There is a growing understanding of the role that “place” plays in influencing individuals’ and communities’ levels of exposure to health risks, as well as their opportunities for being healthy. The problems of unemployment and crime are acute and completely enmeshed with health, housing and education. There are good reasons why an area-based approach to tackling health inequalities is an effective regenerating tool.
Poor people have higher exposure to biophysical hazards such as environmental pollution, traffic volume and rates of road accidents. Poor communities have deficient access to public services, including primary healthcare, public transportation, retail and recreation facilities. The research evidence suggests that unemployment, or employment in jobs with poor working conditions, is generally damaging to health. Changes in employment status have been shown to be linked to changes in health. Poor housing is associated with a range of physical and mental health conditions. If we offer access to decent housing, employment, facilities and public transportation as well as access to education about health issues and intergenerational support centres (See explanation in next section), will we be able to decrease the vulnerability of residents of the new city? At communiTgrow our model of jobs linked to housing and access to healthcare programmes will enable the health problems to be linked to support networks and health programmes, not just for the advantaged but equitably for all. Our approach reflects an ecological model of health promotion which understands health to be determined by a complex interplay of environmental, organisational and personal factors, largely determined outside of health services.
The current healthcare policy environment includes weak or non-existing mechanisms to allow people to engage meaningfully in decisions about health programmes. Therefore residents should be encouraged to not only utilise local health services, but to design the programmes and participate in decisions regarding healthcare. At communiTgrow, our approach is to empower residents to be able to take part in these kinds of decisions, through skills upgrading, life-skills training and a participative governance framework that allows for real choice. The healthcare system will be community focused, while servicing the greater area as well. The scheme will also find ways to accommodate patients from surrounding areas and may link to the national health insurance system, should it become a reality in South Africa as has recently been proposed.
In the World Health Organisation (WHO) Primary Healthcare Strategy made the statement that health improvements were not merely the result of biomedical and technological advances; a focus on the poor and community participation in healthcare also contributed to positive health outcomes. Often the settings in which people are located contribute to ill health (e.g. a lack of sanitation and proper shelter). Although we recognise that there is no all-encompassing solution that can be provided for healthcare at a communiTgrow level, we hope to eliminate some of the location based factors that create health problems. The communiTgrow approach is to support existing initiatives where they sustain the philosophy of regenerative city-making, as well as provide additional programmes where there are gaps in approach. The Ottawa Charter states that “health is created and lived by people within the settings of their everyday lives: where they live, work, play and love.” It is also worth mentioning that the causes of ill-health generally are often closely related to the lack of services such as potable water provision, sewage and sanitation and waste disposal.
Online edition & free download of communiTgrow’s book “2 BILLION STRONG” available here.