Walking the talk: advocating for healthy cities

It's estimated that 68% of the world's population will be living in cities by 2050. In this episode, host Garry Aslanyan speaks with two pioneering leaders who have taken up the quest to make their cities healthier places by encouraging safe and active mobility. Jesús Carlos Soto is the Head of the Mobility and Transportation Department of the city of Guadalajara, and Silpa Wairatpanij is a Committee Member of the Thailand Walking and Cycling Institute Foundation in Bangkok. Guadalajara and Bangkok are two of 74 cities in Partnership for Healthy Cities, a global network of cities committed to reducing noncommunicable diseases and injuries through evidence-based interventions. The Partnership is supported by Bloomberg Philanthropies, Vital Strategies and the World Health Organization.

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Transcript

Walking the talk: advocating for healthy cities

Garry Aslanyan [00:00:05] Hello and welcome to the Global Health Matters podcast. I'm your host, Garry Aslanyan. We are bringing you an episode filled with optimism and inspiration. It's estimated that 68% of the world's population will be living in cities by 2050. Despite the many benefits offered by cities, cities can also be an unhealthy environment for people and the planet. In this episode, I'm joined by two pioneering city leaders who have taken up the quest to make their cities healthier places by encouraging safe and active mobility. In doing so, they are combating the environmental determinants responsible for noncommunicable diseases and injuries. Jesús Carlos Soto is the Director of Mobility and Transport for the Guadalajara Municipal Government in Mexico. He's a citizen advocate turned civil service leader. Silpa Wairatpanij is a committee member of the Thailand Walking and Cycling Institute Foundation and the project manager of the Bangkok Healthy Cities Initiative. He is also an advisor to the Deputy Governor of Bangkok on safe and active urban mobility.

Garry Aslanyan [00:01:29] Hi Silpa. Hi Jesús. How are you today?

Jesús Carlos Soto [00:01:35] Hello. Good. Thank you. 

Silpa Wairatpanij [00:01:37] Fine Garry, and you? Hello.

Garry Aslanyan [00:01:39] Great. I'm so pleased to have both of you today as guests. I know neither one of your career journeys started in health, and yet your work is having really direct impact on the health and residents of your cities. Maybe you could share a brief history of how this came about. Maybe we can start with Jesús. 

Jesús Carlos Soto [00:02:02] Thank you, Garry. Sure, of course. Good morning, and thank you very much for the invitation to share in this space with Silpa and the Healthy Cities Initiative. I have humanist training as a philosopher, although I started in the engineering side, but a vocational crisis made me change my path. At the end of my career in philosophy and social sciences, I became involved in the birth of a social movement hear in Guadalajara that began protesting the imposition of traffic light free roads in my city. So from there we went on to demand a comprehensive mobility plans not only focused on cars, but on people. As a philosopher, it made perfect sense to me because in that moment I also had to work in communities in conditions of urban marginalization, and I knew how important public space was for people in those areas. It is all they have. So from there, I got involved for about 15 years in citizen groups that began to propose another city model, one where there really were spaces for coexistence between different ways of living, and I understood that this involves thinking about spatial justice and climate crisis. And there are important health aspects in it, from road safety and the thousands of deaths caused by the model focus on motor vehicles, to the poor quality, that in my city is quite bad, the air quality, and it also takes many lives and costs year after year. So the most radical moment of my activism was when we camped for a month to stop the construction of an elevated vehicular bridge that destroyed several hectares of green areas and thousands of trees. We couldn't stop it, but it made us stronger, and later we were able to stop a 23 km road. Six years later, I was invited to create the first mobility and transportation direction from the local level of the city of Zapopan I am currently in charge of the direction in Guadalajara metropolitan area we have here that shares these two big municipalities. So from these public agencies we have promoted active and sustainable mobility, safe infrastructure, regulation of public space, education and road culture.

Garry Aslanyan [00:04:42] Jesús, how many people live in that metropolitan area?

Jesús Carlos Soto [00:04:45] We are already 5 million people in the metropolitan area and almost 3 million cars. It's composed of nine municipalities. Guadalajara and Zapopan are the biggest ones.

Garry Aslanyan [00:04:56] Okay, great. Silpa, how about you?

Silpa Wairatpanij [00:05:00] Hi. I'm Silpa. I'm from Bangkok, Thailand. My background is I'm working at the Thailand Walking and Cycling Institute Foundations. What we have been doing is to promote walking and cycling in the city rather than just for sport or exercise. We encourage people to use these kind of transportation mobilities as an everyday use in their life. We just came across an opportunity to join with the PHC (Partnership for Healthy Cities), and we could see this as a great opportunity to join with the municipality of Bangkok to get a grant on promoting safe and active mobility in Bangkok. The background of Bangkok has always been a car centric city for more than 40 years, and we have been building broad and expanding the expressway and highway. Still, the problem is that a city plan doesn't accommodate people to move from their house to the stations easily. The reason is because we have a lot of dead end roads. We don't really have a plan for the road network or street before, so it has become harder and harder for people to walk or cycle in the city, so everybody needs to use their own car just to make them convenience to go around the cities, especially, we have the perceptions that walking and cycling in Bangkok is very dangerous. So people need to protect themselves by using cars. That's ironic. For example, people need to use a car just to cross the road in some areas. There are two department stores and two districts that are close together, just one road separates them apart. But people cannot really use the crosswalk to cross this road so many of us just decide to just drive there, get into your car and go into the street.

Jesús Carlos Soto [00:07:25] It was the same in Guadalajara. 

Silpa Wairatpanij [00:07:27] Oh, wow. So we have example here.

Jesús Carlos Soto [00:07:31] We have López Matteos Avenue that also has ten lanes, and in this avenue we have traffic lights. But in 2007, the Government decided to suspend the red lights and just have green lights. So that divided the whole city in one side and the other, and it was impossible to cross from one sidewalk to the other. And that was the motivation to have a social movement rising, demanding different urban plans of mobility. But this is the same message, same concept and conditions as you.

Silpa Wairatpanij [00:08:10] I am glad that I have a real example here. We need to now change the environment of the city to accommodate people who need to use walking and cycling in the city. That's why this initiative grant, from PHC has come along, and we used this grant to have like a city lab inside the old town of Bangkok. We have a university, Silpakorn University. A professor there has designed these streets inside this area to have more space for sidewalks and less space for cars. We use lane reductions, narrowing the lanes, and also have an extended sidewalk at the crossing junction, so far and so on. So, it's been an ongoing process right now and we hope that by changing the environments of the cities to accommodate walking and cycling here and, in turn, it reduces sedentary activities, people have more activities and that would reduce the cause of NCDs. 

Garry Aslanyan [00:09:26] So as both of you, a ton of insight and thanks for setting the stage for the cities you are in. Clearly a huge amount of people are going to live in cities, some estimate to almost 70% of the people will be living there by 2050. You already mentioned that the cities were designed with cars in mind, not people or not walking, not cycling, not to mention the air that people have to breathe in those cities. So just before you started these initiatives and you started working on them, what were the health and safety challenges in each of the cities?

Jesús Carlos Soto [00:10:12] In 2015, Guadalajara was the second city with the highest ozone pollution in the country, and more than the 80% of the cars were non verified cars. So the contamination and the controls over contamination were very high, old, and so we have a very old and highly polluting vehicle fleet. Around 53% of the vehicles in Guadalajara metropolitan area were over 14 years old and didn't have a catalytic converter. More than 650 premature deaths linked to poor air quality happen each year here in my city. In that year, 2015, five contingency phase events we registered as around 83 contingency phases because the pollution levels exceeds the 115 points of the air quality index. So it was a very bad situation and in the State of Calico, Guadalajara is the capital of Calico, in 2012 around 8000 people were injured and 507 people lost their lives on the roads. So it is a very high rate here in Mexico. Road traffic is the second cause of death in the whole country, and is the first one in kids and young people. Just in my seat in Guadalajara, we have around 70 or 90 deaths per year in road traffic. So that has been the challenge to remediate the air pollution and to avoid more road traffic accidents.

Garry Aslanyan [00:12:14] What about Bangkok, Silpa?

Silpa Wairatpanij [00:12:16] Well, the top five causes of death of Thai people is from 1, 2, 3 and 4 is from the disease in cities, and the fifth one is the road accident. So we have a loss of 200,000 a year, people who die from car crash in the country, and in Bangkok itself is around 10% of it, 20,000 people only in Bangkok. So the population of Bangkok is around six million people and the amount of motor vehicles that have been registered here is 1.1 cars per 1%. Imagine that! So that means everybody in Bangkok has their own vehicle somehow. We had regulations for so many years to drain all the traffic in the cities from one area to other areas and that is a traffic police job. And they have only one job, to drain all the traffic out of their areas to be stuck in other areas. However, the number of death rate in Bangkok has been increasing. COVID-19 banned people from going out of their house. So, in that time, the death rate dropped like 40%, and the number of vehicles that have been using the road, that has been recorded, also dropped 40%. What a coincidence that it could translate that if you reduce the number of cars on the street, you can also reduce the death rate. So that's become the policies of the new governor that has been elected last year. His policy is to reduce the personal automobiles and encourage people to use public transport more. We also played an important role by encouraging and promoting people to use walking and cycling to connect to the public transport.

Garry Aslanyan [00:14:46] Jesús, in Guadalajara, domingo Vía RecreActiva has become a city wide ritual and something very popular. Maybe you could tell our listeners a bit more about it.

Jesús Carlos Soto [00:14:59] I think that Vía RecreActiva is one of the biggest changes that has happened in the city that has been helping to change the car culture in Guadalajara. La Vía RecreActiva is a space where we suspend the use of cars in a lot of streets and avenues, main avenues in the city. It's only on Sundays, from 8 a.m. to 2 p.m. It's only for the use of pedestrians and bicycles, skates and other kind of non-motorized vehicles and dogs, of course, so that people can go there and do many activities. In this year, Vía RecreActiva celebrated its 19th anniversary and has become one of the favourite spots to visit for tourists, for example, and for the locals. We have almost 31 km of road in Guadalajara, so just in Guadalajara, in Zapopan and other municipalities also have another amount of kilometres where we suspend the traffic. In 2007, the municipality of Zapopan joined the initiative of the Vía RecreActiva, back in 2009, 2008. So we have already in Guadalajara 31 km and around 100,000 people going each Sunday to visit La Vía RecreActiva. In September 2022, La Vía RecreActiva obtained international recognition from the Cycle Path Network of the Americas, so it's recognized internationally as an example programme model. So we have 5.5 million people each year going to La Vía RecreActiva, around 100,000 people each Sunday, and there happens around 35 permanent activities around the Vía RecreActiva; yoga classes, salsa, different kinds of dancing, martial arts, etc., and we have around 700 social servers each Sunday helping the people to orientate in La Vía RecreActiva and around an operational staff of 100 people from the municipality and 25 municipal agencies participating in the operation of Vía RecreActiva. Around 50 educational institutions also participate in the assignment of the social service providers, and we install around 800 safety signals each day that we have to implement the Vía RecreActiva. And to give you some more numbers, 53% of the users of Vía RecreActiva go on a bicycle. The other 40% are walking or running or jogging, etc., and 7% use other kinds of non-motorized vehicles like skateboarding, rollerblading, etc. It's a perfect example to show people how we can live in a city not dominated by cars and motorcycles. So it helps a lot to change the mindset and the culture of the people in Guadalajara.

Silpa Wairatpanij [00:18:33] So Jesús, can I ask you a question?

Jesús Carlos Soto [00:18:35] Sure.

Silpa Wairatpanij [00:18:38] Did the car people protest against these activities at the beginning of the activities?

Jesús Carlos Soto [00:18:46] At the beginning, of course. Because it was a huge change for the common operations of traffic in the city, even on Sundays. That's the reason why we do it on Sundays and during holidays. It also happens, for example, Mondays, after a holiday day. For example, this weekend we have on Sunday the Vía and also in the Monday because we have a revolution anniversary happening. So...

Silpa Wairatpanij [00:19:15] How do you deal with it?

Jesús Carlos Soto [00:19:15] We had many protests; dialogue with every programme we do. It involved a lot of tables to talk with the leaders of the neighbors, to give them information and understanding of the positive benefits of La Vía RecreActiva. As authorities, we had to take the decision to do it anyway, to implement the Vía RecreActiva. There were still protests, etc., but in the time we have almost none, because the benefits are very clear and the people are using La Vía. So a very clear aspect is the commercial one. The locals, the commercials, have registered an increase in their income, very significant. So they are the first ones that are asking to make more kilometres of the La Vía RecreActiva. We are now connecting more municipalities in different streets with commercial use. So that's a big ally in the promotion of La Vía RecreActiva.

Silpa Wairatpanij [00:20:20] Thank you.

Garry Aslanyan [00:20:20] I can see Silpa is taking notes.

Silpa Wairatpanij [00:20:24] Exactly. Yes.

Garry Aslanyan [00:20:25] I'm sure he's going to put this into use very soon. Silpa, tell me more about the Old Town Bangkok initiative you had. How was that?

Silpa Wairatpanij [00:20:35] This area, the old town of Bangkok, is like a tourist destination and the planning of the city is quite beautiful. It's a block life. The area is quite compact and it has everything in the radius of two kilometres, which is the radius that people could walk from here and there easily. But the residents themselves don't walk anymore. That's because the small streets in the old town of the cities have been replaced by traffic lanes. If you have been there, you could see that there was no sidewalk at all on any street in the old town of Bangkok, which is very sad, because people have to walk. Some people who still walk, need to walk amongst the cars, amongst the traffic but most people have been moved out of these areas and there are only elderly people who still live there who own a house there. And since we are promoting walking and cycling in the area, we could see new shops have been opened up quite a lot and people start coming back to this area. Not only did we change the environment of the street, of the whole area itself, we also doing like a tourist place. Because if you are foreigners and come to Thailand and this is like a destination that you need to go there to see like an old town, and we are also going to have activities instead of the bus ride tour. We're going to have like a walking tour instead that shows people around historical places, there are a lot of historical places in that area.

Garry Aslanyan [00:22:41] And did you encounter any challenges in terms of changing kind of mindsets about it?

Silpa Wairatpanij [00:22:46] Oh of course.

Garry Aslanyan [00:22:49] And what was it?

Silpa Wairatpanij [00:22:52] It's a habit of people. Some of the people don't really understand the benefit of having a lot of people walking in their area because there are also concerns about parking and accessibility of the cars. They always see the cars as their customers. So I actually had to go there and count the number of customers who go into their shops and how many customers come by car and how many customers come by foot by walking there. And it turned out like almost 80% of their customers have come by foot. 

Jesús Carlos Soto [00:23:36] Of course. Of course, public transport also.

Silpa Wairatpanij [00:23:39] Right, right. Yeah. So that's one of the challenges that we need to do, more work to show the numbers to those who protest, until they realize that, okay, so this is a benefit to them. Then, okay, go ahead and continue your projects. We don't really support, but we don't argue and we don't complain. You know, something like that.

Jesús Carlos Soto [00:24:03] It's the classic no parking, no business.

Silpa Wairatpanij [00:24:05] Right. 

Jesús Carlos Soto [00:24:07] It happens the same here.

Garry Aslanyan [00:24:08] So Jesús, Silpa mentioned some of the research they are doing to use it in designing some of these initiatives. Did you use any research, public health research or any other evidence in designing your initiative?

Jesús Carlos Soto [00:24:22] First, we try to always have public data before implementing any intervention of infrastructure in the streets. So we start from the knowledge that road traffic crashes annually claim around one million lives and causes around 50 million very serious injuries in the world. And that's no different in our cities. So we started to analyse how many people die or have injuries resulting from road traffic crashes as a public health problem. So each intervention we do now measure these kind of public health problems, before and after the implementation of our projects, to see if we have a reduction in these road traffic crashes. We are part of the Bloomberg Philanthropies Global Road Safety Initiative, so we have received important support to evaluate road safety in our cities year after year and refined information and, above all, evidence-based decision-making, scientific... For example, to decide where to invest public resources to modify the infrastructure and reduce the risks. Currently, we already have many interventions on roads that have shown over time, because you need at least two or three years to measure the interventions, that they have worked in terms of reducing accidents with deaths or injuries.

Garry Aslanyan [00:26:00] To have that data already?

Jesús Carlos Soto [00:26:02] Yeah. We have already the data to confirm that that happens. Now we are working with the Johns Hopkins University, through the initiative, to update the economic costs generated by road accidents in our city. We want to measure how much is the cost of each road accident in the state and in the city in terms of public health attendance of these road traffic accidents. All the efforts we are doing now are based on decision-making on data and evidence. It's a huge challenge because the quality of the data is still a little bad, it's not the best one, so we are making the steps in Guadalajara to achieve that so we can know in each moment what is happening in our city. That's the ideal. Where are the road accidents happening in each hour, each day? In which location? What modes were involved in these accidents? So, we have a lot of this information, but not in real time, and we still need to improve more technology and to improve our data collection methods so we can have more accuracy to define the causes of the road accidents in the city. But I can say we have enough information to decide where we have to make modifications in the infrastructure to provide a better quality and safe roads in our streets, and we are measuring that and we are showing the good results of doing this investment, this public investment, in terms of saving lives each year. So that's something very clear in our public politics, and it's improving each year.

Garry Aslanyan [00:28:01] What about public health data, Jesús, like in terms of noncommunicable disease reduction or prevention of some of the health issues? Is there any attempt to look at that or looking into the future? What kind of changes have happened in terms of exercise? Or how about that?

Jesús Carlos Soto [00:28:25] There is still much to be measured in our city in that term, to be able to demonstrate with evidence that these benefits are being generated. What we do know is that the bicycle strips and pedestrian strips are increasing considerably after the construction of almost 134 km of bike lanes in our city, and we know that every kilometre that is pedalled avoids emissions that affect health and generate cardiovascular improvement for the people that are using bicycles. But we don't have actual studies that give us a more scientific approach of the direct impact for the people of Guadalajara, because we have to cross, of course, the quality of the air, the kind of pollution we have here and what is actually happening with the people that are walking and cycling in the city.

Garry Aslanyan [00:29:32] Silpa, what about Bangkok? Any way to measure changes, especially on the health or health effects of the changes? Any attempts there?

Silpa Wairatpanij [00:29:43] So, it is very hard to research for direct correlations between active mobility and health data. There are so many effects on health rather than only the active mobility, but what Jesús said about pollution is a really interesting. We haven't integrated that kind of dimension into our research yet but maybe if it makes projects that we're going to be doing in Bangkok, we probably going to be using that sensors, measuring air quality inside the area that we promoted and to see if the air quality is better or not. To answer you Garry, to find direct correlations by promoting active mobility is still hard to do. I still don't see how could we be doing in these terms of the length of the projects because it probably needs like five more years just to see the cost effects of promoting active mobility for people to improve their health.

Garry Aslanyan [00:30:52] I understand. I'd like to end by asking each of you to give 2 or 3 lessons that you'd like to share with other cities. We have listeners from all over the world. How we can look into inspiring them to replicate some of what you do. I already saw Silpa was taking a lot of notes, Jesús, from some of the things that you were saying. So what advice would you have for our listeners who are in cities working on similar issues? Maybe we can start with Silpa and then Jesús.

Silpa Wairatpanij [00:31:25] The most important thing is scientific evidence, just like Jesús said about that, so we need to collect data. Every argument that has been raised in doing these projects, we've been showing them the data. We need to talk about numbers. Otherwise, by showing their emotions effect of changing the street, changing the environment of the city, is not enough. It doesn't convince people to follow along with treatment data we implement into the city. So I recommend doing a lot of gathering data, public data, and then doing your research to show them, and especially before and after comparisons, after treatment, that you have been implemented into your cities, and using that result to show them, why don't we do more like this in other places too. Something like that?

Garry Aslanyan [00:32:23] Thank you. Jesús, what about you?

Silpa Wairatpanij [00:32:25] In my experience here in Guadalajara, I can say that the involvement of civil society is essential to make changes in the politics. We have a very active and organized civil society promoting mobility as a human right here in Guadalajara and in Mexico, in the whole country, and this involvement wants to make the rights of cyclists and pedestrians visible, the right to the city, the defence of the environment, have provoked that in Mexico and Guadalajara we have taken important steps in this regard. So now we have laws and regulations that allow us to act as authorities. So the first lesson is to get this civil society involvement and provoke changes in the regulations and laws that can support then the legal investments and transformations of the infrastructure. Second, it's very important to understand that all the road traffic fatalities can be prevented. Reaching the goals of zero deaths and zero serious injuries is possible. A fundamental first step in this direction is to know and understand the causes of these road traffic fatalities. As well, to have precise data as Silpa said, and the laws to solve the problem in depth. We need scientific evidence in this term to make correct decisions. Maybe the last one; there will always be political costs of doing the right thing. We have to dare to do it. Of course, it's preferable to do it with enough time to demonstrate that the projects work so you can implement and then measure and demonstrate the benefits of doing it. In that sense, the political cost is lower or there can be none, as has happened in Guadalajara. But we also have to know that we don't always have time. The climate crisis is here and it's happening, and we have to act now. And the deaths and injuries are happening each day. So we have to act now. So I can say, do not be afraid of the political costs if you do the things correctly, very well planned with scientific evidence based decisions and with the support of civil society organizations.

Garry Aslanyan [00:35:12] I think that's an excellent last point, that there will always be political cost, is a very good message to remember for all of us. Thank you for joining me today, Jesús. Thank you, Silpa. Good luck with all of your initiatives and stay on your targets.

Silpa Wairatpanij [00:35:29] Thank you Garry. Thank you Jesús.

Jesús Carlos Soto [00:35:31] Thanks to you, Garry and thanks to you Silpa for sharing.

Garry Aslanyan [00:35:36] The thoughtful planning and creation of inclusive urban spaces can have a significant impact on reducing the number of deaths attributed to poor air quality, road traffic accidents, and of course, chronic diseases. It also has the added benefit of enhancing social connections in city environments that can often feel isolating and lonely. I think Jesús and Silpa are excellent examples, demonstrating the importance of government champions and civil society leaders in public health. As they both mentioned, often the biggest obstacle to achieve healthy cities and healthy populations is changing mindsets. Jesús gives an encouraging message to all of us: may we never shy away from doing the right thing, even if it comes with a cost. 

Garry Aslanyan [00:36:32] Let's hear from Sally Chew from Vital Strategies. Vital Strategies, the World Health Organization and Bloomberg Philanthropies support the Partnership for Healthy Cities, of which both Guadalajara and Bangkok are active members.

Sally Chew [00:36:53] What a great discussion. These two busy, car choked cities face so many of the same challenges. We've seen that it's just not easy getting decision-makers and cities like these to completely reimagine transportation, to go from a car-centric model to one that's people focused instead. But the evidence shows it's really the only way forward. The health and safety benefits are so dramatic in lives saved on the roads, cleaner air and increased physical activity. The work Jesús and Silpa outlined is being conducted through their city's participation in a global network. The 73 cities in the Partnership have committed to reducing noncommunicable diseases and injuries through specific evidence-based interventions. City to city conversations like the one on today's podcast are a huge part of the partnership. So I just wanted to close by saying thank you to Garry, Silpa and Jesús, and that I think a lot of listeners will be fascinated to find out what these two cities are up to.

Garry Aslanyan [00:37:53] Thank you, Sally, for your message and for supporting us with this episode. I'd like to also take this opportunity to make our listeners aware of the podcast called Vital Talks from Vital Strategies. Vital Talks engages with innovative leaders to examine health, equity and collaborative approaches to improving health. Their new season will be launching soon. To learn more about the topic discussed in this episode and how to find the links to Vital Talks podcast, visit our episode web page. There you will also find additional readings, show notes and translations. And of course, don't forget to get in touch with us via social media, email, or by sharing a voice message with your reflections on this episode.

Elisabetta Dessi [00:38:45] Global Health Matters is produced by TDR, a research programme based at the World Health Organization. Garry Aslanyan is the host and the executive producer. Lindi van Niekerk, Maki Kitamura and Obadiah George are content and technical producers. The podcast editing, dissemination, web and social media designs are made possible through the work of Chris Coze, Elisabetta Dessi, Isabela Suder-Dayao and Chembe Collaborative. The goal of Global Health Matters is to produce a forum for sharing perspectives on key issues affecting global health. Send us your comments and suggestions by email or voice message to TDRpod@who.int, and be sure to download and subscribe wherever you get your podcasts. Thank you for listening.