Box 7.4: Inequitable impact of air pollution in Greater Accra, Ghana

7.2.5 Holistic age-friendly strategies Age-friendly strategies are increasingly important in cities with sizable populations of older persons, and integrated approaches can offer meaningful improvements in health, mental wellness and inclusion. WHO’s Age-Friendly Cities programme has highlighted the importance of changing perceptions of older persons, involving a wide range of stakeholders (e.g. community organizations, universities and businesses) and developing multisectoral approaches.95

For instance, the Age-Friendly Manchester Culture Programme brought together 19 cultural organizations (including museums, orchestras and theatres) to ensure these activities are more accessible to older persons. The UK city sought to address social isolation and racial exclusion by partnering with organizations representing older people from black, Asian, and minority ethnic groups. Manchester also established an AgeFriendly Assembly and Older People’s Board that promotes participation and inclusive decision-making.96

In the Turkish municipality of Besiktas (population of 181,000, with 20 per cent age 60 and above), integrated social centres have helped enhance older persons’ cognitive skills and social integration, as well as offering group therapy and counselling ser vices.97 The centres provided several opportunities to join cultural activities such as concerts and seminars, as well as gardening, games and various crafts. Individuals participating in Besiktas’ centres had lower levels of depression and higher social support levels than those receiving home-based assistance.

Finally, in Valencia, Spain, the city council worked with the Older People’s Association to create eight “bio-healthy parks” that simultaneously promote healthy exercise, access to green spaces and enhanced socialization.98 Each Park has several types of exercise equipment tailored to older people’s needs (e.g. to maintain agility and balance), and the initiative also benefited from cross-sectoral collaboration within the city council.

7.2.6 Health as a catalyst for social and environmental justice Health can catalyse interventions that generate far-reaching gains in social and environmental justice. Air quality is strongly linked to climate change, environmental injustices and multiple shortfalls in urban planning. The health burden disproportionately falls upon low-income residents and neighbourhoods who have typically contributed the least to greenhouse gas emissions but often lack the capacities to adapt effectively and require additional support (Box 7.4).99 As discussed in Chapters 5 and 6, building infrastructure to support non-motorized transport and planning for 15-, 20- and 30-minute cities are among the ways that cities can achieve

Health can catalyse interventions that generate far-reaching gains in social and environmental justice

Box 7.4: Inequitable impact of air pollution in Greater Accra, Ghana

In Greater Accra recent findings highlighted the inequitable, far-reaching impacts of air pollution. Amongst patients hospitalized due to air pollution or road traffic injuries, the poorest two quintiles were over-represented, accounting for 45 per cent of admissions. The majority were informal workers and the associated medical costs, most of which they bore out of pocket, represented up to double their annual earnings. Furthermore, indirect costs of air pollution were often extremely high for lung cancer, ischemic heart disease and road traffic (due to lost incomes), making the impacts of air pollution even more unmanageable for the poorest residents.

Source: Lampert et al, 2021.