Urban ecological sanity The age trap - National Center for ...


Urban ecological sanity The age trap - National Center for ...


Urban ecological


Healthy Cities.

Ed J Ashton.

(Pp 235; £14.99.)

Milton Keynes: Open University Press, 1991.

ISBN 0-335-09476-7.

In this city, filled with the sound of alarm bells,

police sirens howl, like animals mating. Vagrants

huddle together in cardboard cities. In a damp

bed-sit a girl dreams visions of Patmos ...

In this city the sound of the bulldozer is

banished from the land, swingeing custodial

sentences imposed on anyone building in shuttered

concrete. Car parks burst into flower, narcissi,

blue-flags, lilies of the valley, pushing up through

the tarmac, the streets heaped with yellow marigolds


As the sun rises over this city, your morning face

on the pillow, through strands of dark brown

hair, the river lying back open to the day, the

lace curtains of terrace-houses, sing like school

children ...-from City 2000 by Adrian Henri.

ff realthy Cities is dedicated to the urban

poor. It reports progress on WHO's

Healthy Cities movement and

reminds us of the advice of Alice's Cheshire

Cat, that if we do not know where we are

going it does not matter which path we take.

It knows exactly and is an unashamedly

utopian deep green. Since strategic planning

is worthless without strategic vision it is

proud to have one, which is beautifully

captured by Henri's poem quoted at the

beginning of the book. Car parks are to burst

into flower, the river is to lie back open to the

day, damp bedsits are to be banished, and the

lace curtains of terraced houses are to be

joyful with song. A town is to make the

minimum intrusion into the natural state, to

have as much variety as possible, to be as

nearly a closed system as it can, and to

achieve the best balance between population

and resources. The means of doing all this is

"networking," which is putting people with

similar problems and opportunities in touch

with one another so that they can encourage

each other, "people" being political and

community leaders and local citizens. All

these are to think about the shortcomings of

their city to define objectives, and to set

about getting them. Cities are to unlock their

organisations so as to work with each other at

every level. Networks already exist for many

purposes, but there are some where they

don't and Healthy Cities is one of them. The

movement has been likened to a "health

infection" passing from one city to another.

Launched at a meeting in 1986, it has

been, in Halfdan Mahler's terminology,

one of WHO's most successful "political

directions" (not directives!), pointing mem-


Engraving by Ambrosius Holbein for Thomas More's

"Utopia" (Basle edition, 1518)

ber states where they should go. Its success

has been remarkable in that what its founder,

WHO's European office, originally saw as a

network of half a dozen European cities, has

already spread globally to involve hundreds.

It is the twentieth century equivalent of the

Health of Towns Association, which first met

in Exeter Town Hall in 1844 and followed

Edwin Chadwick's Health of Towns Commission

of the previous year, the difference

being that the present movement thinks

ecologically and works through collaboration,

whereas its predecessor was preoccupied

with sanitation and worked mostly by legislation

and control.

The Healthy Cities project does, however,

fail to get to grips with what it properly

describes as "the sheer enormity of the

population explosion," such that there will

be 26 cities of over 10 million in 2000,

whereas there were only two in 1950. Here

are Liverpool, Gothenburg, Barcelona,

Canberra, and Noarhlunga (Australia),

but where are Lagos, Sao Paolo, Nairobi,

Manila, Cairo, Madras, and Calcutta? Sadly,

cities in the South where the movement has

taken root are reported on; unlike those in

the North, they don't report on themselves.

Such a diffuse and varied movement does

not lend itself to statistics, nor is it easy to

disentangle the results of the Healthy Cities

movement from those of other programmes

for urban improvement. Some of its most

useful achievements are least easily quantified:

"There has been an important change in

the priority of the City's health department"

(Vitoria, Spain). Better byelaws to prevent

smoking (Toronto). An alcohol control

project (Gothenburg). Services for divorced

parents (Gothenburg). Seventy one model

houses in the Favela do Gato ("slum of the

cats") in Rio de Janeiro (population 18 mil-

lion). A clean lake (Illawara, Australia). A

"Gezondheidwijer" (health promotion shop,

Eindhoven). Although they are varied, the

achievements of the project are piecemeal. So

far this is only the edge of the problem, when

what is really wanted is a carbon tax, outright

war on the car, a global movement towards

sustainability, access to family planning for

everyone, and the national policies that make

these possible. One is left with the feeling

that networking is only part of the answer,

but a useful one none the less. It seems to be

gathering momentum, but if it is to have

much of an impact it will have to snowball

through several more orders of magnitude in

what it achieves. Whether that momentum

will continue, remote from the enthusiasm of

its founders, remains to be seen. May it have

every possible success. Many of the readers

of this journal are well placed to give the

Healthy Cities movement the most almighty

shove.-MAURICE KING, reader in public health

medicine, University ofLeeds

The age trap

Life After Work: The Arrival of the Ageless


M Young, T Schuller.

(Pp 198; £16.)

London: Harper,Collins, 1991.

ISBN 0-00-215929-5.

It is strange that authors committed to an

ageless society should make so much use

of the concept of the third age. Young

and Schuller use this term to denote the stage

in life when attachment to work (and they

mean paid work) has been given up. "Work

free" would be a more positive term, and

Young and Schuller are anxious to be positive

about this stage of life. But their data, from

interviews with 149 men and women-the

men aged between 50 and 65 and the women

between 50 and 60, all of whom had left full

time employment within the previous two

years-are less encouraging. Young and

Schuller categorised their 113 third agers as

positive or negative and reckoned that the

negatives outnumbered the positives by

about two to one.

People like me, in the process of withdrawing

from full time paid work, will be

looking for hints about ways to enhance their

life after work. Women do better than men;

income and interests help, and family is

deemed salient. Surprisingly, there is no

discussion of friendship, and friends rarely

figure in the many quotations.

But this is not a "how to enjoy retirement"

book. It is a thought provoking discussion of

the way work and education are distributed

by age and of the detrimental effects of this

rigid allocation.

BMJ VOLUME 304 13 JUNE 1992

* El:sAIs

As I dislike both being educated and

formal teaching, much preferring an apprenticeship

system, I support the authors'

proposal to abolish compulsory secondary

education until 16. Indeed, I would go

further: whereas they would retain obligatory

formal education until 13, I would make

passing a test of proficiency in reading,

writing, and arithmetic the gateway between

it and a tutoring cum counselling system

that Nould arrange educational courses,

appreniiceships, work placements, foreign

exchanges, etc, for a period at least up to age

18. This may seem over the top to some, as

another of Young and Schuller's suggestions

seems to me-that the ages of adults should

be a private matter to be taken out of the

public and placed in the private domain.

They reckon possible objections to this could

be met and overcome by introducing a social

wage. It's radical and stimulating stiff

presented in a persuasive and readable way.

-ANN-CARTWRIGHT, director, Institute for Social

Studies in Medical Care, London

Does it start in the

brain stem?


Hypertension: A

Synthesis and Review.

C J Dickinson.

(Pp 303; £40.)

London: Chapman and

Hall, 1991.

ISBN 0-412-39630-0.

Professor Dickinson presents again the

arguments from his older monograph,

which he believed established the cause

of hypertension as a deficient perfusion

(generally due to atheroma) of a critical

(for life) area of the brain stem, which he

proposes to be the nucleus of the tractus

solitarius-the main "way station" for afferent

information for the control of the

circulation. He believes that the well known

Cushing reflex-hypertension as a result of

raised. intracranial pressure-operates at

physiological pressure ranges as well as the

pathological levels known to neurosurgeons

and neurologists. He attributes the dearth of

experimental evidence to the anaesthesia

used in animal work. In support of this he

particularly emphasises recent studies on the

very precise relation between intracranial

pressure and blood pressure in fetal lambs

monitored in utero without anaesthesia.

Although this is interesting, particularly with

regard to what mechanisms may have a role,

the control of blood pressure in the fetal lamb

might well be different from that in you and

me, for many obvious reasons.

The book is more wide ranging than its

title suggests. The initial chapters deal with

a restatement of Dickinson's hypothesis,

followed by a review of rival theories on the

cause of hypertension. These are dealt with

shortly and somewhat uncritically. Then

follow chapters on the control of the circulalion

aind on:the anatomy of the nervous

pathways in the brain-particularly in the


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