Towards the Healthy City - Global Built Environment Review

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Whittingham, N GBER Vol .8 Issue. 2 pp 61 - 87 ecosystems surrounding the city. E. Ensuring progress towards what is referred to its ‘sustainable consumption’, - i.e. ensuring that the goods and services required to meet everyone’s consumption needs are delivered without undermining the environmental capital of nations, the world of future generations. As well as city planning approaches, Kamp et al (2003) have further outlined how there are a variety of conceptual models through which goals such as these could be researched, namely: human ecology; quality of life; social indicators; satisfaction research; and a focus on transactions. The array of perspectives shows that a holistic approach to the health within a city is preferable to one that is reductionist (Dooris, 2005). Given the complexity of life in the city, an ecological model of health that attempts to take in a wider variety of influences would seem to be more appropriate as a guide for policymakers and managers, akin to what is termed a critical holism, as encouraged by Vincent Tucker (Pieterse, 2010). Figure 3 is a useful holistic conceptualisation of the interrelationships that would go towards the make-up of a sustainable city. As highlighted in the fifth point in Table 1, perspectives on health can be further complicated by the threat to wellbeing from poor environmental stewardship, such as increased vulnerability to the impacts of climate change. Differing scenarios have forecast affects to the health and wellbeing of the population of a city, such as sea level rise, melting glaciers and spread of disease and pests, for example, which could all have a direct bearing on access to fertile land and water, and, indirectly, upon the prices of food. This can, of course, exacerbate the difficulties of the urban poor and vulnerable to secure a healthy lifestyle or, indeed, their leaders to secure it for them. Coupled with this, economies that have relied heavily on fossil fuels are facing a world where the extraction of oil maybe reaching or has reached its peak. Rapidly rising prices have made the search for more sustainable practices of paramount importance for the shoring up of the resilience within communities (Chamberlin, 2009). Also, an appreciation of the interrelationships shown in Figure 3 is vital if there is to be a genuine challenge to the new epidemics of obesity, asthma and mental illness (Jackson, 2002). Freeman (1998), in using the models of social support and stress to appreciate the relationship between mental health and the environment, argued that psychiatrists could play more of a role in the political process that shapes the environment. As well as obvious dangers from pollutants or cold and damp, research has shown that access to open space and greenery, can not only afford opportunities for exercise; the very sight of it can also enhance a sense of mental wellbeing (Jackson, 2002). Spatially, marked health inequalities exist both between and within cities themselves, however, the question of equitable access to healthy environments is far from a straightforward one. It has been shown for Glasgow, for example, that deprivation is more differentiated, and access to resources, physically and psychologically, can be also be dependent upon i) the quality of the resource; ii) whether the resource is actually health promoting; iii) whether a resource in a residential neighbourhood would be used; iv) whether there may be symbolic barriers to use; and v) the scale and measure of evaluation of deprivation (Macintyre, MacDonald and Ellaway, 2008). 68
Whittingham, N GBER Vol .8 Issue. 2 pp 61 - 87 Figure 3. Sustainable urbanisation: main components and indicative issues Health Care Source: Adapted from Drakakis-Smith in Pelling (2003) Shelter Environmental Infrastructure Social SUSTAINABLE URBAN DEVELOPMENT Demographic Political Ageing Fertility policies Modern challenges for planning for health Given that health is such a multi-faceted concept with a wide variety of determinants, a marked improvement in health and health equity is more likely to be effected through a variety of interventions. Dooris (2009) highlighted the tackling of health inequalities through promoting inclusion, and a synergy with other policies and an approach to modern day issues that has an appreciation of complex systems. Kjellstrom and Mercado (2008) present a broad range of possible interventions for health equity, which is shown in Table 2. They consider that urban planning can play a key role in such interventions. Table 2. Broad Spectrum of potential interventions for health equity (Source: Kjellstrom and Mercado, 2008) 1. Build social cohesion and trust at all levels 2. Improve the living environment 3. Support healthy housing, neighbourhoods and other local settings 4. Invest in clean air 5. Promote easy access to higher quality food 6. Create safe and healthy workplaces 7. Adopt comprehensive strategies to reduce urban violence and substance abuse 69 Employment Poverty Economic Human Rights Industrial policy
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