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Design cities differently and it can help us live longer

In this article, originally published in The Conversation, Dr Tolullah Oni, and Rizka Maulida, write about the urgent need to design cities in a way that protects individual and planetary health.

By 2050, it is projected that almost 70% of the world’s population will be living in cities, up from 55% today. The fastest urban growth is happening in Asia and Africa, which is also where we’re seeing a rapid rise in people suffering from, and dying of, heart disease.

The impact of non-communicable diseases on the world population’s health is growing. Non-communicable diseases are those that are not directly transmissible from one person to another. By 2030, scientists predict they will account for 77% of the global burden of disease. Cardiovascular or heart disease is the most common type, responsible for 44% of all deaths related to this category.

New research from the University Medical Centre in Mainz, Germany, explores how urbanisation exacerbates the risks of such diseases. Young people are increasingly concentrated in the world’s cities. Their future health is at risk. Can city planning can be harnessed to protect their health?

A growing problem

The Mainz study synthesises the existing evidence on the impact of several urban environmental risks. These include air pollution (over half of the global deaths from air pollution are due to cardiovascular disease); transport noise (which contributes to the risk of metabolic disease by raising stress hormones levels, heart rate, and blood pressure); and light pollution at night (associated with changes to the circadian rhythm, which is linked to conditions including obesity and heart disease).

The study then highlights how human health and climate change are linked, and what can be done to help. Urban infrastructure is destroyed and populations harmed by the effects of extreme weather, floods and heat stress.

Scholars speak about this enmeshing of human health and the wellbeing of the natural systems on which we depend as planetary health. Increasingly, this is seen as a guiding principle that should drive all urban policies.

Healthful urban planning

Building cities for cars and urban sprawl encourages car use, traffic congestion, air pollution and noise. The result is more stress, road trauma and physical inactivity as well as worse health overall and more deaths.

It follows that we need better designs for our cities. Research has shown, for instance, that 20% of all deaths could be prevented if cities were designed to meet the recommendations for physical activity, air pollution, noise, heat and green space.

The Mainz authors have identified four urban models that can be described as healthy. The first is the compact city: high-density, with direct public transport and bountiful green space. Melbourne is currently being transformed along these lines.

The second model is the superblock city. Here, blocks are bounded by arterial roads, within which pedestrians and cyclists have priority and residential traffic only is permitted, with a maximum speed limit. In Barcelona, urban planning in this way is estimated to prevent almost 700 premature deaths every year from air pollution, road traffic noise and heat.

The 15-minute city, meanwhile, has recently regained popularity as a means of rebuilding in the wake of the pandemic. Here, the idea –– to which Anne Hidalgo, the mayor of Paris, pegged her 2020 re-election campaign –– is that all residents be able to easily fulfil their essential needs (grocery shopping, the school run) within a 15-minute walk or bike ride from their home.

Lastly, the car-free city model, of which the Vauban neighbourhood of Freiburg in Germany is a successful example, reduces unnecessary, private traffic and provides easy access to active and public transportation.

All four models are designed to promote active transportation and to minimise car use. This in turn reduces air pollution, noise and heat and increases physical activity which improves heart health.

While laudable, these models don’t take into consideration the urban sprawl that characterises the cities growing the most rapidly across the globe. Without due consideration of the historical and colonial contexts of spatial segregation, as in, say, South Africa’s urban centres, the 15-minute city could inadvertently exacerbate spatial inequity.

Similarly, the informal ways in which residents in these cities appropriate the built environment require different approaches to promote active living. In Indonesia, Colombia, Rwanda and Nigeria, to name a few, people are increasingly implementing temporary programmes – such as car-free days – to promote active living. These creative initiatives are crucial, as is robustly investigating the health benefits they bring.

Embracing complexity

To grapple with the complexity of how non-communicable disease and environmental exposure are related, the Mainz study proposes what is known as an exposome approach. The exposome is defined as the totality of environmental exposures from a variety of sources.

Things like air pollution, green space and housing are obviously all interconnected. Thinking about them as contributing in different, interlinked ways to our urban exposures can help to understand how, together, they cause ill health, and how socio-economic status influences the extent of their impact.

The study identifies several knowledge gaps, including the need for better measures for assessing environmental exposures and for greater citizen participation to ensure such assessments reflect people’s actual lived experiences. Crucially, however, it fails to address the fact that existing models are western-centric.

The urbanisation taking place across Asia and Africa is very different to that underpinning cities in Europe and North America. A 2014 study on built environmental factors and physical activity among adolescents in Nigeria, for example, showed that active travel – walking and cycling – by girls and women was frowned upon. Recommendations should therefore take specific cultural and social norms into account, to avoid widening health and social inequalities.

Ultimately, whether it’s our transport, our energy sources or our housing options, there is an urgent need to consider all the urban factors that impact our wellbeing. Doing so would position urban designers and planners as de facto health professionals, with the attendant responsibility to protect human and planetary health.The Conversation

Dr Tolullah Oni, Clinical Senior Research Associate, MRC Epidemiology Unit & GDAR, University of Cambridge and Rizka Maulida, PhD researcher in behavioural epidemiology and urban health, MRC Epidemiology Unit University of Cambridge

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Blog: South Africa must ban sugary drinks sales in schools. Self regulation is failing

Agnes Erzse, Karen Hofman and Nicola Christofides write about GDAR research assessing the food environment in primary schools in Gauteng following a voluntary pledge by a large beverage company. This blog post was originally published in The Conversation

In 2017, Coca-Cola Beverages South Africa voluntarily announced that it would stop supplying sugary beverages to primary school outlets. The company also pledged to remove all branding and advertising from schools. The announcement took the form of a letter noting that that Coca-Cola Beverages wanted to play “an active role in addressing rising obesity rates in South Africa, especially among children”.

Childhood obesity is a serious and growing problem is South Africa. More than 13% of children are either obese or overweight. The consumption of liquid sugar is particularly harmful because it is absorbed so quickly into the bloodstream. Not surprisingly, sugary drinks and their marketing has been linked to obesity especially among children. Just a single sugary beverage per day increases that child’s chance of overweight by 55%. Similarly, once they become an overweight teen, there is a 70% chance they will not be able to lose the weight.

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GDAR film showcased in NCD Alliance Webinar

GDAR film showcased in NCD Alliance Webinar

GDAR’s short film about citizen science in Yaoundé was showcased in an NCD Alliance Webinar on 11 November. GDAR co-lead Tolullah Oni took part in the event that provided a first-hand glimpse at the faces of community mobilisation to act on NCDs in the #COVID19 era.

In commemoration of World Diabetes Day, this webinar convened global experts to discuss the role of civil society engagement, lessons learned from #COVID19, #diabetes prevention and control, and launched the ‘Turning The Tide on NCDs’ series in Africa. It was Co-organized with Ecobank Group.

Watch the webinar here.

Watch the GDAR film:

GDAR researchers supporting COVID-19 response

GDAR researchers supporting COVID-19 response

GDAR researchers have been involved in a range of work in response to the COVID-19 pandemic.

COVID-19 prevention information translated into several widely spoken African languages

An Engage Africa Foundation translation team led by Ebele Mogo has translated information on preventing the transmission of COVID-19 into 19 languages spoken across Africa.

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Turning the tide

GDAR teams up with NCD Alliance and BBC StoryWorks as part of short film series

They’re the world’s biggest killers. Non-communicable diseases like cancer, cardiovascular disease, chronic respiratory diseases, and diabetes account for 70 percent of all deaths. But many of these diseases can be prevented and the suffering from their effects, reduced. Turning the Tide is a series of short films about the bold actions being carried out by communities and organisations to take on NCDs. The stories are about the small and significant changes being made for better, healthier lives.

Watch the full series at ncdalliance.org/turning-the-tide/


Citizen science in Cameroon

The GDAR film shines the spotlight on a citizen science study we’re conducting in partnership with young people and communities in Yaoundé, Cameroon. The study seeks to understand more about how neighbourhoods and daily routines affect health.

Watch it here…

RICHE | Africa Workshop on Healthy Cities – Report

Healthy Cities: Intersectoral approaches to non-communicable disease prevention in Africa

Held 2-4 December 2019, STIAS Wallenberg Research Centre, Stellenbosch, South Africa

Africa is experiencing a double burden of disease. Non-communicable diseases (NCDs) like high blood pressure, obesity, and heart disease are overshadowing the gains recorded in communicable disease prevention.

But cities in Africa also represent an opportunity to take the lead on re-thinking strategies to turn the tide of this emerging NCD epidemic.

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A map of Kenya with photographs of Kisumu researchers and stakeholders

Kisumu: from hypermarket to household

How will changes in the food environment affect communities in Kenya?

This article is an extract from epigram, the newsletter of the MRC Epidemiology Unit, which coordinates GDAR. Read the full issue of epigram 2019 here.

Non-communicable diseases such as type 2 diabetes, heart disease and cancers are a global challenge. In fact they are more common in many low and middle income countries than in high income countries. In the lower income nations, most people with these diseases are of working age, which can leave families destitute and harm development.

The MRC Epidemiology Unit is playing its part in addressing this challenge through its coordination of the Global Diet and Activity Research Group and Network (GDAR). This is a partnership between the Unit and researchers in Kenya, Cameroon, South Africa and the Caribbean, funded through the NIHR Global Health Research initiative.

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A buffet of food

Global diet and health: GDAR and MRC Epidemiology Unit researchers discuss fresh evidence from a huge global study

The Global Burden of Disease study, which tracked trends in consumption of 15 dietary factors from 1990 to 2017 in 195 countries, and is now published in The Lancet, finds that people in almost every region of the world could benefit from rebalancing their diets to eat optimal amounts of various foods and nutrients.

The study estimates that one in five deaths globally – equivalent to 11 million deaths – are associated with poor diet, and diet contributes to a range of chronic diseases in people around the world. In 2017, more deaths were caused by diets with too low amounts of foods such as whole grains, fruit, nuts and seeds than by diets with high levels of foods like trans fats, sugary drinks, and high levels of red and processed meats.

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Funding awarded for new Global Diet and Activity Research Group and Network (GDAR)

Funding awarded for new Global Diet and Activity Research Group and Network (GDAR)

Press Release issued when the GDAR funding was announced in July 2017.

The MRC Epidemiology Unit has been awarded funding by the National Institute for Health Research (NIHR) for a new international research partnership to help combat poor diet and physical inactivity in order to reduce the risk of non-communicable diseases.

The Global Diet and Activity Research Group and Network (GDAR) will carry out research to help prevent non-communicable diseases such as type 2 diabetes, heart disease and cancer, which are a major and growing cause of death and disability in low and middle income countries. Two of the most important causes behind the increases in these diseases are unhealthy diets and a lack of physical activity, both of which are associated with the rapid economic development that is taking place in these countries.

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