Urbanization: A multidimensional challenge and opportunity for health, well-being and equity

February 8, 2018

Dramatic images from some of the world’s largest and fastest-growing cities make visible the impact of air pollution. But what the headlines do not capture is the full scope of the profoundly negative human consequences of unplanned urbanization. Each year more than 3 million people die of diseases triggered by air pollution, and this is only one of many health challenges facing urban centres today.

Struggles of migrants or refugees suffering from non-communicable or communicable diseases, and denied access to health services because of their residency status, are often invisible. Victims of car accidents become simple statistics, rather than the connection with poor street infrastructure being understood. The stories of the poorest, those living in informal settlements without access to quality housing or water and sanitation, are rarely heard. 

If we are to meaningfully improve health, well-being and health equity, we must recognize the features that make city dwellers uniquely vulnerable to disease. For example, high population density and insufficient waste management systems in informal settlements cluster people around water-, food- and air-borne health risks such as cholera and tuberculosis.

Cities also have relatively larger populations at higher risk of HIV, sexually-transmitted infections and other communicable diseases. Furthermore, violence and injuries are more common in urban than rural areas. About 5 million people every year die because of injuries from violence and accidents, and 90 percent of fatal global road traffic accidents occur in cities within low- and middle-income countries. Global warming, rising sea levels, and increased risk of natural disasters further adds unique health risks for cities.

The impact of unmanaged urban development extends beyond poor health; it increases poverty and inequalities, and reinforces exclusion and vulnerability.

Yet, there is much to be optimistic about. When managed well, cities offer greater access to quality services, employment opportunities and education, versatile nutrition, safe housing, and access to clean energy and water. Moreover, cities have shown to be centres of inclusion, innovation and progress, in many cases putting in place policies to protect their residents that are stronger and more effective than national ones.

Sustainable Development Goal 3 (ensure healthy lives and promote well-being for all at all ages) and Goal 11, (make cities and human settlements inclusive, safe, resilient and sustainable) are inter-connected.

Within this context, the theme of the 9th World Urban Forum, “Cities for All: Implementing the New Urban Agenda”, offers an opportunity to help advance specific, practical and impactful health and development solutions for multidimensional urban challenges.

Some of the most effective measures that local governments can take are providing all city residents – including slum dwellers and migrants – equitable access to quality housing and health and social services, curbing air pollution, increasing preparedness to natural disasters, upgrading streets and public spaces, and adopting effective measures to restrict the availability, accessibility and use of unhealthy products. Most, if not all, of these solutions benefit multiple dimensions of development and require the engagement of sectors beyond health, bringing to the fore the importance of strong multisectoral local governance capacities.

In line with its new Strategic Plan, UNDP is well-placed to support countries and cities to develop and implement integrated policies that simultaneously tackle urbanization, health and development. These investments and related partnerships, especially when the urban poor are put at the centre of our response, will yield dividends in the form of lives saved, decreased health expenses and increased productivity.

About the authors
Mandeep Dhaliwal is the director of the HIV, Health and Development group within the Bureau for Policy and Programme Support at UNDP. Follow Mandeep on Twitter: @Mandeep_Dh

Suvi Huikuri is a consultant with UNDP’s HIV, Health and Development team. She works on planetary health and non-communicable diseases. Follow Suvi on Twitter: @SuviHuikuri