# Cities for global health ## Sentence crafting ### Concept of healthy city Concept of [[healthy city]] is proned to be disconnected from the multidimensional complexity of urban development, from demographics, social, natural, built, food environments that are constantly changing. ### Environmental Environmental factors in which people reside contributed to the creation (or destruction) of [[healthy city]]. Infrastructure, technologies, and even regulations collectively constructed a city development that provides clean sanitation. Apart from water, there are a range of other environmental factors that promote healthy living in a city: air pollution, noise pollution, availability of green space, waste management, and other toxic waste. Inequality in cities remain, or even worsen, because the poorer areas are often designated to accomodate waste from richer areas of the same city or even from other locations. For example, in Indonesia, Bantar Gebang is an open-dumping landfill area outside Jakarta, where it receives 7,000 tones of waste daily from Jakarta. Each household near Bantar Gebang gets 13$ in compensation per month. ### Housing ### Nutrition City means better infrastructure, transport, trade, and sales to better nutrition. In short, ample opportunities for better nutrition. However, on the other hand, [[commercial determinants of health|commercial nature]] of food provision in cities can raise the cost of healthy foods, enable corporations to influence unhealhty eating habits through marketing and sales, particularly the [[unhealthy commodity industries]]. Also, [[trade liberalisation could affect popular diets]] , which the poor and marginalised communities bear the consequences, as they don't have choice or fiscal power to buy expensive healthy foods, and instead must choose to eat cheap, high-calorie foods. ### Addiction Cities provide a focal point for the distribution and consumption of addictive substances (tobacco, alcohol, and illicit drugs). Both commercial and informal suppliers typically prey on poor and vulnerable populations. ### [[Universal Health Coverage]] Although social protection, providing healthy nets, and limiting out-of-pocket payment often comes under national jurisdisction, cities may provide additional safety nets for those without insurance coverage. Health facilities in cities also usually provide services not only for their own residents but also act as a referral centre for rural residents who nee specialist care. It's important for cities to have integrated primary care to avoid overloaded secondary and tertiary hospitals. ### Public safety and emergency response Public safety and emergency response are essential functions of cities that can contribute to health through prevention (enhanced neighborhood, traffic safety, reduction in crime) or emergency hotline and through mitigating adverse outcomes from acute events, eg, faster response to heart attacks, road traffic crashes. ### Infectious disease outbreaks Due to its population density compared to rural areas, cities are more prone to infectious disease tramissions, with consequences extend beyond health, as seen with Ebola. Important for cities to have isolation, quarantine, contact tracing system in place. Also cities play a major role in the distribution of medical countermeasures, for example antiviral drugs distribution during the 2009 H1N1 pandemic. “This makes detection and control of epidemics a direct function of cities, which requires robust city based outbreak surveillance, detection, and control systems that are coordinated between neighbouring municipalities.” (Ezzati et al., 2018, p. 3) ### Smart cities and emerging economies and technologies Technology provides opportunities as well as challenges. It might improve health by better sensing, detection, and enhance digital footprints for disease surveillance and disease tracking, early warning system or alert system based on [[Artificial Intelligence (AI)]], and better nutrition tracking. Promote active lifestyle or [[Active commuting]] with bicycle and car sharing systems. On the flipside, such technology may worsen health and wide inequalities. Sharing system like Airbnb may be affecting the already limited housing supply in cities, and the gig economy may be worsening social inequalities by reducing wages and job security, promoting informal sectors and shrinkage of middle class, as seen in Indonesia. ### Migrant, transient, and peri-urban populations Cities are often the homes to refugees, asylum seekers, undocumented migrants, and internally displaced persons. City boundaries are also increasingly blurred by large groups of transient populations who seek jobs in cities, even in China which has a tightly controlled systems. ## Key Takeaways “The agglomeration benefits that attract people to cities inevitably create higher living densities and housing costs, which in larger cities are exacerbated by the presence of highly paid expatriate staff employed by multinational corporations. The high cost of housing in cities leads to inequalities in housing quality and neighbourhood conditions” (Ezzati et al., 2018, p. 2) “Cities can leverage the benefits of food trade and sales through food hygiene laws and inspections and through healthy food programmes that support poor people, such as healthy school meals, food stamps designated for healthy foods,3” (Ezzati et al., 2018, p. 2) “Cities have an important role in tackling addiction and its health consequences37; they can, for example, levy additional taxes beyond national or provincial dues; restrict the locations and opening times of alcohol and tobacco outlets through licensing; regulate product advertising; legislate smoke-free areas; raise the minimum legal age for sales; institute sobriety checkpoints and random breath testing; implement designated driver campaigns; sanction the use of currently illicit substances in monitored locations for harm reduction; and provide addiction counselling and treatment services.38” (Ezzati et al., 2018, p. 2) [[All health politics are local]] “The local politics in cities, whereby politicians and citizens live side by side as members of the same community, provide an opportunity to avoid and resist the exclusionary and austerity trends seen in national politics and economics around the world and to make health inequalities the central focus of urban health policies” (Ezzati et al., 2018, p. 3)