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Urban health is complex because the solutions to health challenges in towns and cities do not lie with the health sector alone but with decisions made by others: in local government, education, urban planners, engineers and those who determine physical infrastructure and access to social and health services. These professionals have to face the challenges of overloaded water and sanitation systems, polluting traffic and factories, lack of space to walk or cycle, inadequate waste disposal, crime and injury.

Nevertheless, solutions exist to tackle the root causes of urban health challenges. Urban planning can promote healthy behaviour and safety through investment in active transport, designing areas to promote physical activity and passing regulatory controls on tobacco and food safety. Improving urban living conditions in the areas of housing, water and sanitation will go a long way to mitigating health risks. Building green, inclusive cities that are accessible and age-friendly benefits all urban residents and their health. The Healthy Cities movement emphasizes the need for community participation in the decisions that affect people’s lives.

Background

Cities throw inequality in health into sharp relief. Wider socioeconomic determinants affect the distribution of income and educational opportunities, and urban poor people typically live in the most polluted, isolating neighbourhoods. They suffer disproportionately from a wide range of diseases and other health problems, with an increased risk of chronic disease, and some communicable diseases such as tuberculosis and HIV/AIDS. They are also most at risk from violence.

People in cities get less exercise and have higher rates of tobacco use, harmful drinking and unhealthy diets, which are all risk factors for diseases such as cardiovascular diseases and cancer. Older people may be isolated; young people may have nowhere to go and children nowhere to play. This affects rates of obesity and mental ill health. Urban areas are by far the most affected by road traffic injuries and vehicle-related air pollution.