Healthy cities, healthy children

Leonard Duhl and Trevor Hancock * 

Economic development has brought comfort and convenience to many people in the industrialized world, but in its wake are pollution, new health problems, blighted urban landscapes and social isolation. Growing numbers of the dispossessed are also being left on the sidelines as the disparity between rich and poor grows. In an effort to remedy these ills, people from disparate backgrounds in thousands of communities are joining together with government agencies under the Healthy Cities/Healthy Communities banner to improve the quality of life in their towns and cities. 

Life is vastly easier in the industrialized world than it was 150 years ago. Most people live longer, eat more and work less. Many live in private homes and drive to work alone in their own cars. Office workers communicate instantaneously across continents through telephone, fax and e-mail. Industries crank out new goods faster than people can buy them in ever-bigger shopping malls. 

© Stephen Shames/MatrixBut the advantages of modern life are not available to everyone, nor do they come without a price: new kinds of health problems, many caused by our own bad habits or by the dirty air and water left behind by industries; the loss of parkland as highways devour open space; declining literacy as television beats teachers in the competition for children’s attention; cadres of unemployed and homeless people overlooked by the free market system; and sprawling, desolate suburbs where neighbours are strangers and fear of crime isolates people behind locked doors. 

Added to these is the disinvestment in services and physical infrastructure over the past 15 years, which has hit urban dwellers—especially poor urban dwellers—the hardest. The cuts in government spending for social programmes are all the more stark when viewed in the context of a world with a widening gap between rich and poor. The fraying of social safety nets, most severe in the United States, has increased the percentage of children under 6 living in poverty from 20 per cent of US children in 1980 to 24 per cent in 1995. Without addressing these fundamental inequalities, programmes developed to mend worsening urban conditions will be unable to secure long-lasting solutions. 

Even when government agencies and private organizations have the economic means and political will to address these ills, the typical approach is fragmented and specialized: A programme is created to fix a problem. A clinic is opened to treat disease, ignoring the fact that good health is much more than the absence of illness. Schools are upgraded, but the curriculum ignores lessons learned on the streets and in the media, which set the patterns for children’s beliefs and perceptions. 

There is a better way. It is rooted in the simple but revolutionary idea that health is less about medical care than about equitable access to such basic prerequisites of health as food, shelter, transportation, clean air and water, education, physical safety and meaningful jobs paying sufficient wages. This way of thinking expands on the idea that no person or family is an island; everyone’s life is bound up in the whole community. 

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