“When we talk about urban planning and residential construction, the issue of antimicrobial resistance should be on everyone’s mind,” says Dina Gvineria, an architect at Dinelljohansson, a Stockholm, Sweden-based firm specializing in sustainable housing.
Antimicrobial resistance occurs when microorganisms change so that they are no longer affected by the antimicrobial drugs used against them. There are different types of antimicrobials, active against different types of microorganisms, such as antibiotics against bacteria, antivirals against viruses and antifungals against fungi. The emergence of resistance is accelerated by the inappropriate use of these medicines: for example, when antibiotics – which help to act against bacteria – are used as a treatment for viral infections such as influenza or as growth promoters. in the agricultural sector.
The emergence and spread of antimicrobial resistance is closely linked to the environment. It is therefore essential to understand the environmental and social determinants of health and to act on them to combat antimicrobial resistance. People in vulnerable situations may be at greater risk of contracting resistant infections or have fewer resources and less capacity to manage the consequences. In the fight against antimicrobial resistance, they are often forgotten. Public health interventions that improve the living conditions of all members of society, thus promoting infection prevention and a healthy lifestyle, constitute one of the most promising avenues, although too rarely taken, to manage the antimicrobial resistance.
The link between urban housing and antimicrobial resistance
Cities can serve as reservoirs for antimicrobial resistance pathogens, encouraging the persistence and spread of antimicrobial resistance through built environments, public transportation, leisure parks and population behaviors. Inadequate housing conditions can expose people to various health risks, including an increased risk of difficult-to-treat infectious diseases. Energy-intensive housing that is difficult or expensive to heat can contribute to respiratory illnesses due to damp building structures and the proliferation of mold and bacteria. In the WHO European Region, low-income households are likely to face poor housing conditions, including humidity and lack of heating. However, a link has been established between cold housing and fuel poverty, on the one hand, and an increase in contact with health care systems, on the other hand.
It is therefore necessary to find safe and efficient energy solutions for housing taking into account climatic zones. Indoor temperatures in homes must be high enough to protect residents from the harmful effects of cold on health. In climatic zones where there is a cold season, safe and efficient thermal insulation should be installed. Without proper ventilation, moisture builds up, which can lead to damp building structures and the spread of mold and bacteria. Improving housing conditions is an important public health intervention to help alleviate the burden of infections in general and limit the need for antibiotics.
“Urban planners have ways to help achieve healthy living and respond to the global threat of antimicrobial resistance if stakeholders, including municipalities, prioritize smart, sustainable options,” says Dina.
An example of improving housing conditions: “positive energy” interventions
Stockholmshem, a public low-income housing company, asked Dina’s office to be part of a multi-sector team to design a pilot project for positive energy residential buildings, i.e. a very energy efficient. These buildings are interconnected and share the same geothermal heat pump heating system, in which much of the heat is recovered from air and wastewater. This concept is inspired by traditional rural houses originally designed for the Swedish climate, in which the living space was reduced to a single heated space in winter and extended to the rest of the house (and beyond) in summer – a smart and pragmatic example of energy efficiency.
“In the case of positive energy housing, the goal is to both save and produce energy,” explains Dina. “The apartments are quite small, but each living space is designed to expand during the warm season. The living space is therefore modular in terms of volume, and adapts to the different seasons. To produce energy, the roof and part of the facades are covered with photovoltaic panels, which convert thermal energy into electricity. To maximize the effect, the ridge of the building is tilted so that the roof surfaces face entirely south. Combined with an efficient ventilation and moisture insulation system, the sustainable energy system ensures a healthy indoor environment at home. By making heating systems as energy efficient as possible, we help reduce health risks related to housing conditions and we offer a sustainable and climate-friendly solution to avoid financial difficulties linked to the cost of heating. energy. »
Architects can play an important role in combating antimicrobial resistance, creating environments that limit the spread of resistant pathogens, improve hygiene and better control infections through thoughtful design. The positive energy pilot project is just one example of a potential solution to help control antimicrobial resistance in urban planning. Other innovations, such as the use of particular coatings and materials in construction (for example, for high-touch areas such as door handles and handrails) can play a role in preventing and controlling damage. infections.
In Sweden, architects and builders of residential buildings are guided by municipal regulations to ensure the participation of all relevant stakeholders and cross-sectoral stakeholders in the urban planning process. Every voice and perspective collected helps optimize the development and implementation of solutions to combat antimicrobial resistance.
WHO/Europe commits to action against antimicrobial resistance
In terms of antimicrobial resistance in the Region, the goal is that by 2030, humans and animals will be better protected from resistant and difficult-to-treat infections, in healthier environments. To achieve this, the 53 Member States of the WHO European Region have endorsed the Antimicrobial Resistance Roadmap 2023–2030, which supports countries in the Region to design, prioritize and implement interventions high impact which will mitigate the repercussions of this resistance phenomenon. WHO/Europe is committed to addressing the global health challenge of antimicrobial resistance, including through environmental and social determinants, which are identified as an area for action in the Roadmap. Improving housing conditions is an important public health intervention, which is part of this commitment.
The Antimicrobial Resistance Roadmap adopts a One Health approach as it seeks to reflect the shared responsibility, at the national level, between the different sectors: human, animal, plant and environmental. It builds on the principle of inclusion by encouraging broad partnerships and alliances, and striving to better engage a diverse set of relevant stakeholders and perspectives.
From a One Health perspective, cities can prioritize sustainable urban development and integrate health considerations into urban planning to ensure adequate housing and living conditions that promote quality of life. . The One Health approach is implemented through the WHO European Healthy Cities Network, which mobilizes cities across the Region and engages local leaders to create a powerful movement for health public within communities. The Healthy Cities vision addresses the determinants of health and the need for cross-sector collaboration to achieve healthier environments and more resilient communities, while mitigating complex public health risks, including antimicrobial resistance. .
“Learning from the experiences of other cities through knowledge exchange allows us to disseminate ideas that we can adapt to our ever-changing context. My message to the next generation of architects and planners who will face the reality of antimicrobial resistance and climate change is to zoom out and see the bigger picture,” says Dina.
Global Antimicrobial Appropriate Use Week
World Antimicrobial Awareness Week is a global campaign to increase awareness and understanding of antimicrobial resistance and to promote good practices among all stakeholders, including the public, in order to limit the emergence and spread drug-resistant infections. World Antimicrobial Awareness Week is celebrated annually from November 18 to 24. The theme for Global Week 2024 is “Educate. Promote. Act now. “, a call to the global community to educate stakeholders about antimicrobial resistance, encourage bold commitments and take concrete action to combat this phenomenon.
Antimicrobial resistance is responsible for 133,000 deaths in the Region each year, and costs countries in the European Union and European Economic Area an estimated €11.7 billion per year. It is urgent to act against this phenomenon for better health and saved lives. It is everyone’s responsibility. The complex problems caused by antimicrobial resistance must be approached from different angles. Echoing the political declaration endorsed by world leaders at the Second High-Level Meeting on Antimicrobial Resistance, held during the Seventy-ninth Session of the United Nations General Assembly, WHO /Europe recognizes the need to leave no one behind. This includes supporting people living in inadequate housing and giving them the means to act. Much more can and must be done to draw attention to the importance of urban planning and improved housing conditions to control antimicrobial resistance.
