Let’s bring back the urban health advantage

The benefits of living in urban centres are fading as poor city planning takes a toll on health, education and the environment. ADB’s Susann Roth talks about how we can reclaim the urban health advantage.

Slums in Manila.
Slums in Manila. Bad urban planning can result in poorer health results for city dwellers. Image: Ingo Vogelmann, CC BY-NC 2.0

Over the past decades, living in cities has been associated with better health. Better access to goods, services and opportunities such as healthcare, education and employment provided an “urban health advantage” to city residents. However, with rapid urbanisation in Asia the urban health advantage is actually becoming a disadvantage.

For poor people, access to quality health services and healthy living conditions remains challenging; this is reflected in worse mother and child health outcomes in South Asian cities compared to rural areas. For wealthy and poor urban residents alike, the impacts of urban pollution and urban lifestyle is leading to a high burden of non-communicable diseases.

Poor air quality in particular has become a silent emergency of global significance, with only about 1 in 10 urban residents breathing clean air. The epidemics of obesity and non-communicable diseases are other public health emergencies with root causes in urban living with long commutes as well as limited time to access healthy food choices and to exercise.

We must leverage growing economies’ capacity to invest in urban development now and ensure that our plans today are relevant for a better life tomorrow.

The reasons for the ‘urban health penalty’ we are now paying for include mismanaged and unplanned city development, rapid investments, weak urban governance, and neglected human needs. Urban development was and still is driven by car- and profit-oriented design.

For example, huge apartment complexes and wide streets have dominated urban development in the People’s Republic of China because the economic aspect drives urban and real estate development. Faster, bigger – but not better. In other Asian cities, the need to invest in public spaces and public transport was also ignored because real estate profits were more important.

With urban populations steadily growing, we are all suffering to some extent from the bad urban policies, choices and designs of the past (and present). We may live longer than before but we also get sicker faster and longer.

This calls for urgent action on urban livability based on four fundamental approaches:

1. Put people at the centre. 

Cities are by and for people, and health needs to be at the centre of urban development for city dwellers to recover the urban health advantage. Municipal governments should form intersectoral planning groups, which are accountable for people-centered urban development.

2. Learn from experience, apply lessons learned. 

Among the solutions for enhanced urban livability implemented successfully in some cities are publicly accessible green spaces, green networks, urban agriculture, ecosystem services for absorption of air pollution, water filtration, and sequestration of carbon dioxide, as well as pedestrian-friendly, car-free urban design.

Each city should mandate that a certain percentage of land is used for “green planning” and that developers need to comply with “green” design.

3. Look at cities as connected ecosystems for healthy lifestyles. 

We should invest in ‘connected cities’ which offer citizens services, workplace and recreational activities that are within reach for all. We won’t improve urban living by building more urban roads; let’s construct less roads and more walkways and pedestrian areas. We should also promote low-emission transport and move industries out of cities because unless the air quality in cities improves, people won’t walk or use bikes.

We need to study people’s mobility needs and ensure that they can live within a 15km radius of where they work. Access is everything. We need to develop a business case, which explains how healthy cities foster knowledge-based economies.  

4. Foster strong leadership, community engagement through civil society. 

The experience of European cities is that leadership at every level—including the community—helps drive demand for and raise awareness about healthy cities. The concept of community needs to evolve from family-centered to ‘community-centered.’

An active civil society and involved private sector are crucial to demand changes in urban planning for enhanced wellbeing and productivity. Intersectoral planning groups should actively reach out to civil society and private sector.

People will always be drawn to cities since cities are the economic engine of countries and the region. We must leverage growing economies’ capacity to invest in urban development now and ensure that our plans today are relevant for a better life tomorrow.

As Ronald E. Osborn rightly said: “Unless you try to do something beyond what you have already mastered, you will never grow.”


Susann Roth is Senior Social Development Specialist (Social Protection), Sustainable Development and Climate Change Department at the Asian Development Bank. This post is republished from the ADB blog.

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