Shaping cities for health: Complexity and the planning of urban environments in the 21st Century (original) (raw)

Although health outcomes are, on average, better in higher-income than in lower-income countries, urban health outcomes in specifi c cities cannot be assumed to improve with economic growth and demographic change. The so-called urban advantage—a term that encapsulates the health benefi ts of living in urban as opposed to rural areas—has to be actively created and maintained through policy interventions. Furthermore, average levels of health hide the eff ect of socioeconomic inequality within urban areas. Rich and poor people live in very diff erent epidemiological worlds, even within the same city. And such disparity occurs in both high-income and low-income countries. Through case studies of sanitation and wastewater management, urban mobility, building standards and indoor air quality, the urban heat island eff ect (the diff erence in average temperatures between city centres and the surrounding countryside), and urban agriculture, we draw attention to the complexities involved in the achievement of urban health improvement through urban planning policies. Complexity thinking stresses that the development of a plan that anticipates all future change for these issues will not be possible. Instead, incremental attempts to reach a goal need to be tried and tested.