Anita Patil - Urban Design & Health of the City

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Share of national gdp andpopulation of selected citiesSources: Van Dijk, 2007.Johannesburg, Cape Town:Naude & Krugell, 2004.grow from 2 billion in 2000 to 3.9 billionin 2030, while the total world populationmay grow from 6 to 8 billion, with themost rapid pace of growth expectedin Asia and Africa.(UN Habitat, 2006) 9While North America, Latin America andEurope are currently the most urbanizedregions, the number of urban dwellersin the least urbanized region, Asia (1.8billion), is already greater than that inNorth America, South America, Japanand Europe combined (1.3 billion).An outstanding feature of theurban population growth in 21st centuryis that it will be composed of poor people.One out of every three, city dwellersnearlyone billion people - lives in aslum. Most of the slum dwellers in SouthAsia, 63% or almost 170 Million people,reside in India. (UN Habitat-2009) 10Role of CitiesCities have traditionallybeen the engines of growth since theindustrialization began. The prosperityof nation is intimately linked to theprosperity of their cities. (UN Habitat2010-2011). 11 In this sense, urbanization,in a way similar to globalization, can beseen as a structural social determinant ofhealth that can challenge the aspirationsof equity due to the tendency foraccumulation of wealth and power amongthe urban elite (Vlahov et al., 2007) 12On one hand cities have becomethe engines of growth, encompassinga large pool of talent, finance, labourand knowledge creation opportunitiesin concentrated areas, thus producingeconomies of scale. On the otherhand they have also become places ofincreasing poverty, disparity, squalor andsocial disruption. Inequalities in the intracityaccess to services, housing, healthand health care, education & employmenthave socio-economic, environmentaland political repercussions. The realchallenge lies in recognizing flaws of theprocess and find solutions that will makethe positive impacts more pronounced,the growth more inclusive and equitableand prevent and / or reduce the negativeimpact of this unprecedented growth.Urbanization of Poverty& Planet of SlumsIndustrialization, urbanizationand associated migration have influencedthe land use patterns in all cities andland has become the most precious andcontested commodity. This is especiallytrue in an island city of Mumbai, thusmaking Mumbai one of the mostexpensive real estate markets in theworld. This has resulted in the growthof slums due to rapid growth of thepopulation and the failure of the citiesto provide the necessary infrastructure,land and low cost housing to themarginalized sector. Cities as diverse asNairobi, Johannesburg, Mexico, Rio andMumbai have large number of residentsliving in slums. The slum populationof Rio is almost the same as the totalpopulation of Helsinki (State of the WorldCities 2007) 13 Mumbai’s more than 6million slum dwellers exceed the totalpopulation of Nairobi. These 6 millionoccupy a total of 8% land of Mumbaithus creating a density of 29,650 peopleper square kilometer compared to 2050per square kilometer of New York.Definition of slums differsfrom country to country and city-to-citytherefore the exact number of peopleliving in the slums in any country isdifficult to estimate. The operationaldefinition of slum as per the UN Habitatis as follows: A slum is a group ofindividual living under a same roof inan urban area who LACK one or moreof the following five conditions1. Durable Housing2. Sufficient Living Area3. Access to Improved water4. Access to sanitation5. Secure TenureVarious Dimensions of Urban Poverty• Poor quality, hazardous, overcrowdedand often insecure housing• Inadequate provision of basicservices which increases the healthburden and the work burden• Inadequate, unstableor risky asset base• Inadequate public infrastructuresuch as schools, and hospitals• Limited or No safety nets• Inadequate protection of rightsthrough the operation of the law• Voiceless-ness and powerlessnesswithin the non-responsive politicalsystem and bureaucratic structure.(Adopted from Satterthwaite 2004)The annual growth rateof cities and slumssource: UN-HAbitat, GLobalUrban Observatory 2004.122 / 04 health04 / 123
Urban Design & Health“The urban setting is a lensthat magnifies or diminishes othersocial determinants of health. Urbanenvironments have a number ofcontextual and compositional attributessuch as size, density, complexity andverticality that affects health equity inboth positive and negative ways.” KNUS14While social and economic conditionsare vitally important, there is a growingbody of work across the disciplines thatrecognize the role of physical urbanenvironment in shaping health anddiseases and thus in contributing tohealth equities (Galea & Vlaho 2005 ) 15Visible and invisible spatialborders that transpire into segregationof the society according to socioeconomicconditions often divide cities.According to UN Habitat 2010‐2011,‘Closer assessment of theurban space in many cities of thedeveloping world unambiguouslyexposes the fragmentation of thesociety with clear differences in the wayspace and opportunities are produced,appropriated, transformed and used’.Some areas features significantinfrastructure, well kept parks, gardensand clean well built residential areas. Incontrast, other areas are characterizedby sever deprivation, inadequate housingdeficient services, poor recreationaland cultural facilities, urban decay andscarce capital expenditure. This kindof spatial injustice has tremendousimpact on the health of the residents.It is in this context that the urbandesign has a critical role to play.Urban planning and design orlack of it can create very different urbanenvironments that can impact health in apositive or negative way. In all countriespoor end up living in unhealthy places…down stream, down wind, in low layinglands, in flood plains, in landslides, overgarbage dumps, near polluting factories.In the city of New York all the bus depotsare located in Harlem, where the AfricanAmerican people are concentrated.Most slum dwellers inMumbai are located along the railwaytracks, over the dumping grounds,or near flooding areas. It has beennoted that ‘Disparities in health areincreasingly linked to the physical andsocial environment that fall under thedomain of planning (Corburn 2004)The issue that can be moderatedthrough urban design and planning:Land use patters, designingof infrastructures, both soft and hard,density and location of facilities and safeneighbourhoods. Availability or lack ofthis has severe impact on the physicaland mental health of the residents.Urban planning and theregulatory framework it provides on landuse, land development, housing andbuilding standards and infrastructurestandards should reduce inequities inliving conditions. Their core purpose is toensure health and safety, including landuseregulations that prevent buildingson unsuitable sites (for instance, floodplains), and ensure that land is availablefor infrastructure and services and open/public space (Barton & Tsouros, 2000) 16 .Six pathways for designinghealthy cities1. Equitable Access toBenefits of Urban life:Assess to livelihood opportunitiesare critical to people’s health. Longand expensive commute to workingplace and lack of easy access totransportation impact both the physicaland the economic conditions of thefamily and makes urban poor vulnerableto unemployment. Spatial mismatchbetween job location and place ofresidence can leave more remote slumdwellers little alternative but to spenda night in public space, squat in thetemporary unit devoid of services. In Riosome workers sleep on benches duringweek saving commuting time as wellas transportation costs that consume20% of their earnings. In Mexico city20 % of workers spend more than 3hours commuting to and from workeveryday. (State of World cities 2010/11)In an affluent country like US,traffic congestion cost $ 4.27 Billion inextra fuel and person hours in Chicagoin 2003 (Urban Mobility Report, TexasTransportation Institute). On the otherhand Victoria Transport Policy in Australiastates that public transit in cities cansave $279 per capita in congestions costsavings. This identifies the importanceof infrastructure. (GRNUHE) 17Traffic accidents are also onthe rise in the cities. Between 1975-1998 traffic fatalities increased by237.1 % in Columbia, 243 % in Chinaand 338% in Botswana. Many who diein traffic accidents are pedestrians.In Mumbai where 6.5 million workerstravel on the commuter trains, 19persons are killed each day in trainrelated accidents (Uncovering theMyth of Urban Development inMumbai’ by Dr. S. Parasuraman) 18 .Better urban infrastructure,pedestrian friendly streets and wellplanned transport system that providesafe options for getting around thecity are needed to curb the rise inthe traffic Deaths (UN Habitat, Stateof the World’s Cities, 2006/7).Other critical access is for thehealth care services and facilities. In poorareas there are no health care facilitiesavailable. In Kaula Bandar, a 40 years oldunregistered slum in Mumbai PUKAR hasfound out that there is no primary schoolin this community of 15000-18000 peopleand the nearest health service deliveryfacility is 1.5 kms away with no publictransportation available to reach thatfacility. (June 2010 Report to RockefellerFoundation, Unpublished data). Researchin higher income countries has revealedthat in densely populated cities the124 / 04 health04 / 125
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Anita Patil - Urban Design & Health of the City

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