Keeping Brazilians Moving: The Importance Of Urban And Transport Planning (editorial)

In September 2011, a high-level UN meeting brought together leaders from across the globe to discuss the prevention and control of chronic diseases. This meeting ack- nowledged that the global burden of preventable health conditions such as cardio- vascular disease (CVD) and type 2 diabetes was so immense that if uncurbed, it will cripple global health systems and undermine social and economic development.[1] Globally, the prevalence of chronic diseases is increasing. Currently some 36 million deaths annually are caused by chronic disease, [2] and notably this is in both the developed and developing world. This is particularly disturbing because most chronic diseases are caused by preventable lifestyle-related risk factors: phy- sical inactivity, sedentariness, unhealthy diets and smoking.  While many may say that these behaviours are something that individuals can, and should, fix themselves, in public health circles [3] and increasingly beyond, [1] it is now recognised that global trends in chronic diseases and their major risk factors are thought to be caused by ‘system’ failure: a system that discourages heal- thy, and encourages unhealthy life style choices; and as a result creates poor health outcomes and health inequity. [3]  Thus, in 2011 the UN leaders agreed that combatting chronic disease was not something that could be handled by the health sector alone. They concluded that many of the solutions to combating chronic diseases would be found in sectors outside of health: in planning, transport, economics, food production, agriculture, and recreation sectors, to name a few. Decisions made by professionals working in sectors outside of health create the conditions for good (or bad) health. Importantly, many health and wellbeing outcomes are affected by the way we build and plan cities. For example, city planning affects whether people have ac- cess to sidewalks, cycle paths and shops and services, which means they can easily walk or cycle locally; whether jobs are co-located near housing; whether people have access to public transport; whether housing is exposed to noise and other transport-related pollution; whether neighbourhoods are safe, and children can walk safely alone to and from school; whether local food is fresh and healthy, or whether the only food available is fast food and unhealthy; and whether local recreational opportunities are healthy enhancing (e.g., parks or sports centres) or whether they are health-damaging (e.g., focussed on alcohol). All of these outcomes, directly or indirectly impact the health and wellbeing of citizens, and hence, their chronic disease profiles. Thus, city and transport plan- ning can be used to reduce health inequity. This idea is not new. In the early 20th century, in the United States, England and Australia, city regulations were used to improve the health of the urban poor pro- foundly affected by living in crowded housing located in polluted neighbourhoods with poor sanitation. Regulations were introduced to ensure access to sanitation and clean water, to separate land uses thereby reducing exposure to environmental pollution and to specify minimum housing lot size to reduce over-crowding.

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