Why City Health?
City living is ubiquitous. While a century ago, just 1 in 10 people lived in cities, today, for the first time in human history, more people live in cities than outside cities. By 2050, nearly 7 in 10 people around the globe will live in cities.[i]
Given that more than half of humanity now lives in cities, understanding how they affect human health is critically important. Cities are places of extremes. They generate excitement and ideas but they can also be fertile ground for diseases to fester and spread. Overcrowding, poverty, and poor air quality in cities creates substantial health challenges, but cities also have the creativity, the resources, and the energy to improve the health of their populations. Even within cities, the quality and quantity of life can vary dramatically. On example: travelling east from Westminster tube station in London, male life expectancy falls by a year at each stop.[ii]
But, despite these challenges, cities are key to improving human health.
First, cities catalyse innovation. With dense concentrations of people, cities can leverage the wisdom of crowds to generate novel answers to entrenched public health challenges. This is what Ed Glaeser has described as “self-protecting urban innovation”.[iii]
Second, cities adapt constantly and can build resilient systems.[iv] From housing to transport, alcohol licensing to parks and recreation, city leaders shape some of the most important determinants of health for their residents.
Finally, in a global market for talent, cities compete on wellbeing and ‘quality of life’, not just on jobs. [v] Access to healthy lifestyles are a central concern for today’s sought-after workers. Cities are investing in their walkability, social diversity, and appropriate green space to attract and retain talent.
As we anticipate the emerging public health challenges, cities can serve as the test bed for new strategies to promote better health.
The Opportunity and the Need
Researchers in public health addressed critical challenges of urban living in the nineteenth and twentieth centuries. Dr. John Snow identified the cause of cholera by analysing the patterns of deaths in Soho, London in the 1850s, paving the way for reforms of the sanitation system in London. The discovery of HIV was accelerated because a clinician in Paris connected with researchers at the city’s Pasteur Institute.[vi]
City health needs are ever changing. Investment in urban infrastructure, including sanitation, public transport, and housing, can have dramatic effects that drive economic growth and improve health. A growing population, a set of new challenges, catalysing economic growth while improving health – these are universal challenges, and they are particularly evident in key cities of Asia and Africa, where the pace of change has been particularly brisk. All cities need to make health a priority, both for the well-being of their populations and for their long-term economic viability. An unhealthy city will, over time, become an unproductive one.
The challenges facing cities in the 21st century transcend national boundaries and individual academic disciplines. With its global reach, convening power and multi-disciplinary academic strengths, Harvard is well-positioned to become a leader in global city health. By bringing together the best global thinkers and practitioners, and seeding innovative and novel research, the Harvard Global Health Institute can help cities around world improve health outcomes of their growing populations.
The Healthy Cities Initiative at Harvard
The Healthy Cities Initiative at Harvard will function as a hub of inquiry, bringing together people and organizations to spark new solutions to the most pressing health challenges facing cities. The Harvard Global Health Institute will begin by hosting a conference on the Health of Cities, with the goal of cultivating new partnerships and amplifying local innovations for the global community.
Second, the Institute will facilitate targeted research into areas that both represent the most pressing challenges facing cities and leverage Harvard’s multi-disciplinary talents. Potential topics might include urban design, rethinking healthcare delivery for pressing health issues, addressing local air quality, or redesigning transportation in ways that increase productivity and health.
Finally, HGHI will bring together senior policy makers to share best practices, lessons learned, build collaborations between cities, and develop working groups who, with senior Harvard faculty, tackle the most pressing challenges facing cities.
We anticipate the following Initiative components:
- Identifying and disseminating the state of city health. Determining key metrics and evaluating how selected cities are performing against these metrics.
- Mapping effective global city health practices. Case study based analysis of city action to address health challenges.
- Imagining the future of the healthy city. Developing tools for mayors and practitioners, including best practices, and other strategies by which cities can evaluate and improve health.
- Resiliency. Establishing a framework to identify exposure and vulnerabilities to pandemics, clean water, physical infrastructure, and air quality; and generate tools to enhance planning, response and recovery.
Supporting these efforts, the Harvard Global Health Institute will bring together scholars and practitioners from across the University, including the Graduate School of Design, the Harvard Kennedy School, the Harvard Medical School and the T.H. Chan School of Public Health, to shape the Initiative and inform its activities.
[i] United Nations. World Urbanization Prospects. 2014.
[iii] Glaeser, E. Triumph of the City. 2011.
[iv] Barber, B. If Mayors Ruled the World. Dysfunctional Nations, Rising Cities. 2013.
[vi] Glaeser, E. Triumph of the City. 2011.