Jose G. Rimon, II, is director and senior scientist of the Bill & Melinda Gates Institute for Population and Reproductive Health at Johns Hopkins Bloomberg School of Public Health. He also directs The Challenge Initiative. He is also the founding director of the new Center for Public Health Advocacy at the Bloomberg School. Here, he shares the issues that should lead the international urban health agenda in 2017 and beyond.

Q: What do you see as the key issues in Urban Health for the next five years in the areas of research, policy, and practice?

A: I will begin with research. We need to look more closely into unique issues faced by fast-growing and mega cities in realizing and harnessing the Demographic Dividend [DD–accelerated economic growth that occurs as population health improves and leads, in part, to a dramatic increase in a country’s number of working residents]. Most DD research is focused on macro issues, but it’s important to understand what happens at the micro level in families, communities, and the collective urban environment. We must ask, are there certain issues that are unique to urban sites which can advance our understanding of the DD? How can we boost women’s employment, bring down child stunting [impaired development due to malnutrition], increase families’ income and reduce cities’ carbon footprint, all at the same time? And how do we measure these benefits?

As we look at policy, we should consider how research is solicited and incentivized to ensure that it is policy-oriented. The goal is bringing scientific rigor and practical relevance closer together. It is also important to look at specific policies and investment priorities in health and education to see what is needed to have the most impact on increasing human potential and capital, especially among the urban poor, women, and youth. We have to persuade city policy makers to invest in sectors and programs that bring about DD benefits.

In practice, we should ask what are the characteristics of effective urban health platforms? Can other issues be layered on top of these platforms? The Challenge Initiative (TCI), for example, is scaling up “business unusual” approaches (i.e. employing approaches that have not been previously used and are proven to be successful and scaling them up) in urban reproductive health globally. Under this approach, cities self-select to become part of TCI, and bring their political commitment and resources to the table. In turn, they get access to additional funding from a TCI Challenge Fund, have on-demand access to technical expertise and become part of the global urban reproductive health community of practice. While initially focused on urban reproductive health, we are testing how it could be bundled with maternal, neonatal and child health interventions, and other health issues can be layered over time.

Q: What is the role of the International Society for Urban Health (ISUH) in responding to these three key issues?  What one area would you target?

A: ISUH could highlight DD issues in its conferences and convene global experts on DD. The African Union has already declared DD as its theme for 2017 and the United States Population Fund (UNFPA) is highly engaged as are many other institutions, especially Development Banks. ISUH could also solicit papers on DD that focus on urban issues and consider a special supplement on urban reproductive health—perhaps for the International Conference on Family Planning in Kigali, Rwanda, in November 2018. And it can collaborate with the Gates Institute, which manages the DD website, a web-based resource developed for researchers and policy makers interested in the DD. 

Q: How can ISUH engage you and your community in these activities?

A: ISUH can work together with the Gates Institute in mutually beneficial endeavors that highlight the need to address the reproductive health needs of women and girls living in underserved poor urban areas. The Gates Institute leads TCI, a global program that is scaling up urban reproductive health solutions initially in Francophone West Africa, East Africa, India and Nigeria with plans to expand to a total of 14 countries in five years, especially in big cities in Asia. While TCI is initially funded by the Bill & Melinda Gates Foundation, it is specifically designed to partner with many other donors—bilateral, multilateral, foundations, high-net-worth individuals, civil society groups and the private corporate sector. It hosts TCI University, which helps train cities on evidence-based solutions and engages them to become a part of the TCI global community. It has developed a learning agenda designed to push the frontiers of knowledge and practice in rapidly scaling up and sustaining urban reproductive health interventions beyond the life of the project.

Yonette F. Thomas, PhD, is the executive director of the International Society for Urban Health.