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Cities are the new melting pots of global development. Over half of the world’s population lives in cities, and this number is increasing by about 2% annually. More than two billion urban dwellers are expected to be added over the next three decades, a significant proportion of whom will be living in informal or slum settlements. Urban areas are extremely complex environments in which environmental, social, cultural and economic factors influence people’s health and wellbeing. Urban governance and decision-making structures associated with managing these complex factors are comprised of elements that vary across different regional and local contexts. Better use of scientific knowledge can have a positive impact on urban health and wellbeing.
The challenge for the scientific community is to generate and communicate this knowledge in a way that can usefully inform policy choices. As a way of addressing this challenge, the International Council for Science (ICSU) developed this science programme, co-sponsored by the Inter-academy Medical Panel (IAMP) and the United Nations University (UNU). The programme proposes a new conceptual framework for considering the multi-factorial nature of both determinants and manifestations of health and wellbeing in urban populations and it takes a systems approach for improving the understanding of health in cities and engaging with urban communities in the process of creating and transferring knowledge.
The overarching vision for the ICSU-IAMP-UNU Urban Health Programme are people to develop aspired levels of wellbeing by living in healthy cities.[A healthy city is one that is continually creating and improving those physical and social environments and expanding those community resources which enable people to mutually support each other in performing all the functions of life and developing to their maximum potential. (WHO 1998). The goals of the programme are to create knowledge about the multi-faceted determinants and drivers of health and wellbeing in urban environments and communicate this knowledge with science, policy and for capacity building.
The programme will generate knowledge which is relevant to people and policy-makers for improving health status, reduce health inequalities and enhance the wellbeing of populations living in urban environments. The type of science applied will take a systems perspective on urban health and wellbeing. This involves systems analysis and modelling approaches but also atransdisciplinary and problem-oriented approach, actively involving stakeholders in the co-production of knowledge.
The study of health in an urban environment requires consideration of a wide range of factors and conditions, acting and interacting at various scales. The particular characteristics of a city – cultural, economic, environmental, geographic, historic, political, and social – vary widely, even across cities within countries. So do the ways in which these factors influence and interact with human health and wellbeing. Health outcomes – physical, mental, or social are shaped by proximal elements acting directly on individuals and distal elements acting indirectly at municipal, national and global levels. At all levels of proximity, health determinants can act synergistically or antagonistically to multiply or diminish observed effects. Moreover, the complex interplay of determinants can produce effects at the individual or aggregate level.
The ICSU-IAMP-UNU Urban Health Programme strives to promote systems approaches to understanding health and wellbeing in urban settings by understanding the functioning of the urban system as a whole. The systems approaches involves one or more of the following elements:
(1) the development of new conceptual models that incorporate dynamic relations,
(2) the use of systems tools and formal simulation models,
(3) the integration of various sources and types of data including spatial, visual, quantitative and qualitative data.
Taking a systems approach means:
Improving the understanding of health in the city as a complex system and improving knowledge transfer, communication and engagement. Both mutually enforce each other: A scientific approach to the city as a complex system is required to understand what the data are telling us. Communication with people in cities is needed to ask the right questions and understand the meaning of the information from the data.
The activities we involve in include:
(1) Promote a systems approach to human health & wellbeing in a changing urban environment among scientists and decision-makers,
(2) Strengthen capacity to conduct research on human health & wellbeing in a changing urban environment using a systems approach,
(3) Advocate for funding of systems approaches for human health & wellbeing in changing urban environments,
(4) Enhance understanding of urban health & wellbeing issues among multidisciplinary & sectors
(5) Influence the international agenda to encompass urban health initiatives.