Health promotion to create healthy cities - the WHO conference in Shanghai

By Layla McCay, Director, Centre for Urban Design and Mental Health

At the World Health Organization’s 9th Global Health Promotion Conference in Shanghai last month, WHO director Margaret Chan pronounced: “Health can no longer be addressed by the health sector alone”. In doing so, she set the tone for this interesting event, which, as Chan stated, meant "changing the living environments in which people make choices about their health-related lifestyle." Non-communicable diseases (NCDs) were of particular interest, with  the Health Minister of Mauritius, Anil Gayan, stating that "NCDs are the modern weapons of mass destruction”. The Lord Mayor of Cork, Ireland further proposed: “It’s our responsibility and obligation as city managers to promote good mental health.”
 
It was in this context that I was invited to speak about urban design and mental health to an audience of international city mayors and other policymakers and experts (see slides). I explained the central place of mental health within the WHO’s definition of health, and that good mental health is integral to achieving thriving, resilient, sustainable cities. I discussed how the city wears away many of our protective factors for good mental health, such as access to nature, strong social networks, sleep, security, privacy, and more. But conversely, the city has the potential to strengthen our mental health and wellbeing, leading to happier healthier citizens with increased education, employment, health and economic potential. But how?
 
We discussed the Centre for Urban Design and Mental Health’s Mind the GAPS framework: any urban design policy can (and should) be assessed for its basic impact on mental health depending on the extent to which it creates access to green, active, pro-social and safe space. The presentation received a great deal of interest from cities around the world interested in integrating mental health into their policymaking and design.

UD/MH Director Layla McCay speaks at the World Health Organization’s 9th Global Health Promotion Conference, Shanghai

Interestingly, the potential of designing the built environment to promote and support good mental health is still not widely recognised. The other speakers at this session focused less on structural and system opportunities to improve population mental health, and more on important but traditional issues: access to treatment and rehabilitation, and changing attitudes to reduce stigma and improve social inclusion.
 
However, built environment innovation did feature strongly in a session on physical activity. Robert Geneau from Public Health Canada led the way, stating that ‘the built environment can improve physical activity’ (the A of UD/MH’s Mind the GAPS framework) and described the shared training that Canada’s public health and urban planning professionals undertake to help make this a reality. While some ideas in the session focused on sports participation, there was a clear wider understanding that promoting physical activity is not simply about sports: walkability and bike infrastructure in cities were at the heart of these discussions, culminating in a call for us all to make better cases for city investment – and for setting shared targets owned by several government departments to improve leadership and accountability.
 
Speakers at other sessions had further interesting ideas. For example, if people are increasingly using shopping malls, how can we target their physical activity and mental wellbeing in that setting (a question that was also raised at Tokyo's Innovative City Forum a month ago)? The question of how to build ‘liveable, beautiful, safe cities’ started to emerge – along with the conviction that health is a political choice. But politicians must be supported with better health literacy and social mobilization if we are to systematically integrate health promotion into all policies – and build better mental health into cities.

Layla McCay's real time graphic notes of relevant sessions.

About the Author

Dr Layla McCay is the Director of the Centre for Urban Design and Mental Health. She is a psychiatrist and adjunct professor in international health. She is currently based in Tokyo.