“Prevention Is Better Than Cure": Planning the Development of Healthy Cities to Promote Public Health.

Written by: Nurul Firdaus Ahamed and Ainul Jaria Maidin

One important aspect dominating public health is the threat posed to the health of the community. Health is defined and promoted differently. The World Health Organisation, the United Nations body that sets standards and provides global surveillance of disease, defines health as:

"A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."

In some ways, public health is a modern concept, although it is said to have been around since time immemorial. From the early beginning of human civilization, it was recognized that polluted water and lack of proper waste disposal may spread vector-borne diseases. Even religions attempt to regulate behaviors specifically impacting on health, ranging from the types of food eaten, and the extent to which certain behaviors could be indulged, such as consuming alcohol or drug intake.

The governments of countries have been empowered to develop public health policies and programs to gain a deeper and better comprehension on the causes of diseases to ensure public well-being, prosperity, to enable the development of healthy and productive human capital. Apart from that, the climate changes have had negative effects on public health as they can cause changes in the geographical range of disease organisms and vectors, the quantity of air, food, and water; and the stability of the ecosystems which we depend on. The United Nation’s intergovernmental Panel on Climate Change and other scientific panels have assessed the potential health consequences of climate change and are trying to curb its effects.

The Quran expressly provides in surah 25:63, for man to walk on the Earth in humility. This verse enjoins on mankind to respect the Earth in the course of carrying out development. The wellbeing of public health can surely be achieved if we treat the land we reside in with respect. It is important to know that both land use and environmental planning go hand in hand when human health is of concern. Environmental degradation caused by indiscriminate land use in cases of development certainly has a great if not absolute effect on public health. The industrial revolution brought about a marked change to the world. This led to the most significant public health threat such as infectious diseases which were predisposed by unsanitary conditions and overcrowded areas that lead to its spread, both directly and indirectly.

Another important point to ponder upon is that public health advocates can and certainly should assist in the planning and structuring the design of cities and suburbs in methods that can promote public health improvement, but to do so effectively they would have to possess a comprehension of the legal framework connected to this particular matter. Development of land and natural resources is essential for promoting economic growth in nations all over the world. There is a general realization that health specialists, land use planning authorities, public health authorities as well as the general public and non-governmental organisations cannot afford to operate in isolation from one another and should in fact work hand in hand, side by side and complement each other.

Apart from that, consumption of contaminated water can contribute towards infection of many common water and sanitation diseases which include diarrhoea, cholera, intestinal worms, malaria, trachoma and typhoid. Globally, a significant amount of progress has been made to control communicable diseases such as malaria, typhoid, hepatitis A, leprosy and TB through improved sanitation facilities, increased access to safe drinking water and improved dental health.

The fading link between the land use planning and health must be re-established or otherwise, the realisation of the importance of public health will never be achieved. This is done by examining the longstanding connection between the built environment; the way we develop and organize our neighbourhoods, cities, and regions; and the “physical, mental and social well-being” of the population.

Planning itself is a multi-objective, multi-dimensional, multi-disciplinary and multi-decision making activity and process. It has developed into a comprehensive exercise of analysis and prescription covering the regulation of environmental and community affairs far beyond its early purpose. It has evolved beyond being a simple technical exercise of land selection and physical design and has broadened into an activity of social purpose where the shaping of the physical environment is emphasized. The process is not merely limited to layout plans of residential, industrial, commercial or recreational activities, but a combination of components and elements which help to create a holistic living, working and recreational environment which in total determines the quality of human life and as an important tool in promoting national unity, and economic development.

Land development planning and poorly designed built environment remain at the root of some of the most intractable public health problems, which includes the declining rates of physical activity resulting from higher dependence towards motor vehicle transportation. Land use, community design, and transportation systems substantially impact local air quality, water quality and supply, traffic safety, physical activity and exposure to contaminated industries. Mental health and quality of life issues also are profoundly affected by factors ranging from the stress and difficulties of commuting to the presence or absence of natural areas and green spaces. Environmental health and chronic diseases such as obesity and physical inactivity are two of the most concerning public health challenges of the 21st century. Therefore, it is of utmost importance that we try to prevent more than trying to cure diseases that can certainly be prevented by proper and strategic planning.

Nurul Firdaus Ahamed is a 2nd year undergraduate student under the Mansoura-Manchester Medical Programme, Mansoura University, Egypt.

Ainul Jaria Maidin is an Associate Professor at Ahmad Ibrahim Kulliyyah of Laws, International Islamic University Malaysia, LL.B (Hons.) (IIUM);Master in Comparative Laws (IIUM); Ph.D. (UWA, UK); Advocate and Solicitor, High Court of Malaya.

Promoting Creation of Healthy Cities

By: Nurul Firdaus Ahamed

In order to promote healthy lifestyles to the public, the healthy city concept was made popular by the “Healthy for All” movement launched by the World Health Organisation (WHO) in 1978. A healthy city is one which is continually creating and improving the physical and social environment on top of expanding community resources which enable people to mutually support each other in performing all the functions of life and in developing to their maximum potential.

A healthy city is expected to comprise the following characteristics:

1. Planning for provision of basic infrastructure such as sewerage and drainage systems;

2. Proper sites for disposal and treatment for solid waste.

3. Proper identification of industrial sites;

4. Provision of adequate open space;

5. Provision of adequate land for suitable housing, including squatters improvements;

6. Planning for facilitating sufficient public transportation and reducing traffic congestion; and

7. Protection and improvement of natural beauty areas, natural habitats and cultural heritage.

Urban and rural communities in the world are facing unique challenges. Rapid urbanization and agricultural mechanization have changed the traditional physical and economical set up in the cities and villages. Migration of the rural population to urban centres has created a strong link between cities and villages. Healthy cities and villages concepts are holistic approaches aimed at improving the quality of the environment, thereby the humans, through a focus on the community development such as healthy housing, proper water supply and sanitation, appropriate handling and disposal of solid wastes, safe preparation and storage of food, control of disease vectors in the environment, prevention of risks from chemicals/pesticides and pollution in general, search for and choice of technologies appropriate for the community involved and generation of income for the poor sections of the community. A healthy city is a place where children are nurtured in the body and mind; where the environment invites learning and leisure; where people work and age with grace and dignity; where ecological balance is a source of pride.

A healthy city is one that is continuously creating and improving the physical and social environment and expanding community resources, which enable people to mutually support each other in performing all functions of life and in developing their maximum potential.

The link between the environment and public health can never be broken and history proves that attempts to do so has caused unnecessary problems to man’s well being. Until very recently, environmental protection, public health and human rights were viewed as distinct areas of public policy by governmental institutions and non-governmental organizations alike at both the national and international levels. With increasing globalization of trade and commerce in the past few decades, the environmental and public health impacts of rapid industrialization and urbanization in different regions of the world are now recognized as having major human rights implications by many policy makers. Human rights in the context of environment and sustainable development recognize that for human communities to survive, they must have an adequate and secure standard of living; they must be protected from harmful substances and unsafe products; they must learn to conserve and equitably share natural resources. Without these environmental and public health policies in place, human rights for respect, dignity, equality, non-discrimination and the ability for the public to participate in decisions that affect their lives cannot be achieved. As the infamous Wendell Berry has once said "You cannot affirm the power plant and condemn the smokestack, or affirm the smoke and condemn the cough", we should take responsibility for linking the built environment with public health.Thus, the role of the local authorities in improving public health must be seriously considered in order to help prevent and reduce the occurrence of diseases rather than to merely cure them.

Nurul Firdaus Ahamed is a 2nd year undergraduate student, under the Mansoura-Manchester Medical Programme, Mansoura University, Egypt.