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Analysis

Cities for global health

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k3794 (Published 03 October 2018) Cite this as: BMJ 2018;363:k3794
  1. Majid Ezzati, professor of global environmental health1,
  2. Christopher J Webster, dean and chair professor of urban planning and development economics2,
  3. Yvonne G Doyle, director for London3,
  4. Sabina Rashid, dean and professor4,
  5. George Owusu, professor and director5,
  6. Gabriel M Leung, dean and chair professor of public health medicine6
  1. 1School of Public Health, MRC-PHE Centre for Environment and Health, WHO Collaborating Centre on Non-Communicable Disease Surveillance and Epidemiology, Imperial College London,
  2. 2Faculty of Architecture, The University of Hong Kong, Hong Kong, China
  3. 3Public Health England, London, UK
  4. 4James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
  5. 5Centre for Urban Management Studies, Institute of Statistical, Social and Economic Research (ISSER), University of Ghana, Accra, Ghana
  6. 6LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
  1. Correspondence to: M Ezzati majid.ezzati{at}imperial.ac.uk

In the first of a new series of articles on the role of cities in health, Majid Ezzati and colleagues call for greater action to reduce health inequalities within cities

The number of people, and proportion of the world population, living in cities has increased steadily, with 4.2 billion urban residents now accounting for 55% of the world’s population (fig 1). That urban living influences health is well recognised and increasingly included in broader discussions about cities and sustainable human development. The general tone of such discourse, however, tends towards the negative aspects of infectious outbreaks, vehicular pollution, waste disposal, and unhealthy lifestyles2 rather than the “positive and progressive aspects of cities . . . recognised by historians, economists, and other social scientists.”3

Fig 1

Number of people living in rural areas and in cities in the world. Data are from the World Urbanization Prospects1

Empirical evidence strongly points to urban residents having better health than their rural counterparts since at least the early to mid 20th century, in high income as well as low and middle income countries.3456 The health advantages of urban living, however, are unevenly distributed in cities, with massive inequalities existing over short distances (fig 2).47891011 Our urbanising world provides an opportunity, and an imperative, to not only further improve population health in cities but also to leverage cities as nodes in a natiotrafinal and global network to improve health in and across countries. Reducing inequalities is fundamental because population health suffers where inequalities are larger.1213

Fig 2

Life expectancy at birth in 2012 in London’s local authorities. Data are from Bennett et al7

The urban health literature commonly uses the “healthy city” concept to frame discussions.1415 The idealised healthy city, …

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