On 25 September, world leaders will gather at the United Nations for the Fourth High-Level Meeting on Noncommunicable Diseases (NCDs).

It comes at a pivotal moment: funding for global health has plummeted, while NCDs like heart disease, cancer and diabetes continue to claim 75% of all lives lost worldwide. This amid recent efforts to water down the list of commitments to be made at the UN meeting, under pressure from industry groups.

Against this backdrop, one of the most powerful allies in the fight against NCDs is at risk of being overlooked: cities.

For centuries, cities have driven public health progress, from sanitation systems to outbreak response. Home now to almost 60% of the world’s population, they are especially well positioned to tackle modern health threats such as NCDs. 

Urban residents are often more exposed to risk factors such as polluted air, unhealthy food environments and unsafe streets than their rural counterparts – and cities have the local knowledge to spearhead targeted solutions.

A seat at the table

This is why it’s imperative that all levels of government have a seat at the table and that cities can secure support based on their well-established leadership on public health. 

In London, for instance, where rising NCD rates among children were disproportionately impacting lower-income areas, the city’s 2019 junk food advertising restrictions in public transportation are estimated to have prevented nearly 100,000 cases of obesity and are projected to save over £200 million in healthcare costs. The policy had the biggest health impacts on people from low-income areas, showing how population-based strategies to address NCDs reduce long-standing health inequalities.

Urban leadership also plays a critical role in implementing national health policies, bridging the gap between country-level policymaking and the realities of community-level enforcement. 

Take Bengaluru in India, home to around 14 million residents. Here, the city has helped bring India’s national tobacco control laws to life through a dedicated network of experts, successfully reducing smoking rates in public places and earning global recognition for their efforts.

Pilot sites for innovation

Finally, cities can accelerate progress by going beyond national legislation, introducing their own policies and even acting as pilot sites for new and innovative ideas. 

Córdoba, Argentina, the Latin American nation’s second largest city, last year removed junk food and sugary drinks from schools, directly benefiting 15,000 children.

The changes gained local support in part because policymakers could cite evidence that such early interventions positively shape children’s health by influencing consumption patterns and decision-making throughout life. The Córdoba model is currently being considered for adoption by other Argentinian cities and at the provincial level as well. 

Now is the time for national governments to empower municipalities to advance this kind of urban NCD prevention – at the September meeting and beyond – by increasing funding and giving local leaders greater authority to spearhead solutions that are working in cities around the world. 

Similarly, international bodies should support cities’ work with financing and technical tools that are tailored to their needs. 

The global Partnership for Healthy Cities network recently released a statement to champion the role of cities in saving lives through NCD prevention, and the World Health Organization (WHO) has developed resources for cities, including an Urban health capacities assessment and response resource kit which supports policymakers and practitioners to strengthen cross-sectoral action for healthier, more equitable cities.

This groundswell for urban authority and innovation must not be ignored, especially as the NCD crisis is getting worse. If we are to meaningfully address it and achieve the UN’s ambitious global targets to slash these preventable deaths by a third in the next five years, what’s required is unity and action.

NCDs are a global problem, but by bringing in allies such as cities, it is one we can tackle together. As the saying goes, a problem shared is a problem halved.

Ariella Rojhani is Director of the Partnership for Healthy Cities at Vital Strategies

Dr Etienne Krug is Director of the Department of Health Determinants, Promotion and Prevention at the World Health Organization

Image Credits: City of Bengaluru, City of Quito/Juan Carlos Bayas.