By: Alanna Shaikh, MPH on April 04, 2016 This is the latest installment of our Takeaway series in which Alanna Shaikh breaks down the latest and greatest reports about global development Getting cities right is the key to our global future. The majority of the human population already lives in cities, and by 2050, 65% of all people will be urban residents. If the cities they live in don’t promote healthy, prosperous lives we’re going to be in trouble. The new World Health Organization Global Report on Urban Health takes a serious look at the impact of our cities on the sustainable development goals. According to the introduction, it seeks to provide “a baseline for understanding achievements to date for urban health, delineates key challenges going forward and highlights innovative solutions undertaken by local, national and international stakeholders to aid in the process of pursuing the SDGs.” The report looks at both the health challenges of an urban environment and the advantages that come with urbanization. Challenges include health inequities, non-communicable diseases, and malnutrition. These inequities are severe. Children in the poorest 20% of urban households are twice as likely to die before their fifth birthday as children in the richest 20%. Even the wealthiest cities still demonstrate major inequities. Non-communicable disease put both the lives of city residents and the prosperity of cities at risk, and they can no longer be seen as the diseases of the wealthy. Cardiovascular disease and cancer are now the top two leading causes of death in urban India, and they affect the poor as much as the rich. Malnutrition and obesity often co-exist in the same cities, and reflect the problems with access to food and city services in different ways. Cities, the report states, can also be designed and managed in ways that support health. “Hospitals, schools, businesses, city parks and planned public spaces are all more sustainable with human density.” If cities support universal health coverage, they can provide high quality health care. This allows for better control of infectious diseases and better outcomes for mothers delivering babies. Ensuring access to clean water and functioning sanitation services is both “achievable and sustainable, even in resource-limited area,” according to the report, and has a substantial positive impact on health. In Lagos, Nigeria, the report describes, an Ebola outbreak was rapidly halted through aggressive contact tracing efforts. All 900 people who had been in contact with the disease were identified. Nineteen were diagnosed with the disease, and the outbreak was stopped. The Denser the Better (Or, Houston, You Have a Problem) Houston, America’s fourth most populous city, is a sprawl City planning that encourages population density also has a positive effect on health and well-being. Denser cities allow people to access necessary services with minimal travel; reducing the need for expensive private and overall transit time. This has been shown to benefit mental health and to increase physical activity among urban residents. Urban sprawl, on the other hand, is harmful. The report points out that “a 2014 update to a landmark study of sprawling metropolises confirmed a negative correlation between sprawl, health and economic opportunity across 221 cities and 994 counties in the USA.” Transportation gets its own section of the report. It leads in by stating that “Transportation in the world’s cities is increasingly moving towards private motorized transportation,” and goes on to lay out why that is not a good thing. While private transportation may improve individual mobility, it contributes to air pollution and is linked to the kind of sedentary behavior that causes diabetes and heart disease. Increased use of individual vehicles also leads to traffic accidents. Massive numbers of traffic accidents – traffic crashes are now the eighth leading cause of death in the world. Crime and violence also get a chapter in the report. Different cities have every different experiences with violence. Levels of urban violence vary widely between and within cities, large and small, rich and poor. The report states that “Evidence implicates social exclusion, poverty, poor educational outcomes and inequality as key risk factors for violence in urban areas.” Urbanization, however, does not mean violence. WHO estimates that homicide rates have declined 16% overall since 2000 – they have been decreasing as urbanization increases. The report ends with a call for better urban governance. City governments, it states, are responsible for many of the factors that affect the quality of urban life – for example, urban planning, environment, safety, housing, pollution and access to health services. The urban governance efforts descried include both public-private partnerships and multi-sectoral action. Among other examples, it cites the case of Karelia, Finland, which launched the North Karelia Project in 1972. The project reduced rates of cardiovascular disease in Karelia, Finland, by engaging community organizations, dairy and meat producers, and schools to improve community health. What the report doesn’t say Cities aren’t bad for everyone. They’re bad for poor people. The report implies this in its discussion of health inequity and universal health care, but doesn’t say it explicitly. The health inequities discussed in the report make it clear that cities can be good for their residents. If wealthy people were suffering from city life, health would be bad but equitable. The better health of wealthy people proves that urban living can be good for health. One sentence takeaway Cities are the future of human life; good governance and fewer cars will make it a healthy future.