Making the links between cities and health for World Habitat Day

By Lynda Keeru

Unbeknown to many, there are lots of connection between cities and health and this becomes even clearer in the face of pandemics. As has been said over and over again since the COVID-19 debut, epidemics reveal the reality of things. This view was reflected by most of the speakers during the  ‘Webinar on Pandemics and Future Cities’  held on 5th October 2020.

With representation from across the world and all continents, one could not help but feel the sense of solidarity and unity brought about by the pandemic and the willingness to join efforts in its eradication.

In April the United Nations Human Settlement Programme (UN HABITAT) started work on a new flagship report – “The future State of Cities in a World with Pandemics” – to be launched during UN’s “Urban October” campaign 2020. Habitat Norway, in collaboration with UN Habitat and world leading experts, facilitated a presentation and discussion of the reports main findings, conclusions and recommendations. It focused on health, human rights, housing and humanitarian challenges.

A statement from the organisers read,

“The pandemic has triggered unparalleled global action and exposed stark social and economic inequalities and system weaknesses. It has shown that we have to abandon the old, normal way of dealing with global emergencies. It has highlighted that long term complex challenges and short term crisis demand new responses and ways of working. As we look ahead: what do we need to do differently? And what can we learn from the pandemic? What kind of collaboration and action are needed to achieve transformative change and prepare us for a radically different world? Cities will because of demographic and economic development be central.”

Participants from all realms including Civil Society Organizations, academia and government representatives met and discussed the new ways of working and living that need to be developed to tackle present and future crises drawing on lessons learnt from capacity building, advocacy and grassroots’ experiences.

To this end, Annie Wilkinson a member of the ARISE consortium, made a presentation –  “Addressing systematic Poverty and inequality in Cities-the health challenge”. She started off by defining the urban health challenge which she said was largely a result of the growing urban population, especially in low- and middle-income countries. Inequality and poverty without a doubt present very negative impacts on health but unfortunately the health determinants in many of these urban settings are unknown to many. Most urban-health interactions are not paid attention to with very little being known on the most vulnerable people and settings especially the one billion people living in informal settlements.

Epidemics are a window into society and they reveal a lot with many wondering if COVID-19 will be a turning point. Annie explained that the way we deal with infectious disease has changed – moving from sanitary and infrastructural reforms to behaviour change and ‘silver bullets’ becoming increasingly disconnected from urban environments.

Drawing on learning from the Ebola epidemic in West Africa, Annie reflected on the challenges that the urban poor faced. She outlined the issue of urban neglect which facilitated spread of the disease, the ill equipped public health teams that could not manage the epidemic response, the histories of structural violence and inequality that led to distrust, violence and resistance. Most noteworthy, locally led control efforts are what eventually bent the curve of the epidemic. Ebola, just like many other pandemics, highlighted the social and political dimensions of health and the need for inclusive responses.

In the case of COVID-19 in informal settlements, people fear the spread of the virus but the greatest challenge is the lack of understanding of vulnerabilities and heterogeneity due to lack of data. Unfortunately, many of the blueprint response guidelines that were prescribed for COVID-19 were not practical and feasible for most populations and people in urban informal settlements. Most of the vulnerable were not reached by state support systems. However, social movements have worked hard and mobilized support networks to plan locally appropriate and inclusive responses. In most cases, this kind of support is made possible by long standing collaboration between residents and local authorities.

A focus on why cities, their inhabitants and urban health interactions are overlooked revealed that the attention and spending on urban development is very limited. The data on the most vulnerable populations and places is sadly very limited and an absence of policy frameworks on national urban policy omitted is from sectoral policies like in health and pandemic preparedness is a huge issue. Siloed expertise and politics of neglect that encompass exclusionary policy and practice and historic blaming of the poor are a huge contributing factor of this misunderstanding.

In order to understand the complex picture of inequality and systematic poverty in cities, we must acknowledge the homogenous social, political and economic relations that shape the urban spaces. Another factor that contributes to this complexity is the fact that drivers of health and wellbeing comprise intersections between environmental deprivations and hazards as well as social marginalization, stigma and violence. The governance in cities is also very complex across different sectors, administrative and spatial scales much of which is unknown and informal to many, making accountability a hard process. People in cities have diverse forms of power and agency and it is quite difficult to identify drivers of multiple, intersecting inequalities in health and wellbeing and routes of redress.

What then is needed to address this challenge?  It is vital to increase investment, gather more data and attention to the issue. It is also paramount to have the right perspective; which will mean, as Annie put it, “seeing like a city”, like a citizen and also paying attention to what and who is not visible. Interdisciplinary, intersectoral and intersectional approaches are required, with special attention to power dynamics and the inclusivity of the most marginalized. Finally, there is need to focus on the social context and infrastructures which incorporates processes of learning dialogue and collaboration.

A one size fits all approach and generalization do not work in this case because cities are different, the settlements in them are varied and so are the populations and people.