1. This document discusses several sectors that influence urban health, including access to services and markets, housing, water and sanitation, transportation and communications, and healthy public spaces. It notes that local governments are key to coordinating between these sectors but often have limited capacity. 2. The document then provides more details on several specific sectors. It discusses the need for better coordination between local governments and health ministries on urban health services. It also discusses the relationship between housing and health, and the importance of communities, NGOs, and local governments working together on water and sanitation issues. 3. Finally, it discusses the importance of considering health in urban planning and developing policies to create smoke-free public spaces

1. Dr Helen Elsey and Dr Siddharth Agarwal
May 2016
DfID Urban Health Reading Pack Slides

2. Multi-sectoral influences on urban health
5.
transport
and
communi
cations
• access to
employment
• access to housing
• pollution
• accidents
1. access
to services
and
markets
• health
• education
• fire/police protection
• food
• electricity/fuel
2.
housing
• location
• structures
• land rights
• safety
• heating/lighting
4.
Healthy
places
• Green space
• Public spaces
• urban
agriculture
• safety
• physical
exercise
3. water
and
sanitation
• refuse collection
• improved water
sources
• disposal of faecal
waste
Governance and citizen engagement

3. Local government is key to coordinating
inter-sectoral action
• But local government has been side-lined in many countries, as energies and
resources have been funnelled to the larger sector ministries
• Where successful, working with local governments has allowed an area based
approach, responding holistically to community needs rather than focusing on
only one or two sectors.
• Local governments often have limited capacity to collect, use and respond to data
and information on their urban constituencies
• Donors are increasingly working with local government to strengthen capacity to
plan, manage services, link with sector ministries, enforce public health legislation
and establish function local/ward level governance structures.

4. 1. Health services: the need for coordination
between local government and health
ministries
• Urban public health services woefully inadequate
• Underinvestment due to years of assumption of the ‘urban advantage’
• Often fall between the Ministry of Health and Municipality with the
responsibilities for staff, their training, equipment/drugs, facilities split between
the two.
• Poor are left with little option but to use meagre resources on private facilities
resulting in high levels of catastrophic health expenditure.
• Poor referral mechanisms due to plethora of NGO and private provider
• Need for monitoring and enforcement of quality standards among providers and
pharmacies – often falling between MoH and local government.

5. 2. Housing: Relationship between Urban
Housing and Health (adapted fromWHO 1989)
Wider environmental, economic and social determinants
rights to property
income generating opportunities
financial and digital inclusion
pollution
community engagment
transport/ road safety
floods
vectors
eviction
Access to basic services
water & sanitation
waste removal
electricity
cooking fuel
health services
education
police/fire services
Structure of dwelling
protection space ventilation damp fire risk

6. 3.Water and sanitation: communities, NGOs
and local governments working together
• Local governments, NGOs and communities working together offers solutions –
where NGO programmes work to improve water and sanitation provision without
engaging governments, programmes become unsustainable
• Approaches such as community led total sanitation are being adapted for urban
areas with diverse and transient communities.
• Concepts of Citizen-LedTotal Sanitation with an emphasis on advocacy and
holding institutions/governments to account to provide improved water and
sanitation are more appropriate.

7. 4. Healthy Places
• Pressure from real-estate developers, poor governance and corruption
undermines local government role in controlling urban development to keep
healthy places within the city.
• Access to green spaces reduces mental ill-health and has been shown to reduce
inequities in CVD and all cause mortality in high income countries – green spaces
are rarely considered in controlled ad uncontrolled expansion of urban areas.
• Urban agriculture can make an important contribution to household food security,
especially in times of crisis or food shortages, but needs support and regulation so
food is grown in healthy environments.

8. 4. Healthy Places: Working across sectors for a smoke-free city: a
group exercise to do with city planners. For more details see:
http://www.who.int/kobe_centre/interventions/smoke_free/SFC_WorkshopGuide.pdf?ua=1
Step 1: Mark the status of policy (ordinance/regulation) with a
square where 1.No ordinance/regulation to
4.Ordinance/regulation completely bans indoor smoking and
extends to perimeters from entrances and exits and/or
delineates distances of smoking areas.
Step 2: Mark the status of information and communication on
existing ordinance/regulation with a star. 1.No
policy/ordinance/regulation to 4.Well planned information
and communication strategy using paid and earned media
and with specific messages targeting different audiences.
Step 3: Mark the status of enforcement of, and compliance
with, existing ordinance/regulation with a circle where 1.No
compliance, no enforcement to 4.Excellent compliance and
strong social norms for 100% indoor smoke-free settings.
Step 4: Mark the status of stakeholder engagement in
advocacy for strong ordinance/regulation and enforcement
with a triangle. 1.No stakeholder engagement to
4.Stakeholder engagement includes the general public and
groups that are usually excluded from decision-making (e.g.
women, children, trainees, cancer survivors).

9. 5.Transport and Communications
• 10 billion trips made every day in urban areas around the world;
• An increasing proportion of urban trips are using high carbon and energy-intensive private
motorised vehicles.
• The urban poorest are disproportionately affected by key negative externalities generated
by transport, including road accidents, air pollution and project displacement
• Regulation to improve road safety can make a substantial difference to accidents e.g. 73%
reduction in accidents due to regulation of ‘matatus’ (mini-busses) in Kenya.
• Keeping cities compact, with opportunities for walking, cycling and public transport
reduce emissions and support public health.
• The enthusiasm for Smart cities offers opportunities to build sustainable, healthy places
through the integration of physical, digital and human systems.