Q&A: Do our cities make us sick?

From who can access HIV drugs to how we plan our cities, health challenges frequently overlap with policy. But all too often, we don’t have the right evidence to make informed decisions. For our XxXX interview series, which profiles 10 inspiring women in science and technology, Tolu Oni, a doctor who is now a Senior Lecturer at the University of Cape Town, shares her thoughts on healthy cities, the importance of open data and how to build a better Africa through science.

You changed track from a career as a doctor to a focus on public health. Can you tell us a bit more about what you do, and what influenced your move?

I should mention that I didn't change career as such. I still consider myself a doctor; simply a doctor of communities and populations, as opposed to a doctor of individuals. In medical school, you learn how the body works, how to diagnose a problem. During my medical studies in the UK, I took a year off to study International Health. Those studies gave me a global perspective on the factors that influence health. Who is responsible for health governance at different levels? Who are the other players? How do global processes and policies influence the local level?

My first research experience was in HIV treatment at Doctors Without Borders. At the time, there was this stigma which meant that anti-retroviral drugs were not available or affordable to low-income countries. The logic was that poor people didn’t have watches, so they wouldn’t know when to take their medicine. We set out to prove that this was obviously not true, and for that matter not moral. We were successful, and that experience gave me a sense of connection with common health challenges around the world, and an understanding of the barriers to accessing medicine.

When I came back to South Africa from the UK, I continued my work in HIV and I started noticing a lot of obesity and hypertension among South African HIV patients. I found that in fact there is a great deal of overlap between infectious and non-infectious diseases. This is important because these diseases are often managed in parallel vertical services. My results demonstrated the changing patterns of disease and the importance of an integrated approach to addressing these common conditions. I started to wonder what the connections were between people’s urban environment and health. Many of the drivers of ill health lie outside of the health sector. As a public health physician, I want to conduct research to understand how to change that governance structure.

What aspects of urbanisation and health are you working on?

One thing I am trying to change is our approach to policy. Policy is set with strategic goals in mind. That’s how we measure success. If something, like health, is not part of that plan, it won’t be reviewed. It becomes a nice to have. I want collaboration.

When the government decides to build a pedestrian bridge, it’s just assumed there will be health benefits. But what if it’s in the wrong place, and no one uses it? There’s nothing wrong with the infrastructure. It looks like a success on paper. Measurable health objectives – looking at whether it actually encourages people to take more exercise - would expose the shortcomings of the project.

Housing is another example. There is pressure to provide affordable homes in South Africa. But rushed, poor-quality projects could lead to respiratory illnesses, the spread of infectious disease, etc. Again, houses are built, objectives met. We may never even notice that public health has suffered. That’s because when people do get sick they go to the health sector, not the building sector. The correlation between cause and effect is lost.

You are involved with a number of organisations aiming to promote the sciences.

Africa is often seen as a consumer of knowledge, but not a producer of it. There are a few organisations working to change that.

The South African Young Academy of Science is one, where we bridge the gaps between scientists, the public and policy-makers. I was also selected as a fellow for the Next Einstein Forum, which highlights those using science to solve global problems. The RICHE project is a platform I created for engaging around the issues of urban health. To understand urban health issues, architects, urban planners, historians and many other disciplines need to work together. The goal is to work across disciplines to improve urban health.

You recently tweeted that data inequity is actually greater than income inequity. What do you think needs to be done to close the gap?

There is a move towards open data, but it is a relatively new thing. Income inequity is happening right now, while data inequity affects the future as we need data and science to be key drivers of development. Without the data, it is difficult to perform research. Africa needs to incorporate science to anticipate and resolve local and global problems, in addition to addressing practical solutions to the problems of the present. The way to do that is to raise the profile of research and science, and for that, we need access to data. There is a lot of inequity in terms of what we can access, even population data is missing for some countries. If we don’t know where we stand now, it is difficult to measure results in the future.

How can science and research be harnessed to build a better Africa?

We need to link researchers and scientists with societal challenges. There are many challenges, including rapid unplanned urbanisation, food and energy security and access, and climate change, which require a broader view, either across the STEM (Science, Technology, Engineering and Maths) fields or further still. We need to educate and train scientists from this perspective, not just by using text books from a long time ago. Another key point is to put more focus on fundamental sciences – from space to nanotech. They might not all be ready for direct application right now but if we don’t develop our expertise we won’t be equipped for the future. We need science made in Africa for the global scientific and societal stage.

What can be done to encourage African women in particular to participate in the sciences?

When it comes to women in the sciences, it varies across the disciplines. Universally, however, as you go further up in the sciences, the gender gap widens. To fix that, we need to fix the environment within the scientific community. Encouraging and mentoring girls and women into science is only part of the solution to addressing gender equity. We need to also focus on retention and advancement of women in science, ensuring we achieve our full potential. Creating better access could also help: conferences with childcare, for example. There is a need to look at the top echelons of science and see how we, male and female scientists, can support gender equity. At an entry level, there are still issues of socio-cultural norms. It’s not an African problem, it’s a global problem that needs to be addressed by all.

Interview by Donald Armbrecht

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