November 2004, Vol 94, No. 11 | American Journal of Public Health 1848
© 2004 American Public Health Association
You Can’t Have One Without the Other: Environmental Health Is Urban Health
Pietro Garau, DArch1,
Elliott D. Sclar, PhD2 and
Gabriella Carolini, MPhil2
1 Department of Territorial and Urban Planning University of Rome—La Sapienza
2 Graduate School of Architecture, Planning and Preservation Columbia University New York, NY
Population health results from the intersection between people and their environment. For the first time in history, most of the world’s population is predominantly urban. Any effort to meaningfully improve population health via environmental interventions must acknowledge that environmental health is increasingly synonymous with urban health.
Virtually all of the world’s population growth over the coming decades will take place in the poorest cities, within the poorest countries. This demographic reality will have enormous environmental repercussions. Urbanization is largely a process of migratory push and pull. Over the past 2 centuries, much of the push came from increased agricultural productivity, which rendered many rural workers redundant. At the same time, industrialization became a magnet pulling surplus rural populations to the cities. This transformation of society from rural to urban was brutal. Nonetheless, though urban life was rife with rising rates of disease and death in the early years, it was also a source of new hope. For the majority of early migrants to the cities, this move meant a far better life for their children and grandchildren.
While the city continues to attract migrants, the push and pull have changed. Now the push from rural areas is caused by falling, rather than rising, agricultural productivity—there are too many mouths to feed in places with depleted soils and droughts. Many of the cities to which contemporary migrants flee are impoverished places in impoverished countries. These cities lack dynamic economic activity; at best, they offer the barest subsistence in an informal economy. Picking over trash is a common "job." Even in cases where migrants make their way to booming economic centers, their reception is harsh. The newcomers are typically offered wages that are inadequate to cover a minimal standard of living, and they often find themselves living in makeshift quarters at the margins of the formal city.
This is the urban context of the new global environmental challenge—a challenge that is daunting, but not insurmountable. The response requires radical rethinking. In many of the poorest cities, some of the most exciting urban environmental projects are now under way. These promising projects share an underlying method: the poor are meaningfully involved in the process of improving the slum conditions in which they live. To bring participatory approaches up to a scale where they can measurably improve the urban environment and population health, it is necessary to institutionalize them in the establishment of democratic government at the local level. After 2 decades of "privatization" and disparagement of government, it is time to change direction and engage in the process of supporting democratic governments at the local level that can work with the urban poor and that can absorb and use sorely needed outside aid wisely.
Such a change is especially crucial at this juncture. The epidemics of HIV/AIDS and malaria are on the upswing in the developing world’s rapidly growing and desperately poor cities. While antiretroviral drugs and antimalarial treatments are necessary, they are effective only if they are provided in the context of robust, accessible medical care systems and strong public health infrastructures capable of delivering core public health necessities, such as safe drinking water and effective sanitation. This simply will not happen unless we invest in building civic and public institutions in which the world’s poor can participate in planning urban environments where they can live healthier lives.
Copyright © 2004 by the American Public Health Association
