Healthy Cities: Old and New Solutions - Theme Cities: Solutions for Urban Problems - page 484

society these local support systems have decayed, making it imperative to plan for
an active older population, not simply to house them. It is tragic that so many old
people's homes are built in remote locations in cities, with few places to walk to, or
to obtain goods, resulting in the almost warehousing and segregation of old people,
rather than building premises to support active living near shopping or transit nodes
and also adopting the other recommendations of the WHO's age-friendly city net-
work (GNAFCC) issues largely ignored by New Urbanism and other themes.

13﻽4﻽2﻽3 Limited Care and Regulations

One of the biggest challenges to modern medicine is to create a more equitable pat-
tern of 'cure and care'. The poorest people in developed countries and the majority
in the developing world still have limited access to health care facilities, even of
a basic level, with resultant high and unnecessary death rates from diseases where
cures are available. One stark example can be seen in Table 13.1 which shows the
persistence of high death rates from the old scourges of childbirth, such as preterm
birth problems (11) and birth trauma (18). A large proportion of these 1.9 million
deaths occur in rural areas, which could be cured by access to modern medical
knowledge and better health care, which should occur with greater urbanization,
one of the reasons why both diseases are expected to drop substantially in the next
15 years and result in lower rankings.

13﻽4﻽2﻽4 Control and Threats of Communicable Diseases

Much of the reduction in mortality and ill-health rates in urban places has been
due to the way that the most widespread communicable disease threats, such as
measles, chicken pox, polio or tetanus, have been controlled by vaccinations that
provide adaptive immunity against the pathogens that cause these diseases, and by
antibiotic drugs that kill bacterial infections. So only respiratory infections (no. 3
in Table 13.1 ), diarrhoeal diseases (no. 5) and tuberculosis (no. 13) are found in
the top twenty of the major causes of death today (WHO 2012a ). In total only a
fifth of the annual deaths in the world now come from infectious diseases. Yet the
proportions vary spatially, with levels of 40 % in the less developed world to close
to only 7 % in developed countries such as the U.K. (Davies et al. 2013 , p. 27). The
limited availability of effective health care, antiseptic methods and the availabil-
ity of vaccinations and antibiotics in the developing world, combined with limited
clean water, sanitary facilities, and more airborne pollutants, means that these treat-
able diseases still kill far too many people, given existing medical knowledge. So
there is still a lot of room for real progress in the fight against such diseases in the
settlements of poorer countries. Moreover, the current control over the most infec-
tious diseases should not lead to complacency. Some, such as smallpox (Kopolow
2003) have been eradicated, with polio well on the way until new outbreaks oc-
curred in Afghanistan, Pakistan and Northern Nigeria, a result of war and fanatical