Sebastiana A. Etzo
Urban areas contribute to over 75% of global CO2 emissions, a significant proportion, considering that they occupy an estimated 3% of the Earth’s land. This contrast highlights the critical importance of sustainable urban planning with a central focus on health. This article explores the powerful nexus of health, urban planning, and climate change, emphasising the need for a unified approach that can directly address environmental challenges, reduce health disparities, and mitigate conflicts.
The health – climate change nexus
The recent COP28, held in December, marked a historic turning point by prioritising health at in the climate change agenda. For the first time, COP hosted a dedicated Health Day and the inaugural climate-health ministerial. The World Health Organization (WHO) had previously referred to climate change as “the single greatest threat to humanity”.
With over half of the global population, roughly 4 billion people, living in urban areas, cities are at the forefront of this challenge.[i] Urbanisation intensifies energy consumption, transportation demand, and resource use, but it’s also influenced by climate change, driving migrations and climate-induced conflicts.[ii]
Placing health at the centre of urban planning and policies offers a pathway to accelerate the energy transition from fossil fuels. Promoting people’s health and well-being is intrinsically linked to creating greener cities, reducing car dependency and promoting active mobility, improving housing and infrastructures, and fostering equity and justice.[iii]
The essence of healthy cities
The concept of “healthy cities” is far from new. Originating in the 1980s in Europe, it has evolved into a global movement that embodies quality of life, ecosystem robustness, inclusive services and feminist perspecives.[iv]
WHO defines healthy cities as
“… places that deliver for people and the planet. They engage the whole of society, encouraging the participation of all communities in the pursuit of peace and prosperity. Healthy cities lead by example in order to achieve change for the better, tackling inequalities and promoting good governance and leadership for health and well-being.” (WHO)[v]
Recognising the complexity
Healthy cities recognise urban spaces as complex ecosystems where public health, urban development, and environmental stewardship must coexist harmoniously. Moreover, they recognise the need to center marginalised voices, address historical injustices, and challenge colonial legacies. Diverse lived experiences and intersectional identities play a central role in shaping urban policies and practices.
Integrating health into urban planning and policies
Understanding urban planning and policies as enablers of human and planetary health is crucial for several reasons:
- Tackling the climate change emergency: urban areas are both contributors to and victims of climate change. We hear more and more about how climate change exacerbates health risks in metropolitan areas where heat islands, air pollution, and extreme weather events are particularly pronounced. Integrating health considerations into urban planning can mitigate these effects while enhancing their citizens’ well-being, as illustrated by the Intergovernmental Panel on Climate Change report (IPCC, 2014).[vi]
- Addressing inequalities: Health disparities often mirror socioeconomic and racial inequalities within cities, as we have seen too well during the COVID-19 pandemic.[vii] Rapid urbanisation can strain health systems, resulting in reduced access to healthcare, inadequate sanitation, increased transmission of infectious diseases, especially in informal settlements and vulnerable communities. Healthy urban planning must intentionally address these disparities with a decolonial and multidimensional approach.
- Reconciling competing narratives about the future of cities: Cities are hubs of innovationl and economic growth. Governments and municipal administrations pursue suggestive ideas of the desired cities, labelled as smart, creative, resilient, just or, more recently, referring to the “15-minute city”. Reconciling these often-competing narratives surrounding the future of town and cities is a complex challenge that demands a holistic approach. The “healthy city” approach integrates technology and innovation with sustainability, equity, and well-being, bridging the gap between competing urban planning discussions.
Translating theory into practice
Creating healthy cities requires working across disciplines and with diverse teams of experts. Multidisciplinary experts serve as a bridge between theory and practical application, fostering discussions and solutions across various fields of expertise. Enhancing the skills of urban planning and policy professionals involves instilling principles of health and sustainability in their training.
Analytical insight, through tools like spatial mapping and health impact assessments, offers pathways for prioritizing well-being while addressing climate change challenges. Evidence-based research, community engagement, and citizen science help understand local climate change impacts and their effects on public health.
Conclusion
In summary, the expertise of multidisciplinary professionals proves invaluable in realizing the vision of healthy cities. They play a pivotal role in connecting theoretical frameworks to practical applications, facilitating cross-disciplinary communication, and embedding principles that directly shape our urban landscapes. The dialogues initiated at COP28 have set the stage for this transformative work, and it is now our responsibility to advance this initiative and craft inclusive places that cater to everyone.
Urban planning as a tool for promoting health is an emerging and rapidly growing field. COP28, with its historic emphasis on health and climate change, has unlocked new opportunities. As we move forward, we have an exceptional chance to build upon the expertise that continues to develop in this field. By adopting a unified approach that centres health in urban governance and planning, we have the potential to create healthier, more resilient, and more equitable societies. This journey is not merely an academic exercise; it signifies a commitment to action, one that holds the promise of reshaping the very foundations of our urban environments for the better.
[i] Nieuwenhuijsen, Mark J. «Cities at the Heart of the Climate Action and Public Health Agenda.» The Lancet 9, no. 1 (January 2024): e8-e9.
[ii] United Nations. «Conflict and Climate.» July 12, 2022. https://unfccc.int/news/conflict-and-climate#:~:text=The%20evidence%20is%20clear%20that,climate%20change%20into%20conflict%20risks.
[iii] Palamar, Marcelina, and Willemien Bax. «How Cities are Addressing the Climate Health Nexus.» The Forum Network. Accessed [Date]. http://www.oecd-forum.org.
[iv] Triguero-Mas, Marta, Isabelle Anguelovski, and Helen V. S. Cole. «Healthy Cities after COVID-19 Pandemic: The Just Ecofeminist Healthy Cities Approach.» Journal of Epidemiology and Community Health 76, no. 4 (April 2022): 354-359. https://doi.org/10.1136/jech-2021-216725.
[v] World Health Organisation, “What is a Healthy City?”. https://www.who.int/europe/groups/who-european-healthy-cities-network/what-is-a-health-city, accessed February 20, 2024.
[vi] IPCC, 2014: Climate Change 2014: Synthesis Report. Contribution of Working Groups I, II and III to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change [Core Writing Team, R.K. Pachauri and L.A. Meyer (eds.)]. IPCC, Geneva, Switzerland, 151 pp.
[vii] Abrams, Elissa M., and Stanley J. Szefler. «COVID-19 and the Impact of Social Determinants of Health.» The Lancet Respiratory Medicine 8, no. 7 (July 2020): 659-661. https://doi.org/10.1016/S2213-2600(20)30234-4.
