Prioritizing Sustainable Solutions
to Urban Health Challenges

As the COVID-19 pandemic surges, cities are struggling to keep residents safe and services functioning, and to mitigate the effects of economic devastation.

While the challenges are immense, continued human development depends on creating healthier urban environments to block the channels through which diseases spread. 

We build strong coalitions with civil society and government health stakeholders, and engage civic authorities to provide equitable service delivery to the urban poor. We are proud to contribute to sustainable solutions to urban health challenges around the world. 

By 2050, 42% of Ethiopians will live in urban settings. Rapid urban population growth is placing pressure on infrastructure, social environments, and health and educational systems. Transmission of HIV, TB, and water-borne diseases are exacerbated by crowded urban areas and changing social norms. Some urban residents, especially those in the lowest wealth quintiles, have similar—or worse—health outcomes than their rural counterparts.

We’re helping the Federal Ministry of Health reach 2.4 million households with health services. Through the Strengthening Ethiopia’s Urban Health Program (SEUHP), we’re building the capacity of urban health extension professionals, who have detected 17,168 TB cases, delivered higher-quality reproductive, maternal, newborn, and child health services to 222,260 people in urban towns, and provided 47,818 priority population members with home-based HIV testing.

While COVID-19 threatens to overburden the health system and reverse gains achieved by urban health extension professionals, the Ethiopian health system is better equipped to maintain its commitment to improving the health of women and children and level of care through the pandemic.

Many sectors influence the health of an urban population. Urban populations benefit when decisions are made in a coordinated way, using data systems to bring together all relevant information and citizens’ input to increase equitable access to healthy lifestyles. These benefits are reflected in improved access to health services, decreased environmental and lifestyle risk factors for chronic diseases, and a lower burden of infectious diseases.

Our USAID-funded Building Healthy Cities (BHC) project is committed to increasing global learning on how the social determinants of health (where you live, how much you earn, etc.) influence the health of city residents. We partner with local governments and other stakeholders in four cities in Asia to study how decisions relating to health are made, and identify ways to improve health through existing structures. One way we document and track challenges is through our quarterly journey maps, which illustrate changes and are created in a simple Powerpoint template. These maps are focused on issues identified as priorities by the community and are shared with city leadership on a regular basis. Learn more about our approach to journey mapping and check out our briefs, including this one on street flooding in Makassar, Indonesia. 

We are also partnering with academia to explore recurrent global themes. In Indore, the  “cleanest city in India” for the fourth year in a row, we are collaborating with Anant National University to explore topical issues including land use regulations and how to design cities for vulnerable populations. Since June 2020, we have co-hosted two webinars and are looking forward to a third, while expanding our collaborations with universities in the other three BHC partner cities on different aspects of urban health. Recordings of these webinars are available on JSI’s YouTube channel. This collaboration will also contribute to BHC’s goal of developing a short course on a systems approach to healthy urban planning that will be available to all who are involved in city planning and development.   

Around the world, the climate is changing, bringing more severe storms, more extreme floods, and more intense heat waves. With these come many adverse health implications for people.

In the United States, we’ve partnered with the City of Cambridge, Massachusetts and urban architects at Kleinfelder, Inc., to develop a Climate Change Preparedness and Resiliency Plan. The plan allows the community to implement strategies in response to climate change and prepare for anticipated effects that arise from more severe and frequent flooding and extreme heat. Sessions with stakeholders identified gaps between what is already in place and what needs are emerging across arenas that span health care, social services, utilities, transportation, food, and housing.

The plan is rolling out in phases, focusing first on environmental justice neighborhoods, which are low-income communities of color that are projected to be first and hardest hit by climate change consequences and are the center of climate solutions. To supplement this effort, we helped community leaders from the Port neighborhood, including the Men’s Health League and youth who work at the Teen Media Center, create outreach materials for their neighborhood, including this video, Protecting the Port – Climate Change and Health. Through these resources, residents became more familiar with climate-related issues and are able to exert more leadership in developing appropriate mitigation strategies.

Increased urbanization has exacerbated a number of health concerns, including the pressing need for immunization strategies and guidelines specifically for urban populations. Large urban settings with high rates of migration face an imminent threat of disease outbreaks like measles as well as risks for other diseases (such as Ebola virus) transmission and regional/global health security.

Exploring how to reach dense urban areas with sustainable immunization services is crucial. Today, 55 percent of the world’s population lives in an urban area; by 2050, that proportion is expected to increase to 68 percent. Almost 90 percent of that increase is expected to be in Asia and Africa. Urbanization can make the challenge of delivering routine immunization services even more difficult.

In the Democratic Republic of Congo, we conducted a situational analysis in two health zones of Kinshasa – Limete and Kimbanseke – to analyze bottlenecks and challenges facing urban populations, specifically access and utilization of routine immunization services by urban poor communities. Each urban context will have a unique set of strategies to meet the needs of its urban populations, given other country priorities, resources, challenges, and opportunities. Targeted strategies identified through situational analysis are needed to address the inequities that arise through increasing rapid urbanization.

India accounts for one-quarter of the global tuberculosis cases, and is the country with the highest prevalence of multi-drug resistant TB. In India’s crowded urban areas, a single person with active TB infection may transmit the disease to 12 others, and will remain infectious for about a year. While TB can be cured, treatment is lengthy and difficult and many patients are lost to follow-up.

To help overcome this problem, we partnered with World Health Partners to implement the USAID-funded Tuberculosis Health Action Learning Initiative (THALI), which aimed to improve TB prevention and control across six urban districts of West Bengal.

A key innovation of THALI was the role played by its TOUCH (targeted outreach for upliftment of community health) agents, volunteers who provided community sensitization and patient-centered care and support. The THALI TOUCH agent was an intermediary between the community and service providers who facilitated the identification of individuals with presumptive TB, referred those people for diagnosis, and facilitated treatment adherence among people with TB. TOUCH agents also provided community sensitization programs. THALI, through its network of 16 partner NGOs, identified and trained 262 TOUCH agents across Kolkata Municipal Corporation, Howrah Municipal Corporation, and Rajpur-Sonarpur and Baruipur Municipalities. These agents provided 3,241 people with TB with services including psycho-social, nutrition supplementation, and linkage with government schemes like Direct Benefit Transfer.