“Mayors are at the forefront of urban health leadership”

On 2 October, the GCH provided a unique opportunity for mayors to meet with Dr Tedros Adhanom Ghebreyesus, Director-General, World Health Organization (see his remarks here). In this interview, he shares his views on urban health, the role of local governments, and the future of multilateralism.

What is the main message specifically Mayors should take away from your address?

Mayors and urban leaders play a pivotal role in addressing a wide range of health challenges within their cities, encompassing noncommunicable diseases, infectious diseases, injuries and violence, health inequity, and health security and emergency preparedness.

Mayors are at the forefront of urban health leadership, and their actions can significantly impact the health and well-being of their citizens. Mayors and other local political and community leaders also play a crucial role in preventing, preparing for, responding to, and recovering from health emergencies.

WHO is dedicated to supporting mayors and urban leaders in their efforts to improve the health outcomes of, and health security within, urban populations. WHO’s technical resources and frameworks on urban health include the WHO Housing and Health Guidelines, the sourcebook on integrating health in urban and territorial planning, and the Framework for strengthening health emergency preparedness in cities and urban settings.

It is crucial to acknowledge that the impact of a mayor’s urban health leadership extends beyond the city limits when they actively engage in international and multilateral initiatives. The Mayors’ Declaration for Better Pandemic Prevention, Preparedness, and Response, signed by more than 70 mayors worldwide, advocates for equity and a comprehensive, whole-of-government approach in the new pandemic agreement currently under negotiation by WHO Member States. The agreement references WHO’s work on urban health emergency preparedness, which supports countries’ efforts to make their cities better prepared for health threats and emergencies.

How does the World Health Organization work with local governments? Could you provide specific examples in that regard?

WHO has established and partners with various global city networks to facilitate the exchange of experiences and provide support for local initiatives to enhance urban health.

Some of these multi-stakeholder networks include:

• BreatheLife: the BreatheLife network brings together cities, regions, and countries that are dedicated to improving air quality and collaborating on innovative solutions to combat air pollution and address climate change mitigation.

• Global Network for Age-friendly Cities and Communities (GNAFCC): Established in 2010, the GNAFCC connects cities, communities, and organizations worldwide with the shared goal of creating communities that are ideal places for older populations to live and thrive.

• Partnership for Healthy Cities (PHC): The Partnership for Healthy Cities, supported by Bloomberg Philanthropies in partnership with the WHO and Vital Strategies, comprises a global network of 70 cities, and is committed to saving lives by preventing noncommunicable diseases (NCDs) and injuries.

• Regional Healthy Cities Networks: Each of the six WHO regions has initiated a Healthy Cities Network, taking into account distinct urban governance contexts and regional urban health priorities.

WHO extends its support to sub-national governments in the development, implementation, monitoring, and evaluation of policies designed to promote urban health. For example:

• The WHO Urban Health Initiative (UHI): UHI equips decision-makers with tools and guidance to comprehensively assess the potential health benefits and risks associated with air and climate pollutants. This assessment serves as solid evidence that can be shared with the public before introducing and implementing local emission reduction policies and strategies.

• The Urban Governance for Health Well-being (UGHW) project: WHO collaborates with the mayors of five cities—Bogota (Colombia), Mexico City (Mexico), Khulna City (Bangladesh), Douala (Cameroon), and Tunis (Tunisia)—to enhance existing mechanisms for participatory urban governance for health and well-being. This is achieved through multisectoral collaboration, community engagement, and the promotion of social innovations and dialogues at the local level.

What involvement and action do you expect from local governments when it comes to urban health?

Local governments are uniquely positioned to understand the specific health needs of their communities through close engagement with residents. Moreover, local governments have the capacity to swiftly implement actions during emergencies and other health threats.

Local governments can lead efforts to enhance air quality, ensure access to safe water supply and improved sanitation, and engage in healthy urban planning. They can implement policies for smoke-free environments, enforce road safety measures, promote healthy food systems and diets, manage the environment to control vector-borne diseases, and prepare for health emergencies. They are also critical actors across the emergency cycle, and are key to effective surveillance, monitoring, community engagement and in reaching vulnerable populations.

Local governments must recognize the profound interconnections between health and well-being in urban areas and complex urban systems. These urban systems encompass various sectors, including housing, transportation, energy, spatial planning, water and sanitation, urban agriculture, and waste management. Actions taken within one sector can affect others in unintended ways.

Hence, local governments should try to adopt strategic and holistic approaches. To implement this multi-sectoral approach effectively, local governments need to enhance their understanding and build capacities in cross-cutting policy areas, including generating and working with evidence, governance and financing, innovation, and partnerships and participation.

How do you see the future of inclusive multilateralism?

Inclusive multilateralism stands to gain from the active involvement of mayors and urban leaders, offering a pathway to more effective, localized, and people-centered solutions for global challenges.

Mayors are at the front lines of addressing compelling global issues, including climate change, public health crises, and social equity. They possess a more nuanced understanding of the needs of their communities and constituents, providing invaluable perspectives to ensure that global policies and initiatives closely resonate with the realities on the ground.

Moreover, mayors are well-positioned to not only shape global policies but also to play a pivotal role in localizing and implementing global agendas, such as the Sustainable Development Goals. By aligning local policies and actions with these global strategies, mayors bridge the gap between international aspirations and the practical, day-to-day progress needed in cities and urban areas.

Looking ahead to the future of inclusive multilateralism, mayors have critical roles to play in advocacy and diplomacy. Pioneering local leaders have already demonstrated their capacity for diplomatic engagement and international cooperation. We can expect an increasing number of mayors to participate in diplomacy and global negotiations, strengthening their voices in international forums.

Collaborative mechanisms that foster exchanges and partnerships among cities and mayors will become increasingly crucial, allowing diverse leaders to present coherent and collective messages to address common challenges in urban health.