1. The Link between Health and Urban Planning
To get a comprehensive understanding it is important to briefly explain the definition of health, planning and urban planning.
The Constitution of the World Health Organization (1946) formulated definition of health:
“Health is a state of complete physical, mental and social well-being and not merely the absence or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being, without distinction of race, religion, and political belief, economic or social condition” (WHO, 1946).
The above definition stresses that health is not a single factor; health is not only about biological factors but also physical, social and mental factors. Lalonde (1974) argued that health is influenced by many factors: environment, lifestyles, human biology and health care systems (Glouberman & Millar, 2003).
While planning also has been defined in various ways by many scholars based on different view point as noted in 7FAQs in urban planning (Levent & Nijkamp, p. 5-6).
Banfield (1959) explains that “planning is the process by which he selects a course of action (a set of means) for the attainment of his ends”(Leknes, 2001).
Wilson (1968) defined “planning can be used as a generic term to denote a certain kind of decision making process which is applicable in a wide variety of situations”(Wilson, 1968).
Hall (1992)) described “planning as a general activity is the making of an orderly sequence of action that will lead to the achievement of a stated goal or goals”(Hall & Tewdwr-Jones, 2010).
While according to Hall (1992) urban planning:
“refers to planning with a spatial, or geographical, component, in which the general objective is to provide for a spatial structure of activities (or of land uses) which in some way is better than pattern existing without planning” (Levent & Nijkamp, p.6).
From the above definition it stresses that urban planning is multidimensional aspects and covers all dimensions that affect health such as land use, transportation, environment, social and economic dimensions.
Although health is recognized as multi-factors, urban planning seldom considers and encompasses health issues and their effects on health (Barton, Tsourou, & World Health Organization. Regional Office for, 2000). Leeder, Ward and Wilmoth (2006) state that strategic planning for urban areas health is often mentioned, especially in relation to health services. However, this is seldom seriously addressed (Leeder, Ward, & Wilmoth, 2006). As a consequence, at the early urban development, much urban planning produced unsanitary conditions which contributed not only to the urban management but also to the spread of infectious diseases (Public Health Advisory Committee, 2008). For instance, poor urban planning has caused Bangkok to grow uncontrollably and resulted in an urban crisis characterized by:
· Rapid population growth in which the number of registered population is 8.6 million but many more are not registered.
· Increase people living in the slum areas with unhealthy conditions
· Increased pollution caused by domestic and industrial sources either government or private business.
· Unwell managed garbage.
· Increased traffic jam caused by the increased the number of cars and motor-cycles and the failure of traffic control (Subhachaturas).
Galea et al. (2005) states that a city with poor management and urban planning can cause several public health problems. The combination of high number of population, high congestion, and various social, economic and political values contributes to the complexity of urban living (Darmawan, Thabrany, & Kamso, 2007).
Therefore, an effective urban planning will have a positive impact on urban dwellers and their environment such as healthier behavior and environment. On the contrary, poor urban planning contributes to the widespread ill health of urban dwellers. Because of the importance of urban planning issues, WHO calls for action to promote urban planning for healthy behaviours and safety as mentioned on the 2010 World Health Day and this is the first point among five called actions (WHO, 2010).
By considering this fact, urban health perspective has changed from an old to new model of urban health. Range of problems, population group emphasis, provider group emphasis, disciplinary emphasis, common concepts, management approach and intervention are now considered as urban health determinants. The examples in table 1 show their influence in urban planning.
Table 1 Comparison between old and new models of urban health
| Aspects | Old | New |
| Determinants | Proximate determinants (such as exposure to infections), physical environment, infectious diseases, malnutrition | Distal and proximate determinants, multiple factors, social and economic factors, acute and chronic (mental health), re-emerging problems (TB, malaria), violence, lifestyle diseases |
| Range of problems | The ‘urban poor’, ‘rural-urban comparisons’, ‘vulnerable groups’ | Rural-urban interactions, city as a whole and intra-urban differentials, within and between household differences |
| Population group emphasis | The ‘urban poor’, rural-urban comparisons’, vulnerable groups’ | Rural-urban interactions. City as a whole and intra-urban differentials, within and between household differences |
| Provider group emphasis | Public sector focus, role of hospital, referral system | Pluralism of providers including government, municipal, district, private, traditional, retail sector, self-treatment |
| Disciplinary emphasis | Epidemiology, public health | Geography of health, epidemiology, public health, social sciences |
| Common concepts | Urban poor as ‘reservoir of infection’ and ‘suffering’ ‘worst of both worlds’ | Inequity, social capital, burden of disease, sustainable livelihoods |
| Management approach | Through Ministries of health | Decentralisation, health sector reform, governance |
| Intervention examples | Vertical, slum improvement projects | Healthy city projects, multi-sector approaches, urban district health team strengthening. |
Barton et al. (1999) divided determinants of health into four levels relation to planning policy areas: (1) individual behavior and lifestyle, (2) social and community influences (3) local structure conditions and (4) general socioeconomic, cultural and environmental conditions (Barton, et al., 2000).
Urban planning agencies are not the only body responsible on health. Social, economic, cultural and environmental organisations are also involved. Therefore, collaboration and partnership are essential. Duhl and Sanchez, 1999 in (Barton, et al., 2000) summarize Lukes’ idea of stakeholders and their relationship to urban planner in healthy city development:
“…urban planning must be sustained by dynamic leadership styles and open to various configurations. For example, it should be open to collaborative and bottom up actions. Healthy urban planning thus makes room for citizens as leaders and requires catalytic leadership from planners. Planners become effective public leaders when they serve as catalysts who reach beyond the traditional boundaries to engage, discuss and mediate among broad groups of stakeholders” (Barton, et al., 2000 p.23).
The WHO healthy urban planning initiatives in Europe show that both political and professional collaboration are very important to develop an effective urban plan. The key of urban planning is an integrated program, across departmental and agency responsibilities with commitment from key decision makers and high awareness at grass roots level. If public health and planning departments can form an effective alliance, improving human well being, quality is promoted and supported across multi-levels (Barton, et al., 2000).
Therefore, what makes a good urban plan or best urban plan? Urban planning has to consider efforts which aim to increase quality of urban life. Quality of life is a central consideration of urban planning, looking for better living conditions is always top the agenda in the decision making process of future planning (Levent & Nijkamp). Urban planning requires a comprehensive and integrated approach to fulfill environmental and health needs. According to VicHealth (the Victorian Health Promotion Foundation in Australia) there four reasons why good urban planning is an important component for population health.
· Good planning can reduce inequalities existing in access to transport for different socioeconomic and vulnerable groups in the population.
· Good planning can reduce burden of disease, disability and mortality due to sedentary life styles by improving access and providing walkable, mixed use communities
· Good planning can contribute to the improved population health by the reduction of pollution.
Public Health Advisory Committee (2008) listed a number of key components to create the ideal conditions for healthy urban planning. They are:
· An acceptance of inter-departmental and inter-agency collaboration so that health implications can be integrated across sectors.
· Strong political support to ensure policy and mobiles resources
· Full integration of health with social, economic and environmental aspects in which placing health in the heart of decision makers.
· Citizens, private, public and voluntary sectors actively involved in the decision making process.
· A toolbox planning methods have to reflect into health promotion goals such as quality of life, impact assessment and monitoring.
Therefore, healthy urban planning will work effectively if government as a key player involves the urban planning body and relevant sectors to give room for citizens to participate in developing a program such as healthy city project. Government functions as facilitator rather than instructing from a top-down approach. Therefore, it is important to review the good governance in developing urban health and to differentiate the good governance and government.
2. Urban Governance
The term governance is not a new term. However, its meaning differs from the term government. The difference between governance and government will be explained. Some institutions and foundations formulate a definition of governance and good governance. The United Nations Economic and Social Commission for Asia and the pacific (UN-ESCAP) mentioned that governance can be explained as a process of decision making and the process by which decisions are implemented or not implemented (Abednego & Ogunlana, 2006). Governance refers to the process whereby elements in society wield power and authority, and influence and enact policies and decisions concerning public life, and economic and social development. Governance is a broader notion than government. Governance involves interaction between these formal institutions and those of civil society (Sajeva & Masera, 2006). UNDP (1997) defines governance is viewed as the exercise of economic, political, and administrative authority to manage a country’ affairs at all levels. It comprises mechanisms, process, institutions through which citizens and group articulate their interests, exercise their legal rights, meet their obligations and mediate their differences (Weiss, 2000). According to World Bank (2000) governance is not only about wealth but also about opportunities to exercise of political competence. Governance needs both voice and choice (Ramakrishna Nallathiga, 2005).
Good governance for a good society has political and economic principles. The political principles of good governance require a strong pluralistic civil society, high degree of public transparency and accountability, law enforcement and good institution. Economic principles in urban governance need policies, investment in people and effective institution to promote economic growth (Commonwealth Australia, 2000).
Why good governance is important to create a healthier and safer city? According to WHO countries that implemented the best urban governance in particular in developing countries can help produce 75 years or more of life expectancy while countries with poor urban governance, the life expectancy can be as low as 35 years (WHO, 2010). WHO (2010) further mentioned good urban governance can ensure opportunities and resources are more evenly distributed as well as access to health care services is more equitable and affordable.
To achieve the good governance it involves three main actors and they interact with each others. These actors are: state or government (city authorities), private sector and community (Jones Lang La Salle, 2004; R. Nallathiga, 2005). They describe urban governance as networked city governance system (see figure 5). Slightly different from the model described by Hamdi and Majale (2005), the idealized model of urban governance can be seen in figure 6. Among urban governance actors, each actor has important roles in the development process. For example government creates and assures the political and legal environment; private sectors open and create job opportunities, while society mobilizes people to participate in economic, social and political activities. Jones Lang La Salle (2004) explains that participants in city governance have to take on different functions. Local governments are the most significant players to coordinate activities in a city, the private sector has to contribute through financial capacity and share expertise by working independently. Individuals (society) contribute through their actions and participate in development process. These three sectors all have strengths and weakness. They have to work together and promote constructive interaction among them to achieve the development goals.
To know how well the implementation of urban governance it depends on established indicators. UN-HABITAT for global campaign on urban governance provides the urban governance index as explained by Stewart (2006) in his paper on designing good urban governance indicators: the importance of citizen participation and its evaluation in Greater Vancouver. Stewart (2006) designed good urban governance indicators into five aspects: effectiveness, equity, participation, accountability and security. From the five indicators he then developed sub indicators (variables) into 26 variables so each indicator has own sub indicators. However, United Nations Economic and Social Commission for Asia and the Pacific tend to follow eight main characteristics of good governances. These are participation, rule of law, transparency, responsiveness, consensus oriented, equity and inclusiveness, effectiveness and efficiency and accountability.
Therefore, based on the above explanation government is only one of the main actors of governance (Hamdi & Majale, 2005; Jones Lang La Salle, 2004; R. Nallathiga, 2005). According to United Nations Economic and Social Commission for Asia and the Pacific all actors outside the government and the military are categorized as part of the civil society. Actors involved in governance rely on the area or issues. In rural areas for example actors involved in governance differ from actors in urban areas. Actors in rural areas are farmers, cooperatives, religious leaders and local leaders while actors are in urban areas such as political parties, polices, military, university, research institutions, NGOs, and the private sector.
In short, good governance encourages stakeholders at all levels and to tackle various problems faced in certain areas including urban health problems. Good urban governance considers the voice of all sectors including the poorest and vulnerable groups who live in the urban environment. However, it is not easy to implement urban governance. Urban governance (Darussalam & Colebatch, 2002) in many cases especially in the third world countries (developing countries) faces a variety of problems in the application of good governance. These are because of poor interconnection with governmental agencies; government as service providers are often inefficient monopolies; extensive problems but uneven regulation; conflict of agenda and interest among agencies; frustration of development opportunities; evasion and ignorance of regulation; and problems related to corruption. A number of urban governance constraints will be a study in my research especially in relation to the implementation of healthy cities program in Indonesia, at local government level.
In conclusion, well urban planning and good urban governance in which government works together with other sectors can improve health outcomes and quality of life.
REFERENCES
a literature review.
Some examples of Indian cities. Indian Urban, Vol XXV, No. 2 1-28.
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