Programme Note

Urbanization, Health and Human Security

Urbanization

The economies of scale, operation, specialization and integration that drove the growth of cities in Europe and North America in the 19th and 20th centuries have also driven urban growth in EMCs. But because the process has been compressed, accelerated and magnified by more productive technologies, massive internal migration and higher net reproduction rates, many EMC cities have grown at breathless speeds to unprecedented sizes and have written new chapters in the world’s urban history.

Urbanization in EMCs is distinguished by its speed, scale and the facts that:

• Most large EMCs (e.g. Brazil, China, India, Russia), like large OECD countries (e.g. USA, Canada, Australia) have relatively ‘balanced’ urban systems featuring dynamic second and third tier cities, whereas, with some exceptions (e.g. Colombia) most smaller EMCs, like smaller OECD countries (e.g. Britain, France), have urban systems dominated by one city.
• Most EMC cities are more socially and spatially segmented than OECD cities with sharper distinctions between high and low income neighbourhoods and districts.
• Most large EMC cities are surrounded by massive suburban settlements, often populated by migrants and characterized by high unemployment, low incomes, poor housing, inadequate infrastructure and urban ser-vices, unhealthy environments and social deprivation and isolation.
• Whereas, since the early 1970s, the populations of some of the largest OECD cities have stabilized or shrunk, Mexico City, Seoul, Sao Paulo, Guangzhou, Mumbai, Delhi, Shanghai, Kolkata, Cairo, Manila, Karachi, Moscow, Buenos Aires, Dhaka, Rio de Janeiro, Beijing, Teheran, Istanbul, Lagos and Shenzheng have each acquired more than ten million inhabitants and have become megacities.
• Rapid urbanization has forced EMC governments to confront questions about diseconomies of urban agglomeration, the management of very large cities, tensions arising from widespread poverty and how EMC cities, particularly megacities, can respond to demands for jobs, health, housing, infrastructure and human services in the context of concentrated poverty in urban, suburban, ex-urban and peri-urban settlements.

Grappling with the potentially overwhelming organizational and financial consequences of explosive urbanization, EMC governments have variously floundered, improvised, innovated and fashioned public-private sector alliances. They have also realized they must mainly look to each other – rather than countries that urbanized earlier – for solutions to many of their problems.

Urban health

The EMS symposium on ‘Health and Healthcare in Emerging Market Countries’ in December 2009 emphasized rural/urban and high/low income contrasts but did not address issues of urban health or healthcare. Its recommendations nonetheless bear directly on the choice of topic for this symposium, the decision to consider health in the context of human security and the premise that solutions to urban health problems demand effective coordination of policies and actions between national, regional and local authorities and between the public, private and voluntary sectors.

Few things have more impact on the quality of life and the productivity of schools and workplaces in emerging market countries than the health of urban populations. Few challenges to national and local governments, private enterprises and voluntary organizations in emerging market countries are more important than those of delivering sustainable public health and healthcare services. And few questions (particularly in the context of global recession) demand more urgent attention than the question of where and how emerging market countries can find answers to those challenges.

Urban health issues are national issues because urban health profoundly affects the economic, social and political fabrics of emerging market countries. They are complex issues: because responsibility for urban health and healthcare policies are invariably split between central and local authorities; because few countries even try to coordinate policies and practices of all branches of government whose activities affect the health of urban populations; and because responsibility for urban healthcare is invariably divided between public and private (and in some cases voluntary) providers.

Emerging market countries searching for answers to urban health and healthcare issues will find insights but, as with answers to other urbanization-related challenges  – will not find off-the-shelf solutions in wealthier countries with contrasting urban, economic and social histories. Most will learn more from the successes and failures of other emerging market countries with different traditions yet broadly comparable conditions. But the search for adaptable ideas is hampered by the difficulty of accessing in-depth knowledge about what has (and has not) worked elsewhere – and why. Books, articles, papers and web-sites are helpful but inadequate sources of information and inspiration because they are not interactive. And because most conferences are long on presentation and short on conversation they fail to access participants’ knowledge, allow them to challenge conventional and unconventional wisdom or create new insight and understanding by refining and expanding their collective knowledge.

Human security

While human security – like human freedom – is most often recognized by its absence it is generally understood to mean security against disease, hunger and repression and protection from disruptions to daily life. The symposium considered the propositions that health and human security (i.e. personal wellbeing and the collective wellbeing of towns, cities and megacities) are closely related; that sound health promotes choice, freedom, and personal development; that poor health, disability and the risk of premature death threaten human security; that access to healthcare and effective public health systems cannot ensure good health if the necessary (economic, social and political) enabling conditions are not met; and that the health of urban populations directly and indirectly affects the economic, social and political fabrics of cities and megacities. It also considered the recent evolution of urban human security in emerging market countries; what needs to change; and how human security can be factored in to national and city health and healthcare policies and programmes.

The Symposium

Objectives

The objectives of the symposium were to: (i) reach findings and make recommendations that are broadly relevant to EMCs as a whole and could, if implemented, materially contribute to improving urban health in EMCs and (ii) identify issues that require further research, training or initiatives to satisfy other preconditions of change.

To achieve these objectives the symposium was designed to: (i) approach urban health as a critical dimension of human security in EMCs; (ii) consider relationships between urban health and rural health and between urban health and housing, infrastructure, physical and social environments and economic and social policies; (iii) explore issues related to the governance of health and healthcare policies and the coordination of action in urban areas; and (iv) identify issues and possible solutions affecting public health and healthcare services for urban populations.

Programme

On Friday 14 January the programme focussed on three contextual themes: (i) the urban context including the distinctive nature of emerging market urbanization, variations in urbanization patterns, generic economic and social issues arising from urbanization and corresponding policies; (ii) the social determinants of urban health in emerging markets; and (iii) urban health as a critical dimension of human security in emerging market cities.

The programme on Saturday 15 January addressed urban health and healthcare issues. The first session was devoted to defining and prioritizing generic health and healthcare problems in emerging market cities. The second focussed on relationships between urban health and urban housing, infrastructure and physical environments and economic and social policies. Against the background of these findings, the third (afternoon) session was an open forum on solutions to urban health and healthcare problems with particular emphasis on innovative approaches that could be adapted and adopted in emerging market countries.

On Sunday 16 January the first session featured a panel of former Mayors of emerging market cities each of whom had practical experience of reconciling demands for public health and healthcare services with competing claims for human and fiscal resources and managing tensions between central and local governments. In the second session  participants broke in to small groups to debate findings and recommendations which were first shared in a plenary session and then expanded and refined in a final session that reached consensus on feasible actions.