A decade ago, a few allotments were the only healthy activity in a stretch of east London dominated by factories, pollution and rubbish. Next month, the London Legacy Development Corporation will start work turning it from a glitzy Olympics hub into a public space with modern sporting infrastructure, cultural attractions, homes, offices and shops.
Peter Tudor, director for venues at what will become the Queen Elizabeth Olympic Park, says: “We are going to make sure this becomes not an isolated island in east London but a park for east London. We are committed not just to providing sporting facilities but quality of life in an area with obesity and shorter life expectancy.”
The result will be the start of one of the UK’s most ambitious – and costly – urban renewal projects that will provide public transport, affordable sports facilities and even personal trainers “prescribed” by local doctors to improve the health of residents. Cycling and walking will be encouraged.
With more than half of the world’s 7bn people now living in cities, there is an increasing need for fresh policies to meet their specific needs, through projects such as those recognised by the FT/Citi Ingenuity awards.
There has been much talk of an “urban advantage” in health. The argument goes that city dwellers, with greater access than people in rural areas to medical facilities, lead longer, healthier lives. But that is far from universally true in richer countries let alone the developing world.
Yvonne Rydin is director of the Environment Institute at University College London and co-authored the recent Lancet Commission report Shaping Cities for Health. “Everybody agrees urban areas have the potential to improve health and we know how to make cities healthier,” she says. “We know what we need to do, but institutions are still not doing it. It’s really frustrating.”
While few diseases are specifically urban, many are more prevalent in urban areas and are exacerbated by high population densities. The surge in motorised transport has made cities a disproportionate locus of accidents, while emissions have contributed to a concentration of respiratory diseases.
The primacy of the car has led to less physical activity in urban working life, while the demand for building land has reduced the amount of green space available for leisure.
Cities also host huge inequalities, presenting policymakers with ethical and practical concerns. Large concentrations of poorer residents with ill health require specific policies; their proximity to richer, healthier neighbours can lead to mental problems and crime for all.
“We need to work with patients and the public, and bring services out of hospitals into the places of highest need,” says Arpana Verma, director of the Manchester Urban Collaboration on Health at the University of Manchester.
In much of the developing world, notably in the informal slums and shanty towns that are the fastest-growing urban residential areas, better provision of sanitation, clean water and other basic services would make the greatest difference to health.
In the absence of more systematic, government-led provision in India, the Child Eye Care Charitable Trust in the slums of Mumbai has worked with mothers to address malnourishment and vitamin deficiency in their children, in the process empowering the community to improve hygiene and the quality of the local environment.
Pro Mujer, another project on the shortlist in the healthcare category of the awards, initially focused its work in Nicaragua but has now spread to other parts of Latin America. It built on its existing networks that offer financial services to women, providing low-cost medical consultations as well.
In Egypt, Protect Your Child has organised competitions for parents, combined with colouring books and cartoons distributed to children, to spread health education messages such as the importance of hygiene and vaccination.
GlaxoSmithKline’s New Citizen Health Care project in Shanghai is providing health education and treatment for migrant workers, one of the most disadvantaged groups in China’s rapidly urbanising population.
While all these examples come from poor city areas, there are two similarities with urban health initiatives everywhere: the importance of prevention rather than simply treatment, and the empowerment of local communities and individuals to make a difference.
That is echoed by Hugh Barton, emeritus professor of planning, health and sustainability at the University of the West of England and an advocate of integrated public transport and green spaces to encouraging walking. “The most fundamental thing is to give power to the cities,” he says. “Public health specialists now recognise the importance of the built environment, but builders, planners and governments are still not taking into account public health.”