The Urbanization Cause-Effect Framework - Coursework Example

IS THE URBANISATION CAUSE-EFFECT FRAME-WORK AN IMPORTANT TOOL FOR ACHIEVING SUSTAINABLE DEVELOPMENT? INTRODUCTION From a historical perspective the decline in morbidity and mortality in the past century was due to changes in health determinants: limitation of family size, improvement of nutrition, a healthier physical environment, and specific preventive measures (McKeown’s research from 1950s to 1980s). The importance of clean water and sanitation for health was accepted in the United Kingdom as early as the nineteenth century (Colgrove, 2002: 725). Investing in improvements to people’s health and their environment is recognized as a central aspect of sustainable development. This is reflected in the increased importance given to health and environment concerns in the formulation of national plans for sustainable development, by many countries. It is essential that these plans are supported and implemented by all sectors contributing to economic development. It is essential that long-term intervention is directed at reducing the driving forces that generate the environmental health threats. Successful public health interventions concentrate on improving human environments and promote a more holistic perspective on health (Corvalan et al, 1999: 656). New tools are needed to ensure that intersectoral action is implemented in the way that the health sector functions. Improving coordination might be one of the most important ways in which we can help put the planet back on a healthy and sustainable path, states Schimding (2002: 632). This paper proposes to critically analyse whether the urbanisation cause-effect framework is an important tool for achieving sustainable development. CAUSE-EFFECT FRAME-WORK OF URBANISATION Urbanization is a universal phenomenon in the postwar world. Some nations have experienced urbanization that accompanied skill upgrading, industrialization, and the expansion of the urban formal (modern) sector, but others urbanized without such modernization and underwent the expansion of the urban informal (traditional) sector simultaneously (Yuki, 2007: 98-99). The links among health, environment and sustainable development present a framework that extends from the epidemiological domain to the policy domain and includes the driving forces that generate environmental pressures, creating changes in the state of the environment and eventually contributing to human exposures, states the World Health Organisation Report (1997: 2). Kahlmeier & Braun-Fahrlander (2004: 104) support the use of the frame-work. Figure 1. Health and Environment Cause-Effect Framework (Corvalan et al, 1999: 656). Recognizing the links between development, environment, and human health (and the need for specific “actions” at each step), a comprehensive framework can be devised (Figure 1). The framework recognizes that although exposure to a pollutant or other environmentally mediated health hazard may be the immediate cause of ill health, the “driving force” and “pressures”leading to environmental degradation may be the most effective points of control of the hazard. The “network” of connections within the framework can be used to identify cause-effect “pathways” or “trees,” depending on whether the framework is used to analyze the multiple health effects of a single driving force (eg, transport policy relying on car transport leading to increased motor vehicle related injuries, effects on the respiratory system, noise disturbance, etc) or to analyze the multiple causes of a single health effect, for example: acute respiratory infections in children resulting from driving forces such as poverty, household energy policies, housing policies, and agricultural policies (Corvalan et al, 1999: 656). According to the World Health Organisation (WHO, 1997: 1) report, environmental threats to human health can be divided into “traditional hazards” associated with lack of development, and “modern hazards” associated with unsustainable development. Traditional hazards related to poverty and “insufficient” development are wide-ranging and include: lack of access to safe drinking-water; inadequate basic sanitation in the household and the community; indoor air pollution from cooking and heating using coal or biomass fuel and inadequate waste disposal. Modern hazards are related to development that lacks health-and-environment safeguards, and to unsustainable consumption of natural resources. They include: water pollution from populated areas, industry and intensive agriculture; urban air pollution from motor cars, coal power stations and industry; climate change; stratospheric ozone depletion and transboundary pollution. “Risk transition” is the changing pattern of environmental health hazards and associated health risks with time and economic development (WHO, 1997: 1). Specifically, driving forces create the conditions in which environmental health hazards can develop or be averted or that are generated by large numbers of people in their pursuit of the basic necessities of life (food and shelter) or in their acquirement and use of consumer goods. Driving forces include policies that determine trends in economic development, technology development, consumption patterns, and population growth. The driving forces in turn generate different kinds of pressures on the environment, in such forms as waste from human settlements and depletion of natural resources or emission of pollutants from activities such as energy production, manufacturing, transport, mineral extraction, agriculture, forestry, fish harvesting, and tourism (Corvalan et al, 1999: 658). The state of the environment change due to these pressures, as seen when land use is changed (deforestation or drainage problems) or when discharges of toxic chemicals or other forms of waste increase concentrations of chemicals in air, soil, water, or plants. The pressures are potentially associated with all stages in the life cycle of industrial products, from initial resource extraction and transportation of raw materials, to processing and distribution, to final consumption and disposal (WHO, 1997: 15-19). Exposure requires that people are present both at the place and at the time when the state of the environment changed and became hazardous. Exposure thus refers to the intersection between people and environmental hazards. Given known exposures and the knowledge of dose-response relations, estimates can be made of the health risk of specific hazards to the extent that current knowledge allows. “Hazard” only describes the potential for causing harm to human health. In contrast, “risk” is a quantitative estimate of the probability of damage associated with an exposure. Environmental hazards, can lead to a wide range of health effects. These may vary in type, intensity, and magnitude depending on the type of hazard to which people have been exposed, the level of exposure, and the number of people affected. Most important diseases are associated with more than one type of exposure, and environmental hazards interact with genetic factors, nutrition, life-style hazards, and other factors in causing disease (Corvalan, 1999: 656). Thus the purpose of the urbanisation cause-effect framework (Figure 1) is to highlight the important links between different aspects of development, environment, and health and to help identify effective policies and actions to control and prevent health effects. Cassidy (2007: 7) states that spiralling global urbanisation, resource allocation and shortages of drinking water are some of the crucial problems which have to be confronted and actions implemented on priority. Environmental Health Indicators: The term “indicator” has been used to identify types of information used for decision making. These indicators can be defined at the different levels of the health and environment cause-effect framework; examples for a common hazard are given in Table 1. An understanding of the steps in Figure 1 given above, is necessary if solutions to environmental hazards are to be found and appropriate action taken. Action can be taken at each step in the framework as exemplified in Table 1 (WHO, 1997: 2). Table 1. Environmental Health Indicators within the DPSEEA (driving force, pressure, state, exposure, effect, action (Corvalan et al, 1999: 659). Descriptive Indicator Action Indicator Driving force Level of poverty in the community. Expenditure on water and sanitation improvements. Pressure Percentage of households without safe drinking water supply. Number of unserved households provided with clean water supply per year. State Coliforms in water. Extent of water quality surveillance and water treatment. Exposure Percentage of population exposed to hazardous water contaminants. Extent of public education programmes on water hazards and treatment in the home. Effect Morbidity and mortality from diarrhoeal diseases. Number of cases treated in hospitals and clinics. In the short term, interventions are often corrective or remedial at the level of the health effect, such as treatment of individuals affected. In the longer term, they should be protective or preventive (for example, various measures to prevent people from being exposed). Preventive interventions may be implemented to reduce or control the hazards at the source (for example, by limiting emissions or installing flood-control systems). The most effective long-term interventions aim at eliminating or reducing the effects of the driving forces that produce the hazards. Interventions at the level of driving forces often have multiple implications, because major driving forces exert influence via several causal pathways. Sometimes this can multiply benefits, but care must be taken that the overall impact is beneficial (Corvalan, 1999: 659). The physical, social, and economic characteristics of rapid urbanisation in developing countries have an impact on health which has captured the attention of international public-health researchers in the past decade. Mental illness is an emerging major threat to public health in the cities of developing countries (Peen & Dekker, 2003: 535) and Berk (2007: 217). The United Kingdom’s Department for International Development has invested almost one million pounds in an urban health research programme, states Harpham (1997: 11-12). Violence, tuberculosis, malaria, and AIDS all have specific urban epidemiologies, so also traffic accidents and heart disease. Societies in transition are often assigning new roles to nongovernmental and community organisations for improving urban public health. There is also decentralisation and emphasis on local government and municipal authorities. Rural-urban mutual symbiosis: Gutman (2007: 383) suggests that a solution for inherent problems needs to be found. The rural population is increasingly marginalized and natural environments are increasingly destroyed. A new rural-urban compact needs to arise where cities acknowledge and pay for environmental sustainability. In this new rural-urban compact there would be more employment opportunities and more income coming to the rural areas, and the cities would benefit from a sustainable supply of rural products and ecosystem services provided by restored rural environments. Urban hierarchies: Henderson and Wang (2007: 308) state that there is no growing imbalance to urban hierarchies and much of urbanization is accommodated in smaller and medium size cities. City formation and the growth in numbers of cities can be explained in large part by: national population growth, inferred technological change, and changes in institutions. Increasing democratization facilitates the formation of new cities. Technology, policy and institutional effects on individual city growth are heterogeneous. Housing: Housing is of central importance to quality of life. Ideally, it minimizes disease and injury, and contributes much to physical, mental and social wellbeing. The home environment should also afford protection against the hazards to health arising from the physical and social environment. Numerous factors in the home environment may influence health negatively. Lack of access to piped water, lack of sanitary facilities, crowded cramped conditions that facilitate the transmission of diseases, etc may influence health negatively (WHO, 1997: 19). The results of a study conducted by Champion (2003: 11), suggest that the British urban system had very largely moved beyond the urbanisation stage by the beginning of the twentieth century and that counter-urbanisation was the prevailing pattern before mid-century. For long-term and beneficial impact on human health: Sustainable development policies should focus on longer-term, broad-spectrum interventions, touching upon the driving forces operating in human society. In many developing countries, this would mean tackling inequities, poverty, and population growth and thereby contributing, for example, to the control of land degradation and deforestation, biodiversity loss, soil erosion, food insecurity, and decline in water quality. In developed countries, inequities are also of importance, as sizeable population groups live in squalor and relative poverty. In addition, emphasis should be placed on reducing unsustainable consumption, curbing the use of nonrenewable fuels, and reducing generation of solid wastes to minimize transboundary pollution, toxic waste problems, and global environmental change (WHO, 1997: 2). To control AIDS and the global pandemic of the human immunodeficiency virus, countries must not only promote changes in individual behaviour but also address social issues such as unemployment, rapid urbanisation, migration, and the status of women (Quinn, 1996: 99). CONCLUSION Sustainable development (Schimding, 2002: 632) means meeting people’s development needs in a manner by which the earth’s carrying capacity will not be exceeded in the long term. To implement successfully proactive preventive approaches, development policies and planning should also incorporate health and environment concerns within the framework of sustainable development (Corvalan et al, 1999: 659). The WHO’s corporate strategy emphasizes increased action to address the health needs of poor populations. However, the lack of financial and human resources is a major deterrent to progress (WHO, 1997: 36). The links between health and economic development have become increasingly recognised, especially with respect to the contribution of health to poverty reduction. As much as a quarter of the world’s total loss of healthy years of life is associated with environmental factors. Much of the disease burden among poor people is environmentally related and mainly affects children. While progress has been slow and uneven, there have also been many achievements in this area. Many countries have strengthened or established ministries of environment, or commissions on sustainable development (Schimding, 2002: 633). Sustainable development can be achieved by building capacity within and outside the health sector, and with help from health professionals to implement the future agenda. The cause-effect framework of urbanisation is a useful tool for an overview of urbanisation, and can help in formulating effective actions for achieving sustainable development. REFERENCES Berk, M. (2007). “Should we be targeting exercise as a routine mental health intervention?” Acta Neuropsychiatrica, 19, June 2007: 217-218. Web site: www.blackwell-synergy.com/doi/abs/10.1111/j.1601-5215.2007.00201.x Cassidy, R. (2007). “Water wars, slums coming soon to a planet near you”. Editorial. Building Design and Construction. June 2007: 7-8. Web site: http://www.bdcnetwork.com/article/CA6450424.html Champion, T. 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(2002). “Health and sustainable development: can we rise to the challenge?” The Lancet, 360, August 24, 2002: 632-637. Web site: http://linkinghub.elsevier.com/retrieve/pii/S0140673602097775 World Health Organization. (1997). Health and environment in sustainable development: five years after the earth summit. Executive summary. Geneva: World Health Organization, June, 1997: 1-36. Web site: http://whqlibdoc.who.int/hq/1997/WHO_EHG_97.12_eng.pdf Yuki, K. (2007). “Urbanization, informal sector and development”. Journal of Development Economics, 84: 75-103. Web site: http://ideas.repec.org/a/eee/deveco/v84y2007i1p76-103.html Read More