CAPE TOWN – From Accra to Kathmandu, a global partnership of 74 cities has had remarkable success in addressing some of the key drivers of sickness and death since it was launched seven years ago.

Ghana’s capital city, Accra, has cut traffic crashes by 20%. In India, Bengaluru is virtually smoke-free – not even hookahs are allowed. Nepal’s Kathmandu has installed air quality sensors to assess air pollution while a number of Latin American cities are supporting better nutrition of their school children. 

“The Partnership for Health Cities (PHC) was formed in 2017 to address non-communicable diseases (NCDs) and injuries, which are responsible for 80% of deaths globally,” said Bloomberg Philanthropies’ Kelly Larson, welcoming city representatives to the PHC’s summit in Cape Town this week.  

“This opportunity for us to come together is very unique because we are all facing the same challenges and you can learn so much from one another. We really do believe in the power of cities to make change. We are here to support you in your efforts to know that you are leading the way on this,” added Larson, whose organisation supports the partnership, along with the World Health Organization (WHO) and Vital Strategies.

The partnership started with 54 cities but now consists of 74 cities that collectively represent over 300 million people.

Each city in the PHC chooses to work in one of six key work areas: food policy, overdose prevention, tobacco control, road safety, safe and active mobility (such as promoting cycling) or data surveillance.

The cities are encouraged to root their work in public health policies and to win as much public support as possible for these. The PHC’s  Policy Accelerator supports cities to create and implement these policies.

“Cities are a place where people are particularly at risk. There is a huge concentration of people exposed to risk of NCD and injuries,” said the WHO’s Etienne Krug.

“But cities are a particularly good place to think about interventions for a number of reasons,” he added. “First of all, they enforce national laws but they can also enhance these with additional regulations. City leaders are geographically close to their populations. It is easier for multi-sectoral approaches than at national level.”

Bengaluru: A model smoke-free city

India’s Dr Vishal Rao has been an advocate for smoke-free laws for a number of years in Bengaluru (Bangalore) and its state, Karnataka. This is hardly surprising as a head and neck surgical oncologist at a cancer hospital and has treated numerous tumours in the thyroid, parotid, and salivary glands caused by tobacco use.

“We first prioritised creating a policy framework around smoking, and have built this policy around the three R’s – making somebody responsible, have it reviewed and reported,” Rao told Health Policy Watch.

“We prioritised smoke free policy because we realised that Bengaluru is a cosmopolitan  economic hub with a very vibrant culture of pubs, clubs, cafes, bars and restaurants, all of which were rampantly violating the smoke free laws,” said Rao, who is also a member of the Karnataka government’s High Power Committee on Tobacco Control.

“Reducing and protecting the non-smokers required a comprehensive approach of policy intervention which is why the mayor and the [state] commissioner came out with the government order completely banning smoking in hotels, bars, restaurants, clubs, pubs and cafes unless they have a designated smoking room which is compliant with the law,” said Rao.

The requirements for these designated smoking rooms were so onerous – including no sales or services of any sort being allowed – that most places opted not to set them up.

A couple of weeks back, the state government also banned hookah bars – including hookah with tobacco, flavoured and herbal hookah – becoming the first state to do so. The pushback has been immediate, with the Hookah Association lodging around 12 litigation cases against the new laws, said Rao.

For Rao, the partnership is less about the grants cities get and more about sharing strategies, tactics and “allowing champions to emerge” to promote the various themes – his city won an award at last year’s summit for its efforts.

Accra: All the laws but little implementation

Rita Agyen Takyi is an advisor to Accra’s mayor on international affairs and the city’s focal person on road safety, the issue her city has chosen.

“Ghana has all the laws. But we needed enforcement, implementation and public awareness,” Takyi told Health Policy Watch. Accra’s Bloomberg Road Safety initiative started in 2015 and it joined the partnership at its launch in 2017.

Over half the city’s road traffic deaths involved pedestrians, cyclists and motorcyclists. Public awareness campaigns have included encouraging the use of seat belts and helmets, speed limit signs and speed detectors for traffic police, direction signs painted on roads and fixed painted bollards to prevent motorcyclists from entering pedestrian crossings.

“We have reduced traffic crashes by 22% since 2021/22,” said Takyi, who also credits this success to Accra bringing different stakeholders “out of their silos” and into one forum with a common goal.

Latin American cities prioritise food policy

Five cities in Latin America have chosen to focus on food policy. Quito in Ecuador is concerned with the nutrition of children, the city’s Marysol Ruilova told the Cape Town summit.

Quito has developed a policy requiring only healthy foods to be advertised near and at schools, and is also providing clean free water in 20 pilot schools.

However, since the COVID-19 pandemic, there has been an increase in child malnutrition so the city has focused on school feeding schemes.

Similarly, Córdoba in Argentina is preparing to restrict the sale and advertising of unhealthy food and beverages in schools and requiring healthy alternatives, while 

Cali in Colombia is also ensuring that scholars have access to nutritious and wholesome meals during school hours.

Lima in  Peru is also working to create healthier school environments through enforcement of a new policy that restricts sales and advertising of unhealthy products. Montevideo in Uruguay is incentivizing food services to provide healthier meals to public sector workers, through its “Healthy Canteens” initiative.

Cape Town: Socio-economic determinants of health

Host city Cape Town has been involved in tobacco control and food policy-related initiatives while part of the PHP.

“Against the backdrop of incredibly challenging national economic circumstances and very deep and wide local poverty, our city is still demonstrating progress,” Mayor Geordin Hill-Lewis told the summit.“But you cannot build a prosperous city or achieve our dream of a city of hope without also focusing on public health in a serious way.”

One of the things that Cape Town is currently focusing on is identifying and addressing the socio-economic determinants of health in the city and addressing these through infrastructure planning, service provision and job creation.

“Cape Town has a very high burden of NCDs and other preventable deaths. And, while we have a good understanding of the various factors that contribute to that burden, this programme will provide crucial information that can help determine strategies going forward,” according to Councillor Patricia Van der Ross.

Image Credits: Partnership for Health Cities, Kerry Cullinan.