Urban public health
G. ANANTHAKRISHNAN
|
Account of a public health initiative to link the global with the local
|
HEALTHY CITY PROJECTS IN DEVELOPING COUNTRIES — An International Approach to Local Problems: Edmundo Werna, Trudy Harpham, Ilona Blue and Greg Goldstein; Earthscan Publications Limited, U.K., distributed by Viva Books Pvt. Ltd., 4737/23, Ansari Road, Daryaganj, New Delhi-110002. Rs. 395.
Scholars who studied the spread of the plague in Surat in 1994 found a variety of factors that made it possible for "black death" to sweep a commercially vibrant city in 20th century India. Lack of good housing and sanitation was a major factor. It led to a dangerous coexistence of humans and rats, and when the disease started spreading, the grossly neglected public health infrastructure could do little to stem it. Surat was, quite simply, a ready incubator for plague.
To many observers, not much has changed in the way cities are run. Expansion of housing remains a subject of interest primarily to speculators, healthcare infrastructure is growing, but mostly in the private sector, safe drinking water is available only in packaged form and universal sanitation is a forgotten goal. Moreover, unplanned urbanisation and motorisation have earned notoriety for five Indian cities as the most polluted, as per the World Bank's global database on air pollution for 2005; New Delhi, despite its recent efforts, is at the top of this list.
But democracies can compel governments to act. Where they do decide to improve their performance in urban public health, this book will prove to be a useful resource.
Edmundo Werna and his colleagues have looked at global concepts that consider public health in some detail. They see health not as a standalone objective but as the locus of policies on housing and sanitation, health, the environment, social and economic welfare.
Civic disorder
The authors begin with the preamble that overall, there is complacency about the state of the cities, although administrators are sometimes forced to act by crises. The civic disorder that the book generally characterises is very familiar in the Indian context. Poverty, insufficient food, crowded makeshift housing, insecure tenure, poor waste disposal methods and unsafe working conditions, all affecting public health.
To this global problem set, Indian cities can add the near-collapse of outdated transport infrastructure and worsening road safety. The objective of Werna, urban advisor to the United Nations Volunteer Programme and the other experts in writing this book is to attract governments and civil society to the benefits of pursuing well-structured policies on healthy cities. Their resource kit draws heavily from the World Health Organisation's Healthy City Projects and the many international charters and covenants on public health. An important distinction that the authors make between cities in the developed world and those in developing countries is the scale of problems in the latter. Vast city populations live in very depressing conditions in the poorer nations, with serious health impacts. The urban ecosystem in the West has, by comparison, only to deal with problem pockets.
Early models
Recognising this challenge, the book lays out Healthy City Projects pursued in some developing countries such as Chittagong in Bangladesh and Quetta in Pakistan as early models. The descriptions on planning, scoping, implementing and evaluating the initiatives will prove useful to politicians, bureaucracies and community organisations alike. The case of Chittagong would appear to be unexceptional in the South Asian context. This is a fast-urbanising city with a maze of bureaucracies spanning 20 agencies and eight ministries for delivery of services and collection of taxes; most have no functional linkages with the other departments. The glue that binds them is the Healthy Cities initiative. Though the vigour of the initiative has at times been sapped by political differences between local and central governments, it has brought the departments under one umbrella. The book emphasises the key role of the government-led health delivery mechanism in developing countries at the provincial, state and central levels and the need for them to work closely with municipal and civic agencies.
Initiatives
Central to the success of healthy city initiatives is a willingness to understand the importance of collaboration. Elected officials, municipal administrators, private and public sector agencies and non-governmental organisations need to work in unison. This is obviously a challenge for cities in developing countries with fledgling systems and institutions. In Quetta, there appears to be insufficient institutional development at the municipal level, but the objectives of the healthy city project are universal in their appeal. These are governance and institutional integration, housing, healthy workplaces, water, sanitation and sewerage, drainage, solid waste management, roads, traffic and transportation, energy, environmental protection, education and health services, among others. The authors have tried to address these concerns by providing a planning base for health. They stress the importance of inter-sectoral participation and cooperation to achieve good outcomes and measurable impacts.
The book argues that better results flow from public health programmes that are structured horizontally (an objective-oriented approach) rather than vertically (catering to interests of segmented groups through dedicated institutions). This is now accepted wisdom and it serves as an inspiration for reform in public health programmes at all levels.
Printer friendly
page
Send this article to Friends by
E-Mail
Book Review
