Leveraging Urban Leaders To Battle NCDs – Healthy Cities Partnership Expands To 70

From clearing the air of hookah smoke in Amman, Jordan to bike lanes in Fortaleza, Brazil and salt-free menu options in the restaurants of Montevideo, Uruguay,  the Partnership for Healthy Cities has been seeding small grants to cities across the globe – backed by a big ambition. The aim is to build a network of cities equipped with smart strategies to combat the epidemic of noncommunicable diseases (NCDs) and injuries that are the cause of 8 out of every 10 deaths annually.

And that now that network just became a lot bigger and stronger – with the addition of the megacity of Tokyo along with 15 other cities to the Partnership – and a new $12 million reinvestment by Bloomberg Philanthropies into the initiative.

“Today, cities are where the action is on issues from climate change to health, and the people who lead them are more important than ever,” said Kelly Henning, head of Bloomberg Philanthropies’ public health programmes, in a press release announcing the expansion of the network to 70 cities, and the new funding commitment.

Cycling in Fortaleza, Brazil – the city strengthened its active transport plans as part of the Healthy Cities Partnership.

Cities have the Power and the Opportunity

“Cities have the power and opportunity to take action to protect people’s health,” said Tedros Adhanom Ghebreyesus, Director-General of WHO, which is providing technical support to the initiative.

Launched in 2017 with some US$ 8.5 million in funds, the Partnership— including WHO, the global health NGO Vital Strategies, and Bloomberg Philanthropies, founded by former New York City Mayor Michael Bloomberg — provides cities with financial assistance and technical advice from publiof health experts to implement their chosen intervention to reduce noncommunicable diseases (NCDs) or injuries.

The Partnership supports, urban action in six key areas , including tobacco control; food policy; road safety; walkable streets and cycle networks for active mobility; drug overdose prevention; and monitoring of NCDs and NCD risk factors.

Grants are modest – each city gets a total of around $US 100,000 – $US 150,000 to plan or implement an intervention, says Ariella Rojhani, director of the partnership at Vital Strategies, which is the lead implementer.  But even so, the initiative aims to support practical measures that “help close the gap between rhetoric and action around NCDs and injury prevention.”

New Tools & Tactics for Preventing NCDs

The tools and tactics cities may choose to use are not always the traditional ones associated with hospitals and health care settings.  They may range from improved physical planning of streets and sidewalks that encourage more physical activity to edgy social media campaigns that build awareness about bad smoking and drinking habits among youth. Often, they may involve the creative use of health and safety regulations to promote, for instance, healthier foods in schools, restaurants and markets.

For instance, in Accra, Ghana, redesigning the pedestrian crossing at a major highway intersection with the highest rate of road crashes and fatalities in the city led to a nearly 35% reduction in serious injuries at the site.

Accra, Ghana redesigned a high-risk pedestrian crossing, resulting in a nearly 35% reduction in serious injuries at the site.

In Quito, Ecuador, school menus were purged of unhealthy foods, and healthier fresh food options were added. The City of Montevideo, which had already adopted a number of forward-looking policies on sugary drinks, targeted salt reduction to reduce high blood pressure risks as their next goal.

“The city they really wanted to address hypertension by reducing salt consumption,” Rojhani noted. “So they passed an innovative regulation that food establishments have to have ten percent of their menu items be salt free.”

Quito, Ecuador launches a healthy foods in schools project as part of the Partnership for Healthy Cities.

The Partnership supported the planning and launch of the Montevideo strategy, including critical consultations with the food industry and private sector, in order to get them on board.  Now, the Health Department is rolling out enforcement policies.

In Ouagadougou, Burkina Faso, where traditional problems of food storage and safety remain a critical issues, even as unhealthy diets lead to growing obesity and hypertension, the challenge was how to adapt the WHO “best buy” recommendations for low-fat, low-salt and low-sugar foods – when ingredients like salt, for instance, might also be an important traditional preservative.

The response was to adopt a ¨ food hygiene¨ approach, said Rojhani, including development of guidelines for local food establishments that stressed safe food preparation and storage, but also built in recommendations for reduced salt and sugar into food and drink preparations.

“Obviously every city has a context that is quite different, so success always looks a little bit different as well,” Rojhani said.

In Amman, Jordan, a country with one of the highest rates of smoking in the world, the Municipality set out to strengthen and enforce a long-ignored law prohibiting smoking in public places, also confining smoking in restaurants and cafes to separated smoking areas. The city also also created a municipal ban on the advertising of tobacco in cafes and restaurants, including hookahs, the traditional water pipes known locally as shisha, which have experienced a resurgence among youths.

Growing the Network & The Commitment

The initiatives may start modestly, but they are structured so as to have long-term impacts on urban policies, after the Partnership support has ended, and strategies used in one city can also provide an example of a successful approach that other cities may want to follow, Rojhani noted.

“By adding 16 new cities, we now have the ability to reach an additional 62 million more people, a total of 300 million people worldwide”, she added.

“Each city is demonstrating that rapid progress against the world’s leading killers is possible, and each serve as a model for change at the country and regional levels,” said José Luis Castro, President and CEO of Vital Strategies, in the news release.

“We recognize the commitment and early successes of our partner cities as they work to ensure healthier and safer environments for their residents, an outcome that will only grow as we expand the global network.”

NCDs—which include heart disease, cancer, diabetes, and respiratory diseases—as well as injuries such as road traffic crashes, together cause an estimated 80% of the world´s deaths every year.

While NCDs are responsible for more than two-thirds of deaths annually in low- and middle-income countries, and account for trillions of dollars in economic losses, they receive only 1-2% of total donor development assistance for health.

With some 68% of the global population projected to be living in cities by 2050, cities are a natural focus for many innovative NCD strategies, officials connected with the Partnership initiative point out.

The 70 cities in the Partnership for Healthy Cities

Municipal and Metropolitan authorities often have significant budgets and authority over a wide array of local planning policies, health and safety codes as well as regulations. And they can use these tools  to shape healthier environments and encourage healthy behaviours that reduce risks of NCDs.

Although the preponderance of cities in the Partnership are low and middle income, high-income cities are very visible and welcome too.

Along with Tokyo, the other new cities joining the Partnership now reflect that diversity and range. They include not only the megacities of Athens and Hong Kong, in upper income countries, as well as Muscat, Oman; Helsinki, Finland; Vancouver, Canada; and Birmingham, United Kingdom, but also low and middle income cities, such as Abidjan, Cote d’Ivoire; Colombo, Sri Lanka; Dakar, Senegal; Freetown, Sierra Leone; Hanoi, Vietnam; Harare, Zimbabwe; Istanbul, Turkey; Kumasi, Ghana; and Tunis,Tunisia.

Explains Rojhani, “High income cities still have a ways to go on NCD and injury policy. Similar to the reasoning behind countries of all income levels adopting the UN Sustainable Development Goals, all areas of the world are facing similar challenges. They likewise all have a role to play in addressing the enormity of the NCD challenge.

“There are regional difference to be sure, but we need action in all parts of the globe. To double down on that point, there are of course large disparities within cities, as well. In high-income cities, we are largely working in lower-income areas,” she added.

And finally, high income cities often have useful approaches that can be replicated even in less affluent cities. Said Rojhani: “There is no need to start from scratch when we have proven policies and programmes already in place.“

Image Credits: City of Fortaleza, Accra Metropolitan Assembly, City of Quito/Juan Carlos Bayas, Vital Strategies.