Cities / Healthy Cities
Healthy City Design 2018
The role of cities in improving population health: international insights
By Chris Naylor | 18 Jan 2019 | 0
Drawing on international case studies, this research aimed to explore the role of city governments and their partners in improving population health, and the conditions for success.
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Cities are playing a growing role in population health improvement and have enormous potential to be health-generating places. However, they also face considerable challenges and need to be governed in a way that gives all citizens the opportunity to enjoy good health.
Purpose: Drawing on international case studies, our research aimed to explore the role of city governments and their partners in improving population health, and the conditions for success.
Methods: The study was based on 50 in-depth qualitative interviews with leaders from 14 cities, including an extended case study on London examining the lessons that the city might learn from elsewhere. It also drew on a literature review of relevant research evidence and an expert roundtable held in London in early 2018. Our approach included a ‘deep dive’ on four major public health issues, selected to represent a range of challenges that may require different responses from city governments: obesity, HIV, air quality, and public mental health.
Results: Our research found that although there is wide variation between cities in governance arrangements, powers and resources, there are also several common themes. We identified five key roles for city governments in improving population health, including co-ordinating relevant activities across the city system, creating an environment that promotes innovation, and ensuring that planning processes are used effectively to create healthy places. We also identified five enabling conditions relating to governance arrangements, regulatory powers, leadership, expertise, and connectivity between cities. Effective political leadership is often a critical enabler of success, with international examples illustrating that significant improvements in population health are possible when city leaders are willing to invest their own political capital to advocate for change.
Implications: In England, debate about the role of cities is closely connected with the devolution agenda, with new ‘metropolitan mayors’ now covering one-fifth of the country’s population. Policymakers should explore the case for giving cities further fiscal and regulatory freedoms to enable them to tackle population health challenges more effectively.