Geography Reference
In-Depth Information
ness of the level of health in particular cities and frequently leads those with poor
profiles to take steps to find ways of improving their record. For example, one of the
reasons why Liverpool joined the Healthy City programme was its recognition that
it had one of the worse health records in the U.K. where life expectancy at birth was
74 years, compared to 79 in Edinburgh and 78 years in London. Only Glasgow with
a life expectancy of 71 years had a worse record among major British cities. Also,
over half of Liverpool's population lived in the bottom 10 % of deprived British
areas, places that were classified by measures of multiple socio-economic depriva-
tion, while a quarter of the population had long-term debilitating illnesses (LPCT
2007). Part of these problems stemmed from Liverpool's decline since the 1930s,
when its population was over 800,000, and the poor health habits of many in the
population. This poor health profile was not only a problem for its people but also
created a negative image, which had the effect of repelling rather than attracting in-
novative migrants or businesses. So health promotion and participation campaigns
were initiated which involved the general public as well as a range of health care
and social service professionals. In some ways this decision to attract public atten-
tion is another version of the comments made earlier in the chapter about the way
that the Health of Towns Association in Britain in the mid nineteenth century en-
couraged discussion of the mortality crises in various towns that often led to major
local improvements.
The so-called Big Health Debate, which took place in Liverpool in 2006-2007,
provides a good example of this process. It began by surveys to find major topics
of health concern, followed by workshops involving medical professionals and rep-
resentatives of the general population, then focus groups that worked on particular
problems that had emerged, as well as analyses of the use of health facilities (LPCT
2007 ). One of the findings was that the general public felt they lacked the power to
take control over many parts of their life, especially in health care, and were critical
of being unable to influence decisions that affected them. So there was clearly an
unmet need to involve the public in the discussions and the decisions being taken
over health care.
13.6.4
Greater Community Linkages and Participation
For most of the twentieth century there were few examples of effective local com-
munity engagement in urban health planning under the older top-down approaches
dominated by medical professionals. Usually the so-called 'community engage-
ment' process involved people being informed about the decisions of medical
planners after the main decisions had been taken, or were invited to attend public
meetings which pretended to discuss issues of concern but were really designed to
reduce resistance to changes. However the Healthy Cities goal of stressing the need
for more democracy and community participation is leading to a different approach
to previous practices. In the case of British cities such as Liverpool the new attitudes
were encouraged by a national government white paper called Our Health, Our Care
and Our Say (DH 2006 ), which outlined:
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