Noncommunicable diseases (NCDs) kill 41 million people each year, equivalent to 74% of all deaths globally. Given the effect of the built environment on people’s health, the Climate Health Review talked to Dr. Harry Kennard to understand the relationship between urban form and NCDs.
Dr. Harry Kennard is a Senior Research Associate at the Center on Global Energy Policy located within the School of International and Public Affairs at Columbia University. His research is centered on the impacts of energy use, particularly on health in the context of the built environment. His main research activities are for the Lancet Countdown on Health and Climate Change, for which he focuses on the health co-benefits of climate change mitigation. Much of his work involves the health impacts of the built environment, particularly due to poor air quality and non-optimal temperatures, and how they relate to the prevalence of non-communicable diseases.
Q: Do you think health needs to play a determining role in decision-making in other sectors to control Non-Communicable Diseases (NCDs) effectively?
A: Absolutely. The “Health in all policies” calls for combating inequalities and promoting inclusive public participation to positively impact health. In the context of buildings and NCDs if you want to implement a policy for reducing energy use in homes, it should be done in such a way that has strong health benefits – in the UK this would be through targeting groups who experience fuel poverty – interventions to improve low-income homes could reduce heating bills, save energy, and have the added benefit of providing healthy space to live. This would mean a reduction in lung problems associated with dampness, but also improvements in mental health as a result of reduced precarity and more comfortable homes.
Q: Can the Building and Housing sector decrease the burden of the NCDs globally?
A: Yes, but the principal priorities are clean energy provision to low-income countries (avoiding air pollution from cooking) and improving energy efficiency in buildings in higher-income countries. If these are done carefully, the NCDs, lung problems, and cardiovascular issues associated with indoor air pollution can be reduced.
Q: The increasing burden of NCDs is linked to increasing urbanization. How to efficiently reduce this burden?
A: One of the primary groups of the NCDs is those associated with physical inactivity. The way that urbanization happens can have profound negative impacts on this. If urban spaces are designed around the car, then physical activity is minimal. This is especially the case in many urban and sub-urban areas in the USA. Often people don’t have the opportunity for sufficient exercise if they have to work long hours, at a job they have to drive to, because the urban spaces have been designed without people in mind. This is seen as a potential and growing issue in developing countries, places like Nigeria and India come to mind, where there has been rapid urban growth but car ownership is still relatively low. The potential harm that could result from car-centric urban environments is potentially huge. But there are also complex interactions with diet and other drivers of public health that are at play so the issues can be complex.
Q: What solutions can you provide in improving indoor environmental quality and in integrating these newer efforts with ongoing work addressing the risks of NCDs?
A: The main ways housing impacts health are through the air supplied when in the home and the temperature one is exposed to. Within that first consideration, the removal of pollutants (CO2, which if at high concentrations can impair cognition) and the avoidance of external pollutants entering the indoor space (NO2, particulates, radon, are some airborne risk factors that come to mind). The second provision, through optimal temperatures, is also essential. Especially as regions experience more extreme heat, buildings will need to be designed in a resilient way to avoid the harms of heat exposure. This can be achieved by providing sufficient ventilation, but in other contexts, active cooling may be needed. Ultimately the power that drives this air conditioning will have to come from renewable sources to ensure that you are not just transferring the harm from one location (an urban environment for example) to another (those living near a coal power plant for example).
Q: NCDs identified as climate-sensitive result in a disease risk magnification?
A: The heating of buildings accounts for around 12% of global energy and roughly the same amount of CO2 emissions. This means there is a huge potential benefit to decarbonizing heat in buildings. The same is true of cooling, though this accounts for around 3% of energy and carbon worldwide. Achieving energy reductions requires improved energy efficiency and better management of buildings. Some of this comes down to educating building users about better use practices, but a lot can be achieved with improved building standards. Worldwide, only 81 countries have building energy codes – that means in most countries new buildings can be built without any energy use considerations.
On the NCD, one important example comes from improving insulation in homes. When this happens you will often either get improved temperatures (in cold climates) or reduced energy consumption, but you often don’t get to have your cake and eat it – i.e. improving energy efficiency gets you a warmer temperature for the same energy input – it’s rare in a retrofit to see increased temperatures and reduced energy. This presents a challenge and underscores that if we want warmer healthier homes we also need to decarbonize the energy that goes into them.
Q: What interventions can effectively address NCDs – termed ‘co-benefit’ solution?
A: Retrofitting existing buildings and improving building standards for new buildings are the best ways to reduce energy (and therefore carbon) use. This has to be provided in a way that targets those least able to afford it, not least because they are often those with the highest NCD health burden for other reasons associated with inequality.
