World Resources 1996-97
(A joint publication by The World Resource Institute, The United
Nations Environment Programme, The United Nations Development
Programme, and the World Bank)
(Data edited by Dr. Róbinson Rojas)
2. Urban Environment and Human Health
MULTISECTORAL STRATEGIES FOR IMPROVING THE HEALTH OF
URBAN DWELLERS
The complex determinants of urban health and the linkages among them
underscore the magnitude of the health challenge in urban areas. Throughout the developing
world, the burden of death and disease related to the urban environment is great. In terms
of global impact, the most pressing need is to improve the health of the urban poor in
their local environments. In cities of the developing world, this will entail both
technological improvements- -chief among them, providing water and sanitation and reducing
exposure to air pollutants--and, equally important, institutional reforms. In the more
developed cities, technological reforms are of lesser importance; the fundamental problems
appear to be those of social justice.
Improving health and quality of life will require a significant
departure from the piecemeal approach that has dominated urban management since the 19th
Century, in which each problem is considered in isolation. Most discussions of urban
environmental management still resort to a listing of priority problems, as if each exists
independently. But the past few years have seen an increasing recognition that the
problems of cities cannot be adequately dealt with by using Victorian approaches (143). In
other words, even though providing water or shelter can make an enormous difference,
neither alone is sufficient to alleviate the burden of ill health.
Recognizing the synergistic factors affecting the quality of life of
the urban poor, some cities in the developing world have devised integrated strategies,
sometimes called "slum and squatter improvement projects" (144). These projects
tend to incorporate diverse municipal agencies, often under an umbrella structure, that
work with communities to improve local infrastructure such as water and sanitation
services, along with providing health programs, preschool education, and income-
generating schemes. To the extent that these projects are proactive in addressing urban
poverty and achieving coordinated action, they represent a step forward in urban planning.
However, there are many obstacles to multisectoral strategies for
improving urban health. Chief among them is the difficulty of integrating disciplines as
diverse as engineering, medicine, social welfare, and economics. Multisectoral approaches
to urban environmental management pose a major challenge to both local governments and
international lending agencies, which must coordinate responses and overcome the political
divisions withi n cities.
To succeed, any strategy must address the actual concerns of the
community affected, which may not match the priorities of the government or the
development agency sponsoring the project. (See Box 2.5.) It has
also become clear that any successful attempt to address the health concerns of the urban
poor must acknowledge the central role that women play in environmental management around
the home, and therefore in their families' health. Difficulties aside, an integrated,
equity-driven approach appears to be essential if we are to achieve adequate quality of
life in an increasingly urban world.
References and Notes
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