69���˵���

As more and more of the world’s population migrates to cities to seek employment, health-care professionals are thinking about ways to ensure that those cities provide healthy environments for large numbers of people.

The , slated for November 3 to 5 at the University of Toronto’s , will bring together experts from diverse fields, including architecture, business, medicine, engineering and public health, to explore ways to design, build or change cities to provide residents with the most equitable opportunities for good health.

“A healthy city is one in that promotes health equity for all citizens,” said Patricia O’Campo, a professor at the Dalla Lana School and director of the at St. Michael’s Hospital.

“Achieving health equity goes beyond equitable access to health care,” continued O’Campo, who co-leads the School’s with Professor Blake Poland. “We also need healthy urban infrastructure, safe recreation, access to good jobs, and an end to violence, racism, isolation and community disenfranchisement.”

Anita McGahan, associate dean of research at the and a contributor to Innovating for the Global South (U of T Press), said, “We still deliver health care at the county or city level, but inequality and human suffering are not city- or country-specific; they can have implications all over the world.”

McGahan believes that resilience, “the ability to adapt to whatever circumstances you’re in and the cards you’re dealt, has more of an impact on health than almost any other factor.”

Poland, another proponent of resilience, noted that “we tend to assume that ‘vulnerable groups’ are most lacking in resilience, but it is also true that marginalized groups deal with stress, hardship and loss on a more regular basis,” often in terms of inadequate funds for shelter or food, for example.

He said equity still gets short shrift in the resilience literature.

“Inequity dwarfs diabetes or smoking as a determinant of health,” he said. “We tend to look at ameliorative programming, rather than asking what is producing and reproducing these inequities in the first place.”

Poland noted that it is also important to look at the emerging threats to health equity, such as the ecosystem and resource depletion.

“The ecological determinants of health are poised to succeed the social determinants in relative importance in the coming decades,” he said. “We need to pay more attention to environmental degradation and climate change. With more uncertainty, we will be hit with surprises – like hurricanes or flooding – and we need to think about our systems’ responses.”

Stephen Verderber, a professor at the who lived through Hurricane Katrina in New Orleans, is looking at what cities can do to heal themselves when they absorb blows dealt by environmental events, such as earthquakes, hurricanes or floods.

“After the Christmas ice storm in Toronto, it took longer than expected for the city to bounce back,” he said. “We need to consider how the built environment can provide prosthetic support, for instance with hospitals, clinics and other portable facilities brought into the disaster zone.”

McGahan said she hopes the discussion of these issues at the Global Health Summit and their implications will “affect how we teach about health and develop public policy.”