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By the year 2000 more than half of the world's population will be living in cities. In western countries already two third of the population is to be found in the cities. The result is that a large percentage of environmental problems, ranging from the global to the local, originate in those very cities which have the greatest concentrations of people and human activities. Consequently there is a growing interdependence between the state of these cities and the global environment.
However, cities do not represent only a reference point for environmental contradictions but they also provide a point of positive reference for the promotion of sustainable development.
After a number of international conferences and protocols, starting from Stockholm in 1972, a series of initiatives got underway at an international level, culminating in the establishment of different networks of cities linked by health-environment themes: Eurocities, Energie Citès, Car-free Cities, Smoke-free Cities, Ecowatt etc.. Above all, there are two projects which need to be referred to: the WHO Healthy Cities Program and the Sustainable Cities Campaign.
The WHO Regional Office for Europe has been promoting the Healthy Cities Program in order to supply a means of experimenting at a local level the application of certain basic principles: to guarantee equal rights to a state of good health, to reinforce preventive measures, to seek collaboration between different sectors in the community, to promote community involvement, to guarantee accessibility to services and to increase international cooperation. In 1986 a few cities were chosen for this project and, later on, national networks of healthy cities were established and promoted.
In 1994, during the Aalborg conference on sustainable cities, 80 cities signed a Charter of Commitment and undertook to allow only sustainable development.
This charter defines the concept of sustainability and identifies a city's environmental responsibilities. It commits cities to development policies and activities which will lead towards a sustainable city. Throughout the text, environmental questions are strongly bound up with social and economic issues, thereby showing that a correlation does in fact exist.
The role of local government comes over as the key factor to the success of environmental policies, along with the role of the citizens themselves.
Among their principal commitments, the signatory cities accepted that they were to establish their own Local Agenda 21. In reality, the UN Conference on the Environment and Development in Rio de Janeiro 1992 had already committed the signatory countries to undertake, by 1996, a process of consultation with their citizens in order to put Agenda 21 into practice in the community.
At the same time and with the same objective, but paying particular attention to the local level, the International Council for Local Environmental Initiatives (ICLEI) was founded.
The two projects have a common methodological objective, which is to involve all the various organisations and bodies operating within a city (local government, business and professional associations, associations in general and so on) so that they might come to some agreement on programs designed to improve that city's environmental conditions and therefore also the health of the citizens.
Cities are in the institutions, or indeed they should be, which are closest to the people. They should therefore make sure that citizens have access to enough and sufficiently stimulating information, to encourage them, in whatever social groups they may belong to, to be interested in and take responsibility for improving the environment in which they live.
Cities are the force that unifies economic, cultural, social and political activities; it is therefore precisely at an urban level that the processes of transformation can be identified and activated to render more sustainable both the world of work and the lifestyle of the people.
It is clearly necessary, in any case, that the cities have a means of coordination on a global level. The environmental complex in which we live does not depend on mere local or national choices but is linked up in a world-wide ecosystem. Environmental emergencies have a supranational character: the hole in the ozone layer, the greenhouse effect, genetic manipulation, risk of a nuclear accident, dangerous products, the loss of tropical forests etc., all these have their origins in exact locations but their effects are global.
On the other hand, based on a recognised systemic epidemiological model, the good health and morbidity of a community depend on urban, demographic, cultural and socio-economic factors, on the social and health-care services available, on the weather-climatic conditions and on geo-ecology.
The chief aim of Doctors for the Environment in this matter could be to help provide a meeting point for the two projects, Healthy Cities and Sustainable Cities.
to collect documentation on this specific thematic area in order to compose some informative material suitable for GOs and NGOs, for the people at large and for health-care colleagues;
to put into motion studies on the effects of environmental degradation on the state of health in cities;
to put some practical initiatives into motion in cities;
to stimulate some form of interaction:
between the various National Associations of Doctors for the Environment;
between the National Associations of Doctors for the Environment and their respective local networks for Healthy Cities and Sustainable Cities (even though it is, above all, the municipal groups of Doctors for the Environment must move into action);
between ISDE and the international referents of the WHO Healthy Cities and of the Sustainable Cities programs, including collaboration based on mutual training, information and research activities;
support the ISDE School and the Bulletin.
In order to achieve these objectives, the methodology will have to be perfected as we go along: in fact all the projects depending on ICDEP are in some ways pilot projects.
However, in the meantime, the following operational methods have been singled out:
1) Indicators, reports and action plans
How to evaluate the quality of life and the environment in cities has already been successfully set in motion through a series of parameters: the WHO healthy cities indicators and those understood by Agenda 21. These indicators measure health and environmental quality/degradation as well as various influencing factors and provide a basis on which changes could be brought about. After the identification of the indicators, the reports are outlined (reports include both the indicators and other measures connected to the environment and also potential solutions for a particular city) and this is followed by the plans of action (a plan of action defines the intervention programs needed to improve the health and environment in a particular city and identifies a development calendar and a monitoring system).
In Italy a research program has already been set in motion on "Health and social indicators in order to evaluate the quality of life in urban centres" financed by the Region of Tuscany and in collaboration with the National Institute of Health; at the same time a pilot program for a Report on the State of Health in Cities is under way.
2) ISDE Day
As members of the International Society of Doctors for the Environment we have already decided to have a time each year, on 25 November, the anniversary of ISDE foundation, the International Doctors for the Environment Day when we define, reflect on and take stock of the social-health-environmental problems of our cities. ISDE Day provides the ideal meeting ground between local groups and local government and fellow citizens. Activities can be carried out which will perhaps have an on-going effect on local health-environmental problems.
3) "Healthy and Sustainable Cities Projects in Schools" .
The idea is to see school populations (students, teachers and parents) to examine environmental problems to see their repercussion on health and then to see how they can eradicate the problems.
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