Life, death and disease in the city
Matt Mukhtar (699032)
Rarely,
due to their seemingly contrasting natures, has town planning and public health
become intertwined. However,
occurring in the 1840s and 1940s were two pivotal movements where design and
health combined forces towards public good. By learning from these examples, there is an argument for
another convergence in today’s age and beyond (Hibbert, 1999).
The
first paradigm was the relationship that Edwin Chadwick associated with disease
and the living conditions of the poor.
Cities were not like they are in the modern world today, being mostly
associated with decrepit living conditions where toilets were commonly shared
between up to 100 people due to lack of infrastructure and rapidly growing
populations (K, Munzer, 2015). Unchanged
air and meagre ventilation became associated with influenced health of the
occupant, conditions only experience by the poor (Chadwick, 1842). However, although Chadwick’s solutions
to these studies were never realised, they lead to more practical remedies,
namely urbanism. Based around the Miasma
theory, sanitation became crucial to reducing excess concentration of bad air,
associated with sickness. This was
to be amended by wider and more open street layouts, contrary to the culs-du-sac,
which reduced airflow.
Furthermore, zoning regulations were enforced to keep land uses away
from one another to protect residential zones, a process still carried out to
the modern day. The author
suggests that there was hard epidemiological evidence that closed-off streets
had higher death rates irrespective of population density. However, although many of these
diseases may have been linked to poor urbanism, many of them may have occurred
due to lack of medical knowledge or lack of economic access to medical
amenities, not something that planners could simply remedy. Despite these false scientific and
medical premises (namely the Miasma theory), the first paradigm lead to
expenditure on extensive sewerage systems and standardized street widths which
contributed to the rise in life-expectancy for British urban dwellers.
Nearly
100 years later, town planning was catalysed for the development of
preventative medicine and uniform welfare provision. Originally based around The Eugenics Society’s beliefs in
natural selection, which sought to encourage the natural increase of
procreation in affluent families in Britain, while simultaneously discouraging
those in poverty from procreating, who were at most risk to diseases and lower
life expectancies by encouraging contraception. Ironically however, Britain experienced a reversal by 31% in
birth rate. Therefore, preventative
medicine began to form around social welfare and not social exclusion, which
called on planners to localise health institutes within urban ‘hubs’ to
increase access and therefore based on this belief, healthiness would spread
naturally amongst society. Similar
practices exist today, with increased competition between insurance companies creating
economic choice and better access to health insurance, eliminating wait
times. Many observers had little
doubt that planned cellular development would reverse the drop in birth-rate as
residential clusters would improve sociability and neighbourly interaction
while simultaneously creating economic safety as neighbourhoods would provide
collective welfare support to mothers giving economic security, encouraging
procreation. As Hibbert explains,
this theory of a cellular city was the ‘most powerful synthesis of medical and
architectural imagery in a hundred years’ (1999).
However,
this second paradigm proved unsuccessful, possibly following the precedent set
by Ebenezer Howard. When comparing
these two urban ideas many similarities appear. For example, Howard formulated the idea of a garden city
based around the statutory town planning system that was introduced in
1909. This had the intention of securing
sanitary conditions and connections to amenities through the layout of land and
direction of streets. This idea
similarly received wide criticism for interfering in natural selection, a
reflection of the wide spread social Darwinism during the early 20th
century in conjunction with the advent of bacteriology at the expense of
sanitation. Furthermore, Howard’s
novel plan was largely theoretical with its health benefits being dubious as
well as having doubts cast about its ability to match social infrastructure to
residential development. Although
these proved successful, their ideas of social harmony and equal access to
amenities are still strived by for cities today and the idea of a garden city
is still well renowned.
By drawing on and criticising these paradigms, public health may
become stronger in the modern age.
Greater links, such as the works of McKeown (1979) are being praised by
Hibbert, showing how life expectancy owes more to improved environmental
hygiene than to the clinical interventions made by doctors and hospitals
(1999). The World Health
Organisation, examining parallels between new and old sanitarianism, now focus less
on urban morphology and more on providing more advanced health delivery systems,
both financially and educationally.
Instead of forcing social cohesion in closed environments, like those
experiences in cul-de-sacs, space is being opened up to create thoroughfares to
create a desire for walkability.
These ideas to change the lifestyle of societies are taking roots in the
modern day because they can ‘benefit all people exposed to the environment
rather than focusing on changing the behavior of one-person at a time’ (Heath
et al, 2006). Strategies include
the funding of public facilities, zoning and walking and bicycle trails.
London is the perfect example of this school of thought. It provides a livable example of how
modern cities, associated with high density and population, can still boast lower
mortality rates when compared to more open environments. As Handy et al explore: as long as land
use patterns vary and transportation systems promote walking and cycling, this
will create a public perception focused around a healthier lifestyle and more
livable communities (2002). This
debate now focuses less on high residential density as it did back in the
1840s, in fact quite the contrary, high densities tend to support amenities
such as public transport as greater demand lends itself to better connections
creating a sense of pride in using this form of transport in place of unhealthy
use of private means of travel. This
is shown as London still boasts comparably low levels of car dependency
(Hibbert, 1999).
The ideas surrounding public health and urban form have dramatically
altered throughout the last two centuries. However, they still remain a vital in ensuring the
healthiness of urban dwellers.
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Reference List:
Chadwick, E.
(1842). Report on the Sanitary
Condition of the Labouring Population Og Great: Britain: Supplementary Report
on the Results of Special Inquiry Into the Practice of Interment in Towns (Vol.
1). HM Stationery Office.
Handy, S. L.,
Boarnet, M. G., Ewing, R., & Killingsworth, R. E. (2002). How the built
environment affects physical activity: views from urban planning. American
journal of preventive medicine, 23(2), 64-73.
Heath, G. W.,
Brownson, R. C., Kruger, J., Miles, R., Powell, K. E., Ramsey, L. T., &
Task Force on Community Preventive Services. (2006). The effectiveness of urban design and land use and transport policies
and practices to increase physical activity: a systematic review. Journal
of Physical Activity & Health, 3, S55.
Hibbert,
M (1999). A City in Good Shape: Town
Planning and Public Health Town
Planning Review 70 (4), pp. 443-453
Munzer,
K. (2015). Lecture 4(a): Life, death and disease in the city. Urban History: ABPL20034. Monday 23rd March 2015. Faculty of Architecture, Building and Planning,
University of Melbourne, Parkville.
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