urban health and healthy cities

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Urban Health and Healthy Cities. Dr Trevor Hancock Public Health Consultant BC Ministry of Health A presentation at ESPN Rio de Janeiro, Brazil 3 rd April 2008. Urban health. Urban health has at least two distinct meanings: - PowerPoint PPT Presentation

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  • Urban Health and Healthy CitiesDr Trevor HancockPublic Health ConsultantBC Ministry of HealthA presentation at ESPNRio de Janeiro, Brazil3rd April 2008

  • Urban healthUrban health has at least two distinct meanings: the health of the urban settlement in terms of how well it functions as a community and as an ecosystem, and the health of the human population that lives within the urban ecosystemIt also sometimes refers to urban health care

  • Healthy citiesIntended to take health promotion out to the streets, into every day lifeHealth promotion is the process of enabling people to increase control over and improve their healthOttawa Charter, 1986So healthy cities is about the process (= governance)

  • OutlineUrban ecosystem healthUrban population healthUrban health careHealthy cities and healthy urban governance

  • 1. Urban ecosystem health

  • Key components of the urban ecosystemThe built environmentSocial, economic, cultural and political environmentsBio-regions and the biosphereHuman beingsOther biota

  • Where North Americans liveWe are 80% urbanisedWe spend 90% of our time indoorsAnd 5% in our carsSo the built environment is the natural habitat of North Americans . . . but we live 100% of the time on the planet, within natural ecosystemsSo we are still subject to global and bioregional changes in ecosystem health

  • Ecosystems "Ecosystems are communities of interacting organisms and the physical environment in which they live."(World Resources, 2000-2001) For humans, the predominant form of community in the 21st century is the citywe are now 50% urbanised

  • Cities as urban ecosystemsWe are communities of interacting organisms and the physical environment in which we live is increasingly the city . . . So the city is the dominant ecosystem for humans.

  • The city is a settingThe fact that we interact, that we are social animals, means the city is, in health promotion terms, a setting both a physical place and a social space

  • Cities do not exist in isolationThey are part of local bioregions and global ecosystemsregional, national and global economiesethno-racial and/or national cultures and systems of values and politics

  • Bioregion A territory defined by a combination of biological, social and geographic criteria, rather than geopolitical considerations; generally, a system of related, interconnected ecosystems.

    Source: Global Biodiversity Assessment

  • Greater Toronto Bioregion

  • Human andecosystem health All development occurs within the context of regional and global ecosystems: "In every respect, human development and human security are closely linked to the productivity of ecosystems. Our future rests squarely on their continued viability.(World Resources, 2000-2001)

  • The social web of lifeThe web of social relations is just as vital to our health as the web of lifeIt too must be sustained

  • Social ecologyStudy of the relationships between individuals, social groups and their environments.The mission of social ecology is the interdisciplinary analysis of complex problems of contemporary society which occur in the social and physical environments.

  • Public health and social ecology"...most public health challenges . . . are too complex to be understood adequately from single levels of analysis and, instead, require more comprehensive approaches that integrate psychologic, organizational, cultural, community planning, and regulatory perspectives." (Stokols, 1996, p. 283)

  • Urban social sustainability the continuing ability of a city to function as a long-term viable setting for human interaction, communication and cultural development . . .

    Yiftachel and Hedgcock, 1993

  • A socially sustainable city is . . .marked by vitality, solidarity and a common sense of place among its residents . . . (and) by a lack of overt or violent intergroup conflict, conspicuous spatial segregation, or chronic political instabilityYiftachel and Hedgcock, 1993

  • Dimensions of urban ecosystem healthHuman population health statusUrban community social well-beingQuality of the built environmentQuality of urban environmental mediaHealth of the biotic communityUrban ecological footprintHancock, 2000

  • 1. Human population health statusThe health status of the urban human population in terms of their physical and mental wellbeing, including the distribution of health and wellbeing across the different segments of the community (health equity);

  • 2. Urban community social well-beingThe health of the urban community - its social well-being - including social, economic and cultural conditions, and the distribution of these and other determinants of health (social equity);

  • 3. Quality of the built environmentThe quality of the built environment including aspects of housing quality, transportation, sewage and water supply, roads and public transport systems, parks and recreation facilities and other civic amenities

  • 4. Quality of the urban environmental mediaThe quality of the urban environmental media in terms of air, water, soil and noise pollution. This is a measure of environmental quality;

  • 5. Health of the biotic communityThe health of the biotic community, including aspects of habitat quality and genetic and species diversity;

  • 6. Urban ecological footprintThe impact of the urban ecosystem on the wider natural ecosystems of which it is a part (the urban ecological footprint). This is a measure of environmental sustainability.

  • Measuring urban health/ the health of the cityThere are six aspects of "health" that need to be measured:- the bio-psychological health of individuals and populations- the social health of the community as a whole, - the quality of the built environment- the quality of key environmental media- the health and diversity of the biotic community - the ecological impact or footprint of the city.

  • 2. Urban population health

  • City health and citizen healthThe health of a city is determined by the broad socio-ecological influences.The health of its citizens is determined by the health of the city and by other factorshuman biology and hereditypersonal behaviourincomehealth and other services

  • 1. Human population health statusThe health status of the urban human population in terms of their physical and mental wellbeing, including the distribution of health and wellbeing across the different segments of the community (health equity);

  • Urban health care?Not the same as urban healthThe provision of health care to urban populationsChallenges (in Canadian cities) includeEthno-racial diversityHomeless populationMobility (home v work, etc)

  • 3. Healthy cities and healthy urban governance

  • Healthy citiesIntended to take health promotion out to the streets, into every day lifeHealth promotion is the process of enabling people to increase control over and improve their healthOttawa Charter, 1986So healthy cities is about the process (= governance)

  • Apply the Ottawa CharterBuild healthy public policyCreate environments supportive of healthStrengthen community actionDevelop personal skillsRe-orient health care services

  • Governancemanagement of the course of events in a social system (Burris, Drahos and Shearing, 2005)the sum of the many ways individuals and institutions, public and private, plan and manage the common affairs of the city (UN Habitat, 2002)

  • Implications for governanceGovernance is more than governmentit involves all the stakeholders in the city Private policy mattersthe policies of the private sector that have public effect, e.g.Lending policies and urban formPortion size and obesity

  • Governance requires involving both community organisations and individual citizens. The governance of cities is concerned with the common affairs of the city.Common concerns/issuesCommon visionCommon approaches/solutions

  • The purpose of governanceThe central purpose of governance and government is (or should be) sustainable and equitable human developmentImproving the health of the urban population is one part of that broader agenda

  • New forms of governanceFocusing on sustainable and equitable human development requires new forms of governance for corporationssocietiescities

  • New corporate governanceThe Natural StepISO 14001Sustainable businessCorporate social responsibilityWorld Economic ForumDow Jones Sustainability IndexEthical investmentWorkplace democracy

  • Healthy Private Policy Policy of the private sector that has public effect, e.g., fatty foods and portion size urban developmenthousing designworking conditionscar design

  • New societal governanceIntegrated planninglink the three sectorsHuman development impact analysisIntersectoral governancepublic, private and NGO sectors work togetherSteering, not rowingDemocratic reforme.g. BC referendum

  • New city governanceAs for society, but alsoParticipatory democracye.g. budget process in Porto Alegre, BrasilEmpowering servicesCommunity developmentworking from the bottom upBioregional government?

  • How we usually operate

  • How we ought to operate

  • 3a. Intersectoral action for healthOriginally one of the key elements of Health for All (1978)Three aspectsInter-department/inter-ministry/inter-agencyAcross different departments within government (whole of government)or within Universities, business corporations, large NGOsCross or intersectoral actionAcross different sectors (public, private, NGO/community, academic etc)Vertical integrationFrom l

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