Our current cities are places that can protect and promote health or, on the contrary, places that can favor the appearance of different diseases. Health research from the urban framework is, therefore, increasingly relevant. Currently, 80% of the population in Spain and Europe live in environments classified as urban. The United Nations global demographic trends predict that two-thirds of the planet will live in cities by 2050.
“Today, cities are taking over the world’s challenges: growing inequality, environmental pollution and unsustainable growth that ignores the climate crisis,” says Dr. Mary Bassett, director of the New York City Department of Health in the United States. years 2014 to 2018 and current head of Health for the state of New York.
Urban health as an area of research has seen enormous development over the last three decades and for this it is key to understand cities today. For example, global cities such as Bogotá, Buenos Aires, Madrid, Barcelona, Sao Paolo, Mexico or New York offer multiple opportunities to work, to train and share leisure spaces and thus continue to attract population. At the same time, these global cities are characterized by their inequalities and urban segregation with large areas with high rates of poverty and unemployment. In Europe, the study Socioeconomic segregation in 13 European capitalsanalyzed the evolution of the gap between rich and poor from 2001 to 2011 and its results showed a general rise in inequality and segregation, where Madrid is one of the cities with the greatest distance between some people and others.
Urban health research must answer questions such as: How do cities and their characteristics affect health? Are urban inequalities and segregation related to health? What are the necessary changes in our neighborhoods and cities to improve the health of the millions of people who live in cities on the planet? What are the diseases that characterize our cities and those that we must prevent?
As we proposed in the Heart Healthy Hoods (HHH) study, there are multiple and different domains of the urban environment that affect the health of the millions of people who inhabit the cities of the planet and we have investigated this in this way. Madrid.
The design of streets, the availability and use of parks and green areas, the presence of sports facilities or active public transport are key features of the design of our neighborhoods and cities that determine the levels of physical activity and sociability that determine our health. .
Access to healthy food, advertising of different food products in our neighbourhoods, levels of food insecurity in families, or the composition of menus in schools affect the quality of our diet and, therefore, our Health. The availability, price, advertising and tobacco and alcohol control measures in our neighborhoods affect their consumption and, consequently, our health.
Years of life between neighborhoods
From the point of view of urban health, we must attend to the different age groups. When we are children and the elderly, the radius of action of our activities is much smaller than that of adolescents and adults. On the other hand, there are important risk factors such as pollution, in its different forms, which affect the health of all residents of any city, such as those we have today, with extremely high levels of pollution, mainly due to road traffic.
A key indicator in health is life expectancy. In today’s cities there may be differences in life expectancy at birth between neighborhoods in the same city of 10 years as in Madrid, 16 years as in Baltimore and 18 years in Santiago de Chile. Studying different cities in Latin America we find that there are up to 14 years of difference between some cities and others. There are cities like Valparaíso, Chile, that have life expectancies like in Europe and others like in situations of armed conflict like Juárez, Mexico. And very importantly, are these differences increasing or decreasing?
The diseases that affect the population of our cities are mainly chronic non-communicable diseases such as diabetes, cardiovascular disease or cancer. In recent years, we have seen a resurgence of mental illness and communicable diseases, most notably COVID-19. We study all these diseases from an urban framework and health prevention and protection in our cities.
Urban health forces us to understand the social phenomena that characterize our cities, our neighbourhoods, in order to finally be able to protect and promote the health of the millions of people who live in cities and, above all, of all those who need it most, those who live in underserved areas. The perspective of equity in health in our cities allows us to improve the health of all its inhabitants by focusing on those individuals and families who need it most, and this is what the New York City Department of Health has been working on since research and intervention.
health, not disease
Urban health research focuses on health and not on diseases. This is a fundamental characteristic of classic urban studies and urban planning, such as the study of functioning urban public spaces that offer pleasant and healthy spaces for the citizen. From this positive point of view and on a human scale, salutogenic in terms of public health, cities were studied by key architects and urban planners such as Jane Jacobs or Jan Gehl.
From the urban health experience of cities such as Gijón, Barcelona and Madrid, we propose the need to establish long-term collaborative relationships between citizens, political decision makers, and research staff, to improve the health of all the people who share the same city.
Research on cities and health necessarily includes the social sciences so that, from anthropology and sociology, geography, economics, political science and demography, among others, we can understand the social phenomena that determine health in our cities. cities. Ecology and environmental sciences are key sciences today to understand the relationship between climate change in cities and health. This area of research goes through the sustainability of our cities in key issues such as transport and pollution or the quality of the diet and the sustainability of urban food systems.
Research in this field requires that the scientific evidence generated from different cities on the planet serve as a guide to act, improve our cities and improve the health of millions of people. And there are very interesting examples of research and its application and evaluation in the real world in different urban domains. How to improve streets, parks, sports facilities so that we have higher levels of physical activity. How to control and reduce the consumption of tobacco and alcohol, especially in the adolescent population of our cities. How to improve the nutrition and diet of older and younger people in our neighbourhoods, our cities.
From this entry to EL PAÍS Salud, it will be a pleasure to share knowledge and scientific evidence on key issues in urban health that serve to build cities where all citizens can achieve the highest levels of health and well-being.
Manuel Franco He is a professor and researcher in Epidemiology and Public Health at the universities of Alcalá, Spain and Johns Hopkins in Baltimore, USA. His research projects focus on Urban Health and Social Epidemiology. He has directed the project Heart Healthy Hoods (HHH), first project funded by the European Research Council (ERC) to study the physical and social characteristics of neighborhoods and the health of their residents.
Health goes by neighborhoods It is a section that explains in a simple and friendly tone the concepts and advances of research in Urban Health, a necessarily interdisciplinary area of Public Health. Urban Health research aims to improve our cities to improve the health of the millions of people who inhabit the complex and unequal cities that characterize life on our planet today.