We do not value the fundamental role the environment plays in our lives, and thus we exploit and damage it in the name of growth, writes Trevor Hancock, in the first of a three-part series.
This essay is about what I have come to call Healthy Cities 2.0, which has a strong focus on the ecological sustainability of our cities, and the serious health consequences of unsustainable development.
In it I first discuss some of the key aspects of the modern approach to creating healthy cities, before exploring a rapidly growing global challenge – the emergence of the Anthropocene age – that threatens the health of the global population, including the majority that now live in urban areas.
This new geological epoch is both a geological and an ecological phenomenon, but it is driven by human activity. We – and especially modern Western societies and economies – have been and still are the main drivers of these global ecological changes, although other countries are following the same path, with serious consequences for us all.
At the root of our problem is an economic system that, while it has brought many benefits to many people, raising their levels of human and social development, is no longer fit for purpose in the 21st Century.
Behind that economic system lie a set of social and cultural values and ideologies – growth, development, greed, the acquisition of ‘stuff’ and a disregard for nature and the Earth’s natural systems – that are also no longer fit for purpose, and that will have to change swiftly and dramatically.
Based on these concerns, I then discuss an evolution in the concept of healthy cities that is rooted in the recognition that healthy people need not only healthy social and built environments, but a healthy planet.
In the 21st Century, cities must put people, planet and participation at the centre of their governance processes, as the 2016 Kuching Statement noted.
The social, cultural, economic and indeed philosophical and spiritual transformations that we need will have to grow up from the grassroots. They will not spread down from the current powerful corporate and political systems that benefit hugely from and are thus wedded to the current way in which we operate.
I end by discussing the work I and a small group of fellow citizens are undertaking in Victoria, capital of the Canadian province of British Columbia, one with a very similar history to Penang as a colonial port and capital city.
We are working to develop conversations in our urban region as a one-planet region; one that has an ecological footprint per person equivalent to one planet’s worth of the Earth’s biocapacity and yet has a high quality of life and good health for all. In my view, this is the challenge of the 21st Century, one that Penang also needs to take up.
Healthy cities: The modern approach
I say ‘modern approach’ because in the 19th Century, people were working to make the industrialising cities of Europe and North America more healthy, in the face of horrendous slums and extremely unhealthy living and working conditions. Their success, and in a fairly rapid time period, remains an inspiration for those of us working to create healthy cities today.
The healthy city concept is a simple one, although a challenge to apply. It begins with the recognition that most of the factors that determine our health have nothing to do with the healthcare system, but involve our built environment, our educational and social systems, our community cohesion, our economic development and many other non-medical factors.
As was the case in the 19th Century, a healthy city begins with clean water and sanitation, which is why public works is the most important municipal ‘health’ department. But many other municipal departments are also ‘health’ departments including urban planning, housing, parks, transportation and community development.
Beyond the municipal government, the school system, community organisations, the private sector, the healthcare system, faith communities and of course ordinary citizens are key players in making our cities and communities more healthy.
The recognition of the relatively minor contribution of healthcare and medicine came to me in the late 1970s, having trained and practised as a family physician, and it led me into public health.
It was in fact a realisation that for me had its roots in Malaysia in the 1960s, although I did not know it at the time. I spent a year in 1966/7 as a volunteer teacher in a brand new high school in the small Sarawak town of Lundu.
At that time, there was no road access to Lundu, even though it was only 60 miles from Kuching, and little in the way of modern western medicine. Yet I had lived in a community that seemed to be pretty healthy and happy; clearly, factors other than western medicine were contributing to this situation.
But in addition to my interest in the health implications of the built environment of our cities, towns and villages, I have always had a strong interest in the natural environment, both in its own right and as a contributor to health.
This led me to co-found the Green Party of Canada, the Canadian Association of Physicians for the Environment and the Canadian Coalition for Green Health Care in the 1980s and 1990s, and to be an advocate for combining the healthy city and sustainable city concepts.
In the last few years, my work in this area has come to focus on the relationship between health, cities and the natural environment. I have in particular been galvanised by the concept of the Anthropocene, and the health implications of this literally epochal change.
Welcome to the Anthropocene
Scientifically speaking, the Anthropocene has been proposed as a new geological epoch characterised by human-driven geological and ecological changes. It will be evident in the geological and fossil record, just as the Age of the Dinosaurs is apparent.
Geologically, it is marked by the deposition in sedimentary layers of uniquely human-made materials (eg concrete, plastic, pure aluminium) and chemicals (eg elevated levels of carbon dioxide, persistent organic pollutants, radioactive isotopes from atomic blasts), and a shift in fossil assemblages.
In the future, paleontologists will note that wild animals now make up less than 5% of the mass of land vertebrates, with humans being about one third and the rest being our domesticated species – cattle, pigs, sheep, goats, chickens and so on.
But the Anthropocene is more than just a geological phenomenon; it is shorthand for the massive and rapid global ecological changes we have triggered across a wide range of fundamental Earth systems. These changes include:
- climate change (which has taken up much of our time and focus)
- the related phenomenon of ocean acidification, which threatens the viability of many marine species and coral reefs
- widespread pollution of air, water and soil
- the contamination of entire ecosystems and food chains with persistent organic pollutants – a phenomenon known as ecotoxicity and manifested in our own bodies (as top predators on many food chains, we are born with and then accumulate a body burden of dozens of these chemicals, which can disrupt our genes, our brain development and our hormonal, reproductive and immune systems)
- the depletion of both renewable and non-renewable resources, especially those involved with food production such as ocean and river ecosystems, fertile soils and freshwater, but also forests
- finally, species extinctions and loss of biodiversity – we are tearing apart the great web of life (of which we are a part) in a sixth great extinction.
Moreover, these changes in multiple Earth systems do not occur in isolation from each other. On the contrary, they interact and multiply each other’s effects, because the Earth is in fact a single planetary ecosystem, which the noted Earth scientist James Lovelock dubbed Gaia, the name the Ancient Greeks gave to the Earth goddess.
These interactive impacts are well illustrated by the case of changes in the oceans and the marine fisheries.
Global warming warms the oceans, which leads to coral bleaching, and further damage to coral results from run-off of nitrogen fertiliser and other pollutants into the ocean, some of which are persistent organic pollutants and heavy metals that both harm the fish and contaminate one of our key food sources.
Coral reefs are important nurseries for fish, as are mangroves; the latter are being destroyed to make way for shrimp aquaculture and urban or resort development.
Then on top of this we are massively over-fishing, driving some species to the brink of extinction and disrupting the oceanic web of life. As a result, the oceans are in crisis, a crisis we have created.
It is not only the scale but also the rapidity of these changes that is breathtaking.
A commonly proposed starting date for the Anthropocene is 1950, with the economic boom that followed the World War Two. I was born in England in1948, so in a very real sense I personify the Anthropocene, as a 70-year-old white male from a high-income country that was the birthplace of the industrial revolution.
In my lifetime global population has almost tripled while the urban population has increased more than five times as people moved into cities. Real GDP (in constant dollars) has increased more than 11 times. Primary energy use went up more than five times. Fertiliser use went up more than 14-fold and international travel arrivals went up 37 times.
The impact on the environment in just my lifetime has also been massive. Carbon dioxide levels have risen by more than a quarter while methane levels – a more potent greenhouse gas – have gone up 60% and the oceans have become about 20%t more acidic.
Both marine fish captures and nitrogen flows into the ocean have increased more than four times while twice as much tropical forest has been lost as was the case when I was born, reaching about 25% of tropical forest – and there are many other dramatic environmental changes.
Health in the Anthropocene
But ultimately, the Anthropocene is not so much a geological and ecological phenomenon as it is a social, cultural and economic phenomenon.
We are the anthropos – the Ancient Greek word for man, or perhaps better, mankind – in the Anthropocene.
As a species – and particularly as western-driven ‘homo economicus’ – we have lost our way. We do not see ourselves as part of the great web of life, but somehow separate from it. We do not value the fundamental role the environment plays in our lives, and thus we exploit and damage it in the name of growth, progress and the pursuit of wealth – ultimately, to our own incalculable harm.
As a public health physician, my concern is with the health consequences of the Anthropocene, both for the population as a whole and for the urban majority.
In the past few decades there has been a growing concern with the so-called social determinants of health; those social factors that to a large extent determine our health – income, education, housing quality, food availability, living and working conditions and so on.
The World Health Organisation even established a Global Commission on the Social Determinants of Health, which issued its report in 2008. Its key conclusion, which I strongly support, is that inequality is killing people on a massive scale, and that this is due to unhealthy public policies.
But in focusing on these social determinants, we have lost sight of an equally important and in many ways more fundamental set of determinants. I call these the ecological determinants of health, and which was the focus of a 2015 report I led for the Canadian Public Health Association.
Ask yourself, how well do you do without water and food? From where do the materials come that we use to build our homes, our cities, our infrastructure, our technologies and our toys? Where does the energy that powers our societies and communities come from, and all the other resources that underpin our wealth and our economy? All from nature.
Then recall that modern civilisation, from the development of agriculture to the birth and growth of cities, has all occurred in the past 11,000 or so years since the end of the last Ice Age, a geological period known as the Holocene. We are now disrupting what has been a relatively warm and stable environment that has enabled that process.
It is not simply a matter of switching our focus from the social to the ecological determinants of health, however. We need to recognise that the social and ecological determinants completely intersect and interact, often compounding each other’s effects.
On the one hand, the ecological factors underpin the social and economic infrastructure of our communities and societies. On the other hand, the wrong sort of economic development damages those ecological underpinnings, threatening the stability of society and the health of the population.
The health affects of the Anthropocene are best understood for climate change. The Intergovernmental Panel on Climate Change has done a good job over the years in outlining them. They include:
- the health impacts of more frequent and more severe weather events, including flooding, storm surges and other storm damage
- increased heat events, affecting urban dwellers and rural people alike, especially the poor who lack air conditioning and other ways of protecting themselves
- more forest fires that lead to high levels of air pollution
- large increases in the areas where mosquitoes and ticks can live, breed and transmit malaria, dengue fever, Zika virus, Lyme disease and other such diseases
Beyond these largely direct health impacts lie many indirect effects, the largest of which are likely to be due to the impact on food supply. In addition to the impacts on the oceans noted above, droughts, degradation and loss of soils and other effects on agro-ecosystems – especially as meat consumption increases – will disrupt land-based food systems.
But perhaps the greatest health impacts, although the most difficult to predict, will result from the sixth great extinction we are creating. When biodiversity is lost, ecosystems change and may even collapse, but as Dwamish elder Chief Seattle noted in the 19th Century, “we are part of the great web of life, and whatever we do to the web of life, we do to ourselves”.
Moreover, as with most other things in life, the benefits and costs of social and economic development and ecological deterioration are unequally distributed. In broad terms, both locally and globally, the wealthy reap the benefits, while the poor pay the costs.
I constantly remind my students that everywhere in the world the poor live downwind, downstream and downhill – or uphill, if the hills are unstable and dangerous. They live in the floodplains and swampy areas, in the coastal zones that are vulnerable to rising sea levels, storm surges and increasingly frequent and powerful severe weather events. They have the worst housing conditions and work in the most unhealthy and unsafe jobs (if they work at all), more exposed to pollutants and heat stress – the latter, of course, will become more severe with global warming, especially in the tropics.
In short, the health impacts of the Anthropocene are felt most severely by the poor, further heightening social injustice by adding ecological injustice to the mix.
The greatest health challenge of the 21st Century then is to both reduce poverty and inequality and to ensure ecological sustainability, especially in the cities where a growing proportion of the world’s population lives.
Because while these problems are both urban and rural, they are concentrated in the cities, which depend upon intact ecosystems, locally and globally, for sustenance and other key resources.
And yet, while cities and the material demands of their populations contribute a large proportion of the ecological harms of resource use and pollution, they also, strangely, may represent one of our better ways to address these issues. They are the intellectual powerhouses of our society, with great capacity for innovation and efficiencies. Properly managed, they could play a significant role in reducing our ecological footprint to manageable proportions.
But to do so, we must create a new and very different economic system, one that reduces poverty and inequality and ensures health and high levels of human development for all, within the constraints of the one small planet we call home.
In short, we need a new economic system that is fit for purpose in the 21st Century.
About the author
Dr Trevor Hancock is a public health physician and health promotion consultant and recently retired from his position as a professor and senior scholar at the School of Public Health and Social Policy at the University of Victoria in Canada.
In the 1980s he was one of the founders of the global Healthy Cities and Communities movement and was the first leader of the Green Party of Canada. He later co-founded both the Canadian Association of Physicians for the Environment and the Canadian Coalition for Green Health Care.
For more than 30 years he has worked as a consultant for local communities, municipal, provincial and national governments, healthcare organisations, non-governmental organisations and the World Health Organization.
His work now is focused on the massive and rapid global ecological changes that are the greatest challenge we face in the 21st Century, a growing threat to the health of the population, especially in cities, and the role of cities in responding to that challenge.
As one of the originators of the Healthy Cities movement more than 30 years ago, he was recently in Malaysia to deliver a keynote address at the eighth Alliance for Healthy Cities conference in Kuching. The alliance is a regional grouping that includes the South East Asian countries, Japan, China, Taiwan, Australia, New Zealand and Oceania. This extended essay in three parts is based on his speech there and two subsequent speeches for Think City in Penang and Kuala Lumpur (23 and 25 October 2018).