Rebuilding the links between health and urbanism
A quick overview of recent events in the world (deadly pollution, the increase in chronic diseases, epidemics linked to the invasion of certain species ...) reveals the immense challenge facing urban areas to continue to be liveable and maintain healthy populations. These events illustrate both the vulnerability and the complexity of urban systems that result in multiple dependencies, whether it is access to quality resources (water, air, food, energy) or the widening of social and economic inequalities with the process of metropolisation.
It also shows that the levers of action on health and well-being depend on broader policies than health stricto sensu, and have cultural, social and economic impacts for which the urban dimension plays an integrator and regulator role.
As evidenced by the New Urban Agenda (NAU) adopted in Quito in 2016 that take over the Sustainable Development Goals of the United Nations (adopted in 2015), and that beyond reaffirming the public health challenges with SDG 3 introduced with the SDG 11 the challenge of sustainable cities. To these two objectives are added SDGs 8 and 9 on planning and infrastructure. These different objectives intersect around living conditions (housing), urban health (individual and collective) and open the possibility of a reformulation of the concept of sustainable development : a process leading to a better quality of life for all.
Challenges to overcome
The African situation
The population dynamics underway on the African continent are of unprecedented scale and pace in the history of humanity: the population of sub-Saharan Africa could double over a period of 30 years (from now to 2050), maybe less. It is not easy to imagine what these phenomena imply from the point of view of food, housing, and jobs needs, or the necessary adjustment of care and education services. West African countries are among those who invest the least, in proportion to their national budget, in favor of the social sectors, including health services.
It is also usual to mention the "double burden" to caregivers and health systems in Africa formed by infectious diseases (epidemic risk, viral hepatitis, malaria, tuberculosis, AIDS, tropical diseases and all those could be prevented by vaccination), and the chronic pathologies responsible for 71% of mortality worldwide (diabetes, cardiovascular and respiratory diseases, cancers ...)
Capitals and major African cities subjected to the effects of globalization during decades, are undergoing an epidemiological transition accompanied by its corollaries, which are the new risk factors for health: stress, pollution, sedentary lifestyle, obesity, fast food, addictions to tobacco, alcohol, cannabis, crack, and ... sugar, not to mention road accidents.
Water is, and will continue to be, the defining resource of the urban future. Africa is one of the regions that needs the most innovative solutions to meet the challenges intertwining water and climate change; however, many parts of Africa also suffer from lack of skills and capacity in the water management sector as well as widespread institutional fragmentation. The impacts of climate change in Africa will be felt through floods, droughts and extreme weather events, with very direct and potentially serious socio-economic impacts. Combined with the urbanization, the increase in population and the corresponding increase in the demand for services and infrastructure are increasing the water needs in cities. Nearly half of the infrastructure needed to meet the needs of African cities by 2035 is not yet in place, this is an opportunity to improve local resilience and reimagine water in our future cities.
If we are pragmatic, we must recognize the urgency of the situation, and realize that it will not be possible to produce the necessary sanitation infrastructure in a time frame compatible with the deadlines of the SDGs by the only conventional techniques of collective sanitation networks and stations. In many neighborhoods and localities, the methods of collection and treatment of individual and autonomous sanitation can be considered as an intermediate solution, or definitive, as an established public service that local authorities have the capacity to develop and manage.
The digital revolution with its positive or contested effects is playing a role of accelerator on several levels in the health sector :
- on scientific innovations and advances in the field of medicine, health and risk-prevention;
- on the modification of the relations between carer / patient with the development of connected objects, telemedicine or networked medicine, the transformations of places of care;
- on the increasing demand of the inhabitants to participate (bottom up) in risk-prevention, to the environmental improvement related to their health and especially on the questions of healthy food, to the extended definition of health to the well-being, the participation of the construction of their living environment.
Faced with multiple challenges, places must organize
- through the establishment of long-term structural policies (infrastructure / equipment / programming of urban functions ...) ;
- by short-term initiatives which must give visibility to long-term policies, initiate new logic of governance and economic model, and also lead to changes in user behavior.
The « Pilot Healthy Places » programme's international ambition is to initiate, in particular in Europe and Africa, a search for innovative solutions with local authorities. It is about entering a pre-operational phase, that is to say closely linked to the territory, which concerns public action as well as private actors and users. The programme aims for a change in urban-health relations and their operational implications in local policies.
It also aims to continue and realize the results of « Design neighborhoods beneficial to health / well-being » research project led by Marie Chabrol (Urbapilot) and supported by Leroy Merlin Source, of which you can see some illustrations under these lines.
This programme is inspired by typologies of solutions developed in research and wants to confront them to operational contexts. It is viewed from the perspective of social innovation, and relies on intermediary actors for their ability to change their own environment. Behavioral analysis and population dynamics will play a key role in stimulating this search for solutions.
illustrations ©Urbapilot of « Design neighborhoods beneficial to health / well-being » research project
INTA and Urbapilot are working together in the framework of this "Pilot Healthy Places" programme to put into action the short-term operational devices that make it possible to invent tomorrow's solutions. We claim a "Lab" way of working that aims at developing collective (and subjective) solutions to counterbalance the dehumanization of indicators and evaluation grids. The goal is to rely on the existing (the places but especially the people) to understand the links between health / social / environment / urbanism, but especially to test the potential of social innovation of places and their actors
A 3-step methodology
We carry out this work in three stages following a methodology enriched by the experiences of both partners :
1.First of all, a first phase of programme launching, to structure the college of partners, communities and sponsors involved.
6 debates on "Rebuilding links between health and urbanism" theme have been organized between october 2018 and may 2019. You can find all the summaries of these events here.
2.Then, a phase of co-construction with the communities engaged in the programme.
This phase will be repeated in each selected territory. It is itself divided into three sequences: scan, focus and experimentation.
- Scan allows the development of the urban / health / environment cross diagnosis with the concerned communities and to identify the ecosystem of local actors. This phase is carried by the project team allowing the development of a shared diagnosis and a shared design of the experimentation device.
Team of 4 people (2 INTA, 2 Urbapilot plus local team) with complementary skills and responsibilities.
Outcome: tools and didactic / educational materials.
- Focus is done in a collaborative way by helping the actors of the community to take a different look at their projects during an international process of exchange of experiences.
Outcome: Roadmap with action tracks.
- Experimentation (optionnal) aims to quickly verify the relevance of a concept and to enrich it through the participation of users. It is the communities and local actors involved in the previous steps that will be in charge of setting up the prototypes to be tested (design / implementation / scenario / animation with users). INTA, Urbapilot and the local team accompany the project management team in practical experimentation. The experimentation stage is optional and could take place later in view of the results of the first two steps.
3.At last, a third phase of Evaluation and communication of the results will be implemented. Its objective will be to allow a shared assessment of the various approaches carried out in the pilot community and the valorisation of the results of these experiments.
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