Health & Place 83 (2023) 103081 Contents lists available at ScienceDirect Health and Place journal homepage: www.elsevier.com/locate/healthplace “In small places, close to home”: Urban environmental impacts on child rights across four global cities Emily Gemmell a,*, Dina Adjei-Boadi b, Asesh Sarkar c, Niloofar Shoari d, Katherine White a, Svetlana Zdero a, Hallah Kassem a, Tina Pujara c, Michael Brauer a,e a School of Population and Public Health, University of British Columbia, Vancouver, 2206 West Mall, Vancouver, BC, V6T 1Z4, Canada b Department of Geography and Resource Development, University of Ghana, MR28+9MQ, Doutor J.B. Danquah Avenue, Accra, Ghana c Department of Architecture and Planning, Indian Institute of Technology, Haridwar Highway, Roorkee, Uttarakhand, 247667, India d MRC Centre for Environment & Health, Department of Epidemiology and Biostatistics, Imperial College London, St Mary’s Campus, Norfolk Place, London, W2 1PG, United Kingdom e Institute for Health Metrics and Evaluation, Population Health Building, Hans Rosling Center, 3980 15th Ave. NE, Seattle, WA, 98195, USA A R T I C L E I N F O A B S T R A C T Keywords: Urban environments influence child behaviours, exposures and experiences and may affect health, development, Child rights achievement and realization of fundamental human rights. We examined the status of eleven UN Convention on Urban health the Rights of the Child articles, in a multi-case study across four global cities. Within all study cities, children Child health experienced unequal exposure to urban environmental risks and amenities. Many violations of child rights are Child development Healthy cities related to car-based transportation systems and further challenged by pressures on urban systems from rapid Urban planning population increases in the context of climate change. A child rights framework provides principles for a col- lective, multi-sectoral re-imagination of urban environments that support the human rights of all citizens. 1. Background international treaty, the UNCRC outlines children’s fundamental human rights in 54 articles, with 41 substantive articles addressing nearly every “Where, after all, do universal human rights begin? In small places, aspect of child life and experience (UN General Assembly, 1989). The close to home […] Unless these rights have meaning there, they have UNCRC is intended to guide policy and legislation in member States, little meaning anywhere.”(Roosevelt, 1999) with progress monitored through State reporting to the Committee on the Rights of the Child. However, consideration of child human rights in The drafters of the United Nations Universal Declaration of Human policies related to urban environments is often inconsistent (Child and Rights emphasized everyday environments as the primary settings Youth Law Section Canadian Bar Association, 2020; Canadian Bar As- where human rights are actualized. Most profoundly experienced in the sociation, 2022). Efforts to ensure child rights in urban contexts have “small places,” human rights also have little meaning unless equally been taken by an increasing number of municipal and local govern- applied to all people, including the smallest (O’Neill, 2005). Child rights ments, and frameworks developed to support subnational efforts (UNI- in urban environments matter, not only because of the powerful impacts CEF, 2022; Vakerelska et al., 2022). However, a holistic understanding of early exposures on health and development and because children are of how modern urban physical environments influence child rights in the future workforce, innovators and leaders of societies but, from a and across cities is lacking; assessments are often countrywide (Payne, justice and equity standpoint, because children are human beings. The 2017; Human Rights Council, 2022), or limited to specific projects UN Convention on the Rights of the Child (UNCRC), as a conceptual and (Wridt et al., 2015), issues (Human Rights Council, 2017) or neigh- legal framework, reflects shared human values across a range of his- bourhoods (Rakhimova et al., 2022). The dynamic, complex interactions torical, geo-political, cultural and religious contexts (UN General As- between actors, agencies, markets and populations that shape cities may sembly, 1989; Freeman, 2020). As the world’s most widely-ratified also obscure the question of who is responsible for upholding specific * Corresponding author. E-mail addresses: emily.gemmell@ubc.ca (E. Gemmell), dboadi624@gmail.com (D. Adjei-Boadi), asarkar@ar.iitr.ac.in (A. Sarkar), n.shoari@imperial.ac.uk (N. Shoari), katherine.r.white@ubc.ca (K. White), szdero@student.ubc.ca (S. Zdero), hallah.kassem@gmail.com (H. Kassem), tina.pujara@ar.iitr.ac.in (T. Pujara), michael.brauer@ubc.ca (M. Brauer). https://doi.org/10.1016/j.healthplace.2023.103081 Received 16 March 2023; Received in revised form 3 June 2023; Accepted 28 June 2023 Available online 26 July 2023 1353-8292/© 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). E. Gemmell et al. H e a l t h a n d P l a c e 83 (2023) 103081 child rights related to these environments (O’Neill, 2005). In this paper, Table 1 we examined the ways in which children’s human rights described in Multi-case study search strategy. eleven UNCRC articles are supported or undermined by urban built UNCRC Broad search criteria Potential urban characteristics environments and identify entities, actors and instruments responsible Article for actualization of these rights across four diverse urban contexts. Evidence for urban Greenspace (Vanaken and By 2050, more than two-thirds of the world’s children will live in environmental characteristics Danckaerts, 2018; Ye et al., 2022) cities, their experiences and exposures shaped by the form and quality of that support or undermine the Space for play, physical activity, urban space (United Nations Department of Economic and Social Affairs best interest of the child, with a social connection (Gemmell et al., Population Division, 2019). Since adoption of the UNCRC, rapid focus on child health, 2022) development and well-being. Active travel environment ( rural-urban migration, expansion of cities, social, geo-political and Evidence for features of urban Rothman et al., 2021, 2022) climate changes have altered the environments in which children’s environments that support the Noise (Stansfeld and Clark, 2015) rights are experienced, with potential impacts on multiple child health right to life, survival and Air quality (Holm et al., 2021) and developmental outcomes (Ye et al., 2022). In addition, children’s development. Traffic environment (Quistberg Evidence for urban et al., 2022; Rothman et al., 2022) experiences and exposures may vary dramatically within cities due to environmental impacts on Housing (Qiu and Zhu, 2017; unequal access to, distribution and quality of urban amenities (Gemmell children’s ability to realize Nasim, 2022) et al., 2022). To gain a broad understanding of how urban environments their highest attainable Water, Sanitation (Fink et al., currently influence the realization of children’s human rights within and standard of health. 2011; Ngure et al., 2014) across the study cities, we addressed the following questions using single Evidence for urban Natural space (Lee et al., 2012) environmental influences on and multi-case methods: children’s attainment of a standard of living adequate for 1. How do characteristics of urban environments support or undermine physical, mental, spiritual, the realization of children’s rights? moral and social development. Evidence for impacts of urban Natural spaces, biodiversity ( 2. What entities, actors and instruments are responsible to ensure environments on children’s Salmón, 2000) actualization of these rights? right to education that prepares them for a responsible life in a 2. Methods free society, and develops respect for the natural environment. We conducted a multiple-case study across four diverse urban con- Evidence for how urban texts: Accra, Ghana; Delhi, India; London, UK and Vancouver, Canada environments influence child (Creswell and Poth, 2018; Yin, 2018). Study cities were selected from rights to culture, religion and countries that have ratified the UNCRC treaty and vary in geography, language. Evidence for how urban Space for play (Derose et al., culture, density, socioeconomic development and demographics, and for environments influence 2018; Gemmell et al., 2022) which at least one co-author had in-depth expertise on local urban en- children’s access to play. Greenspace (Grigsby-Toussaint vironments. For this research, a child was considered to be a person et al., 2011) between birth and 18 years of age, and “urban environments” include Traffic environment (Flowers major physical characteristics of cities. Though referred to as “cities”, et al., 2019) Social space (Adjei-Boadi et al., the study areas are adjacent administrative areas that form continuous 2022; Gemmell et al., 2022) urban regions (Table 1). Evidence for urban Mobility (Morales et al., 2018) We identified eleven UNCRC articles with evidence for direct im- environmental influences on Accessible space for play (Shields pacts from urban environmental characteristics (Table 1). We based our children’s opportunities in et al., 2012) conditions that promote search strategy for the study cities around these eleven UNCRC articles, dignity, self-reliance, active focusing on specific environmental features or exposures but also participation. allowing for flexibility and emergence of city-specific urban environ- Evidence of serious Child perspectives in urban mental factors with impacts on child rights (Table 1). consideration of child planning processes (Feldner et al., We searched for city-specific documentary evidence for how urban perspectives regarding urban 2019) environments. environments influence child rights and the duty-holders with explicit or Inequalities in exposure to Equity issues related to urban implicit responsibility for ensuring the realization of these rights. Data health enabling or harmful environmental exposures ( collection for each city was led by a co-author with expertise in child features within urban Browning et al., 2022) health, environmental health, urban planning, architecture, and/or environments based on racial, ethnic, caste, gender, socio- epidemiology within the local context. Data sources included peer- economic, ability or other reviewed journal databases, international, federal, state/provincial, differences. municipal and administrative area-level evaluations, reports and policy Evidence for application of all Extent to which identified issues documents; non-governmental, community organization evaluations measures and resources to are addressed, prioritized in the and reports; not-for-profit and media reports. Basic demographic data issues impacting child rights context of each city (Payne, 2017) related to urban environments. was collected for each city from existing open data sources (Office of the Registrar General and Census Commissioner, 2011; Ghana Statistical Service, 2021; Nomis Office for National Statistics, 2021; Government of then independently examined by the primary author to validate find- India; Statistics Canada, 2022a). ings, with discrepancies resolved through discussion with co-authors. Co-authors from each city examined documentary data within the Co-authors provided high-level descriptive evidence summaries for framework of the research questions (Yin, 2018), identifying major each city, including major issues, barriers and facilitators to realization themes, duty-holders and their domains of actions. Co-authors drew on of child rights. We then conducted cross-case analysis, organizing local knowledge of formal and informal systems of influence, control, single-case data for each city within a matrix to examine patterns across development and regulation, considering each case holistically, rather cities (Yin, 2018). We identified convergence and divergence in themes than focusing narrowly on a set of variables. We undertook this analytic and summarized cross-case insights for urban environmental charac- approach as best suited to addressing the research questions within and teristic examined. Based on findings from this cross-case analysis, we across diverse, complex urban systems (Byrne, 2012). All evidence was developed a higher-level conceptual model (Yin, 2018) for how a child 2 E. Gemmell et al. H e a l t h a n d P l a c e 83 (2023) 103081 rights framework may inform priorities and action across all levels of due to household cooking with biofuels (Arku et al., 2015; Alli et al., society for healthy and just cities. 2021; World Health Organization, 2021). Nearly all children are exposed to road traffic noise above WHO guidelines (World Health Or- 3. Results ganization, 2018), with higher exposures in low compared to high-income areas (Clark et al., 2021). The selected study cities are diverse in geography, history, climate, Among the urgent and competing demands on city resources, space demographics, population density, culture and urban form and these and healthy urban design priorities such as provision of green spaces is factors uniquely shape local environments in which children’s rights are neglected and the right to play is absent in policies related to children in experienced (Table 2). The proportion of children within each city Ghana (Adjei-Boadi et al., 2022). Widespread encroachment and varies, with the highest proportion of children in Accra, and lowest in rezoning of public spaces for other uses mean that many playground, Vancouver (Fig. 1). parks and open spaces have disappeared. Those remaining are often Below we provide brief, descriptive summaries of the status of chil- unattractive and deserted due to lack of maintenance (Adjei-Boadi et al., dren’s rights related to urban environments for each case city, followed 2022), while for-profit play spaces, though well-maintained, may be by presentation of cross-case results (Table 3). unaffordable for many families. Children play in informal open spaces such as school parks, undeveloped and unoccupied private lands, streets, 3.1. Accra, Ghana pavements and large gutters. Informal spaces close to home provide opportunity for physical activity and socialization, but may expose On February 5, 1990, one week following the signing of the UN children to traffic hazards, injury or infections (Adjei-Boadi et al., 2022). Convention on the Rights of the Child, Ghana became the first country in Though exemplary participatory projects have been conducted by the world to ratify the treaty, committing to adopt its principles into local non-profits, children’s views and opinions are not routinely national law (United Nations, 2022). Ghana has a rich history of lead- considered on decisions regarding design and use of built environments ership on child rights; playwright, author and child rights advocate Efua (Adu-Gyamfi, 2013; Phillips and Serumaga-Musisi, 2020; Adjei-Boadi Sutherland celebrated the importance of play in “Playtime in Africa”, et al., 2022). Members of a youth advocacy assembly who organize and donated land for a public children’s park and inspired the work of the engage with local authorities felt that their input was not seriously Mmofra Foundation, a non-profit supporting children’s rights to culture, considered. the arts and public space (Sutherland and Willis E, 1962; Addo-Atuah, “… they take action only if they agree with us …” 2018). Though healthy urban policies exist, implementation is chal- lenging in Accra’s complex policy context (Audia et al., 2021). Rapid “We were so passionate about the children’s park but we did not have the urbanization, in combination with long-standinginadequate manage- power to get it done.”(Adu-Gyamfi, 2013, p.1769) ment and development of city service infrastructure, has overwhelmed resources, administrative and governance capacity to meet growing demands for housing, water, sanitation, waste management and trans- 3.2. Delhi, India portation. An estimated 80% of Accra households rely on sachets (machine-sealed plastic bags) of water for drinking (Moulds et al., Children and young people make up approximately one-third of 2022). The resulting plastic waste contributes to flooding risk by Delhi’s growing population, representing a major asset to the city’s so- blocking gutters, putting children at risk of injury or infection during cial and economic future (Mody and Aiyar, 2011). However, many urban flood events, especially those living in informal settlements in children live in informal settlements due to the city’s unmet housing flood-prone areas (Amoako and Inkoom, 2018). In Accra, children are needs in the face of rapid rural-urban migration (Manish, 2022). Often exposed to annual PM2.5 air pollution levels averaging 7.2 times higher lacking city services, water and sanitation infrastructure, children may than World Health Organization (WHO) guidelines (5 μg/m3) (World experience recurrent diarrhoea and parasitic infections, contributing to Health Organization, 2021), with higher exposures among girls, likely high rates of malnutrition, stunting and under-5 mortality (National Institute of Urban Affairs, 2020). Among the urban poor (two lowest Table 2 quintiles of the National Family Health Survey Wealth Index), the Characteristics of study cities. under-5 mortality rate was nearly 60 per 1000 live births, compared to non-poor (<50/1000 live births) (National Institute of Urban Affairs, Name Study Definition Area Percent 19 Population (km2) years and totals (n) 2020). Inequality in access to water is reported, with the poorest under (%)c households having least secure access to safe water (Kumar et al., 2021). Accraa Greater Accra 1585 38 5,455,692 Greenspace is inequitably distributed across the city. Of sixty-four wards Metropolitan Area in East and North East Delhi, with densities between 30,000–120,000 (GAMA) persons/km2, fourteen met the WHO criteria for per capita green space Delhib National Capital Territory 1484 37 20,965,000 (9 m2), twenty-four had one or more playgrounds, while some lacked (NCT) of Delhi a any parks at all (Mitchell et al., 2021). Gated communities may provide London Greater London (32 1572 25 9,002,488 boroughs and City of a strong sense of community, greenspace and low traffic that supports London) outdoor play (Bhonsle and Adane, 2016). However, heavy traffic and Vancouvera Metro Vancouver (21 2879 19 2,642,825 lack of pedestrian and cycling infrastructure pose serious risks outside municipalities, one these areas (Traffic Management Division, 2021), often limiting chil- electoral area, one Treaty First Nation) dren’s active mobility to school and other destinations. Densely popu- lated areas with higher proportions of children, fewer assets, lower a Based on census data, 2021 (Ghana Statistical Service, 2021; Nomis Office electricity access and less greenspace have the highest urban heat risk for National Statistics, 2021; Statistics Canada, 2022a). b (Mitchell et al., 2021). Though higher environmental risk is often linked NCT of Delhi is surrounded by the National Capital Region (NCR), also commonly called “Delhi” that consists of urban, suburban and rural areas (Na- to poverty, poor air quality violates the human rights of Delhi’s children 3 tional Capital Region Planning Board, 2018). Data presented here is for the NCT across socioeconomic strata. Local PM2.5 levels may reach 400 μg/m , of Delhi only. Demographic data based on population projections for 2020 from 80 times the WHO guideline levels (Selokar et al., 2020; World Health the Government of India. (Government of India). Organization, 2021). High asthma rates and prevalence of acute respi- c Percent population under 20 years is given to enable comparisons across ratory infections (ARI) are seen in children across socio-economic strata cities, as age structure was only available in 5-year categories for some cities. (National Institute of Urban Affairs, 2020; Selokar et al., 2020). Various 3 E. Gemmell et al. H e a l t h a n d P l a c e 83 (2023) 103081 Fig. 1. Population age structures for a. Accra (Ghana Statistical Service, 2021), b. Delhi* (Office of the Registrar General and Census Commissioner, 2011), c. London (Nomis Office for National Statistics, 2021) and d. Vancouver (Statistics Canada, 2022a), by gender and five-year age groups. *Delhi age/sex structure based on 2011 census data as 2021 census was delayed due to Covid-19. strategic plans at the national and city levels have been developed and school grounds, parks, and play spaces (Sheridan, 2019; Shoari et al., initiated to improve air quality, however, the success of these programs 2022). The issue has risen to prominence following the death of to date has been mixed (Chatterji, 2020) and many are concerned that nine-year-old girl, Ella Kissi-Debrah, the first case of premature death measures to mitigate harm may come too late for their children (Saxena, officially recognized as due to unsafe levels of air pollution (Barlow, 2021). These issues are activating new social and political advocacy in 2021). Despite this, air quality considerations are usually neglected in India (Warrior Moms, 2023). India’s largest citizen-led urban movement designing and planning of new developments (Taylor and Nunes, 2022). is a sustained car-free initiative where cities across the country observe The prevalence of childhood obesity is unequally distributed across Sundays as car free days, closing certain roads, allowing them to be used London and associated with deprivation. Barking and Dagenham, one of by pedestrians and enjoyed as inclusive space for community activities London’s most deprived local boroughs, has the highest prevalence of (Dialogue and Development Commission of Delhi, 2022). obesity among 11-year-olds while Richmond upon Thames, one of the least deprived, has the smallest figure (Office for Health Improvement & 3.3. London, United Kingdom Disparities, 2019). London has considered several initiatives, especially in deprived neighbourhoods to address child obesity. The “School Urban features that affect the rights of London’s children include air Superzone” initiative aims to create healthy spaces in 400 m buffers pollution, green space, traffic safety, affordable housing, neighbourhood around schools by identifying school-specific problems and imple- violence, fast food outlet density, and alcohol and drug use (Greater menting corrective intervention, depending on local needs and cir- London Authority, 2018a; The Greater London Authority, 2018; Mud- cumstances (Fenton and Whiteman, 2021). In one deprived way, 2019; Munro et al., 2022). Children from ethnic minorities, those neighbourhood, a Superzone initiative engaged local businesses to living in poverty and those with disabilities are particularly susceptible support healthy eating, conducted surveys to inform traffic reduction, to unequal exposures to these features, potentially contributing to health establish greenways and green links to schools from transit stops and disparities over their lifespan. engaged students and parents in an air quality campaign to raise The London Plan 2021, which establishes a 20-25-year development awareness of this issue (Fenton and Whiteman, 2021). framework for the city, aims to ensure the provision of accessible and The importance of involving children and young people in creating healthy spaces for children and young people. Though the plan recog- child-centric spaces from early stages in policy-making, design and nizes a discretionary right to 10 m2 area of play space per child (The development is also recognized in the London Plan 2021. Urban plan- Greater London Authority, 2021), local authorities are not proactive in ners, architects, and local authorities are encouraged to understand how delivering the minimum required play space (Taylor and Nunes, 2022). children and young people use spaces through participatory methods Additionally, access to play spaces is inequitable across London schools, such as creative writing, photography and child-led walking tours, and with those in central London often providing limited open and green to seek their views at every stage.(Mayor of London, 2019) spaces (Shoari et al., 2021). Roughly 800,000 (~60%) of London pupils attend schools with less than ten square meters per pupil of greenspace, 3.4. Vancouver, Canada of which 70% have no access to a public park in the immediate vicinity of their schools. Throughout Metro Vancouver, issues related to urban environments Breathing polluted air and childhood obesity are growing concerns in for children are addressed in various municipal plans and some child- London that are directly influenced by urban features. Children are specific urban planning policies exist (City of Vancouver, 2015, 2020; exposed to high NO2 (a marker for traffic-related air pollution) levels in Vancouver Board of Parks and Recreation, 2018; TransLink, 2022). 4 E. Gemmell et al. H e a l t h a n d P l a c e 83 (2023) 103081 Table 3 Characteristics of urban environments and their impacts on child rights across study cities. Urban Accra, Ghana Delhi, India London, UK Vancouver, Canada UNCRC environmental rights characteristics impacted Greenspace Inequality in access based on Inequality in access based on Inaccessible to some children due Inequality in neighbourhood Articles 2, 3, socio-economic status ( socio-economic status. ( to social safety concerns, family greenness based on socio- 4, 6, 12, 23, Adjei-Boadi et al., 2022) Mitchell et al., 2021) resources and time. (Allport et al., economics (Quinton et al., 2022) 24, 27, 30, 2019) Most children live near a park 31 Natural space Poor maintenance of public play Raahgiri Day is a car-free Lack of adequate greenspace and but may not be able to access it and greenspaces (Mmofra citizen initiative that reclaims play space for school children in due to unsafe routes, social safety Foundation, 2020; Adjei-Boadi streets as public spaces for all Central London (Shoari et al., risks, risk-averse parenting et al., 2022) by temporary closure of roads ( 2021). norms. (Gerlach et al., 2019) Dialogue and Development Play Street and School Street Commission of Delhi, 2022). initiatives have been launched to Playable space Ghanaian non-profit School playgrounds may be Play Streets provide children with allow children to play on organizations advocate for appropriated for adult opportunity for social connection, roadway for short periods. ( provision of green and play space purposes (Singh, 2018). physical activity and play in some TransLink, 2022) and inclusion of children in boroughs (Gill, 2015). planning of such spaces (Mmofra Foundation, 2020). Adequate, safe Inadequate housing stock, unsafe Inadequate housing stock, Over 75,000 children are High housing costs (Metro Articles 2,3, housing housing poses risks due to unsafe housing poses risks due homeless or living in temporary Vancouver Regional 4, 6, 23, 24, Secure housing flooding, (Amoako and Boamah, to flooding, infectious disease, accommodations due to shortage Government, 2015; Cuthbert, 27 tenure 2015) infectious diseases, extreme heat, fires, social of social rental housing and 2022; Meissner, 2022) extreme heat (Wilby et al., safety. Residents in informal increasing housing costs. (Firth, contribute to higher family 2021), fire (Frost et al., 1998) settlements lack legal tenure 2022; Munro et al., 2022) stress, fewer opportunities and, and social safety. Residents in and may be subject to forced Overcrowding is high in social resources to support child informal settlements lack legal eviction (Manish, 2022). housing (Munro et al., 2022). development, lack of secure tenure and may be subject to Inadequate housing quality, tenure, and higher residential forced eviction (Afenah, 2009). dampness, cold and mould mobility, which may negatively increase child respiratory influence development of sense illnesses and adversely affect of community and social capital ( mental health (Munro et al., Gerlach et al., 2019; Todd, 2022). 2021). Traffic Road traffic deaths accounted for Pedestrians at highest risk for Increasing socio-economic Traffic risks limit children’s Articles 2, 3, 61.5% of injury-related deaths at traffic-related deaths, young inequality in child pedestrian freedom to access local 4, 6, 12, 23, an Accra teaching hospital, of males nearly three times more safety over time (2010–2020), environments. Parental concerns 24, 27, 29, these, 50% occurred in likely to be killed by traffic with higher injury among more limit child mobility and outdoor 30, 31 pedestrians (Blankson et al., than females (Traffic disadvantaged groups (Shoari play (Vlaar et al., 2019). Traffic 2019). Insufficient pedestrian Management Division, 2021). et al., 2023). Safe travel to school congestion at school drop-off and infrastructure or deteriorated Inadequate pedestrian, cycling is a concern as high traffic-related pick-up poses risks to children. paths, obstructions are barriers infrastructure and traffic injuries in children were seen in New initiatives targeting changes to walking. Informal activities (e. calming around schools (Tarun areas with more schools (Shoari in transportation mode to school g. markets, hawkers) may et al., 2017). et al., 2023). to reduce the number of vehicles obstruct walkways, cars may and increase active travel to compete with pedestrians for school (TransLink, 2022). walkways space (Amegah, 2022). Clean water, Many low-income families 83% of Delhi households have Water delivery is administrated Routine testing of daycare and Articles 2, 3, sanitation experience insecure access to access to piped water supply, by private companies who school tap water is carried out in 4, 6, 23, 24, water (Kangmennaang et al., water tankers supply areas monitor quality. Residents can Vancouver (Wachtel et al., 27 2020). Estimated 80% of without piped water, but some request testing (City of London, 2017), tap water in homes is not households drink sachet water still rely on untreated water 2023). Environment agency routinely tested (Wells et al., due to lack of access to piped sources. Groundwater enforces quality standards (GOV. 2019). water or perceptions of poor depletion is a concern due to UK, 2023). quality of piped water (Moulds high consumption and et al., 2022). In a study of 5 increasing impervious surface informal settlements, only <32% area. Persistent inequality in had access to improved water access (Biswas and sanitation facilities ( Gangwar, 2021; Kumar et al., Kangmennaang et al., 2020). 2021). Active travel, Children generally play in Children cannot ride bicycles Initiatives implemented to Free public transit for children Articles 3, 4, mobility informal spaces close to home. on the street or walk to school increase safety for children’s under 12, walking school buses, 6, 12, 23, However, traffic risks and lack of unsupervised in large active travel in some boroughs. cycling classes and other 24, 27, 29, pedestrian infrastructure pose metropolises like Delhi due Actions include reduced speed initiatives seek to support 30, 31 serious risks that may lead lack of safe pedestrian and limits, improved pedestrian children’s active transportation ( parents to limit children’s cycling infrastructure (Tarun crossings, segregated cycle lanes, TransLink, 2022; Society for independent mobility ( et al., 2017). Despite laws to pocket parks, tree planting, bike Children and Youth of BC, 2023). Adjei-Boadi et al., 2022). promote accessibility, children hangers, removal of parking Lower-income youth (13–18) with disabilities are excluded spaces. may lack access to transportation from many urban spaces due to (Lazaruk, 2021). Safe pedestrian lack of accessibility and cycling infrastructure exists infrastructure (NIUA, 2018). in higher density areas (Winters et al., 2022), however, peripheral areas may lack infrastructure for safe, active (continued on next page) 5 E. Gemmell et al. H e a l t h a n d P l a c e 83 (2023) 103081 Table 3 (continued ) Urban Accra, Ghana Delhi, India London, UK Vancouver, Canada UNCRC environmental rights characteristics impacted travel (Metro Vancouver Regional Planning, 2023). Air quality PM2.5 exposure 7.2 times higher, Poor air quality experienced by Children attending schools in Higher exposure to NO2 and Article 2, 3, on average, than World Health all children in Delhi with local Central London have a high PM2.5 at schools in lower income 4, 6, 23, 24, Organization (WHO) guidelines, PM2.5 levels up to 400 μg/m3 probability (>90%) of exposure neighbourhoods where school is 27, 31 with higher exposures among (WHO air quality guideline for to NO2 levels exceeding WHO more likely to be located close to girls (Arku et al., 2015). PM2.5 is 5 μg/m3) (Selokar guidelines (40ug/m3) (Shoari a major road (Amram et al., et al., 2020; World Health et al., 2022). 2011). Seasonal wildfire smoke Organization, 2021) exposure is increasingly frequent and poses serious health risks to children (Holm et al., 2021). Noise Noise levels for most children Noise levels exceed WHO Modelled noise exposure across Higher noise exposure in schools Articles 2, 3, consistently above WHO recommended guidelines London showed that 19% of the in lower-income neighbourhoods 4, 6, 23, 24, guidelines, most attributable to across Delhi, with most population was exposed to which tend to be closer to major 27, 30, 31 road traffic noise with higher attributable to road traffic daytime noise above WHO roads (Amram et al., 2011). exposures in low-income noise. (Chauhan et al., 2023) guidelines, while 100% were neighbourhoods (Clark et al., exposed to nighttime noise above 2021) guidelines (Gulliver et al., 2015). Climate change- Flooding risk, especially for Flooding risk, especially for Extreme heat events (Giordano, Increasing frequent and severe Articles 2, 3, related risks informal settlements on flood informal settlements on flood 2022), urban flood risk due to seasonal wild-fire smoke 4, 6, 12, 23, plains (Amoako and Boamah, plains (Tomar et al., 2021). increasing population, increasing exposures are expected, posing 24, 27, 29, 2015). Extreme heat events, Extreme heat risks, particularly impervious surfaces and serious child health risks (Matz 30, 31 exacerbated by neighbourhood for children in low income and pressures on urban drainage et al., 2020). Health risks due to and housing characteristics ( marginalized groups (Mitchell systems (Greater London increasingly frequent extreme Wilby et al., 2021). et al., 2021). Authority, 2018b). heat events (Henderson et al., 2022). However, many goals have yet to be realized equitably across neigh- plans (Gerlach et al., 2019). In the short term, prioritizing access to bourhoods, and environmental, structural and social barriers remain. healthy outdoor environments near schools and childcare facilities Most residents can access parks close to home, but overall greenness is would provide children with space for play and exposure to nature, higher in more affluent neighbourhoods (Quinton et al., 2022). Among which may be missing near homes in residential neighbourhoods. Vancouver kindergarteners, the proportion of vegetation or paved sur- Longer-term actions include supporting the development of socially faces around the child’s residence was associated with higher and lower cohesive communities through housing policies that reduce residential scores, respectively, on measures of child development (Jarvis et al., instability, segregation, poverty, and inequality (Bakker and Dekker, 2022). Among 0–3-year-olds, higher greenspace and lower PM2.5 levels 2012; Laurence, 2017). in residential neighbourhoods were associated with lower incidence of Attention Deficit Hyperactivity Disorder (ADHD) at 7 years, adjusting 3.5. Child rights across study cities for neighbourhood-level marginalization (Yuchi et al., 2022). These recent findings suggest that environmental disparities may contribute to “In all actions concerning children … the best interests of the child shall be differences in developmental outcomes across Vancouver a primary consideration” (UN General Assembly, 1989, p. 3) neighbourhoods. Vancouver’s housing market is the most unaffordable in Canada In the complex processes that weigh multiple, competing demands (Statistics Canada, 2022b). High rents contribute to family stress, for urban space and resources, the UNCRC provides a clear mandate to housing insecurity, parental time constraints, fewer resources and op- position the best interest of the child as a top priority (UN General As- portunities for children, especially those in racialized, Indigenous or sembly, 1989, p. 2). Across contexts, various legislative, regulatory, lone-parent families (Gerlach et al., 2019; City of Vancouver, 2022). In a planning and grassroots efforts to address urban air quality, traffic downtown urban neighbourhood with a high proportion of low-income hazards, flood risk, noise and greenspace access have been undertaken residents and many Indigenous, immigrant, and visible minority fam- and leaders uniformly affirm commitments to child wellbeing (Mayor of ilies (Statistics Canada, 2016), social safety in the context of a city-wide London, 2019; Dialogue and Development Commission of Delhi, 2022; opioid crisis, conflicting uses of outdoor space (e.g., play spaces being Human Rights Council, 2022; City of North Vancouver, no date) How- used as shelter by people experiencing homelessness) and lack of social ever, changes are often elusive, slow or incomplete (Selokar et al., 2020; cohesion and sense of community were identified as barriers to outdoor Issah, 2022; Shoari et al., 2022; Chew and Agbayani, 2023). The specific play and independent mobility (Gerlach et al., 2019). In higher-income challenges to realization of child rights related to urban environments neighbourhoods, fears of traffic and social danger have contributed to varied across study cities, with key differences related to economic risk-averse parenting practices and social norms that limit children’s development and governance capacity and structures. Accra and Delhi options for active leisure time and local social connections (Vlaar et al., deal with complex challenges related to housing, water, sanitation, 2019). Recent initiatives such as walking school bus, Play Streets and flooding and transportation infrastructure in the context of more limited free public transit for children under 12 hold promise for improving resources, intense urban-rural migration and overlapping systems of children’s access to opportunity for social connection and physical ac- control (Cobbinah and Erdiaw-Kwasie, 2016; Wells et al., 2019; Manish, tivity (Porter et al., 2019; TransLink, 2022). 2022). In London and Vancouver, pressures on housing markets, Opportunities for inclusion of child perspectives is present in local harmful traffic-related exposures and social inequities result in planning, a result of advocacy and collaboration between not-for-profit dramatically unequal exposures to risks and opportunities among chil- organizations and municipalities (Places for People, 2018). However, dren (Gerlach et al., 2019; Shoari et al., 2021; Yuchi et al., 2022). real safety concerns and limited freedoms due to risk-averse parenting Despite unique challenges and strengths across contexts, we identified norms mean that the reality for many children contrasts with official city common themes from cross-case analysis within the framework of the research questions. 6 E. Gemmell et al. H e a l t h a n d P l a c e 83 (2023) 103081 1. Violations of child rights related to car-based transportation systems et al., 2019; Shoari et al., 2021; Adjei-Boadi et al., 2022; Giordano, 2. Converging risks arising from inadequate services and infrastructure 2022). Converging risks from water insecurity, lack of sanitation and to meet the needs of rapid population increases in the context of drainage infrastructure, inadequate greenspace, housing and lack of climate change electricity in informal settlements mean that extreme weather events 3. Child rights are unequally experienced across socio-demographic may pose life-threatening risks for many children in the most disad- groups vantaged groups (Amoako and Inkoom, 2018; Mitchell et al., 2021; 4. Collective action is required across society for equitable realization Tomar et al., 2021; Wilby et al., 2021). States, municipalities and local of child rights governments play a critical role in implementing policy, legal and reg- ulatory frameworks, allocating resources and engaging international Below we present cross-case findings for the child rights examined in co-operation to uphold ratified rights for children within the State this study, considering duty-holders and their domains of action, with (Bartlett et al., 2021). evidence across cities summarized in Table 3. 3.8. Unequal realization of child rights 3.6. Child rights and car-based transportation systems Unequal exposure to risk or access to urban amenities impacting Evidence from across cities shows that many of the most serious children’s rights was seen across cities. Dramatically different experi- threats to children’s survival and development are linked to car-based ences and opportunities means that children’s human rights related to transportation systems (Table 3). Vast tracts of public space are dedi- urban environments may be violated or upheld depending on their in- cated to car-based infrastructure, limiting land use for housing, public, dividual, family and community circumstances. Children’s rights are green and natural space (Millard-Ball, 2022). Children are largely held without discrimination with regards to “race, colour, sex, language, excluded from these public spaces due to traffic risks, which limit safe religion, political or other opinion, national, ethnic or social origin, property, active travel options, local social interactions and access to disability, birth or other status.” (UN General Assembly, 1989, p. 2) child-relevant destinations (Vlaar et al., 2019; Shoari et al., 2023). However, unequal access to healthy urban environments across socio- Stressful or hazardous physical environments due to heavy traffic, noise, economic, caste, ethnic origin, immigration or disability persist (Allport physical and social disorder or lack of greenspace influence child et al., 2019; Gerlach et al., 2019; Raushan et al., 2022; Chew and physical and mental health and development (Amram et al., 2011; Agbayani, 2023; Odame et al., 2023) (Table 3). Urban systems that Shoari et al., 2022) and may promote mistrust and isolation by limiting reduce biodiversity, deplete or harm the environment violate religious opportunities for local social interaction (Allport et al., 2019; Gerlach and spiritual traditions that teach respect and care for all living things et al., 2019). Exposure to air pollution and noise is related to traffic (Kirmayer et al., 2000; Salmón, 2000; Francis, 2015; Bsoul et al., 2022) density and proximity (Amram et al., 2011; Clark et al., 2021; Chauhan and may be a barrier to the “spiritual and moral development” (UN et al., 2023), with evidence for devastating impacts on child health and General Assembly, 1989, p. 8) of the child. Across the diverse Indigenous development (Barlow, 2021; Salvi et al., 2021). Measures to improve air traditions within Canada, spirituality is “… defined not only in religious quality and noise standards, speed limits, traffic law enforcement and or spiritual terms but also in relation to the land” (Kirmayer et al., 2000, pedestrian and cycling infrastructure hold potential to improve out- p. 612). Urban Indigenous children must be able to interact with natural comes in current city contexts, however, these actions may be slow and space and ecosystems to fully realize the right to practice their own incremental (Chatterji, 2020). The almost immediate improvements in religion (UN General Assembly, 1989; Salmón, 2000). The right to air quality seen during Covid-19 lockdowns demonstrate the potential enjoyment of “… a full and decent life, in conditions which ensure dignity, for radical change when all measures and resources are applied to meet a promote self-reliance and facilitate the child’s active participation in the population health challenge (Dhaka et al., 2020). Our findings suggest community” (UN General Assembly, 1989, p. 7) includes children with that continued commitment to dominant car-based transportation sys- disabilities. However, where evidence could be found across the study tems in urban environments violates core human rights of children cities, it was clear that children living with disabilities were excluded across study cities, with highest risks borne by children in lower income from many public spaces and services (Sanderson et al., 2020; Chew and and marginalized groups (Table 3). Agbayani, 2023; Odame et al., 2023). Though policies for inclusive public space and services exist, championing by private organizations, 3.7. Child rights, urbanization and climate change local communities and parents are often the force behind action to promote children’s dignified and active inclusion in everyday settings New challenges to children’s realization of their core human rights (Mensah et al., 2020; Special Needs Community, 2023). were seen across study cities, arising from imbalances between adequate infrastructure and services and increasing densification in the context of 3.9. A requirement for collective action across society more frequent extreme weather events (Table 3). Intense pressures on housing stock and rapid development of land means that formal and Ensuring children’s right to be heard (UN General Assembly, 1989, p. informal green, play and public spaces may be appropriated for housing 4) in matters pertaining to the design of their neighbourhoods chal- and transportation (Singh, 2018; Adjei-Boadi et al., 2022). Risks from lenges the power relationships between children and adults in ways that car-based transportation infrastructure overlap with those from climate the articles dealing with provision and protection do not. The “trans- changes and increasing urbanization: higher populations and number of formative potential of participation,” beyond the ideological value of vehicles in cities have created hazardous air and noise levels (Amram respect for each citizen, is based on the real value that children’s voices et al., 2011; Selokar et al., 2020; Alli et al., 2021; Shoari et al., 2022), contribute (Verhellen, 2015, p. 196). Often “strikingly direct and un- while more impervious surfaces increase flooding risk and may impact varnished”, honest and unafraid of controversy (Marris, 2019, p. 741), groundwater supply and water security (Amoako and Boamah, 2015; children are concerned with opportunities for play, social connection Biswas and Gangwar, 2021). Urban heat risk is higher with fewer trees, and access to nature, characteristics of a sustainable and healthy city for less greenspace and more impervious surfaces in dense areas (Mitchell all ages (Gemmell et al., 2022). Children’s active presence and partici- et al., 2021), and existing housing materials may exacerbate heat risk pation in neighbourhoods may catalyze social capital and sense of safety (Wilby et al., 2021). Extreme heat and wildfire events, expected to in- (Wood et al., 2013). Across contexts, local non-profit organizations crease in frequency, impact children’s opportunities for outdoor play, (Places for People, 2018; Mayor of London, 2019; Mensah et al., 2020; physical activity and social interaction, adding to existing barriers from Dialogue and Development Commission of Delhi, 2022), lead the way in traffic risks and lack of play and green space in urban areas (Allport elevating children’s voices on issues related to urban space. Despite 7 E. Gemmell et al. H e a l t h a n d P l a c e 83 (2023) 103081 these encouraging initiatives, there continue to be many decisions 2019; Kumar et al., 2021; Odame et al., 2023). regarding urban environments made without consideration of child City leaders and governments across the study cities were key players perspectives (Singh, 2018; Adjei-Boadi et al., 2022). Our findings indi- in articulating vision and providing direction to uphold child rights in cate a need for involvement of children in the co-creation of urban space, local policies, land use, transportation planning and maintenance that beginning with relationship and routine, ongoing, inclusive and shape everyday urban environments (Places for People, 2018; Mayor of embedded participation in the decisions and environments of everyday London, 2019; TransLink, 2022). Many of the most effective initiatives life (Verhellen, 2015). to ensure child rights were a result of collaborative efforts between Across the widely diverse study cities, major categories of duty- grass-roots organizations and municipalities (Gill, 2015; Places for holders responsible for upholding child rights related to urban envi- People, 2018; Mayor of London, 2019; Dialogue and Development ronments and their domains of action were strikingly similar and are Commission of Delhi, 2022). Cities have used UNCRC principles, summarized in Fig. 2. At the most proximal level, grass-roots advocacy implementation frameworks, tools and expertise from UNICEF and other on the part of parents and local non-profits was essential promoting international organizations to develop child-friendly city plans (City of children’s rights to healthy urban space across contexts (Gill, 2015; North Vancouver, no date; NIUA, 2018; Mayor of London, 2019). Mensah et al., 2020; Dialogue and Development Commission of Delhi, However, the duty-holders responsible for upholding child rights in 2022; Warrior Moms, 2023). Schools, childcare, social workers and changing environments span the full range of agents and actors across health care workers and institutions are also important duty-holders, society, and failure to meet obligations at any level may result in vio- with deep knowledge of and responsibility for how child rights are lations of children’s human rights (Fig. 2). being actualized in day-to-day environments within their domains of influence. The right to education, optimizing individual potential and 4. Discussion preparing children for a “responsible life in a free society”, also en- courages “the development of respect for the natural environment” (UN This article provides a high-level, descriptive overview of the status General Assembly, 1989, p. 9). Duty-holders within childcare and of children’s rights related to major characteristics of urban environ- educational systems hold responsibility to advocate for child access to ments in Accra, Delhi, London and Vancouver. We found evidence for natural environments that support health, development, cognitive and unequal exposures to risk and opportunity across contexts, with ongoing behavioural outcomes (Kuo et al., 2019), instill a sense of respect, violation of child rights related to car-based transportation systems, and connection, and responsibility for local spaces and wildlife emerging risks from imbalances between urban services and infra- (Ärlemalm-Hagsér, 2013) and mitigate disparities in home neighbour- structure and population increases in the context of climate change. Our hood quality. Multiple agencies and actors across municipal, provincial findings suggest that fundamental changes in “patterns of production, and federal levels hold responsibility for complex and interacting sys- consumption and transportation” (Landrigan et al., 2019) and collective tems, policies and infrastructure that impact child rights in the study action from duty-holders at all levels of society are urgently required to cities (Cobbinah et al., 2020; Biswas and Gangwar, 2021; City of Van- address violations of children’s human rights arising from characteris- couver, 2020; Munro et al., 2022). Given the evidence for unequal tics of urban environments. realization of rights for children in marginalized groups, awareness at Near-universal ratification of the UNCRC by member states is an each level of government is needed to prevent adoption of policies that immense achievement, reflecting the force and relevance of its princi- (intentionally or unintentionally) systematically discriminate against ples across diverse populations. However, many experts consider the groups (Nardone et al., 2020) and recognize the continued impacts of UNCRC to be incompletely theorized from a legal standpoint, and prone historical discrimination on the rights of urban children (Gerlach et al., to subjective interpretations that are likely to vary across contexts and Fig. 2. UN Convention on the Rights of the Child articles related to urban environments, and the duty-holders responsible for actualization of these rights in cities. 8 E. Gemmell et al. H e a l t h a n d P l a c e 83 (2023) 103081 cultures, while clear allocation of responsibilities for ensuring rights is being and the status of child rights (NIUA, 2018; Sanderson et al., 2020). absent (O’Neill, 2005; Quennerstedt, 2013). This “flexibility and A recent report on the status of urban children in India found similar vagueness”, enabling broad acceptance across diverse contexts, is seen issues: inequality in exposure to traffic, water, sanitation, air pollution by some as limiting the power of the Convention to achieve real change and heat risk and unequal access to adequate housing, greenspace and (Quennerstedt et al., 2018, p. 41). States may derive public and inter- other urban amenities (NIUA, 2018). In Cities for Children: Children’s national approbation by becoming parties to the Convention while Rights, Poverty and Urban Management, Bartlett et al. (2021) focused on avoiding enforceable commitments. They may aspire to, but lack the the role of local governments, also identifying city leaders as key actors economic resources, political will or stability necessary to achieve in upholding child rights and calling for awareness of children and their realization of human rights for children in practice. Even when legal and rights at all levels of society. Our analysis adds to existing knowledge by policy action is taken, political systems and economies often determine specifically focusing on the impact of modifiable urban environments on the extent to which rights related to resources, environments and ser- child rights and highlighting a convergence of issues from widely diverse vices can be ensured by governments (O’Neill, 2005). The emergent urban settings. Recognizing the critical roles of State and municipal properties of cities arise from the interactions of many actors at all levels governments, our results emphasize the roles of duty-holders “in small of society, across time and space. Rather than conceptualizing urban places, close to home” and the need for child rights principles to be change as primarily hierarchical, complex, top-down organization, known and applied across sectors (Roosevelt, 1999). Johnson (2001), speaks of cities’ ability to “… self-organize out of A major strength of this case series stems from the collaboration of millions of individual decisions, a global order built out of local in- multi-disciplinary co-authors with subject-area expertise and deep local teractions.” Though adopted by State governments to inform legislation knowledge of each city’s cultural, policy and physical context. Our and policy, the UNCRC is meaningful and compelling across multiple findings were strengthened by independent examination of evidence by sectors. Reflecting deeply-held values that resonate with people at all multiple authors to validate major themes. Cross-case analysis enabled levels of human society, UNCRC articles provide a simple, powerful us to the identify patterns across cities that informed higher-level con- framework around which cities may dynamically “self-organize” to ceptual conclusions (Yin, 2018). We also recognize some important become sustainable, healthy and resilient (Fig. 3). Such limitations in this work. It provides a high-level overview rather than an self-organization requires that the UNCRC principles be internalized as exhaustive report of urban environmental factors influencing eleven core values, expectations and obligations at all levels of society. The child rights articles. Because of the need to limit the already broad scope capacity of human rights to act as “elements of emancipation” and of our investigation, we focused on common exposures related to out- change depend on their transformation from aspirational or legal door urban environments and did not examine toxic (e.g. micro-plastics, frameworks to a collective, “emergent common sense”, that is man- pesticides, heavy metals) or detailed aspects of indoor environments ifested within social practices (Hunt, 1990, p. 325). The original drafters that likely impact urban child well-being. Our data sources were limited of the UNCRC articles believed in the power of words that express ideals to those publicly available, with evidence sometimes specific to certain to create a common vision. Perhaps the most powerful, yet locations or populations within the city. Though we highlighted child under-utilized potential of the UNCRC lies in its power to motivate and parent perspectives from documentary evidence, interviews with collective action when people internalize, enact and expect that these key informants may have provided additional insights. Despite these ideals become realities (Fig. 3). limitations, this multiple-case study provides an overview of child rights Our findings, focused on specific child rights related to urban envi- in the study cities and provides cross-case insights on major issues and ronments largely align with previous reports on indicators of child well- the potential for a child rights framework to motivate change. Future Fig. 3. Child rights to healthy urban environments as foundational, unifying principles for motivating, informing and evaluating multi-sectoral action towards sustainable, healthy cities (adapted from Graham, 2013). 9 E. Gemmell et al. H e a l t h a n d P l a c e 83 (2023) 103081 work is needed to inform effective promotion of UNCRC principles Arku, R.E., et al., 2015. Personal particulate matter exposures and locations of students across multiple sectors, actors and ages to fully develop the potential for in four neighborhoods in Accra, Ghana. J. Expo. Sci. Environ. Epidemiol. 25 (6), 557–566. https://doi.org/10.1038/jes.2014.56. these principles to inform individual and collective action for healthy, Ärlemalm-Hagsér, E., 2013. Respect for nature - a prescription for developing equitable and sustainable urban environments. environmental awareness in preschool. Center Educ. Policy Stud. J. 3 (1), 25–44. https://files.eric.ed.gov/fulltext/EJ1129478.pdf. (Accessed 8 February 2023). Audia, C., et al., 2021. Loops and building blocks: a knowledge co-production framework 5. Conclusion for equitable urban health. J. Urban Health 98 (3), 394–403. https://doi.org/ 10.1007/s11524-021-00531-4. 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