2
J. I. Boufford and A. Shih
cultural diversity can also make the need for such interventions more challenging to
communicate and manage.
This has all led some commentators to speculate about the death of cities, including
the potential for a mass exodus once the pandemic is over. While this is not an
economic option for most, it also ignores the reality that urbanization is a major
global trend that will likely not be stopped by this or another pandemic. Four out
of five Americans live in urban areas; across the world, over half of the population
does, and the number is growing. In the midst of a pandemic, it’s easy to focus on the
risks of living in cities. What’s not as easy—but just as critical—is ensuring that we
learn from this experience and consider how best to address these challenges in the
future and how to prevent or greatly reduce the negative health and socio-economic
effects of pandemics like COVID-19.
Two other characteristics of cities have been thrust in the spotlight by COVID-19.
One is complexity—the interdependence of the multiple systems that make cities
run well and the challenge of governing across sectors for better health—a systems
approach to problem-solving and decision-making. For example, in transportation
policy, mass transit can act as a hub for the spread of coronavirus but also has a positive effect on air quality and related reductions in rates of asthma. Housing policy
can either advance or impede safe and affordable dwellings. The other key urban
characteristic is the existence of disparities within cities. The wide discrepancies in
mortality from COVID-19 in New York City can be mapped to geographic communities that have long suffered from structural inequalities in housing, education, access
to parks, recreation and healthcare, food security and socio-economic opportunities.
One positive outcome emerging from this pandemic is a broader appreciation for
and investment in the public health infrastructure that monitors and reports outbreaks,
provides critical public information and tests and tracks infection and immunity in
the community. Our hospitals and healthcare workers have been amazing in their
responses and we must be sure this resource stays strong. But as we think about the
configuration of our healthcare system going forward, we in the United States need a
healthcare financing system which supports hospitals to do what they do best—
manage emergencies and diagnose and treat complex diseases—while assuring
additional investment in primary care, telemedicine and more support for critical
community-based organizations that have the trust of communities and can provide
crucial social support to families.
While these policy changes within the health sector would be wonderful and
welcome, COVID-19 is demonstrating to the public what urban health researchers,
practitioners and policymakers have known for decades—the importance of a systems
approach in understanding and acting on the determinants of health. We hope for a
newfound appreciation of how all the sectors that form the core of city life affect the
health and wellbeing of New Yorkers and how a systems perspective to governing
for health reveals that: housing policy is health policy, transportation policy is health
policy, education policy is health policy and political leadership for health improvement can make cities engines to improve national and global health. There are
examples of cities around the world that have taken on and successfully met these
challenges.
J. I. Boufford and A. Shih
cultural diversity can also make the need for such interventions more challenging to
communicate and manage.
This has all led some commentators to speculate about the death of cities, including
the potential for a mass exodus once the pandemic is over. While this is not an
economic option for most, it also ignores the reality that urbanization is a major
global trend that will likely not be stopped by this or another pandemic. Four out
of five Americans live in urban areas; across the world, over half of the population
does, and the number is growing. In the midst of a pandemic, it’s easy to focus on the
risks of living in cities. What’s not as easy—but just as critical—is ensuring that we
learn from this experience and consider how best to address these challenges in the
future and how to prevent or greatly reduce the negative health and socio-economic
effects of pandemics like COVID-19.
Two other characteristics of cities have been thrust in the spotlight by COVID-19.
One is complexity—the interdependence of the multiple systems that make cities
run well and the challenge of governing across sectors for better health—a systems
approach to problem-solving and decision-making. For example, in transportation
policy, mass transit can act as a hub for the spread of coronavirus but also has a positive effect on air quality and related reductions in rates of asthma. Housing policy
can either advance or impede safe and affordable dwellings. The other key urban
characteristic is the existence of disparities within cities. The wide discrepancies in
mortality from COVID-19 in New York City can be mapped to geographic communities that have long suffered from structural inequalities in housing, education, access
to parks, recreation and healthcare, food security and socio-economic opportunities.
One positive outcome emerging from this pandemic is a broader appreciation for
and investment in the public health infrastructure that monitors and reports outbreaks,
provides critical public information and tests and tracks infection and immunity in
the community. Our hospitals and healthcare workers have been amazing in their
responses and we must be sure this resource stays strong. But as we think about the
configuration of our healthcare system going forward, we in the United States need a
healthcare financing system which supports hospitals to do what they do best—
manage emergencies and diagnose and treat complex diseases—while assuring
additional investment in primary care, telemedicine and more support for critical
community-based organizations that have the trust of communities and can provide
crucial social support to families.
While these policy changes within the health sector would be wonderful and
welcome, COVID-19 is demonstrating to the public what urban health researchers,
practitioners and policymakers have known for decades—the importance of a systems
approach in understanding and acting on the determinants of health. We hope for a
newfound appreciation of how all the sectors that form the core of city life affect the
health and wellbeing of New Yorkers and how a systems perspective to governing
for health reveals that: housing policy is health policy, transportation policy is health
policy, education policy is health policy and political leadership for health improvement can make cities engines to improve national and global health. There are
examples of cities around the world that have taken on and successfully met these
challenges.