Synergy in Urban Health and Spatial Planning for Healthy Cities
Rapid, unplanned, unsustainable patterns of urban development and ongoing urbanisation of the population have always made cities in the developing nations focal points for many emerging environmental and health hazards. The public health issues of waste disposal, provision of safe water and sanitation and injury prevention are well-known issues at the edge between urban inequalities, environment and health. Economic development has frequently been considered as the package of solutions to these problems. However, a new agenda of largely non-communicable disease and seemingly intractable health risks is emerging from the urban settlements both in developed and developing nations, in spite of expected growth in GDP.
The need to both intensify and diversify the response to the public health needs has long been recognised as a priority by the government of Bangladesh. When it comes to urban health, the role of local authorities is strongly recognised as important, but with less emphasis on local partnership approaches to promoting healthier communities. Most importantly, the role of spatial planning in supporting and promoting healthier cities has received barely any importance. Spatial planning, as compared to more traditional forms of land-use planning, intends to ensure improved coordination between those sectoral policies that can have an impact on physical development. These sectors comprise employment and economy, education, transport, health, energy, waste, housing and the green and natural environment. Each of these sectors can play a major role in shaping an individual’s physical, mental, social and environmental well-being. In fact, these interrelated components place significant influence over urban health risks, which include physical activity levels, social impacts, air pollution, noise and unintentional injury.
The association between health and the environment in its widest sense has been reformulated in modern times in the shape of the social determinants of health model, most notably articulated by Whitehead and Dahlgren which states that health is a function of a person’s socio-economic and environmental circumstances, as well as hereditary and personal influences. City or spatial planning (as it is more accurately called) has at its core the attempt to manage those very same determinants of health – employment, housing, transport, education and environment. There is strong evidence that a very poor level of mutual understanding and weak integration prevails between planning and health professionals and their interventions, mostly in developing countries as ours. Unlike the developed countries of Europe, modern urban planning practice in countries like Bangladesh is largely concerned with design and maintenance of the built environment while the health professionals have an entirely different agenda, influenced by the imperative of helping the sick, the unwell, the disadvantaged. However, health outcomes, health status and health inequalities are inextricably linked to environment factors. In terms of land use pattern, there is evidence for significant health impacts at the smaller spatial scales of the street. For instance, a review of studies in the United States of America has shown that shops and services within walking distance result in significant increase in physical activity. This has also been confirmed by recent empirical work in the United Kingdom. In the same way, land use patterns, transport system and area of green space determine levels of exposure to air pollution, noise exposure, unintentional injury and urban flooding. What is largely unrecognised in the cities of our country is that there is an intrinsic relationship between an individual’s health status and the broad environmental context within which they live.
No spatial planning can be sound without addressing health issues while this is also an imperative for the health strategies to see spatial planning as a means of improving health. Therefore, policies and government interventions require healthcare and local government to actively collaborate to deliver sustainable and healthier cities.
Comparative studies of progress towards sustainable development in various European cities show that cities which are most noticeably successful in promoting healthy environments and responding to the challenge of climate change are those with strong local government, capable of planning all the different facets of the urban environment in a holistic, integrated way. They have a community approach to land rights, an effective planning regime, and a political system that supports long-term strategies. In Bangladesh, the issue of implementation is mostly a question of political will and there has always been a conflict between efforts to improve environment and health for communities and the political agenda of policy-makers. Nevertheless, an integrated approach to tackling urban priorities including the need for transport planning and the recognition that health can be improved by proper planning of the urban environment is needed immediately for the City Corporations and Pourashavas. The policy makers should recognise the need for broader understanding of the natural urban environment and the added value of the environment to promote health and well-being. Besides, in order to achieve the goal of integration between research and policy in the specific field of urban planning, there needs to be greater collaboration between different policy fields.
Designing spatial policies that will deliver a social justice and tackle health inequities straight away is a momentous challenge, which can, on the other hand, be overcome through active promotion of multi-sectoral collaboration. In addition, generating evidence of causal relationship between health and spatial planning should be encouraged both at public and private level. Studies arising from urban design and transport fields need to be designed to attribute causality and vice versa. Through the translation of evidences into policy and eventually into action, we can expect the recognition of the link between the spatial planning and health and well-being of citizens.
Author: Sohana Samrin Chowdhury
Associate Coordinator, Eminence
[The article was published in Daily Sun on 9 January 2012 and Dhaka Courier on 19 January 2012]