turning points Future-proofng health and health-proofng the future of cities Tolullah ‘Tolu’ Oni is an urban epidemiologist at the Medical Research Council Unit at the University of Cambridge and a Next Einstein Forum Fellow and World Economic Forum Young Global Leader. Tolullah Oni

was working in public primary care methods to push the boundaries of how human immunodeficiency virus (HIV) research is conducted, to be simultaneously Iand tuberculosis clinics in Khayelitsha, timely and slow. one of the largest urban informal settlements Along the way, I worked to develop in . An important component partnerships across sectors and disciplines of this clinical research was providing care and with non-academic partners in the to people living with HIV who presented co-design and co-production of new for primary healthcare. Over this time, I knowledge. I have learned the importance was struck by what was almost a type of role of writing—to help set the research agenda play run on a daily basis between healthcare and raise awareness of this approach. And workers and patients. The script runs as because health does not merely trickle follows: doctor, “your blood pressure is poorly down, I recognize the need to leverage controlled and you need to eat better”; patient, collaborations to aspire, inspire and nodding agreeably, “I promise to do better.” conspire, taking deliberate steps to align the The advice I would give my patients in vision, strategy and interventions in cities that clinic essentially took no notice of the towards creation of health. availability of the food for the regimen I was In late 2019, I was in residence as an prescribing. I didn’t account for the fact that, Iso Lomso fellow at the Stellenbosch in this area of the city, to exercise more could Institute for Advanced Study, where I lead to risking life and limb. There was a convened government, private sector, non- shared understanding that the environment governmental organization and multilateral beyond the walls of the clinic is to be ignored. organization representatives from eight cities As if people were solely patients. This was for a Healthy Cities in Africa workshop. As the moment I turned from thinking about part of this residency, the founding director disease to thinking about health. Credit: Tolu Oni of the institute, Bernard Lategan, addressed Imagine for a moment a town that has the fellows. a problem with fires, which is worsening. Equity focused on the exposures in the The words he used to explain the The fire department would quickly fail to urban environment that could do better at rationale for the establishment of the deal with the daily onslaught. Over time, the supporting health creation. Stellenbosch Institute resonated with me: townspeople would learn more effective ways I now focus my research towards better “If we focus on what is, we are condemned of fighting fire, build more fire stations with understanding of how urban exposures to repeating what was. But if we focus faster fire engines, train more firefighters. All contribute to health and how to better on what is possible, we stand a chance of hands on deck, they would cry! They would co-design, with diverse stakeholders, transcending what is.” then improve, learn to re-build, detect new interventions in the environment to create I remain driven by the potential for fires, build better fire escape routes.... health and enable healthy choices. urban development in rapidly growing cities But through all these laudable and My interest in the prevention of non- to create equitable opportunities to embrace necessary efforts, one should be thinking: communicable diseases is driven by a desire choices that protect the health of people and “why do we have all these fires?” to confront the complexity of improving the planet in the long term. This healthy city That is what was happening, back in health in the future. Can we inoculate future is possible and necessary in Africa’s 2007, in that clinic in Khayelitsha. After this ourselves with the very cities that are rapidly urbanizing spaces and places. Once work, I established the Research Initiative negatively impacting our health, consciously my research plays some role in transcending for Cities Health and Equity, an urban designing them to create health for the what is, towards health-proofing the future health research group at the School of entire population in the long term? of cities, I’ll be content to retire. ❐ and Family at the There is undoubtedly a tension between University of Cape Town. research to address the problems of Tolullah Oni This was a marked pivot from my today—which are plentiful—and research MRC Epidemiology Unit, University of Cambridge, previous research focus on tuberculosis/ to protect the health of tomorrow. The Cambridge, UK. HIV epidemiology at the Institute of latter is more abstract and requires a very e-mail: [email protected] Infectious Diseases and Molecular Medicine different approach to research—exposures at the University of Cape Town. The and outcomes are seemingly disconnected Published online: 11 March 2020 Research Initiative for Cities Health and in time and space. I continue to learn new https://doi.org/10.1038/s41591-020-0788-5 304 Nature Medicine | VOL 26 | March 2020 | 304 | www.nature.com/naturemedicine