Towards the Healthy City - Global Built Environment Review

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Whittingham, N GBER Vol .8 Issue. 2 pp 61 - 87 8. Develop more equitable urban health systems 9. Use innovative financing schemes, e.g. cash transfers 10. Hold urban planners accountable for health 11. Address urban sprawl Such interventions are relevant across the globe. Whilst the local impacts from uncontrolled industry and squalid housing may have been overcome in western economies, the development process has been identified as a predominant cause of climate change. As such, planning in both developed and developing economies continues to play a significant role in whether the layout of cities lends itself to healthy environments for all of its citizens, and in attempting to mitigate and adapt to the threats of climate change. The planning system in the west evolved in socioeconomic circumstances that were changing following years of austerity. Many of the worse problems of the urbanisation process had been overcome, though in the years that followed WWII, increasing car ownership began to put further pressure for the expansion of cities. Within England, for example, a car oriented economy was made a fait accompli by a series of cutbacks of support for the rail network and the support for the road building lobby from the government of Thatcher. In a sense, the second half of the twentieth century was one in which the seeds of a new public health crisis were sown through the creation of environments for city dwellers that contribute to obesity (obesogenic environments), and also to the continued damage to the global environment through economic expansion. Within planning theory, the ills of the modern city are not necessarily perceived as being due to a slow or inadequate response to the socio-economic conditions. If state planning is geared towards achieving state objectives, as Cherry (1982) points out, authors from a Marxist perspective see these objectives as often being geared towards the interest of the dominant class. In the post-WWII neo-liberal economy, planning can be seen as having reflected these interests through the facilitation of the development of space to aid in the accumulation of capital. As such, this can have a differential impact on certain sectors of society, through the creation of an inequitable distribution of unhealthy environments, with the working class and poor bearing the brunt of risk of ill-health through increased commuting times, dangerous roads and isolated, segregated suburban environments, for example. So, for some authors, the planning system can be perceived as having had, as a priority, the facilitation of the demands of capital, through addressing the needs of commerce and the retail industry, and shaping the urban form to remedy disorganisation and aiding the reproduction of a readily available workforce. It is clear that, in affecting the land development process, planning does not overcome the inherent contradiction between private accumulation and collective action (Hall, 2002). The urban planning of cities, therefore, has a strong bearing on the health and wellbeing of its inhabitants through determining the levels of access to resources, be that access to work, ease of movement and transport options, or access to open space, for example. Many factors such as these can have a bearing on the lifestyle and life of expectancy of any given individual in an urban setting. An understanding of the relationships between health and environmental circumstances, then, remains of vital importance in developed economies, as well as, perhaps, less developed or vulnerable ones. The letter of Professor Kevin Morgan to the Planning magazine of 27 August 2010 succinctly emphasises that the planning profession needs to accept responsibility for its part in 70
Whittingham, N GBER Vol .8 Issue. 2 pp 61 - 87 creating obesogenic environments, and he considers that there is an opportunity for civic planning to play more of a role in addressing public health matters, compared to a National Health Service that mainly operates by the biomedical model of the treatment of illness (Morgan, 2010). Public Health and urban planning appear to have a renewed convergence, within the academic theory at least. An example of this can be seen with regard to the encouraging of the public away from the use of cars to increased walking and cycling. The concerns of planners have generally revolved around congestion, danger from crashes, and pollution. Further to this, a reduction in the impact of traffic is now seen as an approach to the mitigation of climate change. These issues coincide with the concerns of public health to overcome illness that is associated with lack of activity and obesity and associated illnesses (Hoehner et al, 2003). Also, new scenarios exist because of the development of computer networks and these are resulting in the imperatives to be located in a certain place to be loosened (Mitchell, 2000). As such, vastly enhanced communication networks can pose both opportunities, such as the reduction in the requirement to travel and easier dissemination of health advice, and threats, such as excessively sedentary lifestyles, and solitary lifestyles behind a computer, both in offices and at home. This convergence of interests points to the opportunities for increased synergy between professions, through multi-level interventions. It would seem that the circumstances are ripe for transition of the working practices of public health and planning into more formal collaborative relationships. The power to shape the city In recent decades, urban planning has, seemingly, adopted more communicative and collaborative approaches, as opposed to ‘top-down’, prescriptive ones (Dale, 2004). It is considered that a clearer appreciation of the political space for the creation of healthier environments, that may genuinely be available for individuals and communities, could be helped through an understanding of concepts from the sociology of development. Awareness of terms, such as agency, capabilities and social capital, and the academic consideration of the movement towards more collaborative working and public participation in the provision of public services, can help underpin more informed urban policy. Agency, capabilities and social capital The capacity for anyone to meet their needs in striving for health is not only dependent upon their physical capabilities, and selfish drives, but also on the state of the wider economy and the societal will to cooperate in the adequate distribution of resources. Amartya Sen has usefully encapsulated this relationship by distinguishing between the processes in society and the opportunities for the individual, and gives the term ‘unfreedom’ to an inadequacy in either. For poor people, restricted circumstances lead to a restricted life (Sen, 1999; Yunus, 2010). Externally established conditions, be they physical, economic or political, are described within sociology as structure, and the capacity of an individual to control their circumstances to lead to a particular health outcome, is seen as agency (Barry and Yuill, 2008). This interplay between the dictates of circumstances and the will, ability and opportunity to change circumstances lies at the core of what determines a 71
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