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 20^th 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.   

  

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 23^rd March 2015.  Faculty of Architecture, Building and Planning, University of Melbourne, Parkville.