Kieron Boyle, Chief Executive, Guy's and St Thomas' Charity
Jul 27, 2020
In all the commentary on whether COVID-19 will lead to the gradual abandonment of cities, one point seems overlooked: those most affected by the pandemic – the vulnerable, those on lower incomes and communities of colour – often have little option over whether they live in cities or not.
For the past 50 years, urban centres have been great engines for prosperity, yet this has always masked huge health inequalities. Cities are responsible for both the best health and the worst health outcomes in ways that are predictable, entrenched but also amenable to change.
It is clear now that COVID-19 has not been experienced equally. The overwhelming majority of people with COVID-19 live in cities. As we are learning at a great cost: a city can’t be safe, unless it is equitable.
If you live in an overcrowded house, journey to multiple jobs on crowded public transport, and have little say over your working conditions, your threat from the virus will be much higher. And it goes deeper than that. Your risk from COVID-19 is higher if you live in polluted areas or if you live in neighbourhoods with few affordable healthy eating options. It is also higher if you already have other long-term health conditions, which you are more likely to do (and at a younger age) if you live in diverse, urban environments.
What the pandemic has done is to fast-forward a clock on urban health patterns that were there all along – less visible, perhaps, but with just as great a human and economic cost. It has also made evident that our resilience as a society depends on tackling these issues. Health is a collective outcome, rather than an individual one.
Urban health is also not just one sector’s responsibility: it goes much wider than the healthcare system or our public health authorities and includes urban planners, investors, employers, and communities themselves. In the main, we also know exactly what to do – the challenge is mobilising to do it.
Urban planners around the world are using this moment to create healthier streets, with widened pavements, car-free zones and easier access to cycling. They could go further – for example, demanding better quality housing that determines so much of our health.
Long-term investors and insurers are particularly exposed to the health effects of urban inequalities. These include workforce shortages, rising healthcare costs, customer expectations and all manner of reputational risks. Our own Healthy Markets campaign has attracted over $1tn of assets from pension funds and other investors dedicated to engaging with retailers and food manufacturers on tackling obesity. We need this across other urban health issues too.
Employers are increasingly aware of their obligations in tackling the sharp divisions in the health of their workforces. Economic recovery relies on a healthy workforce and this is clearly time for a new contract – in return for the taxpayer stepping in to support private enterprise, we should raise the bar on working standards, job security and decent pay; all of which are amongst the most effective urban health interventions known.
Most importantly, though, we need to centre the voice of urban communities in our response. Unfortunately, many existing processes – from public engagement to policy-making, to planning, to philanthropy – disproportionately exclude organisations that are led by people of colour or from lower-income backgrounds. So we need to change the processes. Many cities are embracing approaches such as citizen assemblies, mutual aid groups and open digital platforms, but these need to be on the issues that matter, and not just the ones left over.
In short, there is much to do, but healthcare institutions cannot, and should not, be left to tackle this alone. We need a collective response to urban health.
23 April, 2020
As a funder, our priority is to support our partners and the communities most affected by COVID-19. Our Portfolio Director, Louise Mousseau, sets out the actions we've taken to date and how we're adapting our work in response to a changing environment.