On this segment of ‘Non-communicable diseases (NCDs) and Health in all Sectors’, we learn about NCDs and health in the realm of urban and regional planning in Africa from Prof. Olusola Olufemi, Ph.D MCIP, RPP. She is an Associate Professor of Urban and Regional Planning, an Independent Consultant, and Researcher with over 30 years of expertise and experience spanning across Canada, Nigeria, and South Africa.
Q: What is urban and regional planning?
A: Planning deals with the environment in which we live, work, play and learn. Planning can be described as a set of interdependent processes that, acting together, seek to create more livable, life-enhancing cities and regions (UN-Habitat, 2005:174). It addresses the use of land, resources, facilities and services in ways that secure the physical, economic and social efficiency, health and well-being of urban and rural communities (CIP). Urban and regional planning deals with the functional arrangement and composition of land uses (residential, industrial, circulation etc.) in the built environment. Planners act in the public interest and seek to improve the quality, health and liveability of the community in which we live, work, learn and play.
The Planning profession emerged from a series of public health issues, disease, insanitary living conditions, overcrowding, pollution, and environmental crises that emerged (Cholera outbreak, Bubonic plaque, fire and flood) in the 19th century.
Q: How does urban planning affect human health outcomes?
A: The interconnectedness and complexity of the built environment and health cannot be overemphasised. The relationship between how our communities are planned, designed, and built impacts health outcomes. Certain characteristics of the built environment, such as density, mixed land use, walkability, green space and community size can impact the well-being and ill-being (good or bad health) of its inhabitants. For example, greenery, air quality, safety, mobility, and transportation contribute to human and environmental health. Mixed land uses and diversity is where home and work are in close proximity, a mix of offices, shops/commercial facilities, houses and services like clinics. Density is where residences, offices, services and schools are close together, within walking distance. The essence is for convenience and efficiency of land use.
While cogniscant of the fact that there are some chronic illnesses (communicable or non-communicable) that arise from an interplay of genetic, environmental and behavioral factors with severe adverse influences on social and physical activities and quality of life, the way settlements are planned and designed could also be a trigger. NCDs such as diabetes, cancer, cardiovascular disease however intersects most often with the way communities, neighborhoods, are planned. For instance, the distances people travel to work, the convenience of buying healthy foods, safety, good nutrition and physical activity, which in turn leads to improved mental and physical health. After all, “a healthy city is one that is continually creating and improving those physical and social environments and expanding those community resources which enable people to mutually support each other in performing all the functions of life and in developing to their maximum potential.” (Hancock and Duhl, 1988).
Land use planning is associated with differential health outcomes include: accessibility of food sources, parks and open spaces, transportation options, housing, good quality air, location of services, infrastructure provision, water, employment, educational and social connections. Most of the African countries were influenced by colonial planning and attempts to decolonise our settlements have not been successful. Most African countries like Nigeria were influenced by British Town Planning Acts and Ordinances. For example, the Nigeria Town and Country Planning Ordinance No. 4, 1946 was adopted from the 1932 Planning Act of Britain. However, Decree no. 88 of 1992, a comprehensive physical planning and development law, came into effect after many years of reliance on British town planning laws to guide physical planning in Nigeria.
Q: What is the current landscape of NCDs and urban development in Nigeria?
A: While communicable diseases remain the primary cause of death in Nigeria, the country is currently facing an increase in the burden of NCDs with premature mortality from NCDs estimated at 22%. According to the 2018 WHO country profile, NCDs accounted for an estimated 29% of all deaths in Nigeria with cardiovascular diseases as the primary cause of NCD-related death (11%) followed by cancers (4%), chronic respiratory diseases (2%) and diabetes (1%). Other NCDs in Nigeria include Sickle Cell Disease, Deafness and Hearing loss, Blindness, Violence and Injury including Road Traffic Crashes, Oral Health including Noma and Disability (Obinna, 2020). A new study has shown that three-quarters of the 200 million Nigerians are at risk of NCDs, amidst coronavirus pandemic (Obinna, 2020).
Cases of cancer are rapidly increasing in Nigeria. With over 115 000 Nigerians diagnosed in 2018, the annual figure is expected to double by 2040, according to the International Agency for Research on Cancer (Howletts, 2020). Three quarters of Nigerians are at risk of NCDs (NAN, 2020) and could be worse with the COVID-19 pandemic as persons with underlying conditions are most vulnerable to the virus.
Of relevance to NCDs is the 2030 Agenda for Sustainable Development. Agenda 2030 (para. 26) affirms the importance of promoting physical and mental health and well-being, ensuring no one is left behind. It also stresses the commitment to the prevention and treatment of NCDs, including behavioural, developmental and neurological disorders, which constitute a major challenge for sustainable development. In addition, the Sustainable Development Goals (SDGs) 3 and 11 ensures healthy lives and wellbeing, and making cities and human settlements inclusive, safe, resilient and sustainable.
- Goal 3. Ensure healthy lives and promote well-being for all at all ages
- 3.4 By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being
- Goal 11. Make cities and human settlements inclusive, safe, resilient and sustainable
- 11.3 By 2030, enhance inclusive and sustainable urbanization and capacity for participatory, integrated and sustainable human settlement planning and management in all countries.
Q: What aspects of the urban built environment and its planning and design are risk factors for NCDs and poor health of its inhabitants?
A: Briefly, planning intersects with NCDs in the area of food, diet, housing and environment just to mention a few.
- Housing: Housing conditions affect people’s health and can contribute to non-communicable diseases.
- Homelessness, slum and precarious housing are factors that trigger non-communicable diseases. These Substandard housing presents with hazards ranging from biological (allergens), chemical (lead) to physical (thermal stress).
- Inadequate housing causes or contributes to many preventable diseases and injuries including respiratory, nervous system, cardiovascular diseases and cancer.
- Poor design or construction of houses is the cause of most home accidents.
- Use of proper building materials for construction could prevent indoor pollutants causing asthma, allergies or respiratory or other communicable and non- communicable diseases.
- Indoor air pollution due to poor ventilation and cookstoves also accelerates non-communicable diseases.
- Environment: Walkability and green spaces contribute to good mental and physical health. Most of the transportation and transit systems are poor and the roads are degraded. It is risky walking or cycling on the roads in Nigeria because there is no separation traffic. Pedestrians, cyclists, bikers, trucks and cars all compete for road space. Cities in Nigeria lack sidewalks, green spaces have been concretised and parks are non-existent or have been turned to informal markets. Spaces and places of recreation are an afterthought especially in residential neighbourhoods. The environment in Nigeria is susceptible to disease burden because of poor planning and infrastructures, indiscipline, corruption, lack of political will and commitment, ignorance and ineptitude. Green spaces and public parks are hard to find and the lack of these is a factor in poor mental health including dementia.
- Food: Food is a major human exposure for many chemicals and multiple causes of health outcomes. Human dietary exposure to chemicals can result in a wide range of adverse health effects and some substances might cause non-communicable diseases, including cancer and coronary heart diseases, and could be nephrotoxic (Ingenbleek et. al., 2020). Many food chemicals, including heavy metals, mycotoxins, pesticide residues, and industrial contaminants, are associated with a series of noncommunicable diseases such as infertility, developmental effects, neurotoxicity, nephrotoxicity, coronary heart disease, and cancer (Grandjean and Landrigan, 2014). Food planning is the planning and spatial distribution of edible spaces to enhance accessibility, availability, ecological sustainability and reduction of foodprint in a way that fosters health and well-being. Food planning relates to the spatial location of food retail stores, grocery stores, corner stores, produce markets or open markets. Food deserts occur in neighbourhoods or communities that are poorly served with food retail or where food markets are non-existent. Informal settlements, slums and poor neighbourhoods are mostly affected. This could be a failure to incorporate food retail in the land use planning thereby limiting food access. Food planning is contingent on land use regulations which affect the way food outlets are located and distributed. Food planning is essential to minimise food insecurity, a situation where people experience difficulties in obtaining food.
- Diet: Diet quality comprises four key aspects: variety/diversity, adequacy, moderation and overall balance. According to WHO, a healthy diet protects against malnutrition in all its forms, as well as non-communicable diseases (NCDs) such as diabetes, heart disease, stroke and cancer. It contains a balanced, diverse and appropriate selection of foods eaten over a period of time (FAO, IFAD, UNICEF, WFP and WHO, 2020). Diets of poor quality are a principal contributor to the multiple burdens of malnutrition – stunting, wasting, micronutrient deficiencies, overweight and obesity and both undernutrition early in life and overweight and obesity are significant risk factors for NCDs. Unhealthy diets are also the leading risk factor for deaths from NCDs. In addition, increasing healthcare costs linked to increasing obesity rates are a trend across the world (FAO, IFAD, UNICEF, WFP and WHO, 2020). Food deserts, poverty, non-affordability and lack of accessibility to healthy foods impact negatively on people’s diet in the built environment.
Q: How can urban and regional planning facilitate the integration of health promotion into the planning, design, and infrastructure of African settlements?
A: Effective planning creates supportive settings that promote healthy human habitats and healthy social interaction: access to recreation, schools, jobs, health and social care, strong social networks, good air and water quality, and opportunities for physical activity. Urban planning can promote healthy behaviour and safety through investment in active transport and designing areas to promote physical activity such as walking, biking, and provision of public parks. Integration of these approaches in the planning of our cities would go a long way to ameliorate the negative impact on citizens health particularly reduce the incidence of NCDs:
- Healthy Cities approach reinforced by Agenda 2030 (SDG11): aims to:
- Create a health-supportive environment,
- Achieve a good quality of life,
- Provide basic sanitation and hygiene needs,
- Supply access to health care.
- Smart Cities: Smart cities bring together infrastructure and technology to improve the quality of life of citizens and enhance their interactions with the urban environment.
- 8/80 cities: Cities built for 8 years old and 80 years old, cities that is both child and senior friendly.
- New Urbanism: Urban planning and design that creates safe, liveable and sustainable spaces to live, work, play and learn is critical now and for future generations. “New urbanism provides alternative to sprawl based on a return to traditional town- building principles, such as narrower streets forming a connected grid, closer mixing of land uses, and an emphasis on the design of the public realm. These traditional urban forms are seen as flexible, socially mixed, and environmentally sustainable providing opportunities for walking and cycling…” (Blais, 2010:24).
Q: Who are the key players necessary to better facilitate integration of health promotion into urban and town planning policy and practice in Africa?
A: Urban planners, Politicians, Private Sector, Other allied professionals (Architects, Surveyors, Sociologists, Engineers, Public Health, Urban designers).
Q: What is the biggest barrier to implementing health promoting changes in urban and regional planning in Africa?
A: Corruption, Funding, Political will, Discipline (Behavioural Change). Bureaucratic bottlenecks and influence of politics stifles the effectiveness and efficiency of planning in Nigeria. Politicians disregard planning!
We would like to thank Prof. Olusola Olufemi for her time and sharing her knowledge and insights regarding NCDs, health, and health outcomes in African urban and regional planning.
- Blais, Pamela (2010) Perverse Cities: Hidden Subsidies, Wonky Policy and Urban Sprawl, UBC Press: Vancouver and Toronto, Canada.
- Canadian Institute of Planners (CIP) webpage http://www.cip-icu.ca/About/About-Us
- FAO, IFAD, UNICEF, WFP and WHO (2020) The State of Food Security and Nutrition Around the World in 2020 (SOFI): Executive Summary, Accessed July 22, 2020 from http://www.fao.org/3/ca9692en/online/ca9692en.html#chapter-executive_summary
- Grandjean P, Landrigan PJ. Neurobehavioural effects of developmental toxicity. Lancet Neurol 2014; 13: 330–38.
- Hancock, T. and L. Duhl. Promoting Health in the Urban Context. WHO Healthy Cities Papers No.1, 1988.
- Howlett, J. (2020) Nigeria Looks to Step Up Action Against Non-Communicable Diseases by 2030, March 13, 2020 accessed July 21, 2020 from https://www.iaea.org/newscenter/news/nigeria-looks-to-step-up-action-against-non-communicable-diseases-by-2030
- Ingenbleek, L.; Verger,P.; Gimou, M., Adegboye, A.; Adebayo, S.B. et al. (2020) Human dietary exposure to chemicals in sub-Saharan Africa: safety assessment through a total diet study, Lancet Planet Health 2020; July, vol. 4: e292–300, www.thelancet.com/planetary-health
- NAN (2020) 75% of Nigerians at risk for non-communicable diseases – Study, June 30, 2020, accessed July 21, 2020 from https://guardian.ng/news/75-of-nigerians-at-risk-for-non-communicable-diseases-study/
- Obinna, C. (2020) COVID-19: 3 quarters of Nigerians at risk of Non-communicable diseases — Report JULY 1, 2020, accessed July 21, 2020 from https://www.vanguardngr.com/2020/07/covid-19-3-quarters-of-nigerians-at-risk-of-non-communicable-diseases-report/
- SDG (2015) Transforming our world: the 2030 Agenda for Sustainable Development , A/Res/70/L.1, https://sustainabledevelopment.un.org/post2015/transformingourworld/
- UN-Habitat (2005) The State of the World’s Cities 2004/2005: Globalization and Urban Culture, UN-Habitat, Nairobi, Kenya.
- WHO (2018) Noncommunicable diseases, 1 June 2018, accessed 21 July 2018 from https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases