Ebola pandemic shows that cities, not nations, should lead on public health

Ashish Jha says urban areas, with their unique strengths and challenges, must now take a more active role in guiding policy

PUBLISHED : Thursday, 22 September, 2016, 6:03pm
UPDATED : Thursday, 22 September, 2016, 7:18pm

The 2014 Ebola pandemic offered many lessons but perhaps none more apparent than the need to shift responsibility for public health from nations to the cities within them.

The outbreak became a pandemic when the virus gained a foothold in cities, including Monrovia, in Liberia, Conakry, in Guinea, and Freetown in Sierra Leone. Densely packed urban life facilitated an unprecedented number of infections – 30,000, of whom 11,000 died.

When the virus reached Lagos, Nigeria – a city of more than 21 million people with an airport through which 7 million passengers pass annually – the stage was set for the pandemic to go global. But, just as the urban environment exacerbated the problems, Lagos leveraged its urban strengths to contain the spread of the virus through a vigorous public health effort and social mobilisation.

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It’s time to consider cities as the central organising principle for protecting human health.

Throughout the 20th century, we relied on our national governments for setting health policies and managing public health. And this approach paid real dividends, including achieving near universal access to health care in many places. Last year marked the first time in human history that more people live within cities than outside them. The health of these nearly 4 billion city-dwellers is profoundly shaped by their urban environment. The health threats they face are different from those of their rural counterparts and keeping this population healthy will depend more on what cities do than the actions of the nation states in which they reside. Cities must take the lead in urban health.

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Why? First, they have proven themselves to have a more durable political structure than nations.

Cities also face unique challenges, as Ebola demonstrated, and as is true in the growing epidemic of non-communicable diseases, including diabetes. Poorly designed cities make exercise difficult, and many cities are food deserts – with few options for obtaining fresh, high-quality fruits and vegetables.

But there is hope. To combat obesity and its serious health consequences, for example, cities are taking the lead in taxing sugary drinks.

Humanity’s transition to an urban species has reached a tipping point, raising both new disease threats and novel opportunities to safeguard health and improve care. Cities have become crucial laboratories of innovation in public health.

Dr Ashish Jha is director of the Harvard Global Health Institute. This article is based on his remarks to the Philanthropy for Better Cities Forum convened by the Hong Kong Jockey Club this week