THE FUTURE OF HEALTHY CITIES - and the WORLD Leonard J. Duhl, M.D. Professor of Public Health and Urban Planning, University of California, Berkeley, Ca, USA, 94720- 7360, len-duhl@socrates.berkely.edu - PowerPoint PPT Presentation

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THE FUTURE OF HEALTHY CITIES - and the WORLD Leonard J. Duhl, M.D. Professor of Public Health and Urban Planning, University of California, Berkeley, Ca, USA, 94720- 7360, len-duhl@socrates.berkely.edu

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Title: THE FUTURE OF HEALTHY CITIES - and the WORLD Leonard J. Duhl, M.D. Professor of Public Health and Urban Planning, University of California, Berkeley, Ca, USA, 94720- 7360, len-duhl@socrates.berkely.edu


1
THE FUTURE OF HEALTHY CITIES - and the
WORLDLeonard J. Duhl, M.D. Professor of Public
Health and Urban Planning, University of
California, Berkeley, Ca, USA, 94720- 7360,
len-duhl_at_socrates.berkely.edu
2
Healthy Cities has come a long way since Toronto
IN 1984, and even longer from its first
conceptualization in the early 1960s. What is
important, is that with the world changing, new
paradigms had to emerge, and the way we look at
health, in the Healthy Cities program, is that
shift.First, its important to remember how long
it takes for change. In the Old Testament, when
the Jews left Egypt for the Promised Land, it
took forty years. They wandered in the desert,
tried to return, worship idols, and gradually the
old died off. Only, two got to their goal.
3
What exactly is that paradigm shift? On one hand,
it is the redefining health, from medical care,
to the quality of life, and the totality of
concepts of health promotion. But it is much
more. It is focusing upon the problem and not
upon the institutions and professions that
provide services.In the first redefining health
is hard for people to understand. After all, we
have trained people over many years to the
importance of medical care, hospitals and more.
Science, and treatment are the focus of research,
each offering a relatively simple solution.. It
is a linear model where if you can destroy the
cause, all will be well. As the issues of
medicine become more complex this linearity wont
work.
4
Looking at any disease we find biological,
social, economic, cultural issues. We discover
that psychological states can change the immune
system. Hunger changes our ability to grow and
respond. Poverty change the ability to access
care. We see that water leads to deserts, and
then to hunger. Now, with our understanding of
genetics, we find that each of us is unique, with
uniqueness leading to different means of
response.Let us look at our communities, and ask
how much we know? Most people know their home
area, where they work and play, and rarely see
the places they pass through. Thus, most are
ignorant of the whole community, and define the
community as my turf. This understandable
self-interest has an I quality.
5
We do not know our communities, in this way. We
stay in our silos and happily think we know it
all. I have suggested that this century is an
anthropological one, of different worlds, colors,
smells, values, and much more.However, community
means we, us, and ours. There are places, with
large extended families, or where the sense of
commune-ity has a long hundreds of years history
as in Northeast Italy. There is an important
issue when we look at a problem. We have to know
it totally and fully from the molecule to the
world. This takes mapping, which is the process
of laying our ALL the relevant issues, people and
places that impinge on the problem.
6
As the world gets globalized, and corporations
sell the market economy as the paradigm, greed,
selfishness and self-interest predominates. All
this attacks the idea of community, and pushed
the global corporation as the true community to
govern.Communities mean children. Sadly, in
many places children are superfluous, unneeded
and unwanted. They are raped and pillages. They
are killed by each other. They have little hope,
unless they are well off. Our social environments
kill them, and then the pollution does the rest.
In Sao Paulo, I saw industry pollute so much
that children are born encephalic.
7
All of this, plus increasing costs have forced us
to re-think what we are doing. Lets look at
some examplesFor example in Capela de Socorro,
in Sao Paulo, Brazil, the mayor has used the
Healthy City model as the model for community
governance. He has realized to achieve health
there is need for sewers, water, curbs, schools,
recreation centers, life long education, and
more, each requiring active participation of the
people. And, we have learned that active
participation, in itself, leads to health.
8
Governance of our diverse population is becoming
increasingly difficult. In a way, everyone is
right for each looks at the world and their
problems from their own vantage point. They see
clearly that their goals and values are correct,
and deny anyone elses interpretation. How to
deal with this requires understanding social
change, and the processes necessary to find
resolution. To often impatience leads to use of
force, police or military action. As an example,
when shanty ton inhabitants organize and ask for
services, whether medical or water and sewage,
they are labeled illegals. To be so defined,
they are defying the law, and most often the
solution is bulldozers. This ignores the problem,
and focuses on the irritation, leading to a swift
cure, removal.
9
There are many such examples. However, I will
leave this for the moment and return to the
complexities of the world. Most often, I discuss
with my students the problems of the World Bank,
the International Monetary Fund, the
international banks, multi-national corporations,
and other aid givers. Focused on a paradigm that
makes profit and money the core value, we have
been loosing social, educational, housing and
health services all over the developing world. Do
we have to diagnose the problem as greed? In
California we experienced the result of Enrons
manipulating prices of energy, in such a way are
to treble gas and electricity prices, leaving a
state deficit, which results in cuts for social
and health services.
10
As I travel the world, I have learned something
very important. Those places where change is
taking place are local. Those on higher levels
have no idea of what is happening. Locally we
see social entrepreneurs, mostly women,
developing activities, with participation and
collaboration, many times ignoring national or
state rules. These programs, many of which are
Healthy Cities activities, are in the forefront
of the future. They range from the Grameen Bank
in Bangladesh, Saravodaya in Sri Lanka, and to
cities like Porto Alegra In Brazil, and many
more.
11
Here the great wok of Paulo Friere must be
mentioned. He over many years, has changed the
way education is done, especially in Brazil. He
starts where people are, and people learn how
read, write, do arithmetic and more, dealing with
issues that are central to them. They learn to
organize, and ultimately to advocate for
themselves. This is the origin of the strength
of the Workers Party, now the dominant party in
Brazil, and especially Porto Alegra.
12
The emphasis on active participation is clearly
seen in Porto Alegra, where participatory
governance has been working for more than sixteen
years. Here 36,000 people vote on the budget.
Here they are solving traffic problems, and the
delivery of health care. For example, one
hospital is responsible for 100,000 persons in a
favella, a shantytown. The get full medical care,
mixed with the services of a Healthy Cities like
program. And. its cost by most standards is very
low.
13
On a city level, Helen Davies, appointed by the
Mayor of London, is involved in pulling together
all the resources of the city, public and
private, to deal with the complex issues of
health. She has the power to have all agencies
work together on problems, rather than each
working separately runs the largest The London
Health Commission works in partnership with
agencies across the capital to reduce health
inequalities and improve the health and well
being of all Londoners. The LHC recognizes that
this requires coordinated action to improve the
determinants of health across London.
14
Set up by the Mayor of London in October 2000,
the Commission was created from a partnership of
organizations that first came together in May
1999 to develop a strategy to improve the health
of Londoners. The Health Commission is run by an
Executive Group made up of the Chair, who is
appointed by the Mayor of London, the Deputy
Chair and representatives from its key partner
organizations. The Executive Group oversees the
organizations work program, reporting regularly
to Commission members.
15
Members of the Commission are drawn from across
London and all sectors and represent a wide range
of interests. The Commission meets approximately
four times a year The Commission itself has no
statutory powers, functions or funding. Instead,
its work program is delivered through resources
and expertise provided by its members and key
partner agencies.
16
In partnership with health, employment and
regeneration stakeholders across the capital,
London Works for Better Health aims to- develop
and implement strategies to improve health and
reduce health inequalities through employment and
enterprise - promote and support healthy and
sustainable employment practices - encourage
partnership-working in planning and delivery of
health and employment initiatives.
17
Lets now look at Panyang, MalaysiaWhat do
people want?- they want jobs and not slogans,
health care for my family not policy discussions,
housing that they ca afford, food they can buy,
and security in a crazy world- each time we ask
communities around the world what they want,
there is 90 agreement open space (parks),
cleanliness, water nearby (streams, rivers, lakes
and open water), low-rise housing, small health
clinics and schools, jobs nearby that they like
to do, a sense that they can improve their lives,
public transport )very few see cars in their
future), security (rarely a jail is asked for),
and more in a similar vein.
18
The existing values and paradigms are causing
great difficulty. The gap between rich and poor
is growing in many countries, those in the
developing world and in the US and China. The
poor are superfluous, but they are the majority.
Most importantly something can be done about it.
Not, however, without resistance.
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