Geography Reference
In-Depth Information
responses. Although the move to laboratory sites and techniques produced great
results, the reduced interest from what were real world, not controlled conditions,
meant that the local milieus that caused or assisted diseases were often underesti-
mated.
In addition, the new profession of planning increasingly downplayed the need
to put health issues in the forefront of their concerns. Certainly many planning de-
partments emphasized the need for a more ordered and efficient land use distribu-
tion, especially to ensure that noxious industry would be separated from residential
areas, while ensuring the latter would have various effective public facilities, from
roads, sewers, schools, recreational areas etc. These issues were connected to health
improvements. But Corburn (
2009
, p. 41) has described how attempts were made
by some late nineteenth century American planners (Marsh
1909
), to argue that the
planning profession should focus primarily on the key issues of social justice and the
health of cities that had motivated the nineteenth century reformers. Such opinions
failed to influence leaders of the new American Planning Association. So efficiency
and also aesthetics, such as the City Beautiful ideas, became the main emphasis. Yet
planners often assumed that efficient land use planning was itself a way of improv-
ing health, especially after acceptance of the Neighbourhood Unit principle, with
its insistence on lots of green space, the incorporation of many facilities within the
unit, and the positioning of main roads outside the unit. In addition, the removal
of slum areas and their replacement with new tower blocks was also seen as a way
of improving the housing conditions of the poorest classes and hence their health.
However there is more than a whiff of social determinism in planning, since it is as-
sumed that the provision of new housing in these new low density layouts and new
high-rises would automatically alter behaviours and improve health. Advocates did
not anticipate that the neighbourhood units would became car-suburbs as vehicle
ownership increased, contributing to the lack of exercise, or that many of the high
estates would become crime-ridden areas with few jobs, limited security and social
isolation, creating new areas of deprivation, ill-health and often racial segregation.
Hence in health terms a new set of problems emerged in these newly developed ur-
ban environments, while disadvantaged areas persisted. These were not effectively
addressed by municipal planners. Also the increasing domination of the biomedical
model of medicine meant that despite the sterling work of community health spe-
cialists, most attention was focused on the cure of the diseases of individuals, not
on wider and often long term issues that contributed to these problems, or on the
recognition that decision-making on health care issues should involve more than
medical professionals.
13.4.2
New Medical Challenges for Healthy Cities
At first sight the impressive gains in medical knowledge, care, and disease preven-
tion, and their constant improvements over the past century, would imply that the
health of people in urban areas would continue to improve. However new problems
threaten to reduce the life-span of people in coming generations compared to their
