Professional Documents
Culture Documents
Dr.Kedar Karki
The health of those who live in the more densely populated areas of the world is of
interest and concern for two reasons: (1) the large numbers of persons involved, and (2)
the fact that the population density of an urban area changes the potential for both public
health problems and public health solutions. The potential for problems includes
increased exposure to large a number of individuals who can spread infectious conditions,
larger volumes of waste products at risk of poor handling, the presence of pollutants, an
apparent increase in stress, and a concentration of more serious mental health problems.
Solutions are influenced by economies of scale in providing services, a more varied array
of resources, and the potential for closer proximity to others with similar interests and
needs. Opportunities to work with others who share a concern increases the likelihood of
identifying appropriate actions and generating political support for solutions.
Social cohesion and social breakdown are the two ends of a spectrum describing the
relationship people in a given setting experience. The greater the cohesion, the more
likely the group is to work together, to share common values, and to find positive
solutions to problems in ways that are inclusive of all members of the group. Conversely,
when social breakdown has occurred, individuals are left to struggle with the challenges
of living alone, people turn on one another in ways that are damaging, and problems
accumulate to a level incompatible with a healthy life. Urban areas of today have within
them neighborhoods that could be described as fully cohesive, but far too many urban
areas are at, or are closer to, the other end of the spectrum.
AREAS OF CONCERN
Cities are a center of immigration, both from rural areas (as evidenced by the population
shift of the last century) and from other countries. Port cities (which may not be coastal in
this age of airport travel) experience a constant influx of people from other cultures and
climates. This may add to the health challenge in a number of ways. For example, during
the period following the end of the Vietnam War in which a large number of refugees
from Southeast Asia were arriving in the United States, many health care providers had to
learn about an entirely new range of parasitic diseases that were endemic in these people's
countries of origin. Beyond specific diseases, immigrants bring different expectations of
the health care system, and a different understanding of the range of interventions
appropriate to various disease states. Some immigrant health practices have moved
toward the mainstream, as in the increasing use of acupuncture, once seen as an odd
practice of the Chinese immigrant community. And the increasingly popular herbal
remedies are an echo of the role the botanica plays in Hispanic cultures.
HOUSING
Assurance of safe housing has long been an issue for urban areas, and the history of the
city is one of many cycles of housing development and reform. Failure to plan for
housing infrastructure (water and sewer systems, electricity) when the population is
moving into an urban area can result in extensive, substandard housing for those at lower
income levels. This can be found in the barrios, favelas, and other overnight city
extensions found around many cities in the developing world. Substandard urban housing
more often takes the form of older buildings in central city neighborhoods that have not
been maintained and are not well-served by public or private services of any kind. Health
hazards in such settings include exposure to lead-based paint, cockroach feces
(implicated in the increase in asthma), temperature extremes, or unsafe windows and
stairs.
Delivery of fresh water to residents was often one of the first public health activities
taken up by municipal authorities in the eighteenth century. Using simple surface
impoundment, wooden piping, and gravity, water that was not contaminated by urban
sewerage and waste products could be made available to central pumps and to individual
residences. Over time, the systems have become more elaborate, and contamination
concerns have expanded to include not only the infectious diseases of the past and
present, but a wide range of potentially damaging chemical agents associated with
modern industrial life.
For urban areas, concern about water is not only related to use for human consumption, it
is a significant part of safety, given the role that water plays in control of fire. The
concentration of housing and industry in urban areas has made fire safety an urban
concern since the colonial era. Benjamin Franklin is cited as the father of the modern fire
insurance and fire fighting systems in the United States. Urban areas devote an extensive
portion of zoning and construction regulation to assuring that heating, cooking, and
industrial fires, and electrical transmission systems, are such that the probability of fire is
minimized.
WASTE DISPOSAL
The concentration of populations in urban areas also means an increased accumulation of
waste products. Removal of human waste and garbage is a major commitment in any city,
whether the mechanism chosen is completely public or funded by a mixture of public and
private resources. The treatment of human waste is costly, and new requirements that
protect both people and the environment from contaminants has meant a steady
investment in upgrading treatment facilities and building new ones. Treatment plants
running at or near capacity in systems in which storm runoff drains into the common
sewers may overflow or be bypassed during rainy seasons, causing downstream
problems.
Trash and garbage that accumulate in urban areas must be disposed of safely. The old-
fashioned garbage incinerator is no longer feasible, due to both volume of material and
the air pollution caused by burning. Landfill disposal requires moving the material
outside the urban boundary, and safety requirements for landfills have become
increasingly stringent. While many areas do not want any waste disposal nearby, the
acceptance and processing of urban waste has been welcomed by some economically
suffering rural areas. Trash from East Coast urban areas may be moved long distances by
land or sea for final disposal. The volume of waste is directly related to the degree of
attention paid to recycling of materials. Paper, glass, metal, and plastics all can be
returned to use with proper treatment, but efforts to fully recycle met with varying
degrees of success. Some urban areas have come very late to full recycling efforts, but
most now offer curbside or individual pickup of separated recyclable materials.
At the same time as communities search for more ways to dispose of waste, attention to
the siting of waste disposal has increased due to the awareness that racial and ethnic
minorities have found themselves disproportionately exposed to these sites. Whether this
is because landfills are deliberately located in minority communities, or their proximity is
the indirect result of lower income levels and lower property values adjacent to
environmental hazards, the practice has fueled both rage and concern, and government
action has been taken to address the problem. This issue of environmental justice could
be easily expanded to other land-use issues in urban areas, since neighborhoods with
lower income levels and greater concentrations of minority populations generally have
less open space for parks and playing fields, and the ones they have are often in poor
condition. Lack of safe park space leaves low-income urban children playing in the street
or other unsafe areas, increasing chances of injury.
While there are many negatives to health and health services in urban areas with large
uninsured populations and antiquated care systems, there are also positives associated
with urban health. The concentration of people means that specialized services are
economically viable. It is medical services in urban centers that have pioneered many of
the interventions now taken for granted and that are now being transferred to less
populated areas. The person with a relatively unusual condition who lives in an urban
area is more likely to find the needed care within close proximity than a similar
individual in a rural location.
Urban health is a complex web of both threats to health and supports to health. It cannot
be understood apart from an appreciation for the size and density of the populations
involved, and it continues to evolve as economics shift, technology advances, and public
expectations develop. But the likelihood that urban areas will continue to concentrate
people, problems, and opportunities makes its health concerns unique and important.