chapter 4 - DRK

Strictly under embargo until Wednesday 22 September at 00:01 GMT (02:01 Geneva time)Modern city life takes a heavy toll on health, partly through the unsanitary and oftendangerous conditions in which millions of people are forced to live, partly throughthe lifestyle choices that it encourages and partly from the strains and stresses that itimposes. Lack of policy and poor planning by municipal and central government playa significant role in these outcomes.While it is true that the number of slum dwellers continues to rise, some of the mostsignificant strides in health improvements are being taken in countries where goodurban governance is actively encouraged and supported and where lifting people outof slum conditions is a public policy goal. China and India have made progress inrecent years in reducing their slum populations, showing what economic growth andpolitical will can do. Some specific examples of how this can be done, particularlythrough community-based initiatives, are cited in Chapter 3 of this report, includingthe Thai government’s support to community-driven upgrading whereby scale isachieved through the very large number of local initiatives that it supports. At a locallevel, NGOs such as Asha show what can be achieved by working with slum dwellersto improve living conditions and fight disease. In the 49 New Delhi slums in whichAsha is active, child mortality is now 36 for 1,000 live births, which is less than halfthe rate of India as a whole.When it comes to non-communicable disease, there are signs that political leadersare waking up to the threat. Whether it be Bogotá’s ciclovia (specially constructedroutes for cyclists in the Colombian capital) or Singapore’s green labelling of disheson school menus to help students identify healthy foods, examples are multiplying ofcountries and cities taking initiatives to tackle the problems of inadequate diet and lackof exercise. Community networks are being forged to overcome the challenges of socialbreakdown and violence in poor and underprivileged city zones of both developingand developed countries.Underpinning all such initiatives is the growing awareness that tackling city healthproblems is not just a question of doctors and nurses. Nor is it solely a matter of alleviatingpoverty, although that is a crucial and necessary condition. It requires that citiesbe well planned, well managed and also well governed. Only then will they pose less ofa threat to the health of those who live in them.Chapter 5 was written by Richard Waddington, freelance writer and former Reuters bureauchief. Boxes 5.1 and 5.2 were contributed by Denis McClean, Editor, World DisastersReport. Box 5.3 was contributed by Gérard Lautrédou, Road Safety Adviser, IFRC.110CHAPTER 5Conclusion