Yet a quick glance back through history reveals the importance of megaprojects for health – the Romans built aqueducts to provide clean water and drained the marshes to get rid of malaria, while the industrializing cities of Europe and North America built massive drainage and sewer systems as well as drinking water systems to combat water-borne infectious diseases.
Building healthy cities
The concept of health – as defined by the World Health Organization (WHO) – encompasses much more than access to hospitals and healthcare facilities. “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity,” the WHO notes. And, clearly, the built environment plays a critical role in determining the health of a city.
“The concept of healthy cities is not new; even the ancient Greeks, Romans and Egyptians understood the relationship between the built environment and health of the population,” noted Dr. Trevor Hancock, a Professor and Senior Scholar at the School of Public Health and Social Policy at the University of Victoria in Canada’s British Columbia. “Today, the idea of a healthy city focuses on creating a process that engages all of the different stakeholders – municipal government, the private sector, community sector, faith sector and so on – to develop a shared purpose and focus on creating a healthier environment for citizens.”
Research shows that part of the challenge relates to the ability of a population to lead more active and healthy lives. According to a report conducted for the Heart and Stroke Foundation of Canada (unpublished), “the design of the physical environment in which we live, work and play results in a choice set” for the local population.
Hard infrastructure influences health outcomes
Civic infrastructure also plays a massive role in the health of a city. Transportation options, access to clean water, efficiency of sewer systems and waste treatment plants and the location and type of power generation facilities all influence the health of a local population. So to do the design and location of development projects such as residential and commercial developments, shopping malls, sports complexes and parks.
“One of the biggest challenges facing the movement towards more healthy cities is that the direct link between infrastructure megaprojects and specific health outcomes is not always immediately apparent,” noted Dr. Hancock. “We tend to have a fairly intuitive understanding of the relationship between health and individual assets such as parks, sewage systems and hospitals, but when it comes to items such as roads, information technology and educational facilities, the cost-benefit link is much harder to quantify.”
Good health governance
Given that the health of a population is widely considered to have a direct impact on economic growth, productivity, security and – in many cases – government expenditure, it seems clear that infrastructure planners, developers and investors must start to take a lead role in helping governments and civic leaders create more healthy cities.
“Governance of the city is also a key challenge in encouraging the development of a healthier city,” noted Dr. Hancock. “Public sector leaders must start thinking about how they can govern a city in such a way to maximize the health of the population.” This will require all infrastructure participants and government planners to take a long, hard look at the role that their projects play in the context of a city’s health and, going forward, start to consider the longer-term impacts of proposed megaprojects in terms of their impact on human health and safety. For example, at an October 2012 conference on integrated planning that Dr. Hancock keynoted and supported for the North-West Metropolitan Region of Melbourne, more than 200 participants from 14 local municipalities, 10 state government departments and other key stakeholders, considered the health impacts of four priority issues: housing, transportation, education and employment.
“Megaproject development is not just about engineering or the physical environment,” noted Dr. Hancock. “In cities, you are also designing and putting in place soft infrastructure such as human and social services, education and healthcare, and the soft and hard infrastructure implications must be viewed together within the context of urban governance and the needs and benefits for the local population and key stakeholders.”
Enhancing resilience to enhance health
The drive towards healthier cities also incorporates the need for greater resilience in the face of mega-events such as natural disasters, security threats, and political and economic upheaval. In many high-impact zones, some progress has been made: flood levies in New Orleans, tsunami warning systems in South East Asia, and stronger building codes in earthquake zones in the US and Asia have all been created or extended over the past decade.
“In many cities, the poorest people tend to live in the areas of highest risk, either in floodplains or on the sides of precarious hills,” noted Dr. Hancock. “A major aspect of creating healthy cities relates to either protecting those people with more resilient infrastructure or – better yet – finding ways to move them out of harm’s way.”
Dr. Hancock notes that while incorporating health considerations into the development of infrastructure may require more work, the benefits are significant. “Most of these things are not hugely expensive and the benefits – both economic and social – to the community as a whole are clearly well worth the investment of time and resources. The bottom line is that infrastructure must be seen as a vehicle to support not just economic growth and societal benefits, but also the health of the local population.”
By Joel Finlay, KPMG in Canada