EUGLOREH project
THE STATUS OF HEALTH IN THE EUROPEAN UNION:
TOWARDS A HEALTHIER EUROPE

FULL REPORT

PART I - THE CONTEXT FOR HEALTH

2. THE CHANGING CONTEXT FOR HEALTH IN THE EUROPEAN UNION

2.7. Urbanisation

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2.7. Urbanisation


In 2008, for the first time in history, more than half of the human population, an estimated number of 3.3 billion people, will be living in urban areas. By 2030, this figure is expected to increase to almost 5 billion (UNFPA, 2007). In most countries, the trend towards urbanisation is unbroken and most scenarios suggest a steady rise of urban populations. Within the EU, urbanisation is already on a very high level, ranging from 49% (Slovenia) to 97% (Belgium) and showing a diverse picture. However, EU15 countries tend to be more urbanised than the NMS or Turkey (EUROSTAT, 2003). EURIPA, the European Rural and Isolated Practitioners Association, estimates that about 20% of the European population is living in rural settlements. The countries where a significant proportion of people still lives in the countryside are Slovenia, Slovakia, Latvia, Finland, Ireland and Greece (WHO HFA Database).

The divergence between urban and rural settlements introduces a variety of mechanisms that influence health status and mortality of the population, such as the provision of health care. Key dimensions of the variation between urban and rural settlements are for example the demographic structure of populations, their educational level and their lifestyles, their occupational backgrounds, and their exposure to environmental conditions. As all of these issue may have direct or indirect effects on health, it is up to the health system to provide adequate and accessible services, matching the respective needs of these populations. Specifically, the provision of primary healthcare is considered one of the major characteristics of the urban-rural differences, as in many countries there is a trend for rural areas to be generally underserved for what concerns healthcare services (Marrone, 2007; Arcury et al, 2005).

 

Human settlements have always been changing and developing. Still, there are several future challenges which will force human settlements of today to adapt and prepare for. Some of these major challenges are described below.

 

Megacities. The start of the twenty-first century is marked by a new reality which sees the metropolis take centre stage. Cities and megacities are indeed the centre of public debate, cultural speculation and media attention as not only do they affect the lives of millions of new inhabitants but also the health and sustainability of the entire : they are responsible for 75% of the total amount of CO2 emissions. But the growing economic, social and cultural significance of cities is making them assume more importance as they become meeting points for creativity, economic growth and social conflict. In 1950, just 83 cities had a population of more than one million; in 2000 they had increased to 411 (18 of which had more than 10 million inhabitants). In 2015 these cities will further increase to a population of 23 million, occupying 25% of the earth’s surface. And then they will enlarge and link up with each other, in some cases forming a single entity. This phenomenon is evident when observing earth from space: the area comprising the cities of Boston, Philadelphia, New York and Washington seems to be a single city; in Europe, South-East England has the same effect. Sao Paulo in Brazil has approximately 26 million inhabitants, yet the geographical proximity of Rio de Janeiro with its 19 million inhabitants would seem to suggest a single immense megacity in the making on the Atlantic coastline.

 

Several large-scale exhibitions have recently dealt with the theme of cities and their change, imagining and predicting possible future developments, analyzing opportunities for growth, coming to terms with compromises to be made, and considering the role of determining forces in the development of contemporary cities. These events have provided important opportunities to reflect on and for discussing our metropolitan future.

 

Global Cities, organised in collaboration with the Venice Biennale Foundation, was installed in the Turbine Hall of London’s Tate Modern and included the works of internationally famous architects and artists. The exhibition analysed the changes that have taken place in ten large cities (namely: Cairo, Istanbul, Johannesburg, London, Los Angeles, Mexico City, Mumbai, Sao Paulo, Shanghai and Tokyo) and explored the most pressing issues these must face including migration, mobility, integration and sustainable growth. The five main themes explored - speed, size, density, diversity and form – were drawn from a socio-economic and geographic study conducted by researchers from the London School of Economics.

 

The large-scale monographic exhibition of the work of Renzo Piano, organised as part of the Milan Triennale, highlighted the transformations that have marked the transition from the twentieth-century industrial city to the twenty-first-century post-industrial city celebrated through original drawings, plans and models documenting the production of more than 40 years of activity of the Italian architect, Renzo Piano. His projects can be thought of as an attempt to return to – and revive - the humanistic tradition of the European city, reworking the principles of settlement in the context of contemporary culture. Piano’s city promotes the idea of multipurpose spaces which convey the restlessness of contemporary times through the celebration of complexity, transparency and permeability. In Milan – as in New York, Genoa or Rometraces of the past were not removed but reintegrated, using the ideal of lightness as a starting point for design.

 

Suburbanization/density/sprawl. Human settlements have seen periods of outward as well as inward development. In the 80s and 90s, many large European cities experienced an extreme outward development which has been called suburbanization and has lead to an extension of the settlement area beyond its administrative borders, creating the so-calledcity regions”. Many businesses and services followed and moved to greenfield developments outside the city, where taxes and square meter prices were much lower. However, in recent years, there is a trend back to the city, with new residential areas being established in central areas formerly used for industries. Still, it will be a great task for the administrators of these cities to provide adequate living conditions to the new urban settlers and keep them in the city.

 

Eco-compatible citiesexperiments and buildings. One of the first experiments in eco-compatible cities comes from Stockholm, in Sweden. The new Hammarby Sjostad zone, 10,000 flats for 25,000 inhabitants, is an example of how the modern requirements of individuals can be combined with ecology. After a large-scale environmental reclamation of the ex docks and industrial area, the companies involved in the project created infrastructures and buildings. Today, the citizens of this small jewel created on water live in houses with green roofs that look like gardens, travel on a light metropolitan railway created from advanced materials, and can count on an energy cycle based on a mix of photovoltaic plants, solar panels and biogases. Not to mention the recovery of rain water, the underground waste disposal system and the intelligent traffic development. The result has been a huge cut in pollution, higher quality of life and the possibility of leaving a liveable city to future generations.

The “Hammarby model” has opened the way for a different concept in the creation of residential areas, so much so that in China not just a single zone but a whole eco-compatible city is being created, to be inhabited by 80,000 people. It will be named Huai Rou, and is located little more than fifty kilometres from Peking. The city will be “open24 hours a day, with a university campus, a technological park, a financial centre, an events pavilion and large spaces for culture, with museums and art galleries. The layout of the green areas has been carefully studied and designed to create a harmonious relationship between the natural elements and the colours of building and infrastructures. Research into wind direction has been carried out and buildings have been positioned in order to limit energy consumption and make the best use of solar exposition. Huai Rou will be entirely fuelled by renewable energy sources, including photovoltaic energy, solar energy and waste recycling. Some buildings will even make use of wind power. Moreover, only a year ago it was announced that work would soon begin on one of the first four eco-cities planned in China. Dongtan will be ecologically friendly, with zero greenhouse-emission transit and self-sufficient water and energy systems. The city is being designed around a series of village-style neighbourhoods to make it pedestrian rather than car friendly. Dongtan is located on the third largest island in China at the mouth of the Yangtze River. The 86 square km site is adjacent to a wetland of global importance. The urban area will occupy just one third of the site, with the remaining land retained for agriculture and used to create a buffer zone of “managedwetland between the city and the “naturalwetland.

Within this context, another significant issue is represented by the decision of the German Government to implement a project aimed at ensuring that all the energy used in the Reichstag, the seat of the German Parliament, will come entirely from renewable sources.

 

Mobility. The issue of mobility and transportation will continue to be one of the most-debated challenges of human settlements. As the need for mobility will rather rise than decline, any human settlement will have to choose a strategy that may focus on public transportation, on individualized traffic by cars, or support walking and cycling. Obviously, the options may be different for cities, depending on their infrastructure and their size. However, in many cities and settlements public health would benefit from an improved provision of physically active and environmentally sustainable transportation options, which would also increase efficiency of those trips that cannot be transferred from motorized individual traffic to other means of transportation.

 

Rural neglect. As the section on the policy tools indicated, there is much awareness of the problems or large-scale urban settlements. Research work mostly focuses on large cities and megacities, while little work is invested in identifying the environmental health determinants in rural places and villages. It seems necessary to catch up by providing data on these neglected settlements which in many EU countries represent a significant portion of the overall population.