Sick cities just one symptom of larger health problem
16 August 2006
A record number of runners participated in Sunday's City to Surf run, which makes you wonder about the extent to which we are, as some suggest, living in a city of people doomed to poor health.
It is true that we need to attend to urban design to protect and promote good health, but cities such as Sydney do not have a monopoly on the trade, commerce and lifestyle that we associate with poor health.
The unhealthiest Australians are not among those living in our big cities, but indigenous Australians in remote areas. The diseases from which citizens in remote Australia suffer and die are the same diseases that we worry about in our cities - diabetes, heart disease, stroke, kidney failure, cancer, depression, alcoholism and trauma - except that they experience them at higher rates and die younger.
In fact, surveys of obesity conducted by Professor Michael Booth, of the University of Sydney, found no differences between remote areas and cities in the rate of children who were obese or overweight. His research did find, however, that children of more affluent and better educated parents enjoyed the best health.
Planning cities that promote healthy behaviour and security is preferable to not doing so, but we must take care that we do not confuse the package with the contents, or overinvest in urban design as a magic solution that will solve problems associated with chronic disease.
Land use, travel patterns and air quality all need to be taken into account in the planning, design and building of healthy cities. But it is our damaging behaviour, whether in cities, pleasant country towns or remote areas, that causes obesity and related health conditions.
Urban design can mitigate this behaviour and hence the bad outcomes that follow for city dwellers by planning so that shops that sell fresh food are within easy reach, ensuring the safety and comfort of those who choose to walk rather than drive, and creating user-friendly public transport.
But research does not support the view that the urban environment is the thing above all else that should attract our attention when it comes to preventing and reducing chronic disease.
Three other strategies, alongside urban planning, commend themselves. Of these we should ask which represents the best bang for the buck.
First, to achieve optimal health, education for all from childhood up is essential. Research reveals a strong link between general education and health. In developing countries, for example, maternal education ranks highest among the investment opportunities to improve child survival. Educated people don't smoke as much, for example. Yet education alone is not enough.
As the chaos in Papua New Guinea demonstrates, failing to link education to employment opportunities is a disaster, as it creates a subculture of disgruntled adolescents who are bored, dangerous and unhealthy.
Second, we must encourage all those needing medical care to seek access to it. But the care must be there when it is required. More intelligent policy should overcome the limits of distance within or beyond our cities.
Third, policies relating to food choice and consumption need the attention of government. Subsidies may be needed to ensure access to fresh food, for example. Food advertising is one small aspect of what our governments could attend to, beyond ensuring that the prices of fresh food are competitive for families on low incomes and that shops where such food can be bought are nearby. Outside the larger cities and towns, access to fresh food is a core problem that is rarely the focus of attention.
The problems run deep. Australia is the only country in the Western world where childhood obesity levels have overtaken those for adults.
Today in Canberra another meeting of experts is due to gather to consider ways that go beyond simple medical approaches to reduce the toll of serious and continuing chronic illnesses in Australia.
Urban design is one such important matter to consider, but so are education, access to medical care, and government leadership in securing the supply of fresh food for all Australians, wherever they live.
As the chaos in Papua New Guinea demonstrates, failing to link education to employment opportunities is a disaster, as it creates a subculture of disgruntled adolescents who are bored, dangerous and unhealthy.
Second, we must encourage all those needing medical care to seek access to it. But the care must be there when it is required. More intelligent policy should overcome the limits of distance within or beyond our cities.
Third, policies relating to food choice and consumption need the attention of government. Subsidies may be needed to ensure access to fresh food, for example. Food advertising is one small aspect of what our governments could attend to, beyond ensuring that the prices of fresh food are competitive for families on low incomes and that shops where such food can be bought are nearby. Outside the larger cities and towns, access to fresh food is a core problem that is rarely the focus of attention.
The problems run deep. Australia is the only country in the Western world where childhood obesity levels have overtaken those for adults.
Today in Canberra another meeting of experts is due to gather to consider ways that go beyond simple medical approaches to reduce the toll of serious and continuing chronic illnesses in Australia.
Urban design is one such important matter to consider, but so are education, access to medical care, and government leadership in securing the supply of fresh food for all Australians, wherever they live.
This opinion piece first appeared in The Sydney Morning Herald on 16 August 2006
Stephen Leeder is director of the Australian Health Policy Institute and co-director of the Menzies Centre for Health Policy at Sydney University.
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