Towards the Healthy City - Global Built Environment Review

Whittingham, N GBER Vol .8 Issue. 2 pp 61 - 87
an ideal healthy city, it would seem more appropriate to strive for the achievement of
certain minimum physical and socio-economic standards and to adopt adequate
processes to facilitate the shaping of a healthy urban environment. The history of
urban planning evolved from a symbiotic relationship with the field of Public Health
and so a renewed appreciation of the determinants of health is considered helpful for
understanding the attributes of a place that could foster healthy living and, thereby,
help inform urban policy to meet the challenges facing the modern city.
Within the academic literature there are many different models through which
research into health can be conducted, and as mentioned above, there has been a
broadening out of perspectives on health to a fuller acknowledgement of the impact
of socio-economic and environmental determinants. As well as the genetics of any
individual and their access to health services, health determinants can include the
physical environment, income and social status, education, gender and social support
networks (WHO, 2010). Even where there is ease of access to health services, there
is the question of quality of those services. The term iatrogenesis refers to how
illness can be caused either clinically by the doctors, hospitals and drug therapies, for
example, or even culturally through an overreliance on the consumption of cures and
medicines, instead of taking more personal responsibility for healthy behaviours in
the first place (Barry and Yuill, 2008). It appears then that there are many broad
fields of study from development theory and management theory through to
sociology and psychology that can bring insights to bear for a better understanding
of the determinants of health, and the degree of human control over them.
A useful starting point for considering what actually constitutes a healthy city, are
the questions for planners put forward by Kamp et al (2003) which are: What is
environmental quality?; What is the effect of my (planning and designing) measures/
interventions on the environmental quality and well-being?; Which factors determine
environmental quality?; How big is the effect?; Are the factors of equal importance
to everyone? Clearly, such questions raise issues that are both physical and social
and this highlights the difficulty in conceptualising the multi-faceted nature of health
to aid urban policymakers. Satterthwaite (1999), however, provides a simple
overview that helps in grasping the main issues for consideration by civic leaders of
a city, see Table 1. A closer look at the five categories shows that they all involve
both science and art, in that the goals could involve engineering, biochemistry and
medical science, on the one hand, and the art of persuasion and political acceptance
of the citizenry to shared environmental, health and safety conscious goals, on the
other.
Table 1. Five broad categories of environmental action for assessing the
performance of cities (based on Satterthwaite, D., 1999)
A. Controlling infections and parasitic diseases and the health burden they take on
city populations, including reducing city populations’ vulnerability to them.
B. Reducing chemical and physical hazards within the home, workplace and wider
society.
C. Achieving a high quality city environment for all city inhabitants – e.g. open
space, and provision for sport and culture.
D. Minimising the transfer of environmental costs to the inhabitants and
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