How to build healthy cities and communities post-COVID-19 world

     The COVID-19 crisis has illuminated and exacerbated the structural weaknesses of global health systems, especially in urban areas in developed countries as well.

• In the post-COVID world, we must plan and manage cities so as to minimize the risk of disease and ensure equitable access to healthcare.
• The World Economic Forum Healthy Cities and Communities Initiative is tackling health and well-being in Jersey City, Austin, and Mumbai.

The COVID-19 crisis has unveiled the structural weaknesses of not only our economic systems but also, more critically, our health systems. The world is currently confronting the ineptitude of existing health and well-being infrastructure and the consequences of inadequate preventative health mechanisms, particularly for the most vulnerable in society.

Two key variables stand out in this crisis: urbanization and inequality.

Even as urban centers are engines of economic growth, they are challenged by rising physical and mental health concerns among large segments of people.

Unhealthy diets, physical inactivity, environmental conditions, and community and social stress factors are key contributors to this disease burden. As the urban poor have been disproportionately affected by COVID-19, the challenges of urbanization and access to healthy living have catapulted to the forefront of the global agenda.

As we continue to wrestle with the consequences of the crisis and contemplate the post-COVID world, we are left with a critical question to answer:

How will we plan and manage cities so as to minimize the risk of disease and ensure equitable access to healthcare? Our answer to this question will be the foundation of a more healthy, equitable, and just society.

While the call to categorically rethink and reconstruct the nature of our societies is challenging, it presents a unique and necessary opportunity to reshape a future that was already in jeopardy, with looming disasters such as climate change and growing social disintegration.

In a rapidly urbanizing world, it is imperative that cities are not only drivers of economic growth but also centers of health.

The World Economic Forum is responding to this urgent need to re-examine the relationship between cities and population health through its Healthy Cities and Communities Initiative, which launched in September 2019 as a multi-city platform encompassing a full spectrum of developed and emerging economies.

The mission is to empower consumers to achieve long-term health and well-being, with an improved state of holistic health and physical and mental well-being by 2030.

Dimensions ripe for interventions and scaling efforts include:

• Physical well-being (diet, nutrition, sanitation, hygiene, exercise, physical activity, sleep, rest)
• Mental well-being (emotional, social, environmental, spiritual, occupational, financial)

Spearheaded by the Platform for Shaping the Future of Consumption, the Forum is working hand-in-hand with cities to improve holistic health and well-being for diverse communities around the world.

The initiative kicked off in the United States in Jersey City, New Jersey – a city with 300,000 residents in 2019 – with the Office of the Mayor of Jersey City and the Department of Health and Human Services.

In nine months, public-private stakeholders have established a secure supply of nutritious food, via locally sourced vertically farmed greens in collaboration with Aerofarms, and provided personalized diagnostics for healthy living with other private sector collaborators.

The initiative has also expedited innovative partnerships on sanitation and hygiene by rolling out Mobile Public Showers.

In July 2020, the collaboration also began in Austin, Texas – a city with over 1 million residents – in partnership with global actors such as IBM and local stakeholder groups such as the Austin Healthcare Council.

The third city is the sprawling metropolis of Mumbai, India, a city with more than 20 million residents. The collaboration began in July 2020 in partnership with the Municipal Corporation of Greater Mumbai and India’s Ministry of Housing and Urban Affairs.

In light of the challenges presented by the coronavirus, sanitation and hygiene have been reemphasized as a key priority, particularly as cities grapple with how to limit contagion in highly dense metropolises such as Mumbai.

Innovative public-private interventions will be taken forward with the Toilet Board Coalition’s India chapter. Just as critical will be other cross-cutting dimensions of physical and mental health such as food and nutrition, physical fitness, mental wellness, rest, and occupational and financial health, with mental health being a critical priority for intervention.

The Healthy Cities and Communities Initiative envisages the creation and improvement of physical, social, and community environments that enable people to lead healthier lives and develop to maximize their potential in a truly inclusive way.

As such, the need for symbiosis between urban planning, economic development, and preventative health has never been greater.

Unquestionably, the process of building truly inclusive health ecosystems within cities will be fraught with challenges and difficulties, yet it is an imperative and a responsibility that we cannot overlook.

What’s the World Economic Forum doing about the future of cities?

Cities represent humanity’s greatest achievements – and greatest challenges. From inequality to air pollution, poorly designed cities are feeling the strain as 68% of humanity is predicted to live in urban areas by 2050.

The World Economic Forum supports a number of projects designed to make cities cleaner, greener, and more inclusive.

These include hosting the Global Future Council on Cities and Urbanization, which gathers bright ideas from around the world to inspire city leaders and running the Future of Urban Development and Services initiative.

The latter focuses on how themes such as the circular economy and the Fourth Industrial Revolution can be harnessed to create better cities. To shed light on the housing crisis, the Forum has produced the report Making Affordable Housing a Reality in Cities.

Current Health Issues

1. Physical Activity and Nutrition
2. Overweight and Obesity
3. Tobacco
4. Substance Abuse
5. Mental Health
6. Injury and Violence
7. Environmental Quality
8. Immunization
9. Access to Health Care

Physical Activity and Nutrition

Research indicates that staying physically active can help prevent or delay certain diseases, including some cancers, heart disease, and diabetes, and also relieve depression and improve mood. Inactivity often accompanies advancing age, but it doesn’t have to.

Check with your local churches or synagogues, senior centers, and shopping malls for exercise and walking programs. Like exercise, your eating habits are often not good if you live and eat alone. It’s important for successful aging to eat foods rich in nutrients and avoid the empty calories in candy and sweets.

Overweight and Obesity

Being overweight or obese increases your chances of dying from hypertension, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, respiratory problems, dyslipidemia, and endometrial, breast, prostate, and colon cancers.

In-depth guides and practical advice about obesity are available from the National Heart Lung and Blood Institute of the National Institutes of Health.

Tobacco

Tobacco is the single greatest preventable cause of illness and premature death in the U.S. Tobacco use is now called “Tobacco dependence disease.” The Centers for Disease Control and Prevention (CDC) says that smokers who try to quit are more successful when they have the support of their physician.

Substance Abuse

Substance abuse usually means drugs and alcohol. These are two areas we don’t often associate with seniors, but seniors, like young people, may self-medicate using legal and illegal drugs and alcohol, which can lead to serious health consequences.

In addition, seniors may deliberately or unknowingly mix medications and use alcohol. Because of our stereotypes about senior citizens, many medical people fail to ask seniors about possible substance abuse.

Mental Health

Dementia is not part of aging. Dementia can be caused by disease, reactions to medications, vision and hearing problems, infections, nutritional imbalances, diabetes, and renal failure. There are many forms of dementia (including Alzheimer’s Disease) and some can be temporary.

With the accurate diagnosis comes management and help. The most common late-in-life mental health condition is depression. If left untreated, depression in the elderly can lead to suicide. Here’s a surprising fact: The rate of suicide is higher for elderly white men than for any other age group, including adolescents.

Injury and Violence

Among seniors, falls are the leading cause of injuries, hospital admissions for trauma, and deaths due to injury. One in every three seniors (age 65 and older) will fall each year. Strategies to reduce injury include exercises to improve balance and strength and medication review.

Home modifications can help reduce injury. Home security is needed to prevent intrusion. Home-based fire prevention devices should be in place and easy to use. People aged 65 and older are twice as likely to die in a home fire as the general population.

Environmental Quality

Even though pollution affects all of us, government studies have indicated that low-income, racial and ethnic minorities are more likely to live in areas where they face environmental risks. Compared to the general population, a higher proportion of the elderly is living just over the poverty threshold.

Immunization

Influenza and pneumonia and are among the top 10 causes of death for older adults. Emphasis on Influenza vaccination for seniors has helped. Pneumonia remains one of the most serious infections, especially among women and the very old.

Access to Health Care

Seniors frequently don’t monitor their health as seriously as they should. While a shortage of geriatricians has been noted nationwide, URMC has one of the largest groups of geriatricians and geriatric specialists in any medical community in the country.

Your access to health care is as close as URMC, offering a menu of services at several hospital settings, including the VA Hospital in Canandaigua, in senior housing, and in your community.

There are several forms of depression. Below are some of the most common types.

Major depression

A person with major depression experiences a constant state of sadness. They may lose interest in activities that they used to enjoy.

Treatment usually involves medication and psychotherapy.

Persistent depressive disorder

Also known as dysthymia, persistent depressive disorder causes symptoms that last for at least 2 years. A person with this disorder may have episodes of major depression as well as milder symptoms.

Bipolar disorder

Depression is a common symptom of bipolar disorder, and research shows that people with this disorder may have symptoms around half of the time. This can make bipolar disorder hard to distinguish from depression.

Psychotic depression

Some people experience psychosis with depression. Psychosis can involve delusions, such as false beliefs and a detachment from reality. It can also involve hallucinations — sensing things that do not exist.

Postpartum depression

After giving birth, many women experience what some people call the “baby blues.” When hormone levels readjust after childbirth, changes in mood can result. Postpartum depression, or postnatal depression, is more severe.

There is no single cause for this type of depression, and it can persist for months or years. Anyone who experiences ongoing depression after delivery should seek medical attention.

Major depressive disorder with seasonal pattern

Previously called seasonal affective disorder, or SAD, this type of depression is related to the reduction in daylight during the fall and winter. It lifts during the rest of the year and in response to light therapy. People who live in countries with long or severe winters seem to be affected more by this condition.

Physical symptoms- The physical symptoms of depression include:

• moving or speaking more slowly than usual
• changes in appetite or weight (usually decreased, but sometimes increased)
• constipation
• unexplained aches and pains
• lack of energy
• low sex drive (loss of libido)
• changes to your menstrual cycle
• disturbed sleep – for example, finding it difficult to fall asleep at night or waking up very early in the morning

Social symptoms- The social symptoms of depression include:

• avoiding contact with friends and taking part in fewer social activities
• neglecting your hobbies and interests
• having difficulties in your home, work, or family life

Severities of depression- Depression can often come on gradually, so it can be difficult to notice something is wrong. Many people try to cope with their symptoms without realizing they’re unwell. It can sometimes take a friend or family member to suggest something is wrong.

Doctors describe depression by how serious it is:

• mild depression – has some impact on your daily life
• moderate depression – has a significant impact on your daily life
• severe depression – makes it almost impossible to get through daily life; a few people with severe depression may have psychotic symptoms

Grief and depression- It can be difficult to distinguish between grief and depression. They share many of the same characteristics, but there are important differences between them.

Grief is an entirely natural response to a loss, while depression is an illness.

People who are grieving find their feelings of sadness and loss come and go, but they’re still able to enjoy things and look forward to the future.

In contrast, people who are depressed constantly feel sad. They find it difficult to enjoy anything or be positive about the future. 

Diagnosis

If a person suspects that they have symptoms of depression, they should seek professional help from a doctor or mental health specialist. A qualified health professional can rule out various causes, ensure an accurate diagnosis, and provide safe and effective treatment.

They will ask questions about symptoms, such as how long they have been present. A doctor may also conduct an examination to check for physical causes and order a blood test to rule out other health conditions.

What is the difference between situational and clinical depression? Find out here. 

Tests

Mental health professionals often ask people to complete questionnaires to help assess the severity of their depression.

The Hamilton Depression Rating Scale, for example, has 21 questions. The scores indicate the severity of depression among people who already have a diagnosis.

The Beck Depression Inventory is another questionnaire that helps mental health professionals measure a person’s symptoms.

Is it curable?

While there is no cure for depression, there are effective treatments that help with recovery. The earlier treatment starts, the more successful it may be.

Many people with depression recover after following a treatment plan. Even with effective treatment, however, a relapse may occur.

To prevent relapse, people who take medication for depression should continue with treatment — even after symptoms improve or go away — for as long as their doctor advises.

Find some tips to help prevent depression from returning.

Triggers

Triggers are emotional, psychological, or physical events or circumstances that can cause depression symptoms to appear or return.

These are some of the most common triggers:

• Stressful life events, such as loss, family conflicts, and changes in relationships.
• Incomplete recovery after having stopped treatment too soon
• Medical conditions, such as obesity, heart disease, and diabetes.

Risk factors

Some people have a higher risk of depression than others.

Risk factors include:

• experiencing certain life events, such as bereavement, work issues, changes in relationships, financial problems, and medical concerns
• experiencing acute stress
• having a lack of successful coping strategies
• having a close relative with depression
• using some prescription drugs, such as corticosteroids, some beta-blockers, and interferon
• using recreational drugs, such as alcohol or amphetamines
• having sustained a head injury
• having had a previous episode of major depression
• having a chronic condition, such as diabetes, chronic obstructive pulmonary disease (COPD), or cardiovascular disease
• living with persistent pain

 There’s no single cause of depression. It can occur for a variety of reasons and it has many different triggers.

For some people, an upsetting or stressful life event, such as bereavement, divorce, illness, redundancy, and job or money worries, can be the cause.

Different causes can often combine to trigger depression. For example, you may feel low after being ill and then experience a traumatic event, such as a bereavement, which brings on depression.

People often talk about a “downward spiral” of events that leads to depression. For example, if your relationship with your partner breaks down, you’re likely to feel low, you may stop seeing friends and family and you may start drinking more. All of this can make you feel worse and trigger depression.

Some studies have also suggested that you’re more likely to get depression as you get older and that it’s more common in people who live in difficult social and economic circumstances.

Stressful events- Most people take time to come to terms with stressful events, such as bereavement or a relationship breakdown. When these stressful events occur, your risk of becoming depressed is increased if you stop seeing your friends and family and try to deal with your problems on your own.

Personality- You may be more vulnerable to depression if you have certain personality traits, such as low self-esteem or being overly self-critical. This may be because of the genes you’ve inherited from your parents, your early life experiences, or both.

Family history- If someone in your family has had depression in the past, such as a parent or sister or brother, it’s more likely that you’ll also develop it.

Giving birth- Some women are particularly vulnerable to depression after pregnancy. The hormonal and physical changes, as well as the added responsibility of a new life, can lead to postnatal depression.

Loneliness- Feelings of loneliness, caused by things such as becoming cut off from your family and friends can increase your risk of depression.

Alcohol and drugs- When life is getting them down, some people try to cope by drinking too much alcohol or taking drugs. This can result in a spiral of depression. Cannabis can help you relax, but there’s evidence that it can also bring on depression, particularly in teenagers.

“Drowning your sorrows” with a drink is also not recommended. Alcohol affects the chemistry of the brain, which increases the risk of depression.

Illness- You may have a higher risk of depression if you have a longstanding or life-threatening illness, such as coronary heart disease or cancer. Head injuries are also an often under-recognized cause of depression. A severe head injury can trigger mood swings and emotional problems.

Some people may have an underactive thyroid (hypothyroidism) resulting from problems with their immune system. In rarer cases, a minor head injury can damage the pituitary gland, which is a pea-sized gland at the base of your brain that produces thyroid-stimulating hormones.

This can cause a number of symptoms, such as extreme tiredness and a lack of interest in sex (loss of libido), which can, in turn, lead to depression.