Many cities face a triple threat: infectious diseases, which thrive when people live in close proximity to one another; non-communicable diseases, such as heart disease, cancer, and diabetes, which are on the rise as unhealthy diets, lack of physical exercise, and tobacco use persist; crime, violence, and traffic accidents also pose a serious threat. Healthy cities demand intersectoral action as the quality of urban life is determined by a complex web of factors, such as education, health care, economic development, environmental sustainability, and transportation.
On November 3, 2014, experts from Germany and the U.S. convened at the German Center for Research and Innovation in New York to discuss the kinds of interventions needed to make our cities healthier. Prof. Dr. Susanne Moebus, Head of the Centre for Urban Epidemiology at the Institute for Medical Informatics, Biometry and Epidemiology at the University of Duisburg-Essen, Dr. Karen Lee, Global Health and Built Environment Consultant for the New York City Department of Health and Mental Hygiene, and Prof. David Tulloch, Associate Director of the Grant F. Walton Center for Remote Sensing and Spatial Analysis at Rutgers University, addressed the interrelations of urban planning and public health. This panel discussion was organized by the German Center for Research and Innovation (GCRI) and the New York liaison office of the University Alliance Ruhr (UA Ruhr).
Following welcome remarks by Peter Rosenbaum, Executive Director of the UA Ruhr New York office, Prof. Tulloch introduced the evening’s topic by summarizing the main factors affecting public health in urban areas, namely, traffic accidents, clinics, epidemics, asthma, obesity, and lifestyle choices. He then briefly outlined his research on geospatial technologies, which includes the mapping and analysis of spatial patterns of childhood obesity in New Jersey cities. He noted the extent to which spatial patterns, such as access to care as well as the density of convenience stores and centers of physical activity, impact childhood obesity. What makes cities healthier, though, he explained, is not just a matter of better access and connectivity, but also improved information and data management.
Prof. Dr. Moebus then elaborated on how social, economic, cultural, and physical environments function as key determinants of health. Since the concept of risk factors was launched by U.S. Framingham Heart Study investigators in the 1960s, research has primarily focused on behavioral and biomedical risk factors. The most well-known risk factors include smoking, poor nutrition, lack of daily physical activity, obesity, high blood pressure, and personal genetic makeup. Prof. Dr. Moebus identified lack of education, low-paying jobs, and poverty as a few of the underlying causes behind these individual risk factors. In other words, where one lives and under what circumstances determines one’s health and life expectancy just as much as dietary choices or physical activity.
Prof. Dr. Moebus then presented the renaturation of the Emscher River, an open wastewater conduit, as an example of a public health intervention that testifies to the Ruhr areas’ successful transformation from a former coal mining and steel manufacturing hub to one of Germany’s most vibrant regions for science, research, and culture. With an investment of 4.5 billion euros and a construction phase of several decades, the Emscher conversion project is one of Europe’s largest infrastructure projects that will have positive long-term health effects on the Ruhr Valley’s residents.
To conclude the evening, Dr. Lee discussed how even in the developing world, non-communicable diseases have overtaken infectious diseases as the leading cause of death. Globally, they are responsible for over 36 million deaths each year. Just as improvements in the environment, such as sanitation measures, were the critical factor in the control of the infectious disease epidemics in the 19th Century, evidence is mounting that the design of our communities, neighborhoods, streets, and buildings are influential in shaping risk factors for non-communicable diseases. Doing so will not only provide opportunities for improving health in the 21st Century, but also for ensuring progress for other key priority areas, such as environmental sustainability, universal accessibility, and economic development.
Strategies Dr. Lee discussed included creating more walkable neighborhoods with safer bicycle paths and inviting sidewalks in addition to constructing supermarkets easily accessible by foot. Similarly, to promote physical activity, building interiors should lead individuals to the stairs first rather than to the elevators. The costs of creating these “active” buildings and neighborhoods pales in comparison to the $860-956 billion expected by 2030 in health care costs attributable to obesity, brought on by junk food consumption and sedentary lifestyles. Small changes matter a lot, Dr. Lee emphasized, as simply taking the stairs instead of the elevator on a regular basis could prevent most people from becoming obese or developing diabetes.
In conclusion, healthier environments need broad and intersectoral interventions, not all of which necessarily require major investments like the Emscher conversion project. They do, however, call for policy changes and increased collaboration between city planners, health experts, and designers. A lively discussion with the audience moderated by Prof. Tulloch then ensued, addressing topics ranging from how gamification can be used an incentive to increase physical activity levels to what the government can do to better engage community retailers to improve nutritional offerings.
