Skip to content


30 APR 2020

Can cities become more resilient to global health crises?

Throughout history, epidemics have had a profound influence in shaping and influencing society, alongside attendant rumour-mongering, panic and fear, and sometimes violence. There are lessons to be learned from outbreaks of bubonic plague, smallpox, cholera, Ebola and Sars when contemplating how cities can be healthier and more resilient in the face of public health crises.

Such crises unravel society, relationships and family structures, breaking down accepted social norms, especially where essential commodities are concerned. Resilience in a community has many pillars. But the cornerstones are adequate food, safe drinking water and reliable energy supplies. Epidemics can play havoc with these cornerstones both directly and indirectly. However, with hindsight, these outbreaks can help us understand what we need to do to provide more armour for cities in an ever-changing world.  

During the cholera outbreak in Paris in 1832, almost 19,000 Parisians perished. Among the turmoil, rumours spread that King Louis-Philippe was poisoning people by having arsenic added to water wells. Panic and violence ensued and the army and police struggled to maintain basic order. The lesson? Communications around impactful events need to be authoritative, clear, accurate and proactive.

Some years later, in 1854, in London, the Broad Street cholera outbreak caused 127 residents on that street to die over three days. Within a fortnight, three-quarters of the residents had fled the area and mortality levels in some parts of the city had risen to more than 10%. This outbreak led to the discovery that cholera was waterborne, not airborne as previously thought, and transmission was via the water pump handle on Broad Street. The pump handle was removed, heralding a new age in public health engineering. Improvements were made to water supply and wastewater collection treatment and disposal arrangements. However today, 2 billion people still use water contaminated with faeces; outbreaks waiting to happen.

When there is a threat to public health, the public will soon act

Anne Mott
Global Head – Cities, Mott MacDonald, Hong Kong

By the 1960s many believed that the “war against pestilence” had been won, as former US Surgeon General Dr William H Stewart claimed; communicable diseases had largely been conquered with vaccines and it was thought that malaria would be eradicated by the end of the century. Sadly this was not to be. And as new infectious diseases emerge, existing medicines start to lose effectiveness. We cannot be complacent about public health – ever.

Today we have the ability to travel far and fast, so viruses can affect millions of people in a very short time, both physically and from a global economic perspective.

As we continue to create more intricately interconnected and dependent economies, we effectively create one global city. With such interconnectivity and convenience, however, comes vulnerability and increased risks to public health. The initial spread of Sars and Covid-19 was enabled by people moving from one city to another, and then from one country to another.

And with half the world’s population using social media and many others online, there is the ability to create a situation similar to that in Paris in 1832. Online rumours potentially lead to panic buying and hoarding, seen during the current Covid-19 outbreak, and rational thinking and logical behaviour breaks down. History shows that where there is perceived to be a threat to food supplies or public health, the public will soon act to take control.

Therefore, if we really are to make cities more resilient, then we must keep alert to the reality of online contagion, as well as the threat of epidemics themselves.