Creating Healthy Cities in the 21st Century

THIS PAPER DISCUSSES the most important areas for action to improve health and the environment in cities. It begins by describing how, with "good governance", cities can be among the healthiest places to live, work and visit but that without it, they can be among the most dangerous. After outlining the scale and nature of urban change, the paper concentrates on five themes that are particularly important for healthy cities.

Building healthy cities. This section includes details of Healthy Cities programmes from Europe, North America, Asia and Africa, and of Cali's programme to address housing and health problems.

Addressing emerging and re-emerging diseases (and their underlying causes). This describes the growing number of what are usually termed "new" or "emerging" diseases, of which AIDS is the best known and one of the most widespread. These diseases are new in the sense that they have only recently become a significant public health problem however, in most instances, it is their incidence and geographic range that is new as they previously existed either in nature or in isolated communities.

Environmental pollution and health. This concentrates on the pollutants associated with inadequate provision for water and sanitation, and with inadequate control of air pollution (with a special focus on the impact of lead on children's health and development).

Child health. This describes how the quality of the environment into which an infant is born exerts a powerful influence on whether she or he will survive their first birthday and, if they do, their subsequent physical and mental development. It also outlines the preventable causes of death, illness and injury among children and how health risks change with age; also how well-planned and managed cities can achieve high standards of child health and development.

Women's health. This describes how, in most urban centres, women face five particular disadvantages for health: bearing and giving birth to children without a healthy, secure home and good quality health services; having health services that are inappropriate to their health needs; taking on most of the responsibility for child care and household management when housing conditions are poor and there is inadequate provision for water supply, sanitation, drainage and health care; discrimination in access to education, labour markets and resource allocation within households; and high levels of violence – including domestic violence. This section ends with a discussion of what a gender-aware city would entail.