Improving health through smarter cities: Debut of a major new global science collaboration

Aiming to empower planners and policy-makers to achieve better health for billions of people living in fast-growing urban areas, world health, environmental, behavioural and social science experts today launched a major new interdisciplinary scientific collaboration.

Programme goals:

• Empowering planners and policy-makers with better science to create healthy urban environments and improve wellbeing;

• Identify and manage unintended health consequences of urban policy;

• Understand connections between cities and planetary change

Leading the consortium of science and health organizations behind the new global Urban Health and Wellbeing Programme is the International Council for Science (ICSU), with co-sponsorship from the InterAcademy Medical Panel (IAMP) and the United Nations University (UNU). The secretariat is hosted by the Chinese Academy of Sciences' Institute of Urban Environment in Xiamen, China.

The launch comes amid warnings that urban health risks and illnesses are increasing in tandem with rapid urban growth worldwide, compounded by climate change, resource depletion and other major 21st century trends.

To address these challenges, programme investigators will apply a "systems approach" to understanding interrelationships between urban design, management and lifestyles and health and wellbeing.

It will help spur the development of cities where healthy choices are made easy, where urban decision-making does not lead to unintended negative consequences, and where sustainable design allows current and future generations to share equally in the great benefits of urban living.

Compared with rural residents, people in cities generally have better access to health care, employment and education opportunities, leading to higher incomes. However, urbanites often confront one or more elevated health risks:

• Chronic non-communicable diseases resulting from risk factors associated with urban living, such as physical inactivity, unhealthy diets, tobacco and other drug use. These include cardiovascular disease, certain cancers and Type 2 diabetes, all now at epidemic proportions worldwide

• Infectious diseases that thrive when people are crowded together, often in substandard living conditions, or that emerge at the interface between expanding cities and surrounding areas. Urbanization is a factor in the global expansion of dengue, for example, and may have contributed to West Africa's current Ebola outbreak. Increased global mobility between cities also facilitates the rapid spread of pathogens like influenza

• Health effects of air, water and soil pollution from motor cars and industrial sources, including heart and lung diseases, cancers, developmental disorders and others

• Motor vehicle collisions, violence, crime and workplace accidents

• Health impacts of climate change-among the biggest 21st century health risks -including heat stress and risks from natural hazards, as well as broader societal impacts

• Increased risk of mental disorders, potentially arising from stress, social isolation and other factors.

Moreover, major health-related inequities are common in cities, including differences in life expectancy for people living in slum conditions, in access to health-care and vaccination coverage, and in the rate of work related accidents and injuries, among others.

"Risks to human health and wellbeing are growing with rapid unplanned urbanization,"says ICSU President Professor Gordon McBean. "Infectious diseases spread more quickly and chronic diseases are fostered by more sedentary, unhealthy lifestyles. Rather than narrowly focusing on healthcare, effective solutions for these problems are more likely to be found by addressing and making adjustments to the urban environment. Coastal cities in particular are vulnerable to rising sea levels, storms and riverine flooding with higher impacts of people and the economies as the climate changes. Adaptive strategies are needed to reduce risks."

Despite the significant challenges, there is reason to be hopeful. Around the world, decision-makershave identified a wealth of practical innovations and insights into how to improve urban health, ranging from innovative design of public spaces, transport and housing, through distribution of resources and services, to new models of governance, risk management and economic development.

The challenge is to scrutinize and elaborate on these ideas, integrating them into strategies that build toward a healthy urban ideal - tailored to local needs and respecting the limits of planetary systems.

Hence the rationale for this new programme, the novelty of which lies in its systems approach, says Professor Anthony Capon of United Nations University, calling it "a particularly effective way to understand and manage changing urban environments with profound implications for the way people live, work, learn, move and play,all of which have health implications."

The new programme will:

• Provide a hub for interdisciplinary scientific knowledge development, exchange and communication and a clearing house for information on urban health and wellbeing, and for information on the activities of stakeholder communities

• Support urban leaders and managers to make informed policy decisions by providing scientifically based information on the costs and benefits of healthy urban system structures and better urban health.

• Catalyze interdisciplinary exchange and new knowledge

• Build capacity in science and other stakeholder communities to learn and apply system methods and

• Inform the general public living in cities about healthy urban structures and ways to achieve and maintain better health.

"The fast rate of urbanization occurring in Africa and Asia draws special attention to problems faced by resource poor countries. The demographic advantage of youth in such countries would be lost unless combined with healthy living. Policy makers face the challenge of viewing healthy cities as 'systems' consisting of multiple subsystems along with the overarching super system of climate change."

Indira Nath, Chair of the Scientific Committee of ICSU interdisciplinary programme: "Health and Wellbeing in the Changing Urban Environment: a Systems Analysis Approach"

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"This is an ambitious project being launched at the right time with the right partners Achieving the global goals for sustainable development and resilient growth will increasingly depend on decisions made within and about urban systems. While urbanization has contributed to overall declines in poverty and potential advantages for access to health care and education, there are increasing concerns about emerging challenges that may exacerbate current health disparities within cities. Therefore, a better understanding of the linkages, dynamics and complexities of urban environments is needed."

Jo Ivey Boufford, President, New York Academy of Medicine and Executive Committee Member, InterAcademy Medical Panel

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"People make decisions every day in which they trade off their health for personal pleasure or convenience, be it when they consume fatty food or drive a car to work, for example. That means, living a perfectly healthy life is not the ultimate goal for many. For their own and the common good they are willing to sacrifice parts of their health. One of the questions we need to address in this programme is "how many health risks are people willing to take for the benefits that come with urban lives?" Citizens and policymakers need to be able to make that decision and become active agents of urban change. This programme will support them in making these decisions."

Franz Gatzweiler, Executive Director, International Programme Office, ICSU interdisciplinary programme: "Health and Wellbeing in the Changing Urban Environment, a Systems Analysis Approach"

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"Human health in urban areas represents a growing concern worldwide but nowhere more so than in China, with recent WHO reports of millions of deaths worldwide each year from urban air pollution. Urgent action is needed to protect and promote health through improved urban planning and design. Every week the world's urban population is growing by more than 1 million people, with a projected need to accommodate an extra 2 to 3 billion people in cities, mostly in small and medium-sized cities in low- and middle-income countries in Asia and Africa."

Yong-Guan Zhu, Director-General, Institute of Urban Environment, Chinese Academy of Sciences

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"By anticipating problems and acting now as these new urban areas develop and the built environment is 'locked-in,' we will avoid the difficult, costly task in future of retrofitting cities to make them healthier places in which to live. One of the distinct features of this programme is its intent to involve those who are making the major decisions about cities in all aspects of the programme, from the inception of research activity to making sense of the results. A systems analysis approach is seen as especially valuable to achieving this goal."

Pierre Ritchie, Vice-Chair, Programme Scientific Committee and Director, Centre for Psychological Services and Research, University of Ottawa

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"Human futures are urban futures. As most people now live in cities, and urban environments are important determinants of health, urban decision-making will affect the future health of the majority of the world's people. This new interdisciplinary science programme is particularly timely for the United Nations' post-2015 development agenda because it will deliver critical new knowledge for healthy and sustainable urban policy and planning."

Anthony Capon, Director, International Institute for Global Health, United Nations University

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"This important new programme will enable us to learn about which policies, implemented together, are more effective in improving people's health and well-being while lowering carbon emissions. Policy initiatives provide opportunities for natural experiments from which we can readily learn what works for improving health and what doesn't. Policies which give priority to road building tend to support urban sprawl. Houses built on city fringes, where there is little public transport, evidently increase household transport costs and energy use and reduce opportunities for active journeys in which people can walk and cycle."

Philippa Howden-Chapman, Director, New Zealand Centre for Sustainable Cities, University of Otago

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