Because cities typically generate and accumulate wealth, they are in a strong position to promote good health, security, decent employment, and robust social opportunities—the foundation blocks of well-being. The need is great. Experts convened by the World Health Organization assert that outdoor urban air pollution causes 1.3 million deaths each year, while sedentary lifestyles cause 3.2 million deaths, traffic injuries 1.3 million deaths, and violence some 1.6 million deaths. Sustainable cities will reduce these incidences of mortality dramatically by structuring cities to avoid their causes.1
Well-being requires a broad set of policy choices that ensure that everyone has access to the basics for a dignified life.
In most cities, well-being is lacking for many people or even for most people. Well-being requires a broad set of policy choices that ensure that everyone has access to the basics for a dignified life. Fortunately, the pursuit of urban sustainability can help to advance well-being: a 2013 study comparing the Gallup Healthways Well-Being Index with four indices of sustainability covering 50 or more U.S. cities found that those cities that are more sustainable also tend to score highly on well-being indices.2
Cities will be challenged to ensure that all citizens have access to health care. Attention by a doctor or dentist early in the development of a medical condition can catch maladies before they become serious sickness. Cities, too, can minimize or prevent problems by helping residents stay healthy. By enacting and enforcing strict standards for air and water cleanliness, for example, cities can prevent respiratory and digestive ailments that affect many citizens. In other words, cities can be designed for health.
Decisions about land use and transportation have important health effects.
Decisions about land use and transportation have important health effects. By designing cities for walkability and bikability, with short distances to work and shopping, residents can build exercise—a key to good health—into their daily routines. Many cities see the promotion of walking and biking as key not only to a multi-modal transportation system, but to prevention of chronic diseases such as heart disease and diabetes. Parks, in particular, are an attractive way to promote good health, with sports fields, exercise circuits, and bike paths being popular ways of keeping people active. Where parks are not available, exercise can be brought to people: in China, authorities have created some 4,000 free outdoor gyms since 1998 that contain many of the types of exercise equipment found in private gyms, but adapted for outdoor use. The national and municipal governments have promoted these facilities through public events such as the annual National Fitness Day and Beijing Olympic City Sports Culture Festival.3
Central to well-being is secure income, typically from a steady source of employment. Employment can be public, private, or in the nonprofit sector, and it can be informal or formal in nature. Although a wide host of policies can be used to promote employment, at an overarching level, cities might follow what the International Labour Organization calls a Decent Work Agenda, which includes four objectives: creating jobs, guaranteeing rights at work, extending social protection, and promoting social dialogue. Commitment to these objectives can help minimize unemployment, improve workplace relations and safety, and provide for secure incomes.4
Many cities have a large share of the population working informally, largely outside the protection of municipal rules governing work.
Many cities have a large share of the population working informally, largely outside the protection of municipal rules governing work. But in some cities, innovative schemes exist to improve the conditions of informal workers. In the Indian state of Gujarat, for example, the conditions of homeworkers are monitored by the Self-Employed Women’s Association, which also helped establish minimum piecework rates consistent with the minimum wage. In Sudan, women working in the informal sector have formed associations to cover their health needs.5
Because the bulk of employment in most cities is in the private sector, city governments can seek to influence wages and working conditions in this sector. Contractors at large institutions, such as airports, can be required to provide standard wages and benefits. Wage and benefit minimums also can be set as a condition for economic development subsidies. In the United States, the city of Santa Fe, New Mexico, requires a Community Workforce Agreement with wage and benefit stipulations on any city-funded construction project valued at more than $500,000. 6
When workers are out of work or otherwise cannot get employment income, cities can establish social protection floors—safety nets that keep citizens from falling into extreme poverty. These are best designed not just as crisis management tools, but as extensions of development. In Brazil, the government uses its Bolsa Familia federal cash transfer program to provide the poorest families with financial support, with the proviso that children attend school, are vaccinated, and are monitored for growth and weight, and that pregnant women receive pre- and postnatal care. In 2011, Brazil launched an amended version of the program, Bolsa Verde, which gives approximately $150 each trimester to poor families that adopt environmental conservation actions, generating additional revenue for low-income residents. Women are the primary recipients of funds from the programs and account for 93 percent of program debit card holders, increasing family security and women’s negotiating power vis-à-vis their spouses.7
〉〉 Next: People-centered Development
Gary Gardner is director of publications at the Worldwatch Institute and co-director and contributing author of the State of the World project.
Read more in State of the World: Can a City Be Sustainable?