In addition to coordination across government ministries, national and city governments could coordinate their work better.Īll of this is true of the Caribbean – but the link between urbanisation and health is perhaps more apparent in places like Brazil, India, Pakistan and China, where demographic and socioeconomic change in urban areas are taking place on a much larger scale. Sustainable and affordable housing, water and sanitation, waste management, education, transport, parks and conservation areas: all these directly affect urban health. The keynote speaker, Prof Sir Michael Marmot, president of the British Medical Association, had a simple message for countries about the need to better coordinate policy between government ministries: "Every minister is a minister of health," he said. This was a point made repeatedly at the Emerging Markets Symposium on Urbanization, Health and Human Security, held at Oxford University in mid-January. But this is not always the case, and delivering public health in urban areas, across emerging economies, while achieving the needed policy coordination across all levels of government, is a huge and largely unaddressed challenge. In theory, the fact that people live closer to health providers in an urban setting should lead to greater health service delivery and equity. The reality is that, all over the world, growing urbanisation is inevitable. But the situation is changing and those non-communicable diseases, often associated with affluence – or "revealed by affluence", as some say – are at the centre of this transition. Often the spread of communicable, infectious disease is linked to urbanisation as more people live in towns and cities and overcrowding becomes a problem. Not only are we experiencing a surge in cardiovascular disease and diabetes, but the age at which the conditions are being diagnosed is getting younger even children are affected by them. In this respect, the Caribbean is no exception. Obesity is often used as the example for the sort of medical condition that accompanies urban life.
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