Healthy Cities: Old and New Solutions - Theme Cities: Solutions for Urban Problems - page 471

Chapter 13
Healthy Cities: Old and New Solutions

Wayne K﻽D﻽ Davies

Urban health problems are not the result of one single
condition; they are caused by an accumulation of interrelated
determinants. The coordinated improvements of health
conditions requires a comprehensive vision and strategy that
recognize the complex interplay between determinants.
Otgaar et al. 2011, p. 11

13﻽1 Introduction

Throughout most of history towns and cities had higher death rates than those in ru-
ral areas, creating what amounted to an urban health disadvantage. This was largely
because of their densely packed and insanitary conditions, which made their resi-
dents especially prone to diseases spread by contagion and contaminated water. So
the very creation of these unhealthy man-made environments was responsible for
much of the increases in morbidity and mortality. Of course there were times when
some of these problems were reduced. For example, from the mid-third century
BCE some of the buildings in major cities in the Indus valley, such as Mohenjaro
Daro and Harappa, had installed drainage systems and even running water to re-
move human waste in rooms we would call toilets (Possehl 2002 ). In subsequent
centuries civilizations such as the Minoans in Crete built underground clay pipes for
water supply and sewage removal. But it was Roman engineering in the centuries
before the common era that endowed towns and cities in their empire with the most
sophisticated water systems to date, bringing clean water from long distances to
their settlements, adding water fountains and public toilets near town squares, and
encouraging cleanliness through the many public baths, although their use of eas-
ily worked lead for some the water pipes did produce some poisoning. Moreover,
Vitruvius's classical topic on architecture (Morgan 1960 , p. 21), probably written
during the time of Augustus, included advice to town builders to make sure their