Expert Analysis: Are the Commonwealth's cities getting sick?

We need to make our cities healthier places to live. Commonwealth governments need to understand the urban dimension of health, and plan cities better.

Health professionals and built environment professionals, such as planners and engineers, need to work together. They must involve the urban poor in the design and delivery of local health measures. Then significant progress could be made in tackling waterborne diseases, for example, or reducing death and injury from traffic accidents.

How do cities affect health?

We are living through a helter-skelter period of slum-led urbanisation in the Commonwealth. Recent work on the State of Commonwealth Cities has shown that the Commonwealth goal, adopted in 1999, of making progress towards “adequate shelter for all, with secure tenure and access to essential services in every community by 2015” is not being achieved.

The number of slum dwellers in the Commonwealth is growing by around 10 million a year. Lack of sanitation and clean water, services taken for granted by many, are still killers, especially of babies and children. Infant mortality statistics in the huge slums of rapidly growing cities such as Nairobi far outstrip national averages.

At the other extreme, car-dependent suburban spread in affluent Commonwealth countries fosters obesity and the health problems that come with it. Air quality, and respiratory health, is affected too.

How to make a difference

Trying to stop migration to the cities is not the answer. Planning for public health is. Slums need to be upgraded with better infrastructure. New sites for housing, serviced with drains and water, can be provided, but maintenance also matters. Strategic planning of networks needs to be combined with bottom-up implementation and asset-management. We could stop millions getting sick. The time to start is now.

Key recommendations

The State of the Cities discussion paper makes seven main recommendations:

• The Commonwealth should establish formal cooperation with UN-Habitat.
• The Commonwealth Consultative Group on Human Settlements, a group of ministers, should provide political leadership.
• Twenty-first century urban demands need to be reflected in the priorities of the Commonwealth Fund for Technical Co-operation.
• Commonwealth professional and civil society organisations need to work together more closely.
• Evidence based and systematic research by Commonwealth networks should be supported.
• All countries should scope the scale of urban economic, environmental and governance challenges they face to enable strategic response.
• The Commonwealth Secretariat can be the means to link the monitoring of urban conditions to Millennium Development Goals.

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Professor Cliff Hague is Secretary-General of the Commonwealth Association of Planners.