Special issue: child-friendly cities

Within the field of cities and health, the complexity of cities is mirrored by a plethora of whole-city initiatives and networks trying to address key issues. In addition to various ‘healthy city’ initiatives (de Leeuw and Simos 2017), there are also slow cities, age-friendly cities, resilient cities, compact cities and many more. Focussing on children or any other target sub-population could be seen as an endorsement of this fragmentation. However, as editors of this special issue, we see the focus on child-friendly cities as a valuable entry point for integrated healthy city commitment, policy and action, as set out at the foundation of the WHO Healthy Cities initiative (Hancock and Duhl 1986). To paraphrase Enrique Peñalosa (Mayor of Bogota) if a city is a healthy place for children, it is a healthy place for everyone.

The concept of a healthy city encompasses ‘salutogenesis’ (Antonovsky 1979) meaning that the city as a place protects people from illness and supports the creation and maintenance of health. Healthy cities are also inclusive places; catering for the needs of all regardless of age, gender, income, status or ethnicity. As many of the foundations for a healthy life are laid down in our early years (Kalache and Kickbusch 1997), it follows that urban planning which focuses on healthy development for children will deliver benefits over many decades, and affect future as well as current generations. The economic and social benefits of whole life approaches are significant in terms of a healthier population (UNICEF 2012). However, children are often overlooked in public policy even among public health and built environment professionals working on place-based health (Bishop and Corkery 2017). The reasons for this are varied, and relate to status as well as intellectual capacity. Children do not have the ability to vote or pay taxes, and they are rarely assumed to be capable of contributing to the development of policy (Wood 2016).

There are more people living in cities and more children growing up in cities than ever before. Over one billion children now live in urban areas around the world (UNICEF 2012). By 2030, up to 60% of the global population are projected to live in urban settings and up to 60% of those urban residents will be under the age of eighteen (Woodrow Wilson International Center for Scholars 2003, UNICEF 2018). While cities can be exciting and vibrant settings for urban childhoods, they also come with particular risks and challenges to the health and healthy development of children. Examples of these challenges include noise and air pollution, sedentary lifestyles, traffic dangers, crime, social isolation and disconnection from nature (UNICEF 2012, Christian et al. 2015). Moreover, these challenges are made worse by poverty and inequality (UNICEF 2012). Shockingly, in some high-income countries life expectancy is beginning to fall, with children being predicted to live shorter, less healthy lives than their parents (Office for National Statistics 2018).

All too often children’s health requirements are boxed up as ‘paediatrics’, with a consequent tendency for provision for children’s developmental wellbeing to have a narrow focus on education or children’s services. We argue that the actions of public health professionals outside this specialist area, and indeed many urbanists, can make a significant difference to children’s health and well-being (Gill 2008). Both the ‘nurturing care’ that parents, family and the community can provide and an environment that enables and supports this nurturing care, are decisive factors for healthy child development (Goldfeld et al. 2019). Taking a life-course approach to health (Kalache and Kickbusch 1997) as recommended by the WHO, recognises that health outcomes in later life are strongly influenced by our early years. We argue that there are important life-long impacts for the health of urban populations that are directly influenced by the ability of urban environments to support the establishment of healthy behaviours and habits during childhood. Seeing cities through children’s eyes may help to foster the kind of long-term, socially inclusive values that needed if cities are to overcome the perhaps uniquely ‘wicked’ policy challenges of ineffective planning (Rittel and Webber 1973) and become more sustainable, liveable and equitable places.

This special issue comes at a time when there is an increased focus on children’s health and healthy childhood in cities. There has been an explosion of work in this area in recent years, in academic research, policy and practice. Examples include international initiatives such as Urban95 which reimagines cities from 95 cm, the average height of a healthy 3 year old (Vincelot 2018); Unicef’s (2018) handbook on child-friendly cities and communities and Arup (2017) ‘Cities Alive: designing for urban childhoods’. In addition, 2019 is the 30th anniversary of the UN Convention on the Rights of the Child (UNCRC). The convention, adopted in 1959, sets out 54 articles governing children and their civil, political, economic, social and cultural rights. The articles include a wide range of rights relevant to city life including: the right to play; the right to a safe and healthy environment; and the right to be involved in decision-making and to express opinions. While progress has been made in the last 30 years, rights-based approaches to urban policy are not yet widespread – but their adoption would be transformative.