The case for comprehensive, integrated, and standardized measures of health in cities

Abstract

By 2050, more than 75 % of the world’s population is expected to live in cities. Cities in lower-income countries will absorb 95 % of population growth and will be home to 80 % of the world’s urban population. The health of a city’s residents depends on critical infrastructure, the maintenance of water and sanitation systems, the availability of affordable housing, the protection of spaces for physical activity, the extent of pollution, and the strength of the economy, among many other conditions. The relationships between health and city conditions are increasingly complex and entangled—social cohesion, safety, security, and stability are being challenged by social exclusion, inequities, and shortfalls in basic services. The governance of a city has a profound impact on the health of its inhabitants. Yet little information is available for assessing the character and quality of a city’s governance system and its impact on urban health. This paper seeks to make the case for integrated assessments of the relationship between health and urbanization. The core of our argument is that the evolution of cities has introduced new complexities in governing cities and new research challenges to measure and monitor health in cities. How do we account for the unique health circumstances of each city while exporting best practices and fostering mutual learning across city boundaries? We argue that we can only obtain answers to this and related questions through a much broader and more comprehensive framework for assessing health than is available today, and we highlight a leading initiative along these lines based at the University of Toronto—the Global City Indicators Facility (GCIF).