The Lancet comments on the Quito Declaration

The Lancet has published an editorial in which it considers the Quito Declaration (see below) as a “missed opportunity for urban health”. While the new urban agenda outlines an agreed framework and is “inclusive, green, and clean”, according to the Editor, “it fails badly on one main aspect at the heart of cities: health.”

The WHO released a report Health as the Pulse of the New Urban Agenda in advance of Habitat III “to influence the proceedings and argue the case for health being central”. It notes that despite urbanization providing unprecedented mobility and economic opportunity, as well as greater access to health services, the “rapid, uncontrolled growth of cities is having profoundly negative health, environment, and climate effects.” These include, for example, urban air pollution, sedentary lifestyles, and road traffic injuries, as well as poor access to healthy foods, which contributes to the global pandemic of non-communicable diseases (NCDs).

According to the Lancet, there is “little specific reference to health in the new urban agenda”.  As included in its recent Series on urban design, transport, and health, “cities are a key social determinant for health and wellbeing of most of the world's inhabitants, and one of the greatest assets in achieving sustainable health and development”. Healthy city planning that designs transport to encourage walking, cycling, and public transport, as opposed to the use of private cars, can reduce NCDs and road accidents while managing rapid urbanization. On the other hand, poor urban design can reinforce health inequalities.

The Lancet Series highlights the impact of slum dwelling on people’s health and while the UN Habitat reports that there has been a decline from 39·4% in 2000 to 29·7% in 2014 in the proportion of slum-dwellers, the absolute numbers have grown to 881 million. Slums occupy more than half of megacities such as Mexico City and Mumbai, with unhygienic conditions and lack of basic health and social services.

As pointed out by the Lancet, while acknowledging that slums are a growing form of urbanization that deserve special attention Habitat III offers no specific action. Without adequately addressing the problem of slums, the new urban agenda will indeed fail. And, as the new urban agenda is rolled out, it should “draw more upon expertise and stakeholders in the health arena, and specifically focus on evidence.” The Lancet, points out, moreover, that the agenda that it is voluntary for member states, (as is indeed the case with the 2030 Agenda) and that it will need “an action plan with more specificity.”

Health experts should have a role to play, as also affirmed by WHO in, for example, “assisting with evidence-based standards for air and water quality, transport systems, and housing design; guiding the scientific assessment of the effects and cost–benefit analyses of new interventions; and monitoring and documenting improvements to the health of cities and their inhabitants.”