Geography Reference
In-Depth Information
settlements were not sited near marshy ground which were known to be prone to
fevers and ague, probably what we now know as malaria.
These technical advances in various early civilizations were often forgotten or
ignored by subsequent urban builders. The result was especially disastrous in the
rapidly expanding, but unsanitary and overcrowded large towns created in the In-
dustrial Revolution where levels of mortality and premature death reached such
critical levels that political action was finally taken to solve the problem, primar-
ily through sanitary, water supply and building regulatory policies. These policies
produced the first major changes to improve the health of urban residents over the
last two centuries, at least in the countries of what became the developed world, and
should be known as the first healthy city movement. The second major change in
the health of people in urban places developed from the late nineteenth century on-
wards. Impressive reductions in mortality and disabilities occurred in part through
reductions in family size, better hygiene and nutrition and healthier physical en-
vironments because of the public health interventions, but also by unprecedented
increases in the medical profession's ability to cure people from many diseases and
impaired bodily functions. Together with improvements in prosperity it removed
the historic urban disadvantage in health, so that urban areas in the developed world
had longer longevity rates than those in rural areas.
By the end of the twentieth century doubts began to be cast on the ability of
existing practices alone to further improve the health of the population, especially
in urban places. Three new sets of challenges can be recognized. First, new medi-
cal difficulties have arisen that threaten to turn back the gains of the past centuries,
such as disease-causing bacteria that are resistant to drugs, and the increase in new
chronic diseases. They not only pose problems in poor developing countries, where
they are compounded by inadequate sanitary and clean water facilities and poor
building structures, but in the developed world as the population ages and needs
more care. Second there is a revived emphasis upon the so-called 'determinants of
health' the factors that influence health and ill-health, many of which are environ-
mental in nature and are not always effectively dealt with by individual medical
care procedures and affect health over the long term
.
For example, one of the big-
gest contemporary problems is air pollution, especially from fossil burning in urban
areas and in households with open fires. A recent World Health Organization report
(WHO
2014a
) estimates that over 7 million deaths a year occur from this cause, not
directly, but by creating premature deaths from heart disease and respiratory tract
cancers. The long term effect of this and other factors means there is a need to focus
as much upon the reduction of these problems and the promotion of health, as upon
treatments of diseases or decaying body functions. Third, various agencies, from the
World Health Organization's Healthy City Programme that began in 1986, to local
governments and community groups, have been advocating new ways of improving
health in cities. These amount to new organizational changes and targeting of par-
ticular problems and have a strong urban basis, for this is where increasing numbers
of people live. Like so many of the new urban themes that have been advocated in
recent years, the approach stresses the need for a commitment to look beyond cur-
rent practice in health care, as well as the need for political, community and wider
stakeholder involvement as this WHO statement shows.
