‘Healthy cities’ adopt measures against chronic diseases – 03/12/2024 – Balance and Health

From free bicycle repairs to encourage this form of transport to school canteens free of ultra-processed products, 74 cities around the world are developing public health actions to become healthier. In Brazil, São Paulo (SP), Rio de Janeiro (RJ) and Fortaleza (CE) are on the list.

These municipalities are part of a global network, called PHC (Partnership for Healthy Cities), which seeks to reduce the impact of chronic non-communicable diseases (NCDs) and other injuries, which together account for more than 80% of preventable deaths, through the adoption of urban health policies.

Last week, representatives from more than 50 of them met in Cape Town, South Africa, to exchange experiences and share results and challenges they face.

The projects work to prevent diseases such as cancer, diabetes, heart and lung diseases and injuries caused by traffic accidents and overdoses.

Brazil, for example, presented results from projects focused on combating smoking, especially electronic cigarettes, which are increasingly popular among young people, and monitoring air quality. But there are other initiatives underway, such as actions to ban the consumption of ultra-processed products in schools.

The initiative is supported by Bloomberg Philanthropies in partnership with the WHO (World Health Organization) and Vital Strategies, a global health organization.

“Many public managers still believe that providing health is just about having good hospitals and other services, when in fact we have to act firmly in preventing factors that lead people to get sick”, says Etienne Krug, director of the department of social determinants of health at WHO.

According to him, all actions involved in this partnership of healthy cities are supported by scientific data that maps the problems and people most affected and, later, the impact that the interventions have on them.

Krug says that the initiative faces challenges, such as the population’s ignorance about risk factors and resistance to changing habits, in addition to pressure from the tobacco industry, beverages, ultra-processed foods, automobiles, among others, as actions contradict financial interests.

“Governments need to create regulations and laws that address this and support health, which is most paramount.”

Ariella Rojhani, director of PHC at Vital Strategies, says that the initiative supports municipal governments to have well-defined policies to mitigate conflicts of interest that may conflict with public health actions.

“It’s very difficult, especially when private companies, which have commercial interests, subsidize public programs and equipment.”

Kelly Larson, accident prevention leader at Bloomberg Philanthropies, says that another important action supported by PHC is the reduction of speed limits on urban roads.

“Speeding is responsible for half of motorcyclist and driver deaths. If we reduce the limit, we will see a reduction in deaths as well.”

According to her, scientific evidence shows that 30 km/h is the ideal speed for urban streets, and 50 km/h on expressways.

Larson acknowledges, however, that the measure is unpopular. “There is a lot of political pressure. People don’t want to slow down. But it saves lives and we always encourage political leaders to take action.”

Another action is to pressure the automobile industry to produce safer vehicles. “About 80% of countries in the world do not have federal safety standards. Cars sold in the United States have airbags, devices to protect pedestrians, much more protection than vehicles sold in other countries.”

In the project, each city selects one of 14 interventions that have been proven to prevent NCDs and accidents and has financial and technical support for the creation and implementation of its public policies.

Among the actions around the world, there are some that Brazil has already adopted, such as the mandatory use of seat belts and helmets and the ban on smoking indoors, issues that are still challenges in other places.

There are other very innovative and low-cost policies. In Freetown, Sierra Leone, for example, which faces high rates of stroke, nurses and nutritionists train market vendors on the dangers of excess salt and they, in turn, share tips with customers, including how to cook traditional dishes by replacing salt with other seasonings.

The municipality of Córdoba, in Argentina, approved a law prohibiting the sale of sugary drinks and ultra-processed products in schools and is on a crusade to make these environments healthier, involving principals, teachers, students’ parents and canteen workers. At least 40% of schoolchildren in the country are overweight or obese, according to a national survey.

“The first measure was to ensure drinking water at the appropriate temperature [fria] and free of charge. Then awareness. Many are still unaware of the harm of ultra-processed foods”, says Angel Fiore, director of food quality in Córdoba.

To encourage the use of bicycles as a means of transport, Santiago de Cali, Colombia, started offering free repairs to people who had broken bikes and no money to fix them. Brazilian cities such as São Paulo and Fortaleza also develop actions to promote safe and active mobility.

Fortaleza is also monitoring air quality and evaluating the impact of pollutants on health. According to Victor Macedo, vice-president of the Fortaleza Science, Technology and Innovation Foundation, there was a paradigm that this was not an important problem in the city, but the data showed a different scenario.

In conjunction with the Federal University of Ceará, the city hall developed 30 low-cost monitors to assess air quality.

The city is within the average emission of particulate materials acceptable by the WHO (15 micrograms per cubic meter), but at peak times the values ​​double (reach 30).

Children are the most affected by urban pollution. According to Macedo, the main cause of hospitalization for children up to the age of ten in the city is respiratory problems.

“We are crossing this data with the places where they occur most seriously to direct public mobility, environmental and health policies to mitigate these problems.”

With Rio de Janeiro, the partnership involves anti-smoking actions. Among them is increased inspection at points of sale, banning, for example, irregular advertising. Interventions also include e-cigarettes and water pipes. Now, they appear alongside cigarettes on “no smoking” signs.

“Many people still think that DEFs [dispositivos eletrônicos para fumar] They are water vapors, which are not harmful to health, and therefore can be used indoors”, says Aline Pinheiro Borges, president of the Municipal Health Surveillance Institute of Rio de Janeiro.

As DEFs are illegal in the country, they have been carried out in conjunction with the Municipal Public Order Secretariat of Rio. The proposal now is to analyze the substances contained in these smuggled devices.

“Many think they are nicotine-free, but we know that they use nicotine salts with much higher concentrations, which are more addictive. The impact on health is much greater”, says Borges.

Reporter Cláudia Collucci traveled to Cape Town at the invitation of PHC (Partnership for Healthy Cities)