In the third episode of our “Environments for Health and Happiness” series, Dr. Jo Ivey Boufford delves into the powerful role cities play in advancing public health and happiness. By focusing on the connections between urban policy and health, Dr. Boufford highlights the crucial influence of mayors in driving environmental initiatives and fostering sustainability within cities. She sheds light on critical issues such as the impact of urban environments on social isolation and the importance of community engagement to enhance well-being. Drawing from her extensive experience, Dr. Boufford provides valuable insights and guidance for policymakers, urban planners, and community leaders aiming to build healthier, more connected urban environments. Join us for a thought-provoking discussion that underscores the potential of cities to be vibrant hubs for health and happiness, and learn how collaborative efforts can create lasting positive change.
Ayla Fudala: Hello and welcome to Frontiers in Health and Happiness, the official podcast of the Lee Kum Sheung Center for Health and Happiness at the Harvard T.H. Chan School of Public Health. My name is Ayla Fudala, Center Communications Coordinator, and I'll be asking experts how to live a healthy, happy life.
Welcome to the third episode of our Environments for Health and Happiness series, where we explore the complex relationship between the environments we live in and our overall well-being. As urban areas continue to expand and host the majority of the world's population, they become powerful drivers of progress in public health.
Today, we'll be discussing the critical role cities play in promoting global health and happiness with renowned urban public health leader Dr. Jo Ivey Boufford. With a career spanning decades, Dr. Boufford has held many important roles, including serving as the president of the New York Academy of Medicine and Dean of New York University's Graduate School of Public Service-- not to mention serving on our center's Scientific Advisory Board. Her commitment to addressing urban health disparities, fostering interdisciplinary collaboration, and translating evidence into policy has received international recognition.
I began by asking Dr. Boufford, what role do cities play in the global economy and global health goals?
Dr. Jo Ivey Boufford: Cities are the economic drivers of global GDP. I mean, they're probably responsible for 70% of global economic development worldwide, but they're also responsible for the majority of energy consumption and greenhouse gas emissions and solid waste production. So the idea being that unless you deal with the health of cities, you really can't meet global health goals. And so I think the attention to cities is growing for that reason.
Ayla Fudala: Dr. Boufford, what advantages do policymakers working in cities have compared to policymakers working at national or global levels?
Dr. Jo Ivey Boufford: That's a very interesting level of governance. I've worked in city government in New York City for a number of years, you know, in different points in my career. And the nice thing about working in cities is if you're a policymaker or you're in an agency, you can announce an initiative, but you can also go out to a neighborhood and see whether it's happening or not. And that's pretty hard to do at national level, and certainly, well, it's impossible in global levels, so it's quite eye opening. It's also quite rewarding. But if you get the right political leadership in a city, you can make a lot of change by working across agencies, actively engaging communities, really watching, monitoring your progress and making changes needed.
Ayla Fudala: What role can mayors play in addressing environmental challenges in cities?
Dr. Jo Ivey Boufford: Mayors have become super active. They've been very visible at the international COP meetings on environment. I think when President Trump really pulled out, if you will, from those agreements, I think over 200 mayors in the US came together and committed themselves to meeting the goals that have been set by, I think it was COP26 at the time. There was a network of mayors that's working on air pollution, another network of mayors on age-friendly cities. So it's an active group, and they can really sort of design and facilitate change in a way that I think is much harder at national and global level.
Ayla Fudala: Why is climate change a particularly big issue for cities?
Dr. Jo Ivey Boufford: Most big cities are on bodies of water or on the ocean, so climate change and sea level rise are huge issues for cities protecting against flooding and other issues. Our climate change colleagues have been identifying something called heat island effect, which is pretty unique to cities, where there's a concentration of heat in areas of the city, that can be mitigated by planting trees and greens and urban space that increases greenery and water availability. Cities are also really kind of pioneering on, you know, the kinds of building materials strategies for cooling, like painting roofs of buildings, putting blacktop in cities, and transportation policy, getting rid of cars. A lot of things that really feed into positive effects on environment. And again, because they are the legacies of such a large portion of the population, even though theY are kind of small land area in the world, there are a lot of great examples of, you know, recycling and addressing energy and addressing climate change and environment that are going on. So it's a great space to watch if you're in environment and climate.
Ayla Fudala: Is loneliness a serious issue in cities?
Dr. Jo Ivey Boufford: It's a huge issue. We have a sort of diagram that we use in trying to present the notion of a health in all policies approach for political leaders in cities. And one of the budget bubbles, which represent the sort of major sectors in agencies and in city government, and one of the areas is community engagement and community cohesion. And there's been a lot of work in cities really trying to define it. What are the metrics for measuring whether you have it or you don't have it? And I think that's still a challenge in city government for programming. There are a lot of proxy measures and people are trying to refine them very actively. Public health leadership, and especially people working in cities are fortunate because communities have been developing a lot of strategies for community engagement in problem solving and identifying areas where there is social isolation and failures of communities to create a kind of solidarity and support for each other. And so we're learning a lot in the urban health space about the issue of social isolation and social engagement.
Ayla Fudala: Have you ever done any work in the realm of loneliness?
Dr. Jo Ivey Boufford: I'm involved now with the New York State Master Plan on Aging that's very focused on prevention. And one of the really important risk factors for older people is social isolation. Partially just in terms of socialization, but also in, you know, being active, being able to get out of their apartments, being able to, you know, stay active and engaged and independent as long as possible. So it's a big theme. And people in the in the world of aging-- there's been a recent study by the US National Academy of Medicine, which developed a global blueprint for healthy longevity to try to sort of begin to approximate years of health with years of life lived, rather than having people sort of in significant portions of longer life not being healthy and active and independent as they wish to be. And so social isolation and engagement is a big theme to address there in terms of the prevention space with older people.
Ayla Fudala: Dr. Boufford, you've worked with companies as well as the government to address public health concerns. Could you tell me about your work with the Novartis Foundation? For those who aren't familiar, the Novartis Foundation is a nonprofit and part of the corporate responsibility portfolio of the Novartis pharmaceutical company. The foundation focuses on cardiovascular disease and health inequity across the globe.
Dr. Jo Ivey Boufford: The work with the Novartis Foundation began a few years ago. They were interested in addressing upstream risk factors, diminishing them for cardiovascular disease in cities. And so that was obviously a natural connection. And we brought a partnership with the international society to the work that Novartis was doing with its scientists and program leaders in cities, and their initial work was in low- and middle-income cities. Looking at, I think, especially ways to improve the effectiveness of our early identification of cardiovascular disease prevention, early treatment and detection and sustaining change. So that was a part of it. But another part that has begun to develop and is going to get to be a bigger part of their work, has been looking at the conditions in communities that support or undercut cardiovascular health. And they're now working in these so-called data-rich cities that we're trying to look at now. Not only the clinical indicators, but also the data from other agencies like transportation, urban planning, housing, others that really control the conditions of risk, factors that affect cardiovascular disease. So this is a really interesting project.
Another company, Novo Nordisk, has been working on a project, a global network called Cities Changing Diabetes. So there are a number of companies that are really looking at cities as a locus for their engagement and supporting programmatic and research efforts to advance health and cities.
Ayla Fudala: What are the most important factors required to effectively improve urban public health?
Dr. Jo Ivey Boufford: I think the most important is having political support for what you want to do. I mean, I think the local government level, many local governments in a number of countries, have a good bit of authority. In other countries they don't. So that's an important variable. But when they do, I think, as I said, mayors are very close to people living and working in cities, and they are quite directly accountable for a lot of the conditions in cities. So getting that political support is really, really crucial.
A second feature of effective urban health work is really working across sectors, the public health and health care delivery, so-called traditional health sectors. We really have to work very closely with other sectors like urban planning, like built environment, like natural environment, education, economic development, and really create those links, to make sure that the policies that are being made and programs that are being developed every day in those sectors are promoting health, for example. And in a city, if you are a health promoting transportation policy, you would try to minimize dependency on cars and maximize mass transit, bike lanes, walking sidewalks, you know, active transport. And that has huge effects on human health.
And then I think the third area that's been really important in promoting urban health has been the degree to which the research enterprise has to be interdisciplinary in teaching. So it's really important for urban health scholars to work with scholars in other disciplines. This is sometimes not supported in the academic environment. Academics are very much in a silo in their own disciplines. And so I think part of working in urban health and urban health research has been kind of challenging those boundaries and promoting interdisciplinary scholarship. And in the Academy, as well as the cross-sectoral work at the city level and the political leadership, you need to connect the dots between evidence to policy to change.
Ayla Fudala: This is my final question. Do you have any recommendations for policymakers looking to make a difference in the world of urban public health?
Dr. Jo Ivey Boufford: Policymakers, in my view, would be well advised to try to identify individuals in the academy and policy think tanks and others that are doing work in this area and really make sure that they have good access to not only the evidence that is being developed by academics and researchers, but also that they can inform those academics and researchers about what their problems are so that those individuals can begin to look at, you know, the sort of evidence base to help them solve their own problems. So I think that dialogue with urban policy makers, between academia and if the policy maker happens to be an intermediary between the academy and thinktanks and government, being that bridge is really important, and making sure that the movement is in both directions in terms of informing policy makers and political leadership on the evidence for making change, and then making sure that political leaders and policy makers have those partnerships where they can articulate problems they have, and the areas in which they need help figuring out what the solutions are.
Ayla Fudala: In our conversation, Dr. Jo Ivey Boufford discussed the ties between urban policy and public health. She emphasized the important role of mayors in making positive changes, such as spearheading environmental initiatives, and shared how cities are making strides in sustainability. Her insights shed light on the pressing issue of loneliness in urban communities, and the importance of fostering social connection. Dr. Boufford’s experience is a valuable resource, providing guidance for anyone working to build healthier and happier cities.
In the fourth episode of our Environments for Health and Happiness series, I'll be sitting down with Dr. Lindsey Burghardt, a practicing pediatrician, Chief Science Officer at the Harvard Center on the Developing Child, and Founding Director of the Center’s Early Childhood Scientific Council for Equity and the Environment. We'll explore topics such as the impact of pollution and climate change on children's health, the benefits of exposure to green spaces, and how socioeconomic and environmental factors intersect. Be sure to tune in next time to learn how you can help ensure the next generation's health and happiness.
This has been another episode of Frontiers in Health & Happiness, the official podcast of the Lee Kum Sheung Center for Health and Happiness at the Harvard T.H. Chan School of Public Health. To learn more about upcoming events, visit our website, sign up for our mailing list, and follow us on LinkedIn, Instagram, X, YouTube, and Facebook.
New episodes will air every two weeks. Episodes can be found on the Lee Kum Sheung Center for Health and Happiness website and YouTube channel, as well as on Spotify, Apple Podcasts, and wherever else podcasts are found. Thank you for listening.