In the past, living in cities has been associated with better health. Better access to goods, services and opportunities such as health care, education and employment provided an “urban health advantage” to city residents. However, with rapid urbanization, in Asia the urban health advantage is actually becoming a disadvantage.

For poor people, access to quality health services and healthy living conditions remains challenging in urban areas; this is reflected in mother and child health outcomes being worse in South Asian cities compared to rural areas. For wealthy and poor urban residents alike, the impact of urban pollution and urban lifestyle is leading to a high burden of noncommunicable diseases.

Poor air quality in particular has become a silent emergency of global significance, with only about 1 in 10 urban residents breathing clean air. The epidemics of obesity and noncommunicable diseases are additional public health emergencies with root causes in urban living, which often involves long commutes, limited time to exercise and limited access to healthy food choices.

The “urban health penalty” we are now paying for includes mismanaged and unplanned city development, rapid investments, weak urban governance, and neglected human needs. Urban development was and is still driven by car- and profit-oriented design. For example, huge apartment complexes and wide streets have dominated urban development in the People’s Republic of China because the economic aspect drives urban and real estate development. The result is faster and bigger—but not better—developments. In other Asian cities, the need to invest in public spaces and public transport was also ignored because real estate profits were more important.

We won’t improve urban living by building more urban roads. Let’s construct more walkways and pedestrian areas.

With urban populations steadily growing, we are all suffering to some extent from the bad urban policies, choices and designs of the past (and present). We may live longer than before, but we also get sicker faster and for longer periods. This calls for urgent action on urban livability based on four fundamental approaches:

1. Put people at the center. Cities are by and for people, and health needs to be at the center of urban development for city dwellers to recover the urban health advantage. Municipal governments should form intersectoral planning groups, which are accountable for people-centered urban development.
2. Learn from experience, apply lessons learned. Among the solutions for enhanced urban livability implemented successfully in some cities are publicly accessible green spaces, green networks, urban agriculture, ecosystem services for absorption of air pollution, water filtration, and sequestration of carbon dioxide, as well as pedestrian-friendly, car-free urban design. Each city should mandate that a certain percentage of land is used for green planning and that developers comply with green design.
3. View cities as connected ecosystems for healthy lifestyles. We should invest in “connected cities” which offer citizen services and workplace and recreational activities that are accessible to all. We won’t improve urban living by building more urban roads; let’s construct fewer roads and more walkways and pedestrian areas. We should also promote low-emission transport and move industries out of cities because, unless the air quality in cities improves, people won’t walk or use bikes. We need to study people’s mobility needs and ensure that they can live within a 15 km radius of where they work. Access is everything. We need to develop a business case that explains how healthy cities foster knowledge-based economies.  
4. Foster strong leadership, community engagement through civil society. The model in European cities is that leadership at every level—including the community—helps drive demand for and raise awareness about healthy cities. The concept of community needs to evolve from family-centered to community-centered. An active civil society and involved private sector are crucial to demand changes in urban planning for enhanced well-being and productivity. Intersectoral planning groups should actively reach out to civil society and the private sector.

People will always be drawn to cities since cities are the economic engine of countries and the region. We must leverage the capacity of growing economies to invest in urban development now and ensure that our plans today are relevant for a better life tomorrow. As Ronald E. Osborn said: “Unless you try to do something beyond what you have already mastered, you will never grow.”

This piece first appeared on the Asian Development Blog.