Dhaka Statement

Dhaka Statement on Urban Health in Sustainable Development

International Conference on Urban Health

Dhaka, Bangladesh,

May 2015


A Call for Action

The International Society of Urban Health (ISUH) and the participants in the 12th International Conference on Urban Health call for recognition of urban health as a priority in sustainable development, including in the proposed sustainable development goals, targets and indicators for the post-2015 development agenda, the Third International Conference on Financing for Development, The United Nations Climate Change Conference, and Habitat III, the 2016 Conference on Housing and Sustainable Urban Development.

We are urban health experts across disciplines, practitioners across sectors, and representatives of civil society organizations from around the world committed to advancing the health of people in cities.

The Conference Recognizes that:

Currently, more than half of the world’s population lives in cities and by 2050 it is estimated that 70% of the world’s population will be urban dwellers. While all countries confront challenges from urbanization, the pace and scale of urbanization is now most rapid in low- and middle-income countries.

Cities are the main drivers of national development and offer access to a wide array of goods and services including health, education, and social and cultural opportunities.

  • People are attracted to live in urban areas because of the potential to improve their lives, including through economic opportunities. As a result, urban residents often provide important economic support to their rural home communities.
  • When urban growth is effectively managed, cities can be part of the solution to sustainable national development.
  • If plans for the built environment (e.g., housing, land use, transport) include consideration of health impact, cities can facilitate healthy choices of food, exercise, and social engagement, as well as maximize resilience of its residents.
  • If well managed, cities can be engines of development for national economies, hubs for technological innovation and centers of positive social progress including advancing the education and empowerment of women and child survival and development.
  • Population density in cities can facilitate delivery of development interventions to large numbers of people.

Cities can also be sites of extreme poverty, environmental degradation, inadequate infrastructure and a combination of risk factors that have adverse effects on health.

  • Countries that fail to plan for increasing urbanization place their citizens at serious health, economic, and security risk.
  • The health of slum dwellers and the homeless is typically well below that in other urban and rural areas, even when stratified by poverty level. These inequities are also observed in other critical development indicators that affect the health of all residents.
  • In addition to traditional urban health challenges of water, sanitation, infectious diseases and environmental pollutants, city residents confront chronic diseases linked to poor diets, sedentary lifestyles, and obesity. Urban dwellers also face physical and mental health issues linked to safety, violence, poverty and unemployment, and they are at risk for road accidents and other injuries.
  • Coastal cities face particular risk from the effects of climate change, including extreme weather events, natural disasters, sea level rise and Floods.
  • Settlements without legal status, basic infrastructure, energy security and services can become loci of social tension, conflict, and illicit economic activity.

Strong and effective governance is required to promote urban health – specifically including clear roles for city and local government and a strong public health infrastructure that can work in partnership with other sectors to prevent and mitigate potential risks and benefits to health of policies, programs, and investments across sectors (a Health-In-All approach).

The Conference Welcomes the following reports and initiatives, which acknowledge the growing importance of cities in achieving sustainable development; recognize that the health of people living in cities is affected by multiple factors, that decisions in all sectors can have positive or negative effects on human health, and that healthy people are critical to social and economic development:

  • The Synthesis Report of the UN Secretary General on the Post 2015 Agenda (2014), which identifies six essential elements for delivering the SDGs and proposes 17 Sustainable Development Goals, including a specific goal for Health (#3) and for Cities (#11)
  • The Joint Statement of the UN Platform on Social Determinants of Health (World Health Organization) which outlines the relationship between health and other societal goals across multiple sectors: the economy and employment; security and justice; education and early life; agriculture and food; architecture, planning and transportation; environment and sustainability; housing and community services; and land and culture
  • World Health Organization recognition that urbanization is a major public health challenge in the 21st century and calls for a shared effort involving governments, international organizations, business and civil society to put health at the heart of urban policy (Urban HEART: Urban Health Equity Assessment and Response Tool, 2010) and reduce urban health inequities (Hidden Cities: Unmasking and Overcoming Health Inequities in Urban Settings 2010)
  • The Nine Principles of The City We Need articulated by the World Urban Campaign, a coalition of global partners of HABITAT to promote the outcomes document of Habitat III, the New Urban Agenda and the work of HABITAT to promote well-planned, well-governed, and efficient cities and other human settlements, with adequate housing, infrastructure, and universal access to employment and basic services
  • The updated Global Strategy for Women’s, Children’s and Adolescents’ Health (WHO Partnership for Maternal, Newborn and Child Health) which will support achievement of the women’s, children’s and adolescents’ health related Sustainable Development Goals (SDGs) and which prioritizes gender equality the needs of marginalized and disadvantaged communities, including those living in urban and peri-urban settings, as key to achieving equitable progress in improving health outcomes.

The Conference Encourages the Following Actions:

  1. Specific reference to the critical importance of the health of urban dwellers to achieving the Sustainable Development Goals in the planned political declaration that will preface the Goals;
  1. Mainstreaming consideration of the unique opportunities and challenges of urban environments across the SDGs;
  1. Recognition of the pressing need for evidence-based and cost-effective interventions that address the effects of urban diversity, complexity, density and disparities on the social and structural determinants of health in order to achieve the health targets outlined in SDG Goal 3: Ensure healthy lives and promote well-being for all at all ages;
  1. Inclusion of a commitment that the solutions chosen have a positive impact on human health and do not adversely affect health of people in cities, in the targets for SDG Goal 11: Make cities and human settlements inclusive, safe, resilient and sustainable,
  1. Development of national-level health policy that integrates planning for rural and urban areas, and recognizes the importance of city and local level data and action to advance urban health.
  1. Inclusion of targets and indicators to implement SDGs at the national level that reflect progress towards urban health and health equity;
  1. Incorporation of key tools to advance the health of people in cities, including resource mobilization for capacity building, applied research and strengthening governance for urban health, in the outcome documents of the Third International Conference on Financing for Development (2015), The United Nations Climate Change Conference (2015) and Habitat III (2016);
  1. Incorporation of expertise from the global professional and academic health communities in seeking to define, understand, and address the major challenges of global urban development into the intergovernmental process leading up to the United Nations Conference on Housing and Sustainable Urban Development (Habitat III), to take place in Quito, Ecuador in October 2016; and
  1. Acknowledgment of the role of health as both input for and outcome of development, particularly the broad interplay between urban design, planning and management, and urban health and health equity, in the New Urban Agenda that will emerge from Habitat III.