Declaration on Urban Health
Discussed and approved at the 3rd ISDE World Assembly (Antwerp, 1993)
Written by Lilian Corra
The International Society of Doctors for the Environment (ISDE) has more than 20,000 members in more than 100 countries around the world.
At its General Meeting it was decided to become involved in CITY 93 and EPH, both of which are supported by the WHO and UNEP, because they deal with environmental and urban health, but to add a medical dimension to the projects. The ISDE point of view is that good health is best preserved in the kind of healthy environment which will ensure quality of life not only to the present generation but also to future generations.
The WHO/UNEP Meeting gave added relevance to our association as it provided a focus for our efforts to reach all members of the medical profession who, as they are already working in the field of health, should be expanding their goals to include the global quality of life. Environmental and urban health topics were treated by lecturers from over 67 countries who gave urgency to the need for rapid decisions in order to ameliorate living conditions in urban conglomerations and to stop the environmental imbalance which is affecting the survival of humanity.
Recent years have seen a huge increase in fatalities as a result of respiratory illnesses (like rhinitis, sinusitis, bronchitis, asthma) and cardiovascular illnesses and cancer (mammary tumours, lung tumours, tumours of the digestive tract etc). The incidence of hematological illnesses (anemia, leukemia,) has increased as have those resulting from immunological and genetic alterations (teratogenesis) due to chemical contamination by heavy metals, radiation, contamination of foodstuffs, and an excessive use of biocides (pesticides, fungicides, insecticides and so on).
We are living in a time when the human organism is exposed to many and varied toxic substances and, today, new generations are already being affected by some of these from the very moment of conception as they are accumulating heavy metals and chemical products in their systems, which will have unpredictable results.
Mankind is increasingly being submitted to an unnatural life style in an environment which is unfit for people and the result is not only illness and stress but also socio-economic problems.
ISDE notes that basic needs are being unsatisfied (contributing to the migration to urban centres), that there is a loss of a sense of belonging, a lack of family ties or identification in a social group. The resulting isolation and present-day wide scale unemployment can develop into a form of violence as a defence mechanism for survival.
Violence has been declared by the WHO as a target to combat. It encompasses violence in the family (child abandonment, violence against women), drug addiction, suicide and traffic accidents which can be seen in a similar light to the social violence and wars which have recently afflicted so many countries in Africa, Central & South America, Asia and Eastern Europe.
Doctors too have a responsibility to react against this form of suffering and to help prevent it from becoming more general or from spreading. They need to encourage decision makers to take measures on a global scale to improve the situation and to prevent its occurrence.
Following are some observations and recommendations, first in the context of urban health.
The problem areas affecting urban health are connected with:
Lack of urban planning which leads to the uncontrolled growth not only of megacities but also of smaller or new settlements.
Lack of a transport plan leading to chaotic traffic conditions.
Almost exclusive use of fossil fuels resulting in a high degree of air pollution.
Lack of measures taken to make urban life suitable for young children, the aged and the disabled.
Sustained and dangerous acoustic contamination.
Lack of final solutions for the disposal of urban waste together with inadequate sewerage systems leading to contamination of surface and deep water courses.
Lack of trees and wooded areas in cities as well as inadequate green spaces for recreation.
Increased violence leading to a loss of a sense of security.
Lack of proper controls over composition of foodstuffs and use of pharmaceuticals.
Lack of clean drinking water.
60% of the world's population lives in urban environments and, as these are the centres producing the greatest pollution, these city people are in fact their own victims.
Environmental health problems need to be treated not only on a regional level but, as in many cases their effects create imbalances elsewhere, also on an international, integrating level.
The following measures urgently need to be undertaken, or at least given consideration, in order to improve the quality of urban life:
Immediate decrease in the use of fossil fuels: organising mass urban transport and considering re-ordering patterns of urban development so as to avoid displacing large populations at great distances from work and facilities; changing to less contaminating types of energy (e.g. electric) for urban transport; limiting the use of cars in central areas.
Ensuring adequate supplies of drinkable water and energy as well as efficient final disposal of toxic and pathological waste and proper treatment of sewage.
Adequate control of foodstuff, including urgent limitations on the use of biocides, and standardisation of packages and containers.
Diagnosing and controlling acoustic contamination linked to education campaigns to decrease noise emission.
Protecting and enlarging green spaces in cities along with urban tree-planting programs.
On the mater of environmental health, ISDE demands the recommendations originating from ECO/92 in Rio de Janeiro be put into effect immediately. These have the aim of maintaining a concept of sustainable development, of conserving resources, of working to prevent environmentally-related illnesses by removing the causes, and of planning to increase the quality of life.
This global meeting has led to different solutions throughout the world to a diversity of situations but, at least and in some measure, the common recognition of the problems involved in environmental health is leading to a common motivation and purpose. For, as things stand, it is clear that the inhabitants of urban areas are daily causing great damage and suffering but that, to alleviate the damage and suffering, they are using up the already exhausted existing resources.
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