A presentation by Ebele Mọgọ, DrPH “Sustainable African Cities: Debating Current Challenges and Exploring Future Pathways” Ghana Academy of Arts and Sciences, Accra, Ghana

1. The
Healthy
African
City
A presentation by Ebele Mọgọ, DrPH
“Sustainable African Cities: Debating Current Challenges
and Exploring Future Pathways”
G h a n a A c a d e m y o f A r t s a n d S c i e n c e s , A c c r a , G h a n a
3rd-6th July 2018

2. @ e b y r a l
11
Sustainable
Development
Goal
Make cities inclusive,
safe, resilient and
sustainable
Health and the Sustainable City

3. @ e b y r a l
Developing countries
will account for most of
the urban growth by
2030
Their urban populations
are expected to grow by
1.4 billion and account
for 60% of the global
population
Urban population in
Nigeria to double by
2045
Growth is
unplanned
Resulting in social,
ecological and
economic
vulnerability
Rising exposure to non-communicable
diseases. e.g. burden of diabetes to
rise 110 fold in less than 20 years,
traffic deaths and injuries, mental
health
Exclusion of the urban
poor legally,
economically, financially
Imposition of modernist
ideals that lack context
and often breed inequity

4. @ e b y r a l
What is
the place
of health
in the
city
• Reviewed archives – The Lagos State Development
Plan, The 2016 Budget, The 2013 Digest of Statistics
and The Manifesto of Governor Akinwunmi Ambode,
the current governor.
• Audited neighbourhoods in Lagos to adapt tool to this
context and to characterize facets of the built
environment that can affect urban health
• Interviewed players in civil society, state government
and private sector to understand emerging governance
priorities, challenges, actors, governance processes
and perception of the place of health in governance
Case Study Of Lagos

5. @ e b y r a l
The Situation
Informal features very
prominent and tool adapted
to include them
e.g. additional questions had to
be added to the audit based on
observed features: petty traders,
vulcanizers, clothes sellers, and
nomadic tailors (“obiomas”).
Informal services -
Motorcycles (“Okadas”)
On-street Parking
Informal Security Guards (“Mai
Guards”)
Formal Security Guards
Informal Transport Buses
(“Molues”)
Tricycles (“Keke Napeps”)

6. @ e b y r a l
Wide variation in built
environment features per
segment – reactive instead of
proactive, guideline based
planning.
Physical disorder, power supply,
waste management, governance
and road infrastructure were the
most urgent challenges.
No health promoting
infrastructure – signs were private
(sometimes conflict with health),
business, political and religion
No signs promoting physical
activity, road signs, pedestrian,
bike or traffic signs, speed limits
No sidewalks, trails, transit, street
lights, security warning signs,
traffic calming devices, crossing
aids.
The Situation

7. @ e b y r a l
Development archives have a
focus on vehicular transport not
necessarily health especially in
population where there is high
utilitarian walking
Poor maintenance especially at the
neighbourhood level - poor roads,
abandoned cars on streets,
abundance of garbage, residents
complaining about physical
disorder, waste management,
drainage, governance and road
infrastructure.
Yet not taken seriously - not
adequate tools, commitment to
capture them, and not adequate
best practices for engaging them
with the government.
The Situation
Provision of community services
was insufficient at the
neighbourhood level, with
informal providers filling gaps in
service delivery in areas of
transport, security and waste
management.

8. @ e b y r a l
The Situation
Income
variation in
features -
• High income areas – higher prevalence of private signs, security
personnel, comfort features such as shade trees and benches, a lot
of generator noises, and a lot of noise pollution.
• Low income areas - higher prevalence of poorly maintained roads,
trash overflowing in the streets, religious signs and “at least a little
noise pollution”.
• Its complicated - purchasing power enabling generator ownership
can also be a health problem
• Low income areas may not afford generators but exposed to poor
infrastructure, poor security, and poor waste management in their
neighbourhoods
• Yet data not always broken down to capture such details and hence
tailor interventions

9. @ e b y r a l
The Situation

10. @ e b y r a l
Workers in several sectors
with health implications do
not always connect human
health and wellbeing to work
The Situation
e.g. Ministry of Housing interviewee
noted need to create 100,000 houses
per year to meet the current housing
deficit in the state.
But said their focus is housing not
health
Workers in several sectors
with health implications do
not always connect human
health and wellbeing to work
Yet, housing context can account for
majority of variations in health
outcomes

11. @ e b y r a l
Not all
development
is equal
Without centering health and
wellbeing, “development”
risks aggravating inequity
• e.g. connection between privatization of
environmental management with race and
place inequities in the United States
• e.g. low place of health in policy worsened
Dengue outcomes in Putrajaya, India
Cascades
• e.g. poverty and unemployment -> mental health and safety.
• e.g. poverty drives exposure to infection, inability to manage and reduce
disease, poor health drives deepening of poverty, poverty in poor health
drives death, and even further poverty from catastrophic spending

12. @ e b y r a l
What we
know is
needed
• Intersectoral, multilevel action
• Greater public participation in policies
• Collecting measures and ensuring they are locally
relevant and broken down to show invisibles
• Moving from transactional and top-down
governance to participatory governance that
engages civil society, policy makers, local
communities, informal sector
• Embedding equity into governance priorities,
budgeting, processes and data collection
• Knowledge translation

13. @ e b y r a l
The way forward
Need values
reorientation –
equity, health and
wellbeing, resilience,
inclusive development

14. @ e b y r a l
A public
health and
wellbeing
approach to
sustainable
cities
• It is common sense
• It is ethical and ideal
• It is also pragmatic and evidence based
• It gives us the tools - social determinants of
health, health impact pyramid, ecological
lens, equity orientation, prevention and root
cause lens,
• It has a human wellbeing and an equity
center
• It has growing body of tools for linking
research and action

15. @ e b y r a l
The future
pathway to
2030 should
look more like
low cost, climate friendly, health friendly,
scalable solutions to pressing problems
housing, pollution, land, waste management
and health
• e.g. transport diversification and safety = win for
pollution, mental health, climate, equity.
• power = win for noise and air pollution, mental
health, safety
• housing – win for health, environment, the
economy
• other examples – waste management, flood control
1

16. @ e b y r a l
The future pathway to 2030 should look more like
Legal, financial and political pressure to
ensure that partnerships are framed
around health, equity and the
environment , accountability,
maintenance
2
Critique of donor agendas to see if they
are centered in equity, health, and are
also long-term.
3
Work to see poor as citizens and contributors to society and to develop vehicles for
win-win partnerships with the informal sector e.g. to fill services gaps
4

17. @ e b y r a l
The future pathway to 2030 should look more like
Testing behavioural tools for changing public attitudes to environmental
health
5
• private sector enterprise that used incentives for recycling
• civil society group that worked with community nodes who monitor
rights infringements and report.
• capitalize on pro-social neighbourhood environment
e.g.

18. @ e b y r a l
But not
just that
Data adapted to the context e.g. adapting audits
Data broken down to see “the invisibles” and
demographic variation
Also data on bridging research and outcomes
i.e. integrated knowledge translation initiatives
targeting centering public health lens in the policy
process and program execution
Data is needed

19. @ e b y r a l
On one hand – data for training,
advocacy and knowledge
transfer
• For decision-makers and funders to see urban
development issues through a human rights, equity
and health lens.
• For planning to prevent and manage floods instead
of just dealing with them after they happen.
• Planning and enforcement of built environment
features that promote instead of complicate health
Knowledge
translation
priorities

20. @ e b y r a l
On another hand - collaborative partnerships with decision
makers and funders to guide and evaluate their investments
• Understanding what works in engaging the public
• Cost-effective investments that are win-wins for health, environment, equity
• Suite of best practices for engaging the private sector – accountable, long term,
systems lens, pro-poor
• Tools for influencing decision makers
• Interventions to leverage informal governance arrangements and build community
stewardship - spur trust & community innovation
• Best practices for collaborative partnerships between researchers, civil society,
community and decision makers
Knowledge translation priorities

21. @ e b y r a l
Death and injury
on Australia’s roads
reduced after
raising seatbelt
wearing rates to
90% in 1977
Sweden’s vision zero
– infrastructure
design, vehicle
technology, good
governance e.g.
speed limits – lowest
number of road
deaths world wide
England - heart
disease deaths due
to smoking fell by
20.8% after
implementation of
the smoking ban
Countries with
laws restricting
firearm
purchases and
access to
firearms have
lower firearm
deaths
Glasgow, Scotland - public
health lens to violence
reduction saw knife deaths
in children and teenagers
drop by 100% between
2006-2011 period and 2011
and 2016
A public
health
approach
works!
We can do this

22. @ e b y r a l
Current life
expectancies across
Africa
People must
matter and
be at the
center
According to the World Bank
Highest – Seychelles (74)
Lowest – Central African Republic and Sierra
Leone (52)
Average – 60
Worldwide average – 72
Start putting ALL people, and their health and wellbeing behind our visions of
urban development.

23. @ e b y r a l
The vision for the future African
city should no longer be this

24. @ e b y r a l
It should be this

25. @ e b y r a l
And this

26. @ e b y r a l
Thank you to the organizers and
sponsors

27. @ e b y r a l
Work primarily consulted for this presentation
Heynen, N., Perkins, H. A., & Roy, P. (2006). The political ecology of uneven urban green space: The impact of political
economy on race and ethnicity in producing environmental inequality in Milwaukee. Urban Affairs Review, 42(1), 3-25.
Mọgọ, E., Litt, J., Leiferman, J., McManus, B., Risendal, B., & Oshodi, L. AN AUDIT OF URBAN NEIGHBOURHOODS IN
METROPOLITAN LAGOS, NIGERIA.
Mọgọ, E., Litt, J., Leiferman, J., McManus, B., Risendal, B., & Oshodi, L. (2018). Exploring government and civil society workers’
perceptions of urban health as a governance priority in the Lagos metropolis. Cities & Health, 1-14.
Mọgọ, E., Litt, J., Leiferman, J., Mcmanus, B., Risendal, B., & Oshodi, L. (2017). Urban health and community resilience in the
context of Lagos state's development agenda. African Journal of Governance and Development, 6(1), 27-50.
Mọgọ, E. (2015). Health and equity must be central to the Africa rising narrative. Africa at LSE.
Mọgọ, E. (2018). Death by design.
Mulligan, K., Elliott, S. J., & Schuster-Wallace, C. (2012). The place of health and the health of place: dengue fever and urban
governance in Putrajaya, Malaysia. Health & place, 18(3), 613-620.
Life expectancy at birth, male (years) | Data. (2018). Retrieved from
https://data.worldbank.org/indicator/SP.DYN.LE00.MA.IN?display=