Healthy Cities: Old and New Solutions - Theme Cities: Solutions for Urban Problems - page 474

This description emphasizes that the health sector cannot solve health problems
alone. It has led to the popularization of the concept of 'wellness', which is being
used to describe a more holistic approach to the improvement of health, emphasiz-
ing health promotion, as much as treatment.
Health is not simply the absence of illness and disease, but as something we build with our
families, schools, communities and workplaces, in our parks and playgrounds, the places
we live, the air we breathe, the water we drink and the choices we make. (Alberta Health
2014 2014, p. 4)

So there is a new emphasis upon prevention, of encouraging healthy living, not
just treating our way out of ill-health through existing and future medical knowl-
edge. Yet a more healthy living is not the only benefit; the work of researchers
discussed in the Knowledge City discussion (Chap. 11) has shown the link between
I.Q. growth and disease reduction, which means a healthier population is likely to
be a more productive and innovative one, which assists future economic and social
progress (Eppig et al. 2010 ). These new perspectives have led to the need to pay
more attention to the many factors, or health determinants, that affect health in both
the long as well as the short term. They lead to interventions designed to create
healthy cities that are not limited to the current health care system.

13﻽3 The First Healthy Cities Movement

13.3.1 Mortality Crises

It was well known throughout history that urban places were less healthy than rural
areas and from the seventeenth century some individuals provided quantitative evi-
dence of these differences. For example, John Gaunt ( 1662 ) in England showed that
1 in 30 died annually in London, whereas the rates in the country were 1 in 50, with
a third of deaths from infant mortality. Plagues were particularly feared. Although
always present, there were extreme epidemic plague years, usually at 10 or 20 year
intervals in London but with even more severe outbreaks, such as those in 1563 and
1625 where deaths increased five to six times above normal rates (Harding 2012 ,
p. 31). Limited medical knowledge meant that there was no clear understanding of
the causes of the high mortality but most attributed it to miasma, the effects of foul
air and filth in these densely populated, unsanitary urban areas. Within cities there
were important variations in mortality rates as shown by Villerm￩'s pioneering study
in Paris in 1817 which showed how wealthy areas, such as the second and third ar-
rondissements, had annual mortality rates of 1 in 62 and 1 in 60 respectively, whereas
the two poorest areas, arrondissements 11 and 8, had higher rates of 1 in 43 (La
Berge 1992 ). In recent years these historical spatial variations within cities have been
investigated more thoroughly. For example, it has been demonstrated that the richer
areas in the centre of seventeenth and eighteenth century London, with its more sub-
stantial houses and a better fed and clothed population, had far lower mortalities than