The Role of Human Agency in Global Urban Health

Abstract

Introduction Global health is facing critical challenges (e.g., climate change, environmental degradation, biodiversity loss, increasing non-communicable diseases), particularly within urban settings (e.g., cities) where over half of the global population resides (Romanello et al., 2024). As rapid urbanization continues, pressures of current global health challenges increasingly threaten both human and nature health. Drawing upon previous health concepts (e.g., Global Health, Planetary Health, Biodiversity-Health-Nexus), this research postulates a new multi-dimensional approach to health indicators. This research emphasises human agency (i.e., ability of individuals to make choices and take action; Bandura, 2006) as core tenet and – grounded in a socio-ecological perspective (see Hagger, 2024) – both the recent driver of and the potential solution to global health challenges within urban settings, resulting in a novel concept of Global Urban Health.

Methods Conceptualization was done through iterative literature reviews, including citation tracking of key papers, which informed a Delphy study to reach consensus with the expert consortium of the EU-Horizon project “GoGreenNext” on key socio-ecological components (SECs). Following the socio-ecological perspective, the Global Urban Health concept situates individuals within social and physical surroundings, which are overarched by government national and regional (e.g. urban) policies. Various health indicators and concrete measurement modalities to assess certain SECs are identified. The health indicators and measurement modalities are illustrated with example interventions that use nature-based solutions (e.g., green infrastructure) and emerging technologies (e.g., artificial intelligence) within urban settings to mitigate adverse health impacts of global health challenges.

Results As core SEC in the Global Urban Health concept, every individual brings certain biological (e.g., genes, age, sex, physiology), sociodemographic (e.g., cultural background, education level, socioeconomic status), psychosocial (e.g., motivations, attitudes, self-efficacy, intentions, emotions, stress), and behavioral (e.g., physical activity, diet, pro-environmental actions) factors with them. Further SECs in individuals’ social surroundings contain close relatives (e.g., family, peers), (online) social networks, health care services as well as communities (e.g., neighbourhood, organisations) and the culture individuals live in; SECs in physical surroundings are the (built) environment (e.g., streets, housing blocks, parks), the biodiversity and climate of the specific area an individual is located in. Both surroundings are embedded in policies that govern the urban setting an individual resides. Each SEC and its associated health indicators potentially interact with each other. Human agency acts as the central force within Global Urban Health, linking individual actions to SECs and shaping transformative efforts against global health challenges.

Discussion/Conclusion The Global Urban Health concept focuses on an interrelated multi-dimensional approach to health indicators that includes key SECs within urban settings. Considering urban settings as hubs for innovation and long-term sustainability (Nieuwenhuijsen, 2024), the concept of Global Urban Health underscores the need for transdisciplinary strategies to address pressing global health challenges and mitigate their adverse health impacts. By encouraging policy makers, urban planners, ecologists, and public health professionals as well as individuals in communities to adopt sustainable practices that benefit both human and nature health, the Global Urban Health concept provides a potential pathway for sustainable development of the entire globe (Brundtland, 1987).