Better urban planning can result in a reduction in non-communicable diseases
DOES LIVING IN THE CITY AFFECT HEALTH?
Although living in the city will give you access to better healthcare, education, infrastructure and facilities, urban living will, however, increase your risk of getting non-communicable diseases (NCD).
Studies done in developing countries show that city living will increase one’s risk of getting hypertension and diabetes, and being overweight as well as engaging in low physical activities.
The trend is similar in Malaysia, where hypertension, obesity and physical inactivity are more common in urban areas, based on the results of National Health and Morbidity survey in 2015.
A report by the department of statistics, Malaysia in 2018 showed that the main cause of death in Malaysia’s urban area is ischemic heart disease, compared to pneumonia in rural areas. It showed that NCD is the main cause of death among urbanites.
There are several reasons why the risk of getting NCD is higher in cities. An unhealthy lifestyle and air pollution may contribute to the increase in these diseases. Sedentary behaviour is also more prominent in urban areas.
The increase in NCD will be more severe as more and more people move to urban areas. More than 50 per cent of the population in the Asia-Pacific region in 2018 resided in urban areas.
In Malaysia, it is estimated that in 2020, almost 80 per cent of people will live in urban areas, and the number is increasing. This will increase the number of NCD in urban areas if nothing is done to improve the environment.
HOW CAN ACTIVE LIVING IN A CITY REDUCE NCD?
Physical inactivity is an established risk factor of NCD. The World Health Organisation reports that physical inactivity is the fourth risk factor of death after hypertension, smoking and high blood glucose.
A study published in the British Medical Journal in 2009 showed that low cardiorespiratory fitness is the main cause of death, followed by hypertension, smoking, diabetes and obesity.
Improving level of physical activity and fitness in a city will reduce the risk of getting NCD, mainly cardiovascular disease.
A study using computer simulation model was done in North Carolina by researchers from the University of North Carolina to look at the health effects of a city’s features to promote walking.
It predicted that increasing the average daily time spent walking for transportation by 17 minutes resulted in a decrease of annual death of all causes by 5.5 per cent and annual new cases of diabetes, coronary artery disease, stroke and hypertension are predicted to decline by 1.9 per cent, 2.3 per cent, 1.3 per cent and 1.6 per cent respectively.
This study showed that proper urban planning promotes active living and will result in more health benefits for the people.
WHAT INITIATIVES IN A CITY MAY PROMOTE ACTIVE LIVING?
Proper urban planning is important to promote active living and reduce the burden of NCD in a city.
In various studies, four attributes were found to help increase level of physical activity — net residential density, intersection density, public transport density and number of parks.
High residential density will require more pedestrian walkways to get to nearby shops or services.
More intersection density will make it easier for residents to move around their neighbourhood.
Better public transportation will make it easier for people living in the city to commute to work. It will also encourage them to walk to the transport facility.
More parks will allow city folk to use it for recreational activities and provide them an area with clean air.
The Lancet series of publications in 2016 has suggested a few recommendations to promote active living via proper urban planning that are also environmentally-friendly.
The recommendations include safe active transport, building pedestrian paths, non-motorised cycling lanes, green space and parks for recreation and building infrastructure at commutable distance.
Governments must also have policies in their urban planning to consider the health impact and monitor health outcomes continuously in the city.
* An avid sportsman who believes in the healing powers of exercise, Assoc. Prof. Dr Ahmad Taufik Ismail is Universiti Teknologi Mara’s Public Health Consultant and Exercise Physician. Reach him at atjamil@gmail.com