with the private sector to create charging points and smart infrastructure.
3. Intervene for the public good
Fatty and sugary foods can be tasty and cheap. About 13% of the world’s adult population are obese, and the number of people with diabetes has risen from 108M in 1980 to almost 500M today. In that time global prevalence of diabetes among adults has almost doubled from 4.7% to 9%. Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.
Healthy diet, regular physical activity, normal body weight and avoiding tobacco use are ways to prevent or delay the onset of (the most common) type two diabetes.
Policies that play a part in assisting the population to maintain a healthy weight span health, agriculture, transport, urban planning, environment, food processing, distribution, marketing, and education. Some are within direct control of city mayors, while others require joined-up action with national government.
Through transport policy-makers they can promote walking and cycling; through planning and the discretion over business rates levied, they can encourage neighbourhood stores selling healthy foods at affordable prices; and they can promote healthier school meals, a significant part of children’s diets, and regulate the number and type of food outlets located near schools.
With intercontinental air travel and mass migration, no city can expect to fully isolate itself from infectious diseases and global pandemics. But a city that invests in initiatives and infrastructure to improve public health will be more resilient to health crises. As with other aspects of healthcare, relationships with the private sector are crucial for preparing to prevent or manage pandemics.
Most mayoral responsibilities have a public health aspect, and awareness of this should inform masterplans and policy-making across the board. Aspects of urban life like the physical environment, social connectedness and public safety act as barometers of the health of a city, guiding mayors where to take action and prioritise investment.
Set the example
Municipal governments are major employers, often the biggest in the city, and they can set an example by implementing working practices that encourage their workforces to adopt healthy lifestyles – and encouraging organisations in their supply chains to do likewise.
Mayors, local government and business can together improve the health of citizens. It involves recognising the benefits business brings and constructively challenging business practices which endanger health.