The place where somebody lives matters for their physical well-being. Even within the same country, residents of different cities can have on average better or worse health, partly due to policies their city governments have adopted.
Consider life expectancy in Latin America. The gap between the highest and lowest life expectancies in urban areas of Argentina, Chile, and Ecuador is about two to three years as shown in Figure 1, which examines life expectancy across 188 cities in five Latin American countries. That is similar to the country-level gap between the US and Brazil in 2015. That gap is much wider in larger countries of the region, reaching 13 years in Brazil and 17 years in Mexico, comparable to the country-level gap between the US and Haiti in 2015.
Figure 1. Differences in Life Expectancy Across Cities in Five Latin American Countries
What can local governments do to improve health outcomes? In many countries of the region, city governments are legally limited in their ability to direct public health investments to things like improving the quantity and quality of healthcare infrastructure, equipment, and supplies and staffing. They may also find it difficult to boost citizens’ access to insurance. But, as explored in a recent IDB paper, there are a number of policies within the legal competences and toolkits of local governments that can have demonstrably important effects on health in their cities.
Two local public investments that do so are sanitation and drinking water. This is shown in Figure 2, which uses data from 81 cities in Brazil and 63 cities in Mexico. In both countries, connectivity to sewerage and piped water is positively correlated with life expectancy, consistent with many studies that show the same positive effect of these services on health. Access to sewerage, for example, reduces the incidence of open defecation, which leads to greater infant mortality, particularly in places with high population density. Completing these projects well is critical: while sewerage projects can reduce under-five mortality when completed, interrupted or abandoned projects can actually lead to increases in infant mortality, because of children’s greater exposure to water-borne diseases. In the same vein, researchers have shown that supplying more potable water led to lower local infant mortality in Argentina, Brazil, and Colombia, and a lower incidence of diarrhea and typhoid fever in other developing countries.
Figure 2. Correlates of Life Expectancy Across Cities in Four Latin American Countries
Public investments in mass transit can also help improve local health. A recent study looked at 58 new subway systems which were opened between 2001 and 2016 around the world and found that in high-pollution cities, these openings led to a 4% reduction of particulate matter, which would prevent between 22 and 34 infant deaths per year in large cities. Another study, focusing on Latin American cities, shows that when the availability of mass transit improves, there is a significant decrease in infant mortality rates.
Expanding the provision of potable water, sanitation, and public transportation usually involves large, expensive, multi-year projects. However, there are a variety of lower cost interventions that can also improve local health outcomes. Zoning policies, for example, can protect local populations from being exposed to air pollution produced by vehicles and factories or from biological hazards associated with the proximity to open waste disposal sites. The enforcement of regulations related to road safety – such as laws on drinking alcohol or on the use of helmets by motorcycle riders – can help significantly reduce injuries and fatalities. Local policymakers can also promote healthy lifestyles through policies like building public parks and other open spaces, and urban planning that promotes walkability. These interventions tend to have a larger impact on low-income people who have less access to privately-provided facilities. Local governments in Latin America and the Caribbean often have to navigate numerous budgetary and legal constraints. But there are still many policy options that they can pursue to make a positive difference in promoting better health outcomes among their citizens. And the fact that the COVID-19 pandemic has put public health high on the list of policy priorities only creates more opportunities to mobilize support and make significant, long-lasting progress.