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Urban Health and Healthy Cities

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Urban Health and Healthy Cities Dr Trevor Hancock Public Health Consultant BC Ministry of Health A presentation at ESPN Rio de Janeiro, Brazil 3rd April 2008 – PowerPoint PPT presentation

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Title: Urban Health and Healthy Cities


1
Urban Health and Healthy Cities
  • Dr Trevor Hancock
  • Public Health Consultant
  • BC Ministry of Health
  • A presentation at ESPN
  • Rio de Janeiro, Brazil
  • 3rd April 2008

2
Urban health
  • Urban 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

3
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)

4
Outline
  • Urban ecosystem health
  • Urban population health
  • Urban health care
  • Healthy cities and healthy urban governance

5
1. Urban ecosystem health
6
Key components of the urban ecosystem
  • The built environment
  • Social, economic, cultural and political
    environments
  • Bio-regions and the biosphere
  • Human beings
  • Other biota

7
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

8
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

9
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.

10
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

11
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

12
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

13
Greater Toronto Bioregion
14
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)

15
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

16
Social ecology
  • Study 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.

17
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)

18
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

19
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

20
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

21
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)

22
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)

23
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

24
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

25
5. Health of the biotic community
  • The health of the biotic community, including
    aspects of habitat quality and genetic and
    species diversity

26
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.

27
Measuring urban health/ the health of the city
  • There 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.

28
2. Urban population health
29
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

30
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)

31
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)

32
3. Healthy cities and healthy urban governance
33
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)

34
Apply the Ottawa Charter
  • Build healthy public policy
  • Create environments supportive of health
  • Strengthen community action
  • Develop personal skills
  • Re-orient health care services

35
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)

36
Implications for governance
  • Governance is more than government
  • it involves all the stakeholders in the city
  • Private policy matters
  • the policies of the private sector that have
    public effect, e.g.
  • Lending policies and urban form
  • Portion size and obesity

37
  • Governance requires involving both community
    organisations and individual citizens.
  • The governance of cities is concerned with the
    common affairs of the city.
  • Common concerns/issues
  • Common vision
  • Common approaches/solutions

38
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

39
New forms of governance
  • Focusing on sustainable and equitable human
    development requires new forms of governance for
  • corporations
  • societies
  • cities

40
New corporate governance
  • The Natural Step
  • ISO 14001
  • Sustainable business
  • Corporate social responsibility
  • World Economic Forum
  • Dow Jones Sustainability Index
  • Ethical investment
  • Workplace democracy

41
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

42
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

43
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?

44
How we usually operate
45
How we ought to operate
46
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

47
Intersectoral Action for Local Development
Inter-department/Inter-ministry/ Inter-agency
Government NGO and Community Academics Private sector
Local
Regional
State
National
International
Whole of Government
48
Intersectoral Action for Local Development Cross
or Intersectoral Action
Government NGO and Community Academics Private sector
Local
Regional
State
National
International
49
Intersectoral Action for Local Development
Vertical integration
Government NGO and Community Academics Private sector
Local
Regional
State
National
International
50
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?

51
Local government partners
  • Interested in
  • designing better communities
  • protecting humans and the environment
  • creating safer communities
  • improving human potential
  • moving people and goods efficiently and
    safely
  • Planning department
  • Engineering dept
  • Police
  • Education
  • Transportation
  • Others?

52
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?

53
Caveat partner!
  • Dont partner with those who
  • make money from selling ill health
  • the tobacco industry and others
  • lose or dont make money if the health of the
    population improves
  • the medical-industrial complex?
  • profit in ways that harm health

54
Whose bottom line improves?
  • So whose bottom line improves when the publics
    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

55
How is health produced?
The main determinants of health are
  • a stable ecosystem
  • sustainable resources
  • social justice and equity
  • peace
  • food
  • shelter
  • education
  • income

Ottawa Charter for Health WHO, 1986
56
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

57
Urban Ecosystem Management . . . As if Health
Mattered
  • What is our purpose/end point
  • How do we measure it?
  • How is it to be achieved?
  • The health sector's role
  • Strengthen community action
  • Healthy public policy
  • Private sector partnerships
  • Governance
  • Building community capital for the 21st century
  • Research issues
  • Hancock, 2000
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