Pertanika J. Soc. Sci. & Hum. 11(2): 165-172 (2003) ISSN: 0128-7702© Universiti Putra Malaysia Press

Promoting Quality of Life Through Participation in Healthy CitiesProgramme: Sharing the Experiences of Kuching City

AISHAH EDRISDepartment of Social and Development Sciences

Faculty of Human Ecology, Universiti Putra Malaysia43400 UPM, Serdang, Selangar, Malaysia

Keywords: Healthy city, quality of life, community participation, experiences, smart partnership,multisectoral linkages

ABSTRAK

Kita berada di era di mana isu 'kualiti hidup' khususnya di kawasan bandar telah menimbulkanrasa bimbang, terutamanya terhadap kemerosotan dalam kedudukan alam sekitar dan sosial, rasakurang selamat yang kian bertambah dan pendedahan kepada penyakit-penyakit yang berjangkitdan berisiko tinggi; maka tidak hairanlah jika bandar raya dipersalahkan atas kemerosotan dalamkualiti hidup. Kemerosotan dalam kedudukan sosial dan alam sekitar di kawasan bandar menuntutkeperluan untuk mencari jalan penyelesaian segera dan mengambil tindakan-tindakan konkritsupaya kemerosotan berlanjutan boleh disekatkan. Gerakan Bandar Raya Sihat adalah hasildaripada kesedaran yang kian meningkat terhadap krisis yang berpunca daripada perbuatanmanusia sendiri yang terpaksa ditanggung oleh penduduk bandar raya. Selari dengan semangatGerakan Bandar Raya Sihat, bandar raya Kuching bersetuju untuk menyertai Program BandarRaya Sihat yang bermula pada tahun 1995 dan berakhir pada 2000. Tujuan kertas kerja ini ialahuntuk berkongsi pengalaman-pengalaman bandar raya Kuching dalam melaksanakan program inidengan memberi tumpuan kepada aspek bagaimana tindakan di peringkat tempatandikoordinasikan melalui pendekatan pelbagai sektor atau 'rakan bestari' yang kemudiannya telahmenghasilkan jalinan hubungan antara agensi. Maklumat yang digunakan untuk tujuan kertaskerja adalah daripada sumber sekunder.

ABSTRACT

We live in an era where the issue of 'quality of life' is of prime concern with special referenceto urban areas in the face of environmental and social deterioration, growing human insecurityand exposure to infectious and high risk diseases; not surprisingly, cities are blamed for thedeclining quality of life. The declining social and environmental conditions in urban areaswarrant the need for swift solutions to be found and concrete measures/actions to be taken toarrest the further worsening of urban conditions. The Healthy Cities Movement was conceived asa result of the growing realization of the gravity of human-induced crisis that has besieged urbandwellers. It is in line with the spirit of Healthy Cities Movement that Kuching agreed to participatein the Healthy City Programme which began in 1995 and ended in 2000. The purpose to beserved by this paper is to share the experiences of Kuching city in implementing the programmewith a focus on how coordinated local action is achieved through multisectoral approach or'smart partnership' which in turn engenders collaboration through community participation andinter-agency linkages. The information collated for the purpose of this paper is mostly derivedfrom secondary sources.

INTRODUCTION

Improving urban environment underlines theimportance of sustainable human settlementsand for continuous effort to be directed towardachieving better quality of life for city dwellers.

The varied defmitions of 'quality of life' are inthemselves a reflection of the multi-dimensionalissues which confront human society and thedynamic relationship between man and hisenvironment. International initiatives like the

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"Earth Summit" held in Rio de Janiero in 1992(articulated in Agenda 21) and Habitat II - the"City Summit" in Istanbul (1996) have set theglobal agenda for sustainable developmentincluding promoting sustainable cities throughinternational programmes and cooperation. Itis believed that a productive, healthy andsustainable city will contribute to social andeconomic development.

Earlier on, the idea of Healthy Cities wasintroduced in a 1984 Conference entitled'Beyond Health Care' held in Toronto, Canada.The Healthy Cities Project is intended to providesupport to city-based health promotion efforts.The WHO Healthy Cities Programme was firstinitiated in Europe where it had its firstinternational meeting in Lisbon, Portugal in1986with the participation of 27 cities. Since then,many cities have participated in Healthy CitiesProject including Quebec, Liverpool, Kyoto,Toronto, Pasadena, Bangkok, Katmandu,Chittagong, Lahore and Teheran. Each city hasits own unique set of problems and thus has itsown reasons for participating in the project.The World Health Organization (WHO) projectstarted as an invitation only project but presentlya group of 35 cities are working directly withWHO and over 2,000 Healthy City projects havecommenced in cities, towns and villages acrossthe globe. l Though the preliminary work wasfirst started in Europe which began in 1985, thehealthy city project has been adopted andimplemented across the globe. Participatingcountries have been encouraged by WHO to setup their own national networks and these varyfrom place to place, even within countries. Tofurther illustrate this, in Europe the project wascalled Healthy Cities but as it went around theglobe the name changed. In Canada it is calledthe Healthy Communities and the reason forthis is that smaller towns in Canada are not citiesand therefore the name 'Healthy City' isinappropriate because people in smaller townsfeel they are not directly linked with theprogramme. However, in the Western Pacificsituation, the programme is called the HealthyIslands Programme.

The underlying spirit of Healthy CitiesMovement is that health is an important part of

the development of the city and its people. Theapproach adopted incorporates a broaddefinition of health and it encompasses all aspectsof people's lives including housing, education,employment, cultural and religion, nutrition,leisure and recreation, health and medical care,good transportation, a clean and greenenvironment, safe streets and parks and friendlypeople which are all factors that help to promotea Healthy City. But the underlying value beingpromoted is empowering the people throughtheir involvement in public health; where aHealthy City is a shared responsibility of theentire community, not just the health careproviders or professionals. This would meanthat decisions about health must involve localpeople, which at the same time, shall makethem more aware of how their lives will beaffected by these decisions. By involving localpeople the hard-to-reach group like the poorfamily, the squatters and the homeless, the youngand the elderly would have a greater chance ofnot being isolated or excluded from acommunity's decisions or actions. Importantly,beside the involvement of the public, a HealthyCity recognizes health also as the responsibilityof the private and nonprofit sectors. Hence, theHealthy Cities approach provides a frameworkfor the community problem-solving process bybringing together a partnership betweencommunity (through their leaders) andgovernment, private and voluntary agencies,institutions and organizations. The Healthy Citiesprocess helps to empower community leaders byhelping them to realize the importance of theirrole in promoting community's health throughcoordinated local action.

The basic principle of Healthy Cities is ­health for all- by reducing inequalities in health,preventing diseases and problems, promotingcommunity participation, emphasizing primaryhealth care (as opposed to tertiary care inhospital) in health care systems, reducingenvironmental risks and fostering intersectoralcooperation and international cooperation.Healthy Cities focused on urban health, andamong the key development problems addressedare poor health among urban dwellers especiallyin high-density low -income settlements, deficient

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Dr. Trevor Hancock. "The Healthy Cities Programme."An article based on an interview with Dr Hancockpublished in RAKAN SARAWAK/SCSN The date and year of the newsletter was not stated.

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basic services, poor housing and environmentalpollution in certain areas and the inability ofmany government agencies to act alone oncertain health and environmental issues.

Thus, this paper focuses on the issue of howthe mission of the Healthy City is beingimplemented by Kuching city, and shares theexperiences of what has been achieved. Theintention of this paper is to account the practicalexperiences of Kuching city in implementingthe Healthy Cities project by looking at how co­ordinated action at the community and inter­agency level were organised and implemented.This is achieved by highlighting the experiencesraised in several papers presented at a series ofconferences related to Healthy City held in themajor towns of Sarawak (the conferences arementioned at the end of this paper).

The Kuching City Experience

Kuching is one of the two Malaysian cities (theother being Johor Baru) selected to participatein the WHO Healthy Cities Programme. Dr.Trevor Hancock2, one of the co-founders of theprogramme, got his inspiration for this ideawhen he was a volunteer teacher in Lundu (atown in the First Division of Sarawak). Thereare positive factors that facilitate the entry ofKuching into the programme among which are:(i) the city was in the good state when it joinedthe programme in 1994, (ii) a good networkingacross different sectors and (iii) a vibrantcommunity spirit.

Healthy City for Kuching is defined as a"city that enhances the quality of life of itscitizens". The mission of the Healthy City isachieved by (i) enabling the citizens of Kuchingto increase control over their health andimproving their health at the individual, family,organisation and society levels, and (ii)developing and supporting a broad, multisectoralapproach to make the city environment (physical,economic and social) conducive to healthy living.Although Kuching has achieved city status and

has award-winning landmarks like the Kuchingwaterfront, the Sarawak Cultural Village and theinternationally renowned museum, it still hasproblems which range from squatters, cleanlinessof the marketplace, outbreak of diseases, unsafeand improper accommodation for constructionworkers, the use of residential houses as businesspremises, flash floods and others.

Kuching participated in the Healthy Citiesproject in 1994 with the agreement of KuchingNorth City Hall and The Council of KuchingCity South. Though the project was scheduledto run from the year 1995 to 2000 the conceptof Healthy City continues to be embodied in theway of life and the way to plan the city. Both theKuching North City Hall and The Council ofKuching City South have their own vision ofKuching. The Kuching North City Hallenvisioned Kuching as a "beautiful, well-plannedand cultured City," while the vision for TheCouncil of Kuching City South is " clean, greenand beautiful Kuching." Following the briefingof Dr. Hisashi Ogawa, a WHO consultant, acommittee was formed. It was jointly chaired bythe mayors of the two city councils with the StateHealth Department acting as technical advisor.The first task of the Committee was to organisethe first Healthy City Kuching Conference whichwas held at the end of 1994. This was followedby Second Inter Agency Conference to DevelopPlan for Healthy City Kuching in March 1995and a follow up by another Fourth Inter AgencyConference held in Sibu in April 1998. Themost recent one was the 6th Healthy City KuchingConference held in Miri in June, 2000. On thepart of the implementing committee andagencies, there is a concerted effort to createawareness about the Healthy Cities programmethrough conferences and activities and at thesame time to instill the commitment and toharness support from all sectors from topleadership in government and the civil service toagencies, the private sector, the businesscommunity and members of the public. It can

He worked as a volunteer at a secondary school in Lundu , Sarawak from 1966 to 1967. He is an AssociateProfessor in the Faculty of Environmental Studies at York University, Toronto where he teaches in the areaof health promotion, healthy cities and healthy public policy. He worked for the City of Toronto HealthDepartment in 1980. It started with the mission statement to make Toronto the healthiest city in NorthAmerica and the opportunity came when he organized a conference in 1984 to mark the 100th Anniversaryof the Board of Health of the City of Toronto. Part of the conference was a one day workshop called"Healthy Toronto 2000", where the layout for the agenda of a healthy city was laid out.

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be said here that the smart partnership approachhas actually facilitated the implementation ofthe programme where each sector has acontributing role in making the programme asuccess.

The Consolidated Multi Agency Plan forHealthy City Kuching was actualised from theplans of action presented by individualdepartments and agencies at the Second InterAgency Conference as well as the outcomes ofthe workshop discussions at the conference. Theplan which had been developed identifies threebroad dimensions as shown in Table 1 and theareas of concern were addressed for eachdimension. In general, the dimensions andfactors essential for Healthy City Kuching are asshown in Table 1 and characteristics of HealthyCity Kuching in Table 2.

A few interesting questions to raise at thisjuncture are: what are the necessary elements

needed in the implementation process ofHealthy Cities Programme or what is the kind ofcapacity and support required to carry it out?What are the experiences that have been learned?These questions are dealt with in the sectionthat follows.

Capacity and Support at Public andCommunity Level - through Multisectoral orSmart Partnership Approach.

In implementing a programme which adoptsa multisectoral approach or smart partnershipapproach requires looking into many things.One is the willingness and readiness of thepublic to embrace the value advocated by HealthyCities. This is determined by factors like thelevel of awareness and knowledge of the publicof the 'good value' in Healthy Cities Programme.Two, how much is the public willing to changeits attitude because it would be a hopeless effortif the public mindset remains unchanged and

TABLE 1Dimensions and factors for Healthy City Kuching

Economic Dimension

1. Employment2. Labour3. Industry4. Occupational Safety and Health5. Energy resource needs

Social Dimension

1. Community Safety2. Food3. Entertainment4. Leisure/sports/recreation5. Alcohol6. Family values7. Vagrancy8. Tourism9. Caring society10. Religion11. Health12. Education13.Art and cultural heritage

Physical Dimension

1. Environment2. Housing3. Open space/parks4. River5. Transportation6. Road7. Buildings8. Factories9. Drainage10. Solid waste management system

Source: http://sarawak.health.gov.my/hcity/ charac.htm

TABLE 2Characteristcs of Healthy City Kuching

• provides the basic amenities for all its citizens; • is a dynamic City, with a vibrant and resilient• is one where racial harmony exists between ethnic economy, and ample employment opportunities

groups and religious beliefs; for all;• is safe, secure and affordable; • has state-of-the-art transport, communication• has efficient management and delivery systems and and information systems;

services; • is beautiful, clean, and pollution-free;• is well-planned; • has adequate and easily accessible recreation• has responsible, dedicated, disciplined, caring and facilities, to meet the diverse needs of its citizens;

health-eonscious citizens; • is a City where the culture and arts are activelypromoted and appreciated; and

• has available and affordable opportunities forfurther education.

Source: http://sarawak.health.gov.my/hcity/ charac.htm

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the public still harbour the old notion that thetask of keeping the city clean and beautiful isthe job of the public servants of town halls andgovernment departments. What is certain is thatefforts need to be constantly directed ateducating the public on environmental issuesand one of the ways is making Healthy CityPlans available to the public, and also to increasepublic participation through public discussionsor forums and town hall meetings. Though theprogramme schedule ended in 2000, thecommitment to upkeep the image of HealthyCity needs to be maintained as it would be anadded mileage for state tourism.

In spite of the promised support, the lowcommitment by some agencies and a lack of fullawareness of the Healthy Cities programme bythe public, one of the significant changes thathas taken shape is that the Healthy Cities projecthas provided a common forum to discuss issuesin the City; hence, paving the way for inter­agency co-operation and co-ordination whichwas of minimal consequence before.

Dr. Andrew Kiyu (2000) identified thestakeholders, players and others who have rolesto play in the city as depicted in Fig. 1. Thediagram which he presented is useful forunderstanding the key players in Healthy CitiesProgramme in Sarawak.

achievements of the Programme has beenconsolidating local actions in promoting healthysettings which are defined as places where peoplelive, play, work and this includes work places,residential areas, schools, market, hospitals,streets and others. Some of the publicicommunity activities in promoting healthy livingsettings are home frontage beautificationprojects, Neighbourhood Watch Programme,motor cycle lanes and Safe IndustriesCompetition. Examples of multisectoral projectsare like improving sanitation of traditionalvillages along the Sarawak river bank, reinforcingremedial measures for business activities carriedout within residential premises, Neighbourhoodand Environment Watch (NEW), HealthPromoting School Programme and HawkerResettlement programme.

A further illustration of co-ordinated localaction involving community and local agencyparticipation is the Neighbourhood WatchProgramme which will be discussed in detail asa case. The Neighbourhood Watch presentedillustrates the partnership of Kuching SouthTown Hall Council, Royal Malaysia Police andlocal community as in the case of Batu Lintangresidential Neighbourhood Watch and RoyalMalaysia Police and business community as inthe case of India Street Pedestrian Mall.

Neighbourhood Watch Programme as a Case

The Neighbourhood Watch programme was frrstconceived by the Royal Malaysia Police andintroduced with the intention of familiarisingthe local community neighbourhoods with theidea of community policy. Involving communityin fighting against crimes in residential areas isviewed as a necessary effort in helping to reducefear of crime and enhancing the quality of lifein the community as the Police cannot beeverywhere at all times. Community policing isa collaborative effort involving the police, townhall council, politicians and the community withthe intended purpose of building resilience andself-sufficiency at the community level inidentifying and preventing problems of crimeand disorder. The case presented in this paperis the Neighbourhood Watch programme inBatu Lintang residential area and India StreetPedestrian Mall in Kuching.

For the Batu Lintang residential area, aNeighbourhood Watch Bureau was set up withseveral objectives in mind: frrst, prevention of

YB State Secretary

Heads ofDepartment

}--~~JLocalAuthorities

YB Chief Minister

Others

VoluntaryBodies

Members ofPublicicommunity

From the above diagram, it is obvious thatfull support and commitment are needed notonly from top leadership in the government andcivil service but also from members of the public,business community, community leaders andrepresentatives and voluntary bodies.

Thus, this paper highlights the examples ofpublicicommunity participation throughmultisectoral projects. One of the outstanding

Businessmen

Fig. 1: Key players surrounding healthy citiesprogramme in Sarawak

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The Healthy City concept which focuses oncommunity participation for a better life is verymuch aligned with the spirit fostered byNeighbourhood Watch concept which promotescommunity involvement and participation tocreate a crime-free environment throughpartnership with relevant government agencies.Some of the benefits that are derived from sucha partnership are:

crimes such as robbery, theft and house-breaking;second, promotion of general well-being andpertinent to this is access to infrastructure andutilities and preventing potential environmentalproblems and social ills; and third, encouragingthe spirit of neighbourliness to enable peopleto live in harmony, helping and respecting eachother.

In the Neighbourhood Watch structure, acommunity leader is appointed to head theBureau and the primary function of the Bureauis to set up units in the neighbourhood by azoning system and the appointment of voluntaryArea Co-ordinators, Zone Leaders and BlockChiefs/Coordinators from the community tolead, help and coordinate with the Police andother government agencies in reporting ofimpending crimes or common problems likethose related to street lighting and water supplythus creating a practical-oriented and energisingnetworking system. Because it is a community­based program the positions in the Bureau mustbe filled by residents who live in theNeighbourhood Watch area. As reported up toJune, 2000 within the areas of jurisdiction ofKuching South Town Hall Council, 56 Zonesand 166 Blocks have been created, benefiting22,000 people.

The following is a simple NeighbourhoodWatch Structure:

•

•

Increased awareness of the importance ofcommunity participation. The structure andthe networking system laid down by theNeighbourhood Watch programme offer anexcellent launching ground for Healthy Citycommunity-based projects like CommunityClean-up project, and adoption of openspaces and parks by community associations.Developing two-pronged purposes whichestablished Neighbourhood Watch asEnvironmental Watch. Through thereporting system called the CIR (Caring IsOur Responsibility) the Kuching South TownCouncil gathers useful information andfeedback regarding environmental problemslike improper depositing of refuse, flooding,poor drainage and businesses operating onillegal premises (including residential) asfew examples which create health nuisancesthat can undermine the well-being and

10-11 Blocks to each Zone Each block isunder 1 Block Chief/Coordinator

coordinating with 8 - 15 houses

Source: A paper presented entitled "Neighbourhood Watch Programme: A Review," by Daniel Voon at Fifth Inter­agency Conference for Healthy Cities Programme (2000).

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comfort of members in a communityneighbourhood. Through the CIR, the TownHall Council can take immediate action toensure Environmental Watch is effectivelycarried out.

• Creating a venue for forum and healtheducation talks. The Neighbourhood WatchBureau holds regular dialogues with thecommunity in residential houses in theevening that help the Town Council togather feedback on environmental problemsand at the same time to impart knowledgeon health-related matters and conduct healtheducation talks on mosquitoes and dengue,which is still a major health concern in theState.

A second case presented is India StreetPedestrian Mall which is a shopping mall famousfor its fabric and textile trade. Crime has beena growing problem in India Street PedestrianMall for the last few years and the commonones are pick-pocketing, burglary and shoplifting.The business community in India Street isconcerned about the growing crime because thePedestrian Mall is a popular spot for touristslooking for inexpensive merchandise. Hence,they decided to organise a Neighbourhood Watchwhich selVes as information feeder to the Police.

India Street Neighbourhood Watchcommittee was set up in 1998 with the assistanceof Central Police. The motto of the program isNEIGHBOURS WATCH OUT FORNEIGHBOURS. Similar to Batu Lintangresidential Neighbourhood Watch, the one inIndia Street has a similar structure. The IndiaStreet Neighbourhood Watch Committee aimedto:• provide help and support for crime victims.• reduce the number of preventable crimes

and prevent the fear of crim.• improve personal and household security.• Implement and maintain an effective system

for reporting and recording criminalactivities.

• implement and maintain property markingand identification scheme which will:

- discourage theft.

- assist in the identification and return ofproperty when located.

- develop a greater sense of neighbourlycooperation and responsibility.promote the importance of reporting crimeand suspicious activities.enhance the relationship between policeand the residents of India Street.

Beside public participation and multisectoralprojects, other achievements include policy(gazettement of Greens and Parks, prescribedActivities Act and financial funding for HealthyCity, inter-agency co-ordination) and recognitionby WHO as one of the successful healthy cities.

Based on the above examples ofNeighbourhood Watch for the residential andbusiness area, the role of the community inensuring the success of community-basedprogramme is of great significance. Furthermore,the existence of a working partnership betweencommunity and relevant departments or agenciessuch as in community policing or environmentalwatch would aid communication and co­operation in co-ordinating joint actions.

CONCLUSION

Healthy Cities Programme is not just aboutmedical health but it is about enhancing thequality of life in the city through sharedresponsibility and commitment by the entire citycommunity in public health. The underlyingforce is the people themselves and how much ofthe values of the caring society and the culturedsociety are internalised and manifested in theiractions. Raising public awareness througheducational programmes, public campaigns andactivities by all sectors about the importance ofhealth and cleanliness will help towards creatingresponsible, caring and health-eonscious citizens.One aspect is unique The Kuching cityexperiences have shown the importance ofcommunity mobilisation through participationin city-health promotion programmes and howco-ordinated local actions are achieved throughmultisectoral and inter-agency collaborativelinkages. A healthy city is a sustainable andhealthy community that has three interacting

Note: This paper is written based on collation of information from papers presented at conferences, namely, Fourth Inter­Agency Conference on Healthy City/Towns in Sarawak held at Tanahmas Hotel, Sibu, Sarawak 21"1 - 24th April 1998and Healthy City Kuching Conference at Rihga Royal Hotel, Miri, Sarawak 20 th

- 22ndJune 2000.

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elements - environment, economy andcommunity - working in tandem towards thebetterment of people and quality livingenvironment.

REFERENCES

ANDREW KIvu. 1999. Budaya hidup sihat menjaminkesejahteraan bandar kita. A paper presentedat Fifth Healthy City Inter-Agency Conference, 27­30 April, Park City Beverly Hotel, Bintulu,Sarawak.

ANDREW KIvu et al. 2000. Healthy and update ofhealthy city Kuching. A paper presented at 6thInter-Agency Healthy City Conference, 20-22 June,Rihga Hotel, Miri, Sarawak.

DANIEL VOON. 2000. Neighbourhood watchprogramme: A review. A paper presented at 6thInter-Agency Healthy City Conference, 20-22 June,Rihga Hotel, Miri, Sarawak.

http://sarawak.health.gov.my/hcity/charac.htm

INDIA STREET PEDESTRIAN MALL COMMITTEE. 2000. Casestudy of neighbourhood watch in India Street,Kuching. A paper presented by the Chairmanof India Street Pedestrian Mall CommitteeKuching at (Jh Inter-Agency Healthy City Conference,20-22 June, Rhirga Hotel, Miri, Sarawak.

Pous DIRAJA MALAYsIA. 2000. Towards a crime freeKuching city through community policing. Apaper presented at 6th Inter-Agency Healthy CityConference, 20-22 June, Rhirga Hotel, Miri,Sarawak.

(Received: 10 July 2003)

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