Towards the Healthy City - Global Built Environment Review

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Whittingham, N GBER Vol .8 Issue. 2 pp 61 - 87 considered important for achieving ‘sustainable livelihoods’ . As well as social capital (which they define as networks of helpful friends, neighbours and associates), these are: human capital – the capacity to make a living through skills, knowledge, labour and good health; natural capital – the resources available; physical capital- the infrastructure and goods; and financial capital – money and credit to achieve objectives (Bridge et al., 2009). A reflection upon the concepts of agency, capability and social capital has hopefully been useful, then, to highlight how there is an interplay between imposed physical circumstances and political structures and the knowledge, skills and will of individuals and the community to shape that environment. It is useful to view urban policy in terms of how the capital of the disadvantaged is actually served or enhanced. Collaborative approaches to shaping the environment If control over one’s environment is seen as a significant element of psychological well-being, active involvement of the public in using their agency to shape urban policy can contribute to improving both physical and mental health, as well as working towards the goal of sustainability. Urban policy, in acting as an intervention to steer development, is generally perceived as either mitigation against the worse possible environmental impacts of development, an aid to the facilitation of financial capital or a combination of the two. Within so-called ‘mixed’ economies, there is a general perception that there are democratic opportunities to influence the design and layout of cities. For any individual, the capacity and knowledge to shape their environment in order to enhance their health is mediated through the degree to which involvement in decision-making is welcomed. It is useful to consider whether the move towards collaborative and participatory working practices for urban policy has potential to more directly impact upon social capital in a way that is beneficial to the poor. The degree to which public involvement in public services is welcomed and facilitated stems partly from developments from the conflict of ideas between the capitalist United States and the state socialism of the Soviet Union. The fall of the Berlin Wall was seen by many commentators as the end game in an ideological battle over how resources should be distributed, both intra and internationally. Famously, Thatcher had referred to capitalism as the only game in town and Francis Fukuyama declared that alternative political ideologies had been defeated and that liberal democracy was the final highpoint of the history of human political and economic systems. However, over the last twenty years, within academia and policy thinktank circles, the neo-liberal policies have become under renewed attack as there have became growing disparities between rich and poor both across the globe. Anthony Giddens became influential to policymakers through his ‘Third Way’ which posited a more socially responsible form of doing business, an increase in partnership working and policies geared towards social inclusion to bring about a change in the relationships between the market, the state and civil society (Howell and Pearce, 2001). In theory, and subsequently in practice, in recent years there has been an increase in collaboration in the provision of public services, between the public and private sectors and civil society. From a Marxist perspective, greater public involvement in the overall context of a neo-liberal economy, through the use of voluntary labour and 74
Whittingham, N GBER Vol .8 Issue. 2 pp 61 - 87 the creation of a perceived ‘sense of ownership’ of the processes that effect civic life, could be seen as a way of staving off more radical challenges to the overall structure. Also, as Arnstein pointed out in her ladder of participation, governmental programmes can be seen as tokenistic if the public are merely informed of a proposed development rather than involved in its design or conception. Also, the choices of who gets involved in a collaborative programme or project can be unrepresentative and it has been argued that the actual forms of discourse used in collaborative projects can further the maintenance of unequal power relations, if certain sectors of the community are uncomfortable with particular formalities or styles of communication (Fairclough, 2001; Stern and Green, 2008). If the collaborative approaches that are put into place are to be a valid use of the agency of the poor, who bear the brunt of the manifest unhealthy environments, the degree to which the processes prove to be beneficial and ‘pro-poor’ is a salient question to consider. The evolution of collaborative approaches to the provision of public services is, however, generally considered beneficial by both the political left and right. Collaboration can be considered along the lines of whether it is a betterment administered by outside agencies or empowerment through a degree of community self-determination (Sullivan and Skelcher, 2002). Towards the Healthy City A development that, in theory at least, has represented a greater opportunity for collaborative empowerment, is the Healthy Cities project of the World Health Organisation (WHO). A closer look at this is considered helpful for an appreciation of the challenges faced in working collaboratively to address health and sustainable development challenges. The WHO Healthy Cities Project is a prime example of a partnership approach, and has become widely accepted for health promotion in the urban setting (Norris and Pittman, 2000). As noted above, the prevailing paradigm within public health of a biomedical model of medical treatment, and a ‘victimblaming’ approach to health education, came under mounting criticism in recent decades. With an increased acknowledgement of the social and environmental determinants of health, the work of Thomas McKeown, highlighted the importance of Public Health improvements to the nineteenth century city. Following this, and the Lalonde Report of 1974, which forecast the importance of the promotion of healthy lifestyles, a consolidated place for community participation in facilitating healthy lifestyles became accepted, in theory at least, with the WHO Alma-Ata Conference and Declaration on Primary Health Care (Davies and Kelly, 1993). The conference began a move towards a strategy for ‘Health for All by 2000’, and the push for a new public health, which culminated in the Ottawa Charter for Health Promotion of 1986, which encouraged more effective community involvement, and the formal launching of the WHO Healthy Cities project that year. The Healthy Cities moniker is now used throughout the world and it has become a global network for health promotion at the city level (Kenzer, 1999). The European arm of the Healthy Cities Network has grown from an initial thirty five cities, for the first phase between 1987-1992, to currently over ninety. Through a series of phases, the WHO has guided networks of the civic leaders of cities in the adoption of policies, multisectorally, that aim to improve health and wellbeing of their populations, through a collaborative approach to health promotion. To join the 75
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