Health promotion

The mandate for healthy cities

Globally, more people live in urban areas than in rural settings. While cities offer many opportunities for employment and access to better services (health, education, social protection) that are necessary for good health and human development, cities can also pose unique health risks.

In urban slums and smaller informal settlements, overcrowding and lack of access to safe water and sanitation contribute to the spread of infectious diseases such as tuberculosis (TB), for example. Rates of noncommunicable diseases (NCDs), violence, and mental illness are also often higher because of cities’ social, built and food environments.

Meanwhile, only 12 percent of cities globally reach pollution control targets. With such trends in mind, the World Health Organization (WHO) has identified urbanization as one of the key challenges for public health in the 21st century.1

The importance of managing and planning urbanization in a way that advances, rather than holds back, health and health equity will only grow. By 2050, 70 percent of the world’s people will live in cities. We must strive to ensure that they are living in healthy and liveable cities that are: “continually creating and improving those physical and social environments and expanding those community resources which enable people to mutually support each other in performing all the functions of life and developing to their maximum potential.”2

From Ottawa to Shanghai & the sustainable development agenda

Thirty years ago, the Ottawa Charter for Health Promotion recognized the need to enable people to increase control over and to improve their health and well-being by ensuring healthier, sustainable environments where people live, work, study and play.

Social justice and equity were highlighted as core foundations for health, and there was agreement that health promotion is not simply the responsibility of the health sector. Subsequent WHO global health promotion conferences have reiterated these elements as key for health promotion.

The 2030 Agenda for Sustainable Development, the world’s ambitious and universal “plan of action for people, planet and prosperity , includes 17 Goals, 169 targets and 231 initial indicators. The Agenda offers a new opportunity to involve multiple stakeholders to ensure that all people can fulfil their potential to live in health and with dignity and equality.

With this in mind, the theme of the 9th Global Conference on Health Promotion, Health Promotion in the Sustainable Development Goals is both timely and necessary to ensure policy coherence and alignment of agendas for action. The slogan: Health for All and All for Health” captures the commitment to leave no one behind and to involve all actors in a new global partnership to achieve this transformative Agenda.

The 2030 Agenda for Sustainable Development places renewed emphasis on just how interconnected our social, economic and environmental ambitions are. Health promotion efforts grounded in a healthy cities approach can contribute to achieving the Sustainable Development Goals (SDGs), including SDG 11: Make cities and human settlements inclusive, safe, resilient and sustainable.

The unique contributions of the successful WHO Healthy Cities programmes/movement have included a strong value-based commitment to innovations at the cutting edge of social determinants of health and Health in All Policies. Today, thousands of cities worldwide are part of the Healthy Cities Network in all WHO regions. This has become an important platform for achieving health and sustainable development in many parts of the world, as cities are often at the forefront of innovation with mayors and municipalities spearheading efforts to improve the daily conditions of urban life.

A healthy cities approach which catalyzes political leadership and participatory governance can be transformational for health and health equity, as well as help mitigate the impacts of environmental degradation, climate change, ageing, migration, growing inequalities and social isolation.

Major health inequities persist across the world, with rates of illness and premature death significantly higher amongst the poorest and most excluded groups. This is true across countries, within countries, and most starkly within cities. As a result, groups least able to deal with the costs of illness are also those most likely to endure them.

This is not a matter of chance – the poor and marginalized are more likely to live and work in environments that are harmful to health and have less access to services and amenities. A healthy cities approach can uniquely address this and other injustices. It can advance health and health equity while also advancing other sustainable development goals.