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Cities as the cure to disease and poverty

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Can a city be an inherently more healthy place?

Health, by the World Health Organisation definition, is “not merely the absence of disease or infirmity”, but “a state of complete physical, mental and social well-being”. Although often criticised, this definition is useful to broaden our perspectives and thinking on health – and urban planning.

In South Africa, the emphasis on rural development speaks of the traditional scepticism with which (rapid) urbanisation is greeted. Although this bias is understandable, given the unbearable levels of rural poverty and the many social ills often associated with urban poverty, it is short sighted. Rural areas, because of their lower population densities, will never be able to provide the standard of living which can be attained in cities, and this very fact will always encourage urbanisation in a setting like ours. Therefore, government’s focus should shift towards managing urban migration.

This is the greatest opportunity of our generation. If we can find models to include new migrants into our cities in an effective manner, the end of poverty becomes a realistic goal instead of a bureaucratic pipe dream.

In this regard, health will have to become a central pillar of urban policy and design. The rural poor streaming into our cities today have a greater risk for the so-called diseases of poverty, including infections and malnutrition directly attributable to poor urban design in the form of housing and sanitation. As the poor become more wealthy, the increasing westernisation of their lifestyles lead to new risks – so-called “lifestyle diseases”, again attributable to stressful city environments which more often than not promote unhealthy choices. Poor city planning also contributes to decreased surveillance of public spaces, breakdown of community and non-inclusion of especially poor males, thereby increasing the risk for crime. Thus, a city like Cape Town faces a quadruple burden of disease – malnourishment (and other childhood and maternal illnesses), infectious diseases of poverty and lifestyle diseases like diabetes or high blood pressure, all compounded by violence and injuries.

This status quo needn’t be a fixed destiny.

The resilience of cities is in their capacity to generate more creative solutions to the problems facing individuals and societies, a case beautifully argued by Edward Glaeser in Triumph of the City.

It would therefore be a mistake to focus on these problems, rather than creatively engaging in the search for solutions.

The question should be: Why can cities in general – and Cape Town specifically – not be engines for full realisation of human health? Of “complete physical, mental and social wellbeing”?

Through the application of correct design principles, a city could in fact become not merely the space in which health improvements occur, but the primary driver of health. We can indeed design our city to encourage exercise, to curb the spread of disease or even to purify our air.

The opportunities are boundless.

Throughout the world, a multitude of exciting examples exist of urban planning leading to greater health. The time has come for Cape Town, the World Design Capital 2014, to start leading the way on innovative answers to the immense public health challenges facing not only our city, but our continent and the world.

Image via by EU Humanitarian Aid and Civil Protection

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Petrus Steyn

Medical doctor with a passion for a healthy, sustainable and urban future for Cape Town and South Africa.

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