10.5. LIVING AND WORKING ENVIRONMENT
10.5.1. Houses, schools, transports, recreational areas and other main
The history of shelter, recognized as one of the most
fundamental human needs (add Istanbul Habitat Conference reference), dates back
to the beginning of mankind and may be best illustrated by the stereotype of
the cave during the Stone Age. With the increasing ability to change and modify
the environment, humans started to actively create and shape their shelter and,
during the Neolithic revolution, began to settle down in more stable and
functional shelters. Since this time, the development and growth of settlements
has played a key role in the development of European peoples and has resulted
in a trend that has never stopped and today is known as “urbanization”. Urbanization
was initiated by the industrial revolution, which created large-scale migration
from rural to urban areas and led to the development of large cities. The
resulting urban development is a departure from the traditional human
settlement and its impact on health is not entirely understood (Lawrence,
2000). Nevertheless, urbanization is linked with a number of assets from both
public health and sustainability perspectives, as large-scale settlements open
the door to a variety of technological advances and services that are
supportive to health (e.g. better access to water supply and sanitation
systems; public transport networks; distant heating technologies; health
services; etc.). However, human settlement implies also environmental problems
linked to transport (noise and air pollutants), household and industrial
emissions and urban pests. Sealed land and contaminants are other implications.
Green spaces are positive for health and wellbeing. The urban sprawl has many
drawbacks encouraging suburban expansion and increases private local car
transport and obesity. Housing can lead to the use of hazardous construction
material and unhealthy indoor air quality, also influenced by outdoor pollution
determinants, energy saving and energy use in air conditioning. The impact of
crowding on sanitation, hygiene and infectious diseases is probably very
important, but difficult to quantify. Within the thematic framework of human
settlements, a variety of policy tools has been developed.
The data in this chapter is mostly taken from scientific
publications and reports produced by international Institutions working on
settlement issues (e.g. UNHabitat, EU, ROSTAT, WHO, UNECE, etc.). As the issue
of human settlements covers a variety of environmental as well as social
determinants, the information sources naturally tend to be diverse. Within the
text, all relevant sources will be identified.
One major challenge when describing the health impacts of
human settlements is the availability of comprehensive data. Human settlements
are a melting pot of uncounted health risk factors and it is very difficult to
integrate them into one general assessment. Therefore, generalized assessments
can only summarize the more focused evaluation of individual conditions, such
as air quality, traffic, safety, sanitation, etc. This problem becomes even
more critical when looking for data on the variations within a city. Various
projects have shown that both health as well as environmental and housing conditions
can vary extremely within a given city, and these variations can significantly
exceed those that are found when comparing average and generalized data from
cities or countries. Therefore, separate from the available data, we should
bear in mind that in any given human settlement, there is an unknown part of
the population living in socially and environmentally deprived conditions which
cannot be captured by the available data.
description and analysis
As human settlements are meant to provide some kind of
privacy and protection from outside events to the dwellers, any kind of human
settlement can be looked at from two perspectives: the inside environment and
the outside environment. This is especially true for individual homes or
dwellings, which are part of more or less attractive neighbourhood
environments, but also for settlement areas such as villages or cities, which
are located within more or less advantaged natural landscapes. Both dimensions
are directly linked to the impact of human settlements, with the first being
more focused on the individual settlement (home or dwelling) and the second
being more related to the settlement area.
In the following section, the human settlement as an
overall living setting is discussed first, before more details are given on
specific settings of human settlements, such as housing, schools, correctional
facilities and recreational facilities.
Looking at human settlements, many
problems that often are defined as “urban problems” come into consideration.
Nevertheless, it needs to be stated that in many cases the environmental
determinants of urban and rural settlements may be rather
similar in general terms, while the detailed mechanisms of exposure may be
different. For example, there are air quality problems and noise exposure in
many rural places but tend to be looked at as typical problems for large human
In all settlements, there is a list of potentially
health-relevant conditions that affect the residents (Macintyre et al, 2000).
This very much depends on the settlement, its size and environmental conditions
and whether these conditions are acceptable from a public health perspective.
Also, these conditions may change strongly from one neighbourhood to the next
(WHO Commission on Social Determinants of Health, 2007). Below, a list of major
environmental determinants of human settlement areas is presented and
Although residential buildings are supposed to be safe
shelters and refuges, there is no built environmental structure for habitation
that by itself is free of risks. Within the private home, the problem of
pollution is one of the most important determinants for health impacts. There
are many sources of pollution within the indoor environment, in some cases even
desired (for example, open fireplaces). Indoor physical pollution, associated
for instance with particular construction materials and furniture and poor
ventilation as well as with other factors such as crowding, indoor pests and
moulds, unsafe building conditions and inadequate sanitation/ hygiene
equipment, may have important impacts on the health of specific population
groups. For example, large air conditioning and water cooling plants not
complying with EWGLI guidelines are sources of risk for severe pneumonia in
humans (legionellosis) due to the inhalation of droplets of water
contaminated with Legionella Pneumophila (see chapter 6).
Construction materials and products
There are a variety of construction materials and products
that may result in potential health effects (Federal Environment Agency, 2007).
For radon, asbestos and lead, the health effects have been identified many
years ago but are still present in many European dwellings. Today’s concern is
more related towards volatile organic compounds (carpets, paints, furniture),
particulate matter, PCBs and other chemical elements emitted or contained by
construction materials and products. In most cases, these compounds affect the
indoor air, from which they are inhaled by the residents (European Commission,
et al, 2007).
Heating sources, thermal comfort, dampness
The health impact of hygro-thermal
conditions within a building operates basically through two mechanisms.
First, the combustion of fuels used for
cooking and heating (such as coal, wood, gas) within the building may lead to
the emission of pollutants and gases such as particles, carbon monoxide (CO),
and carcinogenic compounds (Desai et al, 2004). With faulty equipment or lack
of venting, these pollutants can accumulate within the home and trigger severe
Second, the indoor temperatures by
themselves can directly affect health if they fall under or exceed specific
thresholds (Vandentorren et al, 2007; Wilkinson P. et al, 2007). Such extreme
indoor temperatures can occur during heat waves and cold spells and mostly
affect poor households and low-quality buildings with inadequate heating
systems and poor insulation. Moreover, indoor temperatures can affect the
degree of dampness and humidity which may lead to mould growth. However, there
is very little data on the average indoor temperatures in European homes
(Wright et al, 2005).
Indoor pests and moulds
Mould is recognized as one of the major allergens in the
home environment, and can lead to allergic reactions and respiratory
infections. In particular, moulds have been identified as a factor in the
origin and exacerbation of asthma attacks (Richardson et al, 2005) and are
considered dangerous for children and sensitive / allergic population groups
(Seltzer / Fedoruk 2007). Within Europe, the exposure to damp and mould in the
home varies strongly between countries, ranging from above 30% (Portugal) to
under 5% (Finland), with an average of 16% (2001 data, EUROSTAT WHO 2007).
For many domestic pests (such as mites, cockroaches, ants,
bugs, lice or fleas), the relatively warm and humid conditions within buildings
provide a good habitat. While the health impact of hygiene pests such as ants
and cockroaches are mostly related to the intake of contaminated food (Milstead et al, 2006), other pests such as
lice and fleas bite through human skin and can cause allergic reactions,
inflammations or infections.
The behaviour of the residents is a key factor for most of
the common health threats within the home (Federal Office for Radiation
Protection et al, 2005). First, the behaviour of residents does actively lead
to the initiation of exposures: cooking and showering increases the relative
humidity, the use of cleaning detergents brings chemical products into the
home, and dust cleaning may actually make settled dust volatile again. In
addition, smoking or keeping pets in the home releases a number of pollutants
Second, the behaviour of residents can enforce, prolong or
increase the exposure to indoor pollutants and risk factors. As most of the
health-relevant exposures of residential behaviour are related to air
pollution, it is especially the air exchange rate that plays a role in
controlling indoor conditions. Inadequate ventilation may therefore lead to
increasing humidity and pollution as it accumulates indoor emissions (Emenius, 1998).
Finally, there is the contribution of outdoor pollutants
to be recognized. Many outdoor sources of pollution enter into the building,
mostly through open windows but – in the case of noise – also through the
building structure. The main outdoor determinants that can affect the indoor
conditions are traffic-related (air pollutants, noise), or stem from industrial
activities or neighbourhood activities (playing children, bars, lawn-mowing
etc.). Using data from the European EXPOLIS study, it is estimated that in
homes without special indoor sources (such as smoking, open fire etc.), around 60-70%
of indoor particulates may be due to infiltration from outdoor sources
Next to the health risks posed by environmental pollution,
other threats can be related to the structure, size and layout of the building,
its built features and its amenities.
Unsafe building conditions
There are two factors relevant to home accidents – human
behaviour and dwelling design / maintenance. The main dwelling design features
that may increase the risk of an accident are for example inadequate design of
staircases and doors, low window sills, slippery floor material, sharp
furniture edges or inadequate lighting. Such risk factors are of special
concern for children (European Child Safety Alliance, 2006).
Unintentional home injuries are a serious public
health problem. Each year in the EU there are around 20 million home and
leisure injuries requiring medical attention. About 2 million of these lead to
hospital admissions, and around 83 000 result in death (KFV, 2007). Within EU
countries, it is estimated that roughly half of these home and leisure
accidents occurred in or around the home. Data from several countries show that
often, the number of home injuries can exceed the number of road traffic
injuries (Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit,
2008) (see chapter 6 for fatal and non-fatal home and leisure accidents per
year in selected EU countries).
Floor space and density
A crowded household is defined as one where the number of
people living in the dwelling exceeds the capacity to provide adequate shelter
and services to the household members. However, there is no agreed
international definition or standard for “crowding”.
The potential consequences of insufficient living space on
residential health must be split into two effect dimensions: the physical
effects of high population density (mostly related to infectious diseases) and
the psychological effects of crowding. Multi-occupation dwellings and flats,
particularly high rise flats, are the housing risk factors most strongly
associated to poor mental health (Evans, 2003).
Within the EU, high density levels that may lead to
crowding are identified for below 10 percent (The Netherlands) to above 25%
(Portugal, Greece) of the national populations (Eurostat, various years).
However, the burden of this housing problem is mostly carried by large families
and poor households and is not visible in the national averages, which mainly
range between 2 and 3 residents per dwelling (National Board of Housing, Building
and Planning of Sweden, 2004).
Sanitation / hygiene equipment
The supply of clean water and the provision of hygiene and
sanitation amenities are key elements for a dwelling. Still, even highly
developed countries know the challenge of contaminated drinking water and water-related
disease outbreaks triggered by biological contamination and bacteria as well as
by chemicals and heavy metals.
Within Europe, the connection of dwellings to public water
supply is above 90% for many countries. However, some countries fall short of
this figure and may provide public water only for 80% or less of their
population (2002 data, EUROSTAT). In addition, it needs to be kept in mind that
connection to water supply is mostly a problem in rural
areas, where the percentage of connected households can be much lower
than in urban areas.
It is estimated that as many as 50 million Europeans
receive water from small or very small supplies (Michaud et al, 2001). There is
a lack of information on the quality of water from these sources, as supplies
that serve less than 50 people or produce less than 10m3/day are not covered by
the EC Drinking-water Directive, unless the water is supplied as part of a
public or commercial activity (European Commission, 1998). Most countries have
very limited information on the number of small supplies and the number of
people served by these supplies. Microbiological contamination of small water
supplies is a problem and can pose a significant health risk that is generally
underestimated. For example, in Finland, food and waterborne outbreaks have
been recorded annually since 1980 by a voluntary reporting system. In 1997, a new monitoring system for waterborne outbreaks was launched and municipal health protection
authorities are now obliged to report all outbreaks of suspected waterborne
diseases to the National Public Health Institute; even the smallest outbreaks,
such as outbreaks related to the use of private well water, are reported. The
new system improved detection rates. While during the voluntary reporting only
zero to four outbreaks were reported annually, with the single exception of
seven outbreaks in one year, from 1998 to 2005 between four and ten waterborne
outbreaks were observed each year. A total of 52 outbreaks (which resulted in
over 16 700 cases of illness) were recorded over this period. The majority of
the outbreaks occurred in communities with fewer than 500 inhabitants (FFSA,
2006). In the UK, about 1% of the population obtains water from a private water
supply, and despite being subject to the same regulatory standards as public
water supplies, outbreaks of disease are common. Between 1970 and 2000 there
were 25 reported outbreaks of infection associated with private water supplies
in England and Wales. The main pathogen, Campylobacter, was implicated in 52%
of outbreaks (Said et al, 2003).
In many countries there is no national legislation and in
general private well owners are responsible for assessing the quality of the
water. An example of the potential size of the problem is provided by the Czech
Republic, where analyses of water samples from 1700 public and 3300
private wells carried out by the Public Health Services found that water in 70%
of the wells was unsafe to drink (Hulssman, 2005).
Moreover, connection to sewage and sanitation systems is
less common than access to water (WHO / UNICEF Joint Monitoring programme,
The prevalence of homelessness varies across countries.
However, it appears to have increased in Europe since the 1980s, particularly
among young people and women. There is clear evidence of the significantly
poorer health status of homeless people when compared to the general
population, including some communicable diseases. Homeless people tend to have
problems obtaining adequate health care and may experience barriers to access
care, due to discrimination, appointment procedures, and financial constrains.
Conditions requiring uninterrupted treatment such as TB and HIV are often
inadequately controlled and difficult to manage without a stable residence.
Nomadic and semi-nomadic populations such as the Roma (also known as Gypsies)
form another vulnerable and at-risk community for communicable diseases. The
estimated population across the EU is 8-12 million, mainly concentrated in
Central and Eastern Europe. Despite the small number of studies, it is
estimated that the life expectancy of Roma is shorter on average by ten years
than that of the rest of the population and that the child death rate is up to
four timer higher and also that their exposure to certain CDs is higher.
In brief, the indoor dimension of human settlements can be
affected and influenced by the residents to a quite large extent. However,
there are determinants of the outside environment that do impact on the
internal experience of living and that cannot be mitigated or removed by the
individuals. The relevance of the indoor quality and conditions of human
settlements in total, as well as in relation to outdoor and urban conditions, cannot
be assessed in general terms, as it depends to a large extent on very local
circumstances. However, the problems described above can be considered as some
major challenges faced by at least several, and sometimes most or all EU
For children, the school environment is the most important
indoor environment, besides home.
School studies, mainly from North Europe, have shown that
children are affected by poor ventilation, chemical exposures such as formaldehyde,
moulds and bacteria from damp buildings, and furry pet allergens in settled
dust (Daisey et al, 2003; Tranter et al,, 2005). The environmental effects
include asthma and allergic symptoms, sick building syndrome symptoms,
increased airway infections and impaired learning ability (Daisey et al, 2003;
Mendell and Heath, 2005).
There are very few international comparative studies on
the school environment in different parts of the world. One small comparative
EU-funded study in west-Europe found low ventilation rate in most schools, with
typically 2000-3000 ppm carbon dioxide (CO2) levels in classrooms. Moreover,
this study could demonstrate associations between elevated CO2 levels and
elevated levels of particles (PM10) in the classrooms and respiratory health in
pupils (Simoni et al, 2006). Classroom levels of PM10 in school may exceed the
recommended 24-h limit value of 50 microgram/m3.
Swedish intervention studies have shown that the increase
of asthmatic symptoms in pupils was reduced after improving the ventilation in
the classrooms through the installation of new and more efficient ventilation
systems (Smedje and Norbäck, 2000). This point seems to be widely verified also
in non-European contexts: school studies from China and South Korea have demonstrated
that schools in Asia often have inadequate ventilation flow with levels of CO2
ranging from 1000-4000 ppm (Kim et al, 2007; Zhao et al, 2006), microbial
contamination from fungi and bacteria (Zhao et al,, 2008a) and furry pet
allergen contamination from cat and dogs (Kim et al, 2007; Zhao et al, 2006).
Some indications of a protective effect of bacterial components with respect to
respiratory symptoms have been demonstrated (Zhao et al, 2008a).
Besides the indoor sources of air pollution, schools in
larger cities are affected by outdoor air pollution from traffic and industrial
air pollution (Mi et al, 2006; Zhao et al, 2008b). Recently, there has been a
focus on impaired learning in relation to classroom conditions. Experimental
studies have shown that a reduction of classroom temperature from 25 to 20°C increased speed at different tests in 10-12 y old pupils (Wargocki and Wyon 2007a). Moreover,
test performance was increased when the ventilation flow was increased
(Wargocki and Wyon, 2007b). Although the school is the work environment for
teachers and other school personnel, there are less studies on associations
between the school environment and teachers health (Norbäck, 1997). Violence
and accidents in schools as well as burn out reactions among teachers are all a
part of the school environment (Norbäck, 1997).
Moreover, classroom noise can cause physiological and
psychological stress reactions in pupils (Wålinder et al, 2007).
Therefore, there is a clear need to improve the indoor
environment in schools. Classrooms should have frequent cleaning and this
should include floors, textiles, open shelves and other areas above the floor
level. The classroom should be designed to facilitate cleaning. Low emitting
building material should be used when redecorating schools in order to avoid
unnecessary chemical exposure.
Building dampness and indoor mould growth should be
avoided, and the concept of mechanical ventilation in schools should be
introduced. City planning aimied at situating new schools away from roads with
heavy traffic should be considered.
Recreational areas and green spaces
Within human settlements, the provision of places for
leisure, recreation and social activities is as important as the provision of
shops and services. The major benefits of such places have been identified as
(a) social bonding between residents, producing an own identity and building up
social capital and trust, and (b) increased levels of physical
activity within the local population, producing a healthier and less
overweight population (Frumkin 2003; Takano et al, 2002).
The availability of such places in close enough distance
for daily use is a key feature for healthy housing areas and enriches
neighbourhood life. Still, contemporary human settlements often lack public
gathering places and green areas for social and recreational activities. There is evidence that the use of recreational facilities
has a positive effect on health. The effect seems to be twofold, with regular
users showing higher survival rates and better mental health (Konlan et al,
2000; Bohnert and Garber, 2007; Rogers and Zaragoza, 2003). In addition, green
and open spaces can help to reduce noise and air exposure and also have a
compensating effect on the urban heat island in summer time (Elmqvist et al, 2004). Data from the Urban
Audit of EU cities shows that in average, only half (52.4%) of the
participating cities provide urban green areas within walking distance of up to
15 minutes (data based on 66 cities with data on this indicator).
The need for transportation is probably the most typical
characteristic of larger human settlements and it increases with the size of
the settlement area. In public health terms, transport is associated to three
major health determinants: noise, air pollution and modal split as the decisive
factor for physical activity.
Noise is one of the most commonly considered health
determinant in settlement areas. Main sources of noise include road, rail and
air traffic; industries; construction and public works; but also neighbourhood
noise from playgrounds and gardens (WHO 2000). Within Europe, a large part of
the population is exposed to traffic noise levels of 55 dBA, and in most
countries 10% or more suffer from exposure to noise levels of 65 dBA. The
European Commission stated that in the EU, there are an estimated 80 millions
of citizens living with unacceptable noise exposure conditions, while for
another 170 millions, the noise conditions are defined as critical (European
Commission, 1996). City data from the Urban Audit project show that noise
exposure is a key problem especially (but not exclusively) for bigger cities,
where the exposure to increased noise levels often affects more than 20% of the
Figure 10.5.1.1. Proportion of residents exposed to
day-time noise above 55dB(A)
In addition to having cardiovascular effects, excessive
noise is known to affect sleep, mental health, concentration and stress levels
(Stansfeld et al, 2000; Muzet, 2007).
The problem of transport-related air pollution is one of
the most recognized effects of human settlements in public health literature
(WHO, 2005; EEA, 2006b).
Figure 10.5.1.2. Concentrations of
elemental carbon and organic compounds, PM10 and PM2.5 in relation to settlement
Engines and fuel combustion produce a number of air
pollutants such as hydrocarbons, nitrogen oxides, and carbon monoxide and –
depending on the fuel type – particles. Especially the production of
particulate matter has recently been considered as a major threat to health, as
the monitoring of particulate matter in some European cities showed that as
much as 89% of the population is exposed to levels exceeding the WHO guidelines
The modal split represents the breakdown of transport
means that are being used for mobility needs. It usually considers individual
transport by motorized vehicles (cars and motor bikes), public transport (bus
and train) and individual transport without motorized vehicles (walking,
cycling). The modal split indicates to what extent trips in a given human
settlement lead to emissions. However, another indication provided by the modal
split is the number of residents engaging in physical
activity in relation to mobility and transportation (WHO, 2006).
With rising rates of obesity and decreasing levels of physical
activity, physically active transport modes are one of the main
strategies to get people active (Shetland Islands Council, 2006). Still, the success of
these strategies is restricted when settlements do not provide adequate
opportunities for cycling and walking and instead favour car transportation. As
forecasts predict a rise in motorized transport, it will be a key challenge for
many cities to provide adequate infrastructures for walking and cycling in
order to mitigate this trend. However, especially in bigger and densely
populated cities, it is possible to reach high levels of active transport
behaviour: in Berlin, roughly one third of all trips is made using
non-motorized traffic (Senatsverwaltung für Stadtentwicklung, 2004).
Household and industrial emissions and waste
In addition to air pollution by transport, human
settlements suffer from exposure to industrial activities and fuel combustion
in households. These emissions can affect large parts of the settlement areas
as they are spread by wind and may – depending on weather conditions – pollute
the streets and open spaces. Reducing particulate air pollution from solid fuel
use - for example - reduces the number of respiratory and cardiovascular
deaths, as the example of the ban on coal burning in Dublin shows: after the
1990 ban on coal sales and coal burning, black smoke concentrations declined by
70%. In just one year after the ban, deaths from respiratory causes decreased
by 15.5% and deaths from cardiovascular causes decreased by 10.3% (Clancy et
An additional problem is the immense amount of waste in
large settlements, which may cause health-relevant problems when not collected
regularly. Also, local incineration plants may add to the urban air pollution
Outdoor urban pests
As within the building, the human settlement areas provide
ideal opportunities for a range of species that live in the city but need to be
prevented (Brenner et al, 2003). Main concerns regard pigeons, which leave
their droppings on public places and buildings, and rodents such as rats and
mice that live in public parks and in the sewage system. In both cases, hygiene
concerns are predominant while direct health effects are rare. On the other
side, cockroaches can trigger severe allergies and are found in a variety of
housing stocks all over the world (Miller / Meek 2004).
Future scenarios of urban sprawl as well as climate
changes may add to this concern, as new pests may invade the city or the city
may spread to former rural and forested areas, thus increase the number of tick
infections (encephalitis etc.) and lyme disease.
Sealed-off land and contamination
As settlement areas are spreading, also the overall
surface of sealed-off areas is increasing. However, in most cities, the
expansion of the built-up areas increases in a stronger mannner than the actual
resident number of the cities (European Environment Agency, 2006a).
Streets, buildings, parking lots and other public
infrastructure seal off the ground and reduce the uptake of surface water and
rain, which needs to be channelled through waste water channels. Various cities
have already seen the limitation of these systems in extreme climate
situations, which can quickly lead to flooding as the water flow cannot be
managed anymore (Eisenreich et al, 2005).
The industrial heritage of many European cities gives rise
to another health threat that is to be considered in conversion projects which
turn industrial or military sites into urban quarters or service areas: many of
these areas are affected by contaminated soil (brownfields) in which a number
of chemicals or heavy metals may be found (Bagaeen, 2006).
tools and policies
It is evident that human settlements still have a long way
to go to provide their residents with adequate and healthy living conditions,
but human settlements also offer unique and unprecedented chances as public
transport, efficient energy solutions, and reduced space consumption / urban
sprawl. Still, noise, air quality and adequate housing conditions remain a
challenge for almost all human settlements. However, human settlements will
always be a diverse mix of local neighbourhoods with specific features. This
means that city-level data is merely an indicator to monitor the general trends
of change within the city, but cannot be representative for the assessment of
the human settlement quality and the related health impacts as these are
related to specific individual circumstances. The following data from EUROSTAT
illustrates this problem for national data and shows what variation in the
quality of living conditions can occur for different socio-economic groups.
Housing problems by household income group in EU15
However, taking the example of crowding, the following
chart continues the argument above by showing not only the impact of the income
category, but especially the impact of specific social circumstances. The
example suggests that the problem of crowding is much more affected by the household
situation than by income, and thereby shows that even if we analyse data by
income or social group we do not get an adequate insight. Therefore, given the
complexity of relevant factors, it must be kept in mind that the average data
for countries or cities provided by this chapter is a very weak indication of
the actual condition of human settlements, with a large amount of citizens
being much more or much less affected than the indicated average.
Crowding by income and household situation, EU 15, 1996 and 2001
In brief, it can be stated that within human settlements
there is a variety of health-relevant conditions which depend mostly on local
conditions and relate only little to the overall quality of the human
settlement as such.
Within the thematic framework of human settlements, a
variety of policy tools has been developed by a number of actors and agencies.
The by far largest number of these addresses “urban health issues”, focusing on
larger human settlements. There is a striking lack of policy tools in relation
to smaller and rural human settlements.
Most policy tools have been developed for (a) benchmarking
and comparison of urban conditions and (b) for the improvement of urban
conditions, focusing on specific topics (transport, etc.). A list of policy
tools is given here below:
The Urban Audit collects information on the living
conditions in 258 large and medium-sized cities within the European Union and
the candidate countries with the main goal to allow mayors and other locally
elected officials to compare their city directly to other cities in Europe. The
data covers a variety of topics such as Demography, Social Aspects, Economic
Aspects, Civic Involvement, Training and Education, Environment, Travel and
Transport, Information Society and Culture and Recreation.
THE PEP - Transport, Health and Environment Pan European
The Transport, Health and Environment Pan European
Programme (THE PEP) was set up to address key challenges to achieve more
sustainable transport patterns and a closer integration of environmental and
health concerns into transport policies. The priority areas are the integration
of environmental and health aspects into urban transport and demand side
management. The PEP coordinates action in these key areas and provides good
WHO - Health city program
The WHO Healthy Cities Network is based on the scientific
awareness that good urban spatial planning can shape
people’s health and that the policy decisions can have a positive or a negative
impact on the physical and mental health and well-being of citizens. To achieve
this goal it is necessary to put health considerations at the heart of all
urban planning and generate political commitment and resources.
With reference to their key advocacy and leadership role,
the WHO commits to the following objectives and priority actions:
1. Raising local awareness
and creating a common understanding of the concept of healthy urban planning
and all that is implied as a key for changing practices;
2. Gaining local practical
experience from the application of healthy urban planning principles and
approaches in the following five priority areas: Transport and mobility,
Healthy Ageing and accessibility, Urban design and physical
activity, Neighbourhood planning and Long term strategic and master
3. Mainstreaming healthy
urban planning through appropriate and feasible institutional and technical
Various city case studies, evidence reports and working
tools can be found on the who website.
LHHAP - Local Housing and Health Action Plans
Together with the Ministry of Health of Portugal, the WHO
housing and health programme has produced a tool box for the development of
Local Housing and Health Action Plans for use and implementation by local
authorities. In terms of public health, the realization of LHHAP will provide
the participating municipalities with elements for developing a preventative
strategy against housing-related health effects and injuries, and mitigate
social and health inequities within the local population.
Urban matrix, knowledge networks
Urban matrix, knowledge networks etc. are providers of
valid knowledge and good practice examples to support guiding leaders in
business, academia and government. They compile and edit scientific awareness
and turn the results into simple, specific recommendations, which allow
providers and end-users with an accelerated processing of
the required information.
Urban health indicators
Based on the awareness that the health needs of urban
dwellers and the ability to monitor urban health will become a high priority,
the EU Public Health Programme work plan 2005 identified the development of an
urban health indicator system as an essential part of a comprehensive and
integrated EU health information and knowledge system. Based on previous works
such as ECHI, ISARE, ECHIM and other projects, an international group has
started work on the development of a system of urban health indicators.
The United Nations Human Settlements Programme,
UN-HABITAT, is the United Nations agency for human settlements. It is mandated
by the UN General Assembly to promote socially and environmentally sustainable
towns and cities in order to provide adequate shelter for all. It carries
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