Urban Health and Healthy Cities

1. Urban Health and Healthy Cities Dr Trevor Hancock Public Health Consultant BC Ministry of Health A presentation at ESPN Rio de Janeiro, Brazil 3rd April 2008

2. Urban health Urban health has at least two distinct meanings: • the health of the urban settlement in terms of how well it functions as a community and as an ecosystem, and • the health of the human population that lives within the urban ecosystem • It also sometimes refers to urban health care

3. Healthy cities • Intended to take health promotion “out to the streets”, into every day life • Health promotion is “the process of enabling people to increase control over and improve their health” Ottawa Charter, 1986 • So healthy cities is about the process (= “governance”)

4. Outline • Urban ecosystem health • Urban population health • Urban health care • Healthy cities and healthy urban governance

5. 1. Urban ecosystem health

6. Key components of the urban ecosystem • The built environment • Social, economic, cultural and political environments • Bio-regions and the biosphere • Human beings • Other biota

7. Where North Americans live • We are 80% urbanised • We spend 90% of our time indoors • And 5% in our cars • So the built environment is the ‘natural habitat’ of North Americans . . . • but we live 100% of the time on the planet, within natural ecosystems • So we are still subject to global and bioregional changes in ecosystem health

8. Ecosystems "Ecosystems are communities of interacting organisms and the physical environment in which they live." (World Resources, 2000-2001) For humans, the predominant form of community in the 21st century is the city • we are now 50% urbanised

9. Cities as urban ecosystems • We are “communities of interacting organisms” and the physical environment in which we live is increasingly the city . . . • So the city is the dominant ecosystem for humans.

10. The city is a setting • The fact that we interact, that we are social animals, means the city is, in health promotion terms, a setting • both a physical place and a social space

11. Cities do not exist in isolation They are part of • local bioregions and global ecosystems • regional, national and global economies • ethno-racial and/or national cultures and systems of values and politics

12. Bioregion “A territory defined by a combination of biological, social and geographic criteria, rather than geopolitical considerations; generally, a system of related, interconnected ecosystems.” Source: Global Biodiversity Assessment

13. Greater Toronto Bioregion

14. Human andecosystem health All development occurs within the context of regional and global ecosystems: "In every respect, human development and human security are closely linked to the productivity of ecosystems. Our future rests squarely on their continued viability. (World Resources, 2000-2001)

15. The social web of life • The web of social relations is just as vital to our health as the web of life • It too must be sustained

16. Social ecology Study of the relationships between individuals, social groups and their environments. The mission of social ecology is the interdisciplinary analysis of complex problems of contemporary society which occur in the social and physical environments.

17. Public health and social ecology "...most public health challenges . . . are too complex to be understood adequately from single levels of analysis and, instead, require more comprehensive approaches that integrate psychologic, organizational, cultural, community planning, and regulatory perspectives." (Stokols, 1996, p. 283)

18. Urban social sustainability “the continuing ability of a city to function as a long-term viable setting for human interaction, communication and cultural development . . .” Yiftachel and Hedgcock, 1993

19. A socially sustainable city is . . . • “marked by vitality, solidarity and a common sense of place among its residents . . . (and) • by a lack of overt or violent intergroup conflict, conspicuous spatial segregation, or chronic political instability” Yiftachel and Hedgcock, 1993

20. Dimensions of urban ecosystem health • Human population health status • Urban community social well-being • Quality of the built environment • Quality of urban environmental media • Health of the biotic community • Urban ecological footprint Hancock, 2000

21. 1. Human population health status • The health status of the urban human population in terms of their physical and mental wellbeing, including the distribution of health and wellbeing across the different segments of the community (health equity);

22. 2. Urban community social well-being • The health of the urban community - its social well-being - including social, economic and cultural conditions, and the distribution of these and other determinants of health (social equity);

23. 3. Quality of the built environment • The quality of the built environment including aspects of housing quality, transportation, sewage and water supply, roads and public transport systems, parks and recreation facilities and other civic amenities

24. 4. Quality of the urban environmental media • The quality of the urban environmental media in terms of air, water, soil and noise pollution. This is a measure of environmental quality;

25. 5. Health of the biotic community • The health of the biotic community, including aspects of habitat quality and genetic and species diversity;

26. 6. Urban ecological footprint • The impact of the urban ecosystem on the wider natural ecosystems of which it is a part (the urban ecological footprint). This is a measure of environmental sustainability.

27. Measuring urban health/ the health of the city There are six aspects of "health" that need to be measured: • - the bio-psychological health of individuals and populations • - the social health of the community as a whole, • - the quality of the built environment • - the quality of key environmental media • - the health and diversity of the biotic community • - the ecological impact or footprint of the city.

28. 2. Urban population health

29. City health and citizen health The ‘health’ of a city is determined by the broad socio-ecological influences. The health of its citizens is determined by the ‘health’ of the city and by other factors • human biology and heredity • personal behaviour • income • health and other services

30. 1. Human population health status • The health status of the urban human population in terms of their physical and mental wellbeing, including the distribution of health and wellbeing across the different segments of the community (health equity);

31. Urban health care? • Not the same as “urban health” • The provision of health care to urban populations • Challenges (in Canadian cities) include • Ethno-racial diversity • Homeless population • Mobility (home v work, etc)

32. 3. Healthy cities and healthy urban governance

33. Healthy cities • Intended to take health promotion “out to the streets”, into every day life • Health promotion is “the process of enabling people to increase control over and improve their health” Ottawa Charter, 1986 • So healthy cities is about the process (= “governance”)

34. Apply the Ottawa Charter • Build healthy public policy • Create environments supportive of health • Strengthen community action • Develop personal skills • Re-orient health care services

35. Governance • “management of the course of events in a social system” (Burris, Drahos and Shearing, 2005) • “the sum of the many ways individuals and institutions, public and private, plan and manage the common affairs of the city” (UN Habitat, 2002)

36. Implications for governance • Governance is more than government • it involves all the stakeholders in the city • ‘Private policy’ matters • the policies of the private sector that have public effect, e.g. • Lending policies and urban form • Portion size and obesity

37. Governance requires involving both community organisations and individual citizens. • The governance of cities is concerned with the “common affairs of the city”. • Common concerns/issues • Common vision • Common approaches/solutions

38. The purpose of governance • The central purpose of governance – and government – is (or should be) sustainable and equitable human development • Improving the health of the urban population is one part of that broader agenda

39. New forms of governance Focusing on sustainable and equitable human development requires new forms of governance for • corporations • societies • cities

40. New corporate governance • The Natural Step • ISO 14001 • Sustainable business • Corporate social responsibility • World Economic Forum • Dow Jones Sustainability Index • Ethical investment • Workplace democracy

41. Healthy Private Policy Policy of the private sector that has public effect, e.g., • fatty foods and portion size • urban development • housing design • working conditions • car design

42. New societal governance • Integrated planning • link the three sectors • Human development impact analysis • Intersectoral governance • public, private and NGO sectors work together • Steering, not rowing • Democratic reform • e.g. BC referendum

43. New city governance As for society, but also • Participatory democracy • e.g. budget process in Porto Alegre, Brasil • Empowering services • Community development • working from the bottom up • Bioregional government?

44. Human capital Social capital Natural capital Economic capital How we usually operate

45. Social capital Natural capital Human capital Economic capital How we ought to operate

46. 3a. Intersectoral action for health Originally one of the key elements of “Health for All” (1978) • Three aspects • Inter-department/inter-ministry/inter-agency • Across different departments within government (“whole of government”) • or within Universities, business corporations, large NGOs • Cross or intersectoral action • Across different sectors (public, private, NGO/community, academic etc) • Vertical integration • From local to regional to state to national to international/global

47. Intersectoral Action for Local DevelopmentInter-department/Inter-ministry/ Inter-agency “Whole of Government”

48. Intersectoral Action for Local DevelopmentCross orIntersectoral Action

49. Intersectoral Action for Local DevelopmentVertical integration

50. Partnerships are key Which means finding common cause is key • What is in it for ‘them’? • Why would they help you? • How can you help them?