Originally published in El País on 5 March 2024 (in Spanish)
During the COVID-19 pandemic, the role of cities in protecting health suddenly came into focus. As areas of high population density, cities were on the frontline for decisions and policy responses, and the world started to see how important local actions were for containing the spread of a virus.
But a city’s role in health is by no means limited to a pandemic.
In my time at the Wellcome Trust, and in my current role as Chief Scientist at the World Health Organization, my focus has been on global health. But my early career was spent at the local level, and as a result I have first-hand experience of the crucial role that city authorities play in protecting health at all times, not only during global health emergencies.
Between 1996 and 2013 I was living in Ho Chi Minh City, working as the Director of the Clinical Research Unit at the Hospital for Tropical Diseases in Viet Nam. During that time, I lived through the city’s incredible development but also a remarkable transition of improving road safety. More crosswalks were added to the city’s roads, making it possible for pedestrians to cross safely instead of playing a deadly game of roulette with traffic. Inclusive street design, mandatory wearing of motorbike helmets and policies for safer roads started to protect pedestrians, motorbike riders and the increasing number of car drivers.
These types of laws are not always seen as public health policies, but they are vitally important to protect us all in our daily lives. They are also essential for protecting the health of the next generation: road traffic injuries are the leading cause of death for children and young adults aged 5–29 years.
My time in Ho Chi Minh City came to an end, but the city’s efforts to improve road safety have not. The city has continued their work, and are now part of several programs supported by WHO: the Partnership for Healthy Cities network, and the Bloomberg Philanthropies Initiative for Global Road Safety (BIGRS). With support from international experts and peers, the city has enforced local regulations on speeding and drink-driving, improved infrastructure around schools to reduce speeding and strengthened data collection to help inform policies. Meanwhile, the city regularly runs mass media campaigns to encourage people to follow traffic regulations like following speed limits or not drinking and driving. This is important because we know that with every kilometer you increase your speed the risk and severity of a crash also increases. The risk of death for pedestrians hit by a car travelling at 65km/h is 4.5 times higher than if a car is travelling at 50km/h.
The city saw a nearly 23% decrease in road traffic fatalities in 2022 compared to 2016. With statistics like these you can see the power of local policies and programming based on robust scientific evidence. The success seen at the city level has translated nationally making Viet Nam one of the top countries to reduce fatalities, with a 40% decrease between 2010 – 2021.
Even during the COVID-19 pandemic itself, road safety did not cease to be a priority for many cities. During various stages of lockdown, road traffic in cities reduced and many cities opened more bike lanes and pedestrian paths to give people more opportunities for safe and active mobility. In some cases, these initiatives have become permanent changes, creating safe spaces for better health and a more sustainable future.
Accra, Ghana is enhancing safety at several of the city’s multi-lane intersections and surroundings to reduce speeds and prevent injuries and fatalities in the area. Measures included speed limit signs, ground painting to mark directions, and fixed painted bollards at pedestrian crossings to discourage motorcyclists from entering. More than half of all road traffic deaths are among vulnerable road users, including pedestrians, cyclists and motorcyclists.
Recently Mexico City introduced a new policy to increase sanctions for motorcyclists who aren’t licensed or wearing a helmet. Correct helmet use can reduce the risk of death in a crash by more than 6 times and the risk of brain injury by up to 74%. But its importance as a health topic is frequently underestimated. Through the Partnership for Healthy Cities, Mexico City is now sharing their experiences with other cities in the region who are hoping to advance local policies on the same issue.
The number of people living in cities is on the rise, and by 2050 nearly two-thirds of the world is forecast to live in an urban settlement. Cities have a huge weight of responsibility to create the right environments and policies to protect the health of their inhabitants.
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About Dr Jeremy Farrar, World Health Organization, Chief Scientist
As WHO Chief Scientist, Jeremy Farrar oversees the work of the Science Division, bringing together experts and networks working in science and innovation from around the world to guide, develop and deliver high quality health policies and services to the people who need them most.
Prior to joining WHO, Dr Farrar was Director of the Wellcome Trust for nine years, focused on fundamental discovery research and infectious diseases; climate and health; and mental health. Before joining Wellcome, Dr Farrar spent over 17 years as Director of the Clinical Research Unit at the Hospital for Tropical Diseases in Ho Chi Minh City in Viet Nam. He was trained in neurology and infectious diseases and has a PhD in Immunology.
About the Partnership for Healthy Cities
The Partnership for Healthy Cities is a prestigious global network of over 70 cities committed to saving lives by preventing noncommunicable diseases (NCDs) and injuries. Supported by Bloomberg Philanthropies in partnership with WHO and the global health organization Vital Strategies, the initiative enables cities around the world to deliver a high-impact policy or programmatic intervention to reduce NCDs and injuries in their communities. For more information, visit https://cities4health.org.