Healthy and Age-Friendly Cities in the People's Republic of China
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Healthy and Age-Friendly Cities in the People's Republic of China

Proposal for Health Impact Assessment and Healthy and Age-Friendly City Action and Management Planning

Najibullah Habib, Stefan Rau, Susann Roth, Filipe Silva, Janis Shandro

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eBook - ePub

Healthy and Age-Friendly Cities in the People's Republic of China

Proposal for Health Impact Assessment and Healthy and Age-Friendly City Action and Management Planning

Najibullah Habib, Stefan Rau, Susann Roth, Filipe Silva, Janis Shandro

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About This Book

Rapid urbanization and aging in many countries including the People's Republic of China, along with lessons learned from the coronavirus disease pandemic, emphasize the urgent need to make cities healthier and more accessible for the elderly. This report offers an operational framework to turn the challenges of an emerging four-generation urban society into opportunities. Health impact assessments as well as healthy and age-friendly city action and management plans are proposed as holistic tools to create positive health outcomes and improve urban livability, services, and public spaces. Integrated with urban planning, these practical tools will help make cleaner, healthier, and safer cities that are more pleasant and competitive for people, business and economic development.

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Year
2020
ISBN
9789292624781

1   Health and Aging as Opportunities in an Urbanizing Four-Generation World

There is an urgent need for health impact assessments (HIAs) and healthy and age-friendly city action and management plans (HACAMPs). Health and well-being in cities will be central for people and communities and an essential factor for cities’ competitiveness, especially in a post–coronavirus disease (COVID-19) world. Urban centers became the central focus of the pandemic as overcrowding, hot spots, and bad air quality exacerbated people’s vulnerability to the infection. Urban health and aging are closely linked, as the share of older people increases in cities, requiring changes in policies and public health perspectives. Urbanization challenges include continued social and demographic inclusion, community cohesion, social-protection systems and urban fiscal sustainability (both facing significant systemic challenges), and environmental and climate change. Many countries, cities, and communities are evolving into four-generation urban societies characterized by small families, small households, and single-person households; with more elderly, and many them reaching high age, and fewer babies, children, and young adults. This four-generation social structure will require a more vibrant and interconnected community life. The future of work and technology will likely lead to a polarization of work and employment, with more people retreating into precarious and informal employment arrangements, changing their work-life patterns, or advancing toward technology opportunities such as those found in age-friendly smart cities and communities.
People are becoming urbanites and living longer. Urbanization is a key determinant of health and welfare across the globe and, by 2050, about 68% of humans will live in urban areas, as Africa and Asia will have caught up rapidly with other regions.10 In the People’s Republic of China (PRC), the urban population increased from 17.9% in 1978 to 59.2% in 2018, and is expected to reach 70% in 2030.11 The number of people aged 60 and older will represent 18%–20% of the total PRC population by 2030.12 The aged population is expected to reach 437 million in 2051, when one out of three Chinese will be aged 60 and older, and people aged 80 and older will rise to 90 million.13 The process of urbanization coincides with an increase of life expectancy overall. Urban women in the PRC lived on average 6.64 years longer than rural women in 2010, and urban men lived on average 7.09 years longer than rural men.14
Cities can place a heavy burden on environmental and health issues. The PRC has achieved remarkable progress since its opening up and reform policies started in 1978. Industrialization and urbanization lifted millions out of poverty, and urban infrastructure and assets have been built at an unprecedented rate. Despite the positive impacts on infrastructure, services, disposable incomes, and life expectancy, the negative impacts on the urban environment and health are significant, and the financial and health burden resulting from a focus on economic growth has taken a heavy toll. Health impacts from pollution were estimated to be over $70 billion for half of 2015 alone.15 Projected economic losses associated with noncommunicable diseases, including cardiovascular disease, diabetes, cancer, and respiratory illnesses, are estimated to be $23 trillion from 2012 to 2030.16 Urban centers have a higher prevalence of noncommunicable disease than rural centers. At the same time, densely populated cities can become centers of outbreaks and epidemics—as in the case of Wuhan, a city of more than 11 million people, where COVID-19 started and spread widely—via centralized hospital systems and among infected people who had come in close contact with the uninfected. Human density in cities, and the connectivity of cities by land, water, and air lead to the easy spread of infectious diseases beyond the cities and national borders. The spread is particularly difficult to manage if new emerging infectious diseases come into play. However, such situations tend to have time limits, while cities and urban areas provide a long-lasting physical framework for organizing human life, and even some wildlife. Therefore, whether or not such urban areas should be altered must be considered from a long-term perspective that takes into account all the social, environmental, economic, and cultural benefits that well-planned urban areas generate because of their density; mix of uses; sustainable mobility options, including mass public transit; and green space systems.17
Many countries, cities, and communities are evolving into four-generation urban societies characterized by small families, small households, and single-person households; with more elderly, and many them reaching high-ages, and fewer babies, children, and young adults.
Continued urban development needs to integrate health and aging aspects. As the PRC moves from an approach to development focused on gross domestic product (GDP) increase to one focused on quality (social inclusion and environment improvements and others) in its 13th Five-Year Plan for Economic and Social Development,18 continued rapid urbanization presents both challenges and opportunities, and integrating health issues becomes critical. Integrated and sustainable urban and regional planning, governance, and management require coordination, environmental management, adequate urban infrastructure and services, good-quality housing, sustainable urban transport, water supply and sanitation, solid waste management, drainage and flood-risk management, energy supply, health care (converging disease profiles, aging populations), education, and employment. The emergence of a four-generation urban society is a significant societal shift that requires city policy review and adjustments—specifically, in how urban communities live together and how social services are organized and financed with health and well-being at the center of sustainable development of cities, regardless of size and development stage. The PRC is a unique case for several reasons: its deeply rooted culture of healthy lifestyles; vibrant community life; increased life expectancies; the migration of the working-age population from rural areas to major urban centers; and the demographic transition caused by the one-child policy from 1980 to 2016, and now by the two-child policy. An important consideration in integrating health and aging into urban planning and management is the long-term demographic transition and resulting population decline, including many cities. The population is expected to be reduced by half by 2100, starting at mid-century, with one-third of all urban areas in the PRC already seeing declining populations from out-migration, mostly smaller provincial cities.19
Human density in cities, and the connectivity of cities by land, water, and air lead to the easy spread of infectious diseases beyond the cities and national borders.
Innovative approaches to healthy and age-friendly cities are necessary. Many of the present approaches to urban planning and city building do not meet the needs and challenges of the rapidly growing urban population, who must remain healthy and have a high quality of life to be economically productive. City planners and public health officials rarely have meaningful exchanges on the best ways to plan healthy cities. This report describes how related disciplines—urban planning and public health management—can come together to develop healthy and age-friendly cities based on a flexible HIA and a HACAMP framework.
Healthy and age-friendly cities align with sustainable development. Leveraging healthy and age-friendly cities to become an integral part of environmentally sustainable, socially inclusive, and economically competitive urban development is critical. In developed countries, where basic services have been met and life expectancies extended, the challenges may lie in promoting healthy lifestyles and healthy communities. Cities in developing countries have to ensure that fundamental risks to health are mitigated, by ensuring clean air, surface water, and soil; acceptable noise levels; and other environmental factors; as well as safe drinking water and sanitation, food, clothing and shelter, solid waste management, education, and basic health services.
Application of HIA and HACAMP in urban projects can influence urban investment decisions. The question of whether health and age-friendly considerations could be drivers for urban investments needs to be discussed—including such factors as the development stage and other particular circumstances—to determine the nature of the applications of an HIA and HACAMP. For example, many urban infrastructure programs and projects in the PRC, including many financed by multilateral development agencies, directly contribute to positive public health outcomes by providing access to safe water and sanitation, solid waste management, and reducing flood risk, among other benefits. Under such projects, the HIA and HACAMP would focus on strengthening the positive outcomes of the planned investments, providing systematic sector assessment, and on planning for the addition of further health and age-friendly benefits that align with the general objectives of the project.
The HIA and HACAMP could also be seen as an additional dimension and added value to urban development and/or infrastructure projects (both domestic or externally financed). In such cases, there would be additional incremental investments leading to further health and age-friendly benefits. Then incremental costs would have to be compared against economic benefits. In the case study of Yanji (Chapter 8), the additional incremental investments are fairly small compared with the anticipated benefits for urban livability and more conscious living of the residents (through consultations and awareness raising), with more physical activity and more green spaces, and better urban microclimates, air quality, and exercise equipment (bicycle, pedestrian, and jogging paths; public toilets; smoke- and alcohol-free zones). The authors believe that HIA and HACAMP should be considered and mainstreamed as constructive tools, as they present a valuable opportunity to generate some additional health benefits, given that they align with or create many co-benefits for low-carbon, climate-resilient, sustainable urban development. Moreover, the incremental costs are quite low compared with the multiple benefits (including health) created.
The HIA and HACAMP could also be seen as an additional dimension and added value to urban development and/or infrastructure projects (both domestic or externally financed).
Health, safety, and well-being can be drivers of new types of urban projects. In the context of the PRC’s Healthy China 2030 strategy, launched in 2016 (following the Hygienic City Campaign, operational since 1992), and from the perspective of a multilateral regional development bank, the authors strongly recommend that health, safety, and well-being be given a more central role when considering urban development support. The authors also believe that urban projects can be driven by the health and age-friendly needs of people (including children in a four-generation urban world), and that these projects could become an integral part of a people-centered approach to urban development, especially urban rehabilitation and retrofitting. This would contribute to the overall objective of livable cities through the integration of these dimensions into planning and management. An HIA and HACAMP will contribute to more inclusive development, and likely to greener and more environmentally sustainable development (through additional, better-designed green spaces and healthier lifestyle options, as in the Yanji case). They will also likely result in more economically competitive development, as cities will become more attractive, with features that can be marketed to attract and retain qualified workers, companies, and jobs.
In the context of COVID-19, all these considerations have even greater relevance, as people have become more concerned about sound health service systems and healthy lifestyle options in an urban environment. Hence, the authors are hopeful that in the case of the PRC as an upper-middle-income country, a focus on health and elderly care, and on their integration into urban development, may serve as a starting point for some projects. If that occurs, these projects should provide lessons for other developing member countries of the Asian Development Bank (ADB), lessons that go beyond the goal of adding value to urban infrastructure and services; and these lessons should be mainstreamed, as mentioned above. For the PRC, this starting point could also fulfill a significant task for the medium- and long-term future: the rehabilitation and retrofitting of existing cities and urban areas, including many urban districts built since the 1980s that lack livability and options for healthy lifestyles. As an example, in some major developed cities, obesity has become a serious health problem for many residents, one that is directly related to lifestyles and urban planning. Features such as suburban development with wide roads and no sidewalks in residential neighborhoods, and long distances to schools, shops, and parks, are very conducive to driving, but less so to walking or cycling. Some mayors have been making it their key mission to fight obesity, and they have been successful through urban transformation and awareness-raising campaigns that gave rise to lifestyle changes.
Human capital development can address shortages in health and elderly care sectors. The global shortage of health-care workers will reach more than 15 million by 2030. Many countries face a substantial and widening mismatch between the demand, expressed in the required numbers of health-care workers, and supply, expressed in a country’s capacity to educate, train, and employ them. Health and elderly care needs will become more complex due to aging and to the increasing number of people with noncommunicable diseases and chronic illnesses, and there will be a stronger demand for nursing care services and home-visit care among the elderly. To achieve universal health coverage, health systems in all countries require an adequate number of trained health professionals providing quality care. In the PRC, the deficit of health professionals is alarming, with three nurses per 1,000 population, which is far below the average for member countries of the Organisation for Economic Cooperation and Development (OECD) of around nine nurses per 1,000 population.
Many countries face a substantial and widening mismatch between the demand, expressed in the required numbers of health-care workers, and supply, expressed in a country’s capacity to educate, train, and employ them.

2 “Healthy Cities,” “Age-Friendly Cities,” and “Child-Friendly Cities” Concepts and Programs

The concept of healthy and age-friendly cities aims at the integration of previously isolated concepts. Its purpose is to contribute to an overall objective of making cities more livable and, in the case of ADB operations, to contribute to ADB’s Strategy 2030 and its operational plans, including the Operational Plan for Priority 4: Making Cities More Livable.20 This integrative concept builds on a wealth of work—by the World Health Organization (WHO), United Nations Human Settlements Programme (UN Habitat), United Nations Children’s Fund (UNICEF), and many other organizations and municipal governments. These concepts and initiatives in urban planning, urban design, urban management, and governance remain highly relevant: they target urban health, the needs of elderly people and the issues surrounding aging in cities, and/or child-responsive or family-friendly city planning. The proposed HIA and HACAMP framework seeks to promote and achieve the integration of these areas and to expand into more detailed concepts regarding the new opportunities presented by community life in cities with four generations under one roof...

Table of contents