Download - Urban Health and Healthy Cities
Urban Health and Healthy CitiesDr Trevor Hancock
Public Health ConsultantBC Ministry of HealthA presentation at ESPN
Rio de Janeiro, Brazil3rd April 2008
Urban healthUrban health has at least two distinct
meanings: the health of the urban settlement
in terms of how well it functions as a community and as an ecosystem, and
the health of the human population that lives within the urban ecosystem It also sometimes refers to urban health
care
Healthy cities Intended to take health
promotion “out to the streets”, into every day life
Health promotion is “the process of enabling people to increase control over and improve their health”
Ottawa Charter, 1986 So healthy cities is about the
process (= “governance”)
Outline1. Urban ecosystem health2. Urban population health
a) Urban health care3. Healthy cities and healthy
urban governance
1. Urban ecosystem health
Key components of the urban ecosystem
The built environment Social, economic, cultural and
political environments Bio-regions and the biosphere Human beings Other biota
Where North Americans live
We are 80% urbanised We spend 90% of our time indoors
And 5% in our cars So the built environment is the ‘natural
habitat’ of North Americans . . . but we live 100% of the time on the
planet, within natural ecosystems So we are still subject to global and
bioregional changes in ecosystem health
Ecosystems "Ecosystems are communities
of interacting organisms and the physical environment in which they live." (World Resources, 2000-2001)
For humans, the predominant form of community in the 21st century is the city we are now 50% urbanised
Cities as urban ecosystems
We are “communities of interacting organisms” and the physical environment in which we live is increasingly the city . . .
So the city is the dominant ecosystem for humans.
The city is a setting The fact that we interact,
that we are social animals, means the city is, in health promotion terms, a setting both a physical place and a
social space
Cities do not exist in isolation
They are part of local bioregions and global
ecosystems regional, national and global
economies ethno-racial and/or national
cultures and systems of values and politics
Bioregion “A territory defined by a
combination of biological, social and geographic criteria, rather than geopolitical considerations; generally, a system of related, interconnected ecosystems.”
Source: Global Biodiversity Assessment
Greater Toronto Bioregion
Human andecosystem health
All development occurs within the context of regional and global ecosystems:
"In every respect, human development and human security are closely linked to the productivity of ecosystems. Our future rests squarely on their continued viability.
(World Resources, 2000-2001)
The social web of life
The web of social relations is just as vital to our health as the web of life
It too must be sustained
Social ecologyStudy of the relationships
between individuals, social groups and their environments.
The mission of social ecology is the interdisciplinary analysis of complex problems of contemporary society which occur in the social and physical environments.
Public health and social ecology
"...most public health challenges . . . are too complex to be understood adequately from single levels of analysis and, instead, require more comprehensive approaches that integrate psychologic, organizational, cultural, community planning, and regulatory perspectives."
(Stokols, 1996, p. 283)
Urban social sustainability
“the continuing ability of a city to function as a long-term viable setting for human interaction, communication and cultural development . . .”
Yiftachel and Hedgcock, 1993
A socially sustainable city is .
. . “marked by vitality, solidarity
and a common sense of place among its residents . . . (and)
by a lack of overt or violent intergroup conflict, conspicuous spatial segregation, or chronic political instability”
Yiftachel and Hedgcock, 1993
Dimensions of urban ecosystem
health Human population health status Urban community social well-
being Quality of the built environment Quality of urban environmental
media Health of the biotic community Urban ecological footprint
Hancock, 2000
1. Human population health
status The health status of the
urban human population in terms of their physical and mental wellbeing, including the distribution of health and wellbeing across the different segments of the community (health equity);
2. Urban community social
well-being The health of the urban
community - its social well-being - including social, economic and cultural conditions, and the distribution of these and other determinants of health (social equity);
3. Quality of the built environment
The quality of the built environment including aspects of housing quality, transportation, sewage and water supply, roads and public transport systems, parks and recreation facilities and other civic amenities
4. Quality of the urban environmental
media The quality of the urban
environmental media in terms of air, water, soil and noise pollution. This is a measure of environmental quality;
5. Health of the biotic community
The health of the biotic community, including aspects of habitat quality and genetic and species diversity;
6. Urban ecological footprint
The impact of the urban ecosystem on the wider natural ecosystems of which it is a part (the urban ecological footprint). This is a measure of environmental sustainability.
Measuring urban health/ the health of
the cityThere are six aspects of "health" that
need to be measured: - the bio-psychological health of individuals
and populations - the social health of the community as a
whole, - the quality of the built environment - the quality of key environmental media - the health and diversity of the biotic
community - the ecological impact or footprint of the
city.
2. Urban population health
City health and citizen health
The ‘health’ of a city is determined by the broad socio-ecological influences.The health of its citizens is determined by the ‘health’ of the city and by
other factors human biology and heredity personal behaviour income health and other services
1. Human population health
status The health status of the
urban human population in terms of their physical and mental wellbeing, including the distribution of health and wellbeing across the different segments of the community (health equity);
Urban health care? Not the same as “urban health” The provision of health care to
urban populations Challenges (in Canadian cities)
include Ethno-racial diversity Homeless population Mobility (home v work, etc)
3. Healthy cities and healthy
urban governance
Healthy cities Intended to take health
promotion “out to the streets”, into every day life
Health promotion is “the process of enabling people to increase control over and improve their health”
Ottawa Charter, 1986 So healthy cities is about the
process (= “governance”)
Apply the Ottawa Charter
Build healthy public policy Create environments
supportive of health Strengthen community action Develop personal skills Re-orient health care services
Governance “management of the course of
events in a social system” (Burris, Drahos and Shearing, 2005)
“the sum of the many ways individuals and institutions, public and private, plan and manage the common affairs of the city”
(UN Habitat, 2002)
Implications for governance
1. Governance is more than government
it involves all the stakeholders in the city
2. ‘Private policy’ matters the policies of the private sector
that have public effect, e.g. Lending policies and urban form Portion size and obesity
3. Governance requires involving both community organisations and individual citizens.
4. The governance of cities is concerned with the “common affairs of the city”.
Common concerns/issues Common vision Common approaches/solutions
The purpose of governance
The central purpose of governance – and government – is (or should be) sustainable and equitable human development Improving the health of the urban
population is one part of that broader agenda
New forms of governance
Focusing on sustainable and equitable human development requires new forms of governance for
corporations societies cities
New corporate governance
The Natural Step ISO 14001 Sustainable business
Corporate social responsibility World Economic Forum Dow Jones Sustainability Index
Ethical investment Workplace democracy
Healthy Private Policy
Policy of the private sector that has public effect, e.g., fatty foods and portion size urban development housing design working conditions car design
New societal governance
Integrated planning link the three sectors
Human development impact analysis Intersectoral governance
public, private and NGO sectors work together
Steering, not rowing Democratic reform
e.g. BC referendum
New city governance
As for society, but also Participatory democracy
e.g. budget process in Porto Alegre, Brasil
Empowering services Community development
working from the bottom up Bioregional government?
How we usually operate
Socialcapital
Humancapital Natural
capital
Economic capital
How we ought to operate
Socialcapital
Humancapital
Natural capital
Economic capital
3a. Intersectoral action for health
Originally one of the key elements of “Health for All” (1978)
Three aspects Inter-department/inter-ministry/inter-agency
Across different departments within government (“whole of government”)
or within Universities, business corporations, large NGOs Cross or intersectoral action
Across different sectors (public, private, NGO/community, academic etc)
Vertical integration From local to regional to state to national to
international/global
Intersectoral Action for Local Development Inter-department/Inter-
ministry/ Inter-agency
Government NGO andCommunity
Academics Privatesector
Local
Regional
State
National
International
“Whole of Government”
Intersectoral Action for Local Development Cross or Intersectoral
Action
Government NGO andCommunity
Academics Private sector
Local
Regional
State
National
International
Intersectoral Action for Local Development
Vertical integration
Government NGO andCommunity
Academics Privatesector
Local
Regional
State
National
International
Partnerships are key
Which means finding common cause is key What is in it for ‘them’? Why would they help you? How can you help them?
Local government partners
Planning department
Engineering dept Police Education Transportation Others?
Interested in designing better communities protecting humans and the
environment creating safer communities improving human potential moving people and goods
efficiently and safely
Private sector partners
Lots of capacity – people, money, skills and competencies, facilities etc
But - caveat partner! Who makes money out of creating illness,
or profits from illness? Whose ‘bottom line’ improves when
population health improves? Who are the ‘producers of health’,
who could help?
Caveat partner!Don’t partner with those who
make money from selling ill health
the tobacco industry and others lose or don’t make money if the health of the population improves
the ‘medical-industrial complex’? profit in ways that harm health
Whose bottom line improves?
So whose bottom line improves when the public’s health improves?
health and life insurance companies tourism and recreation industries sport and fitness industries others?And all businesses when the health and
productivity of their employees improves
How is health produced?
peace food shelter education income
a stable ecosystem
sustainable resources
social justice and equity
The main determinants of health are
Ottawa Charter for Health WHO, 1986
So who are the producers of
health?Those who Build peaceful relations, locally and
globally Grow our food Build our homes and communities Educate children and adults Create safe communities Protect our environment and
resources Create good jobs and generate income