A multilevel governance approach to preventing and managing NCDs: the role of cities and urban settings

WHO/Vitali Shkaruba

More than half the world’s population lives in an urban setting, which means that city and municipal governments are well placed to intensify the battle against noncommunicable diseases (NCDs).

The third high-level meeting of the United Nations General Assembly recognized the role of the local level in the prevention and control of NCDs. This spurred WHO/Europe to develop a policy paper for the WHO high-level conference on NCDs set to take place in Ashgabat, Turkmenistan, on 9 and 10 April 2019.

Municipalities are at the front line of global threats, including infectious diseases such as HIV/AIDS and tuberculosis, and NCDs such as asthma, heart disease, cancer and diabetes. They also face increased rates of violence and injuries, including road traffic injuries.

The WHO Global action plan for the prevention and control of noncommunicable diseases 2013–2020 is underpinned by a number of principles that cannot be implemented without the engagement of local governments. In particular, universal health coverage and the empowerment of people and communities can only be achieved by working directly with cities and municipalities.

The scope of competences delegated from the national level to the local, city and municipal level differs across Member States of the WHO European Region, meaning that each local government has a different role in this process.

These competencies cover many elements related to health and well-being. In relation to NCDs, they include partnering with health services for service delivery, addressing and tackling risk factors, regulating the sale of alcohol, and creating smoke-free public places.

Cities also provide adequate housing and essential education and social services, and address environmental determinants of health. Local governments play a key role in tackling the health inequalities that lead to increases in vulnerability and poorer health outcomes in communities.

Cooperation between various levels of government is critical, because while cities occupy just 2% of the world’s total land mass, they account for 80% of the world’s economy (gross domestic product). They also account for over 60% of the world’s energy consumption and emit roughly 70% of the world’s greenhouse gases.