Promozione della salute nei contesti urbani: l’approccio urban health

In a very brief definition, urban health denotes the application of the public health concept and methods to urban processes and situations.¹ The urban health approach looks at urban populations, systems, and environment through what has been called the “health prism” or “health lens”. In other words, it focuses on health (promotion), on disease (prevention), and on the numerous interrelations with urban factors. In a complementarily manner, for health professionals, who commonly think in health terms, urban health introduces “urban lens” which reveals a plethora of innovative ways to tackle population health and sustainability of welfare systems.
Urban health exemplifies what the World Health Organisation (WHO) calls “Health in all policies”, a concept of health most strongly connected to societal sectors beyond traditional health care, i.e., housing, education, environment, economy. Therefore, urban health brings health professionals together with a range of other experts including city planners, architects, landscape designers, environmental engineers, and many others.
Why is Urban Health a timely and appropriate idea? Fistrly, in the 21^st century, after about 11,000 years of urban development, cities have become the globally dominant form of settlement,² characterized by high density and diversity of populations and activities as well as by complex fluxes of matter, energy, information, goods, and – prominently – by movements and migrations of people. Urban settings feature multiple health-positive opportunities of access, communication, and integration, but also higher risks of exposure to several agents, including physical, mental, and social stressors. In addition, due to new technologies or social trends, the urban and metropolitan environments are constantly changing. Again, this provides opportunities and, at the same time, necessitates vigilance to safeguard everybody’s health.
The papers published in a special section of this issue of Epidemiologia&Prevenzione cover a wide range of relevant topics. Increasing physical activity is, of course, pivotal for overcoming current health challenges.³ Urban environments conducive to walking and cycling are rightfully held in high esteem.⁴ There are numerous factors co-determining mobility, including physical network design, attributes of urban quality, and social arrangements, e.g., the walking bus for school children.
With people spending large lifetime fractions at home, the attributes of housing require careful attention. While preserving classic, time-tested hygienic standards, new concepts of quality, safety, and comfort emerge and want to be incorporated.^5-7
The collection of papers illustrates that, beyond substantive issues, urban health requires a range of diagnostic assessments as well as interventive approaches.⁸ This includes adequate indicators, scores and scales. Quantitative modelling helps to estimate risks and benefits,⁹ thus contributing to a prudent mindset of foresight and precaution.¹⁰ Prospective environmental and/or social impact assessments of policies, projects, and urban plans are consistently meant to include human health, but often fail to do so.¹¹ Innovative multi-criteria tools might help improving the practice.
Reference to the activity promoted by the European Public Health Association (EUPHA)’s Urban Health section, by WHO, and by the European Commission (EC) was instrumental in recent efforts in many European countries to revitalize the traditional proximity of planning with health. In Germany, a foundation-sponsored research programme “City of the future: healthy and sustainable” was established, after having been prepared by debates and joint academic excursions of planners and health professionals.^12,13
In recent years, there has been a rise of awareness in designing urban plans and promoting initiatives of community design that could improve qualities of urban contexts in European cities.¹⁴ Furthermore, there are an increasing number of research groups on public health that explore, in synergies with schools of architecture and urban planning, characteristics and qualities of the built environment which are able to promote healthy lifestyles.¹⁵ But much more could be done.
The papers included in this issue of Epidemiologia&Prevenzione show great promise for urban health in Italy and beyond. The successful work needs to be continued: suitable ways to implement betterments for health and sustainability, both locally and on larger scales, will arise and consolidate.

Conflict of interest disclosure: the authors declare they have no conflict of interest.

References

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2. Talukder S, Capon A, Nath D, Kolb A, Jahan S, Boufford J. Urban health in the post 2015 agenda. Lancet 2015;385(9970):769.
3. McCormack GR, Shiell A. In search of causality: a systematic review of the relationship between the built environment and physical activity among adults. Int J Behav Nutr Phys Act 2011;8:125.
4. D’Alessandro D, Buffoli M, Capasso L et al. Green areas and public health: improving wellbeing and physical activity in the urban context. Epidemiol Prev 2015;39(4) Suppl 1:8-13.
5. Capolongo S, Buffoli M, Oppio A, Nachiero D, Barletta MG. Healthy indoor environments: how to assess health performances of construction projects. Environmental Engineering and Management Journal 2013;12(S11):209-12.
6. Capasso L, Capolongo S, Faggioli A, Petronio MG, D’Alessandro D. Do Italian housing regulations and policies protect poor peoplÈs health? Ann Ig 2015;27(4):688-89.
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10. Fehr R, Mekel O, Hurley F, Mackenbach J. Health impact assessment – a survey on quantifying tools. Environmental Impact Assessment Review 2016;57:178-86.
11. Fehr R, Viliani F, Nowacki J, Martuzzi M (eds). Health in Impact Assessments – Opportunities not to be missed. World Health Organization, Regional Office for Europe; European Public Health Association (EUPHA), International Association for Impact Assessment (IAIA); Bonn, 2016. Available from: www.euro.who.int/health-in-IA
12. Baumgart S, Fehr R, Hornberg C. Health issues and spatial planning: approaches towards a Planning Tool Kit. In: Caeners S, Eisinger M, Gurr JM, Schmidt JA (eds). Healthy and liveable cities. Joint Center “Urban Systems” at the University of Duisburg-Essen, Essener Forum Baukommunikation, avedition GmbH Ludwigsburg, 2013; pp. 16-26.
13. http://www.urban-health.de
14. Capolongo S, Buffoli M, Oppio A, Petronio M. Sustainability and hygiene of building: future perspectives. Epidemiol Prev 2014;38(6):46-50.
15. Capolongo S, Buffoli M, Oppio A, Rizzitiello S. Measuring hygiene and health perfomance of buildings: a multidimensional approach. Ann Ig 2013;25(2):151-57.

Rainer Fehr, through his website, pays further attention to the issues here presented You are very welcome to visit the website www.rfehr.eu at «Topics&Activities» section, where dr. Fehr shows in deep the «Urban Health» project of 2013 https://rfehr.eu/portfolio/2013-project-urban-health-building-bridges/ and the discussions of the European Public Health Association – EUPHA https://rfehr.eu/portfolio/2014-health-assessments-with-eupha-sections/