If health is the absence of disease, then in the urban context, one might think achieving it is impossible. Yet in the past couple of days I was reminded that wellbeing is the result of a multitude of factors and that in our cities, just like at the individual level, such complexity means health is an ongoing process. Moreover, it is our capacity to bounce back, both physically and emotionally, that helps fight illness. Similarly, our cities require more than the physical environment to nurture healthy citizens; they rely on community resilience to meet the many unexpected challenges constantly facing them.

The image of bucolic surroundings in the countryside with space for people and animals to roam has, for some of us, been ingrained as the only setting conducive to a healthy existence. I remember my parents as I was growing up bragging that their kids had the luxury of breathing fresh air and playing freely (never mind the fact we had to travel 30km to school every day!). While there is a lot of truth to the benefits of rural life, as an adult I quickly learned that it was in cities where opportunities are and where society thrives. It is, therefore, indisputable in my mind that cities hold the seeds of the future and according to experts at the Urban Health in Africa Conference I attended this week, harvest time is upon us as most of the population across the globe already inhabits cities.

The big question at this gathering which convened an impressive group of academics, medical practitioners, urban planners, policy makers and media was: “What do we mean by ‘urban health’?”. The discussions ranged from the impact of hypertension, diabetes and non-communicable diseases to the need for urban infrastructure and programmes that enable and promote healthy lifestyles.

As is often the case with our personal health, however, what we didn’t get to discuss in depth was the impact of our emotional state as a collective. Nobody can deny we live in a constant state of anxiety and unease; and though this may have been the status quo for many generations before us, the current social tensions and the structural violence in our cities are a clear symptom of hurt and pain. In Cape Town, we don’t need to look far to appreciate the many social ailments that afflict our city. From the clear segregation and lack of mutual respect in our public spaces to the type of stories we read in the media daily, it is clear we are a city in distress.

Perhaps, like with all other health challenges (and challenges in general), we need to first recognise that we have a problem – better yet, a myriad of problems – to address. And while the practical solutions discussed in the past couple of days are crucial to achieve healthier cities (of course people need to be more physically active and eat better, and government needs to regulate through mechanisms such as sin taxes and better healthcare), we must also recognise the urgent need to tackle those things that are less tangible, the “social contract” that ultimately makes or breaks our collective “wellness”.

Great ideas were discussed and a nice summary was written by the Sunday Times’s Tanya Faber. My big take away was that for the urban realm to achieve a state of better health, we all need to take part. Whether we are growing urban gardens, helping clean up rivers or advocating for more walkable spaces, the problem – and, therefore, the solution – lies with every single resident of our city. I had a chance to share the story behind Open Streets Cape Town as an example of how people can “practice” urban health in a way that gets everyone involved and that promotes change at the policy level. But at the end of the exercise, I was left with many more questions to take home to my team. How do we best share our experience thus far so that communities can take initiative independently and use their streets for physical activity on a more regular basis? How do we ensure that the community engagement process addresses health issues head on? Who else can we work with to showcase the existing initiatives that are building a healthier city? And, most importantly, how do we effect change to ensure our streets are healthier on a permanent basis?

Perhaps it’s time to ask yourself what hurts you the most about our city and to come up with some ideas to address it. Once you’ve taken the first step of acknowledging a problem, what type of “remedy” are you prepared to start following in order to achieve a sense of wellbeing that goes beyond your home and addresses the bigger home we share: Cape Town.


  • Born and raised in Bogota, Colombia, Marcela Guerrero Casas is passionate about cities and public space. Marcela holds a master's in public administration and international affairs from Syracuse University and has worked in policy and advocacy for over a decade. Marcela moved to Johannesburg in 2006 and worked in Zimbabwe, Swaziland and Kenya before moving permanently to Cape Town in 2011. In 2012, Marcela co-founded Open Streets, a citizen-led organisation working to transform how streets are perceived, utilised and experienced. Marcela is also a co-founder of SUR Collective, a platform for cultural exchange between Latin American and sub-Saharan African countries. In 2015, Marcela was one of 200 Young South African achievers recognised by the Mail and Guardian


Marcela Guerrero Casas

Born and raised in Bogota, Colombia, Marcela Guerrero Casas is passionate about cities and public space. Marcela holds a master's in public administration and international affairs from Syracuse University...

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