One Urban Health

Have we destroyed the balance of our planet? Professor of Urban Health and Policy Evelyne de Leeuw shares her thoughts and approach on Healthy Cities and their connection to spiritual and ecological concepts.

A Fragile World

Fires, floods, droughts, heatwaves, minor and major pandemics. Perhaps more than ever before, the last few years have made us realise we live in a fragile world. And particularly where we, people, huddle together, the impacts of disturbing that fragile balance is felt more gravely than elsewhere. We – humans – have increasingly concentrated our own life in particular places: from about 10,000 years ago we have moved into cities. Readers of this blog will know for good reason why the 21st century has been dubbed “The Urban Century”. For the first time, the majority of people on the planet live in cities.

Urbanisation knows many drivers. But integrative world views are rarely part of the lists. Many Indigenous peoples share integrative cosmologies – that all life exists in harmony, and that balance extends to other aspects of the natural and spiritual world.

Rediscovery and Re-Integration

This holistic and integrative view of the many scales and dimensions of the world has (re-)entered the world of science and technology over recent decades. ‘One Health’, alongside its relatives Eco Health, One Medicine and Planetary Health, is a field of practice and scholarship that recognises the interconnectedness of all life on the planet.

However, this recognition of interconnectedness is mostly absent from urban planning and health in cities. We have shaped cities with a perilous degree of ignorance of the integrative One Health perspective. Of course, since the dawn of human settlement, there have been efforts to protect and promote people’s health. In the ancient cities of the Levant, Mesopotamia and the Indus Valley, there were rules and facilities to secure a stable and safe food supply, access to fresh water, and mandates for sanitary behaviour.

But city developers and dwellers increasingly lost sight of the connection of the built environment with the natural world. Cities became places purely for people. In my own earlier work, thinking about and helping stakeholders develop Healthy Cities, I was also lured into that phantasmagorical farce. Explaining ‘good’ urbanisation, in that context, I claimed needed to follow only two rules: (1) concentrate stuff; and (2) keep that stuff moving. The values that ought to be pertinent for the successful pursuit and implementation of those two ideas, I still believe, have been identified by the Healthy Cities Project of the European Office of the World Health Organisation. Helped by Trevor Hancock and Len Duhl, they adopted eleven qualities any Healthy City should pursue.

Urban (Health) Inequities Exacerbate

Fairly recent shifts in patterns of health and disease have prompted a reconsideration of these positions. City life, and in particular city life in suburbia, can be blamed for vast ongoing endemics of chronic disease. The occurrence of those conditions, including obesity, diabetes, asthma, and what many – unfortunately – deem lesser perils such as allergies, depression, and chronic pain can be mapped onto the wealth of neighbourhoods and communities in a deeply upsetting way (e.g., Figure 1, Diabetes prevalence in Greater Melbourne, Australia).

Infographic: Diabetes prevalence in Greater Melbourne, Australia

Diabetes prevalence in Greater Melbourne, Australia

The further into suburbia, the higher the levels of socio-economic disadvantage, and the more of these chronic conditions we see. And although some would refer to these conditions as “lifestyle diseases”, there is very little lifestyle choice involved in the cause and consequences of such dramatic urban health inequities. More than anything, they can be attributed to unfair or absent service delivery, including schools, public transport, and health care.

There is more at hand, though. When famous urbanist Jane Jacobs wrote The Death and Life of Great American Cities in 1961, she used references to living and mortality in purely metaphorical ways. As a famed public health practitioner critically observed at one of the launch events of Healthy Cities in the mid-1980s: “Cities are inanimate objects; they cannot be healthy.” But we have come to realise that cities are, in fact, highly complex and sophisticated ecosystems in which a delicate balance between all sorts of animal, plant, and human communities can and should be struck. This moves beyond access to green space, although trees are important. The overall shape – or morphology – of the urban environments may well facilitate reaching and maintaining that integrative balance. A recent review suggested a strong link between urban design, planning and respiratory pandemics (including COVID-19) but also showed a dearth of well-crafted research and development to indicate ways forward. Cities are alive.

One Health in Cities

When new and ‘exotic’ infectious diseases emerged, new parameters in glocal urban health started to appear on our radar. Both, HIV/AIDS in the 1980s and Ebola in the 1990s have urban dimensions that transcend spatial design and human behaviour. With outbreaks of Zika, Chikungunya and SARS in the new millennium, there should have been greater concern about the nature of cities, cities and nature, and their local and global contexts. Fragile ecosystems in cities can be violated and disrupted. And the question is not which particular animal (a pangolin, primate, or bird) became the zoonotic vector for the SARS-CoV-2 virus in Wuhan, but how we have become so ignorant of that delicate balance between human-inspired and -dominated urban planning and a natural world that some technocrats seem to wish to sanitise out.

I have argued for a rebalancing of the values of Healthy Cities (equity; empowerment; economic, social and natural sustainability; heritage and culture; participation; a rights-based society) with integrative approaches such as One Health. It would be a reconciliation between broad-based values of our natural environments with deeply humanitarian perspectives. I framed this call as an invitation to establish One Health(y) Cities, or One Urban Health, and the challenge has been accepted, most pleasingly, by colleagues from the “Global South.”

But this exploration of One Urban Health is merely nascent. Intriguing questions can be put on the agenda (e.g., ‘What is the relation of a healthy human gut microbiome with the urban ecosystem – the macrobiome?’). For me, entering this integrative arena, there is one overarching concern. Indigenous peoples have embraced this cosmology for eons. They know about balance, and connection to country. ‘Country’, to most Indigenous peoples, is not separate and lifeless. Country is our connection to heritage, the cosmos, humanity and the amazing complexity of ecosystems. And ironically, and most painfully, our cities have perhaps become the ultimate expression of colonising and dispossessing country. They have removed not only Indigenous people from country, but they deprive all of us of spiritual and ecological, healthful balance. Most of all, One Urban Health must have a spiritual dimension.

Evelyne de Leeuw
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