Geography Reference
In-Depth Information
Being a Healthy City depends not on current health infrastructure, rather upon, a commit-
ment to improve a city's environs and a willingness to forge the necessary connections in
political, economic, and social arenas…. It aims to: to create a health-supportive environ-
ment; to achieve a good quality of life; to provide basic sanitation and hygiene needs; to
supply access to health care. (WHO
1998
)
The emphasis upon factors other than the existing health care system requires a
more holistic view of the various determinants that affect the health of the popula-
tion in urban areas. In many ways it represents a new emphasis upon a different
type of
public health
approach, one which has gradually declined from the 1880s
after the success of the sanitary approach in improving the physical environment.
This has has strong links with emerging ecological ideas (Ashton and Ubido
1991
).
This chapter begins the review of all these changes by summarizing these new
attitudes to health, not just ill-health, before reviewing the nineteenth century urban
improvements that helped reverse the high mortality rates. This is not included only
for historical reasons but because it provides an exemplar of policies that are still
needed in many cities in developing countries today if the health of their urban
residents is to be improved. The historical review is followed by sections providing
a summary of the very serious new challenges to medical care, followed by descrip-
tions of the policies that can be used to improve the various health determinants and
then the initiatives of the Healthy City movement. Although many of the policies
may be made and financed by national governments, there is not only an important
urban component in the delivery of the services, but also the increasing realization
that life in an urban habitat may be creating new health problems.
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Changing Concepts of Health
Health is not an easy concept to define. Superficially it seems to relate to the idea of
a population that is disease-free. However, the constitution of the World Health Or-
ganization has described health in a wider way: “
Health is a state of complete physi-
cal, mental and social well-being, and not merely the absence of illness
” (WHO
1948
). The trouble with this health definition is that the use of the word 'well-being'
covers much of the human condition and does not lend itself to easy measurements.
Nevertheless the phrases 'well-being' and 'absence of illness' do mean a wide view
of health issues is envisaged. Later this led to a more wide ranging statement about
health promotion, as much as curing illness, from the European office of the WHO
in its Ottawa Charter for Health Promotion in 1986.
Health promotion is the process of enabling people to increase control over, and to improve,
their health….To reach a state of complete physical mental and social wellbeing, an indi-
vidual or group must be able to identify and to realize aspirations, to satisfy needs, and
to change or cope with the environment. Health is a positive concept emphasizing social
and personal resources, as well as physical capacities. Therefore, health promotion is not
just the responsibility of the health sector, but goes beyond healthy lifestyles to wellbeing.
(WHO-E
1986
, p. 1)
