Health in the city / Jean-Paul Jardel

Health in the city by Dr Jean-Paul Jardel Assistant Director-Genera/, World Health Organization, Geneva hat will our planet look like 50 years from now? The shape of things to come will inevitably be defined by the breathtaking growth of the great cities, a contemporary phenomenon which is already a number one concern for the international community. The T echni- cal Discussions, which traditionally take place at the same time as the annual World Health Assembly in Geneva, are this year devoted to the ways in which Health for All strategies can deal with all the problems of urbanization. Since 1950, urban populations have grown at a furious pace and are expected to increase further in the next 35 years to the point where, in the year 2025, 5000 million people will be living in cities. In less than ten years, by the year 2000, no fewer than 24 urban agglomerations will each have over ten million inhabitants; five of these, including four in developing countries, will exceed 15 million. People from the countryside migrate towards the towns, to the detriment of the quality of life there - since they are already bulging at the seams and unable to cope with such an influx; meanwhile the countryside itself is drained of its life-blood, and risks being left behind in the race for devel- opment. In many countries, hasty efforts have had to be made to provide the urban populations with such vital matters as lodging, job opportunities, and social and health services. The public authorities often have to face insur- mountable problems to deal with pro- liferating slum settlements, and to prevent any further deterioration of the environment as well as of health and social welfare. Such problems are graphically described in this issue of World Health Moreover, the concentration of What will the future hold for these little girls in Kathmandu, Nepal? Equity of access to health services can only be ensured if the local authorities include health in the political a!/enda. productivity in cities - one extreme example is the case of Thailand, where 10 per cent of the inhabitants of Bangkok provide 80 per cent of the whole country's gross domestic pro- duct - means that a certain number of residents enjoy a far higher standard of living, and better health services, than is the lot of their rural compatriots or of their less-favoured fellow citizens. Every possible effort has to be made to ease this gross discrepancy and bring about equity of access to services. In view of the complexity and the degree of interdependence of all the factors contributing to this situation, the primary health care approach and intersectoral cooperC!tion combine to form the strategy of choice to confront these daunting problems. Action at the local level is also to be encouraged to the full . The Healthy Cities project is one example of the efforts being made to convince coun- tries to put health firmly on the political agenda of communities and local governments. Once again, it's a matter of "thinking globally and acting locally." Local action is by far the most effective approach, all the more so if it takes place within a national, regional and even a worldwide framework. The interdependence of human beings with their physical, social and economic environment must now more than ever be taken into account in health-related activities. Local power to act must therefore be reinforced, and local authorities must be con- vinced of the important role of health in development efforts. Furthermore, all sectors that have an influence on health must be integrated into a collaborative team. The planning and carrying out of strategies must be flexible, to take into account the wide diversity of towns, countries and situations. Enlightened leadership is called for, to encourage the participa- tion of everyone. And, finally, it must never be forgotten that Health for All is a common, shared objective, which alone can allow us to hope for eventual justice and equity in ensuring the fundamental right of every human being: the right to health. • Cover: People ~~ matter. Their health will depend on the willingness of city planners to meet their real needs. WHO/J. -L. Ray IX ISSN 0043-8502 World Health is the official illustrated magazineofthe World Health Organization. Editor: John Bland Deputy Editor and this Issue's Theme Editor: Christiane Viedma Art Editor: Peter Davies News Page Editor: Philippe Stroot World Health appears six times a year in English. French. Portuguese. Russian and Spanish. and four times a year in Arabic and Farsi. The German edition is obtainable from: German Green Cross. Schuhmarkt 4. 3550 Marburg. FRG. Articles and photographs not copyrighted may be reproduced provided credit is given to the World Health Organization Signed articles do not necessarily reflect WHO's views. The designations employed and the presentation of material published in World Health do not imply the expression of any opinion whatsoever on the part of the Organization concerning the legal status of any country. territory or other area or of its authorities. or concerning the delimitation of its frontiers or boundaries. Contents Health in the city by Jean- Paul Jardel .... .. . .. ... ..... 3 Wanted: a redistribution of wealth by Jorge E. Hardoy ...... ..... .... .. . 4 Rapid growth in the Americas by Juana A Palma ...... ... ... .. .. .. 7 Street children by Victoria Rialp .. . ... . .. . .... . ... . .. 8 The present is appalling, the future bleak by Robert J. Maxwell ............... 11 Floods threaten the world's cities by Diane Rollman .. .. .............. 13 Tackling Africa's slums by Layi Egunjobi . ... .......... ..... 14 Cities of tomorrow .. . . ...... . . 16-17 Immunizing the children of poverty by John Clements & Diana Silimperi .. 18 Housing and health by Roderick J. Lawrence ............ 21 Places for the soul .. . by Christiane Viedma ..... . . . ...... .. 23 Keeping a mental balance . by Anthony J. Marsella & Hugh Freeman ................... 24 High-density life in China by Chen Changhui & Solvig Ekblad .. 26 The false lure <>f the city lights by Fredj Starl'lbouli . .. . .. . . .. .. ..... 28 ~ws Page .. . . . .. . .... . .. .. ... 30-31 3