The breakthrough of life expectancy the most commen measure of health is the

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1 Simon Simonsen Lecture Working paper 2010 work in progress Urban Health and the case of the segregation trend of Los Angeles city Center for Urban Health, Metropolitan UC & Roskilde University Thanks to Department of Community Health Sciences, School of Public Health, UCLA - University of California, Los Angeles, for hosting me. Urban health The breakthrough of life expectancy the most commen measure of health is the consequence of better hygiene, better nutrition, better production, better treatment and building better citys. Urban health is complex because the solutions to health challenges in cities do not lie with the health sector alone but with decisions made by others: in local government, education, urban planners, engineers and those who determine physical infrastructure and access to social and health services. Its also violence and security, transportation and injuries, housing and infrastructure, neighborhoods and the urban environment, reproductive and maternal child health, the social determinants of health, substance use and homeless populations to mention af few. The geographic and physical definition is a rather limited understanding and we expand this understanding with a focus on the dynamics of the city that is 1

2 social and cultural constructed. (p.6-7 Freudenberg N, Galea S & Vlahov D A framework for the Study of Urban Health pp.3-19 in Freudenberg N, Galea S & Vlahov D: Cities and the Health of the public Vanderbilt University Press.) Urban health is about human life and health in the city. Urbanization, modernization and individualization affects human health. The concept of Urban Health used here stresses that urban human face both obstacles and resources in relation to health on the basis of ethnicity, socioeconomic status, age, sexuality, disability, citizenship, family status, religion, etc. The city provides a complex interaction between the individual, its social communities, natural environments and structural and political conditions (Visionspapir for Center for Urban Sundhed. Professionshøjskolen Metropol 2009). The concept of Urban Health has the premise that health and health promotion takes place in a context and that the city's conditions and problems play a special role for individuals, groups and peoples health, health behavior, health risk perceptions and experiences in everyday life. It also stresses the improvement of the health status of underserved communities by providing affordable, comprehensive, and high quality primary and specialty medical care and by assuring the performance and advancement of innovative best practices. In the litterature on there is a focus on the city as often unhealthy place to live, characterized by heavy traffic, pollution, noise, violence and social isolation. But this is only one side of the city. The city is also full of culture, sports, politics and lots of ressources. 2

3 The WHO Zagreb Declaration for Healthy Cities puts this vison into three principles: 1. Creating caring and supportive environments. A healthy city is a city for all its citizens: inclusive, supportive, sensitive and responsive to their diverse needs and expectations. 2. Healthy living. A healthy city provides conditions and opportunities that encourage, enable and support healthy lifestyles for people of all social groups and ages. 3. Healthy urban environment and design. A healthy city offers a physical and built environment that encourages, enables and supports health, recreation and well-being, safety, social interaction, accessibility and mobility, a sense of pride and cultural identity and is responsive to the needs of all its citizens. (WHO. Zagreb Declaration for Healthy Cities. World Health Organization 2009 p.5) Urban planning can promote healthy behaviour and safety through investment in active transport, designing areas to promote physical activity and passing regulatory controls on tobacco and food safety. Improving urban living conditions in the areas of housing, water and sanitation will go a long way to avoid health risks. Building green, inclusive cities that are accessible and age-friendly benefits all urban residents and their health. Los Angeles LA is the biggest metropol in California and California is what America is for the world: here are born cultural, technological, economic and political trends that are moving in our direction, thrown away with the force of dreams. The privileges and 3

4 problems of LA is what more and more cities around the world will have to contend with in the future. The city is a five-county metropolitan region, incorporating the counties of Los Angeles, Orange, Riverside, San Bernardino, and Ventura. It comprises 177 cities. The United States Census Bureau has designated the five county area also known as Greater Los Angeles Arearegion as a combined statistical area, with a July 1, 2006 population estimate of 17,776,000. (Combined Statistical Area Population Estimates File for Internet. US Census Bureau. 2006) The city has its Hollywood and its beach cities with sun, sand, and surf, and its foothillscitys like the privileged enclaves of Bel Air, Beverly Hills, etc. where the financial and high income people is. With its unimproved wilderness and an air of deeply buried privacy. It has also like other cities endlessly gridded with streets and low suburbian houses. It has a lack of a big traditional center. The City Hall is located here and also some cultural institutions and sports venues. Downtown L.A. has experienced several building booms since And downtown L.A. now even looks like a conventional downtown: a cluster of high-rise office towers, some starchitect-designed civic and cultural buildings, sports venues, top restaurants, and burgeoning residential neighborhoods. But its not big enogh. And despite many years of trying to build a strong downtown it never succeded. Trying to revive the city originally intended center, so it actually becomes a center for the entire city. Is an attempt, one also has 4

5 unsuccessfully made several times over the past 50 years. LA is in some sense an urban chaos, whose development it is impossible to manage and plan. The case of segregation in Downtown: Skid Row Skid Row is the designation for the area of Los Angeles' downtown, where more than 1000 homeless people lives within a small geographical area on a few streets. A proces of urban sprawling has taken place in LA, meaning the spreading outwards of a city and its suburbs to its outskirts to low-density, auto-dependent development on rural land, high segregation of uses (e.g. stores and residential), and various design features that encourage car dependency. The area is mostly offices and less apartments and middleclass has been fleeing the apartments. Disadvantages includes a decline in facilities e.g.: cultural and a segregation into work areas and living ares. (Coutts A, Kawachi I. The Urban Social Enviroment and Its Effects on Health pp in Freudenberg N, Galea S & Vlahov D: Cities and the Health of the public Vanderbilt University Press.) The homeless people come from all over the city, attracted by the area's church missions and because they do not have anywhere else to go. Garbage floating in the streets, and many of the predominantly black outcasts must live in tents on the sidewalk cement when there is bed space in area shelters. The homeless under a mile from Los Angeles' Broadway and next to the skyscrapers and office towers. Cities experience increased rates of noncommunicable disease, injuries, and 5

6 alcohol and substance abuse, with the poor typically exposed to the worst environments. Its frequent that central urban environments have a greater concentration of homeless but the problem in LA is massive. Their base is the church missions that gives them food and a place to sleep. Its not possible to make a coordinated effort throughout Los Angeles, which could alleviate the problem. The case of privatizing the urban space and the Gated communities psychotic forms of territorial possession Signs like: No access for pedestrians is to be found severel places in the city. Especially many of rich neighborhoods is privatized in that way. So inn practice it is only possible to move into the area if you have a car. One thin is signs, but often there are no sidewalks. The pedestriens are possible violaters when they walk around in the night. Even more significant is the privatization of urban space that takes place in the socalled gated communities or fenced communities. Iron Gates and walls keeps the public away from these areas. Private guards will check and record all motorists who have a purpose behind the wall and pedestrian are banned. Some of these fenced residential areas consists of a few houses, while others are larger and contain everything that is necessary for the residents only have to leave the area when they go to work. The autonomous and mostly white-dominated areas are administered by owner associations and according to common regulations. Gated communities of closed neighborhoods find their motivations in that fact that the suburbs no longer a 6

7 guarantor to escape big city crime. Conclusion: Participation and empowerment The solutions to health challenges in cities do not lie with the health sector alone but with decisions made by others: in local government, education, urban planners, engineers and those who determine physical infrastructure and access to social and health services. The individual and collective right of Los angeles citizens to participate in decision-making that affects their urban life is weak. Los Angeles has grown beyond its own borders but politics has not followed. It now comprises 177 cities each city with its own rule. No higher authority can plan or implement major changes in either infrastructure or social policy. Planning takes place, but within the fragments of the city. Its a postmodern fact where peripheral urban communities predominate over an evacuated city center. Advantages of urban sprawl includes more single family residences on larger lots, lower land prices, less experience of noise and pollution. Suburban areas tend to have lower crime and higher-quality schools. LA has growth of areas on the fringes (Suburbanization). It is one of the many causes of the increase in urban sprawl. Many residents of metropolitan areas no longer live and work within the central urban area. Living in a satellite community or suburb and commute to work via automobile or mass transit. Others have taken advantage of technological advances to work from their homes, and chose to do so in an environment they consider more pleasant than 7

8 the innner city. These proceses means a lack of a commen political projet or ideal and norms. Not only are the poor and marginalized is lacking influence, but the entire population, is lacking power to control their everyday lifes collectively. There is need to mainstream and address the social disparities in the provision of polittical processes. Where people live affects their health and chances of leading flourishing lives. Communities and neighbourhoods that ensure access to basic goods, that are socially cohesive, that are designed to promote good physical and psychological wellbeing, and that are protective of the natural environment are essential for health equity. Closing the gap in a generation, WHO headquarters,