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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