Towards the Healthy City - Global Built Environment Review

Whittingham, N GBER Vol .8 Issue. 2 pp 61 - 87
Conclusion
This article has been an exploration of the issues surrounding health and sustainable
development. Health impacts are increasingly being seen as a perspective that should
be taken in all aspects of life. Developing country cities have huge challenges ahead
to secure water supply and adequate sanitation and the provision of adequate housing
in safe locations (Kjellstrom and Mercado, 2008). However, as Marmot et al (2010)
have shown, health inequalities on a large scale can also exist in a supposedly,
developed country. The Marmot review outlines six key policy objectives to act as a
framework for assessing performance in enhancing health and overcoming health
inequalities. These are presented in Table 9.
Table 9. Framework of policy objectives for assessing performance in
enhancing health and overcoming health inequalities
(Source: Marmot et al, 2010)
A – Give every child the best start in life
B - Enable all children, young people and adults to maximise their
capabilities and have control in their lives
C – Create fair employment and good work for all
D- Ensure healthy standard of living for all
E - Create and develop healthy and sustainable places and communities
F - Strengthen the role and impact of ill health prevention
With the appropriate political will, inequalities in access to different resources could
be tackled and health inequalities overcome. However, such inequalities are due to a
variety of determinants and overcoming them requires approaches on a number of
fronts. Coupled with this, the threats of climate change have led to increased political
pressure for economies to be tailored to address such challenges, whilst also
promoting health and wellbeing. Shiva (2009) argues for the need to avoid climate
chaos through a threefold paradigm shift: from a reductionist to a holistic worldview
based on interconnections; from a mechanistic, industrial paradigm to an ecological
one; and from a consumerist definition of being human to one that recognises us as
conservers of the earth’s finite resources and cocreators of wealth with nature. With
such a perspective, it is considered that participatory measures taken to respond to
the twin threats of climate change and peak oil could also represent an opportunity to
enhance the health and wellbeing of the poor and vulnerable and reduce health
inequalities in the shorter and longer terms. Upon reflection, the Healthy Cities
project represents an opportunity to find such common solutions to difficult
syndemic problems, especially if a focus is shifted, in a new form of praxis, from the
study of vulnerabilty to the study of healthy resilience and how people adapt and
thrive (Dooris, 2009; Harpham, 2009). There are however many difficulties to
overcome for effective implementation of health promotion initiatives. A holistic,
participatory perspective, if further translated to healthy cities research could help to
further transcend the dominance of the academic, scientific research paradigm,
provide a greater degree of accountability for the researchers and more effectively
link action, research and evaluation (Smithies and Adams,1993). It is considered that
with further multi-sectoral amendments to practice, further research over holistic
approaches to health and its determinants, and further developments in community
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