Originally published in The Conversation by Haim Yacobi, Professor of Development Planning and Programme Leader of the MSc Health in Urban Development.

The US developers of a 300ft glowing orb, set to be built in the middle of Stratford, east London, and accommodate upwards of 21,500 concert goers, have withdrawn their planning application.

Las Vegas, in the US, already boasts one such venue, known as Sphere. Citing its “extreme” disappointment at London residents not similarly benefiting from what a spokesperson said was its “groundbreaking technology and the thousands of well-paying jobs it would have created”, Madison Square Garden Entertainment (MSG) has decided the British capital is not one of the forward-thinking cities it aims to work with.

Campaigners have responded with glee, not least because, in response to concerns over the proposed structure’s potential noise and light pollution, developers had initially suggested they invest in blackout curtains. “Residents would be served far better by building social housing on the site,” a representative for Stop MSG Sphere London reportedly said.

Quite how a city both caters to its residents’ needs and sustains its economy is an enduring debate. The tension is between innovation aimed at boosting investment (in this instance, in the entertainment industry) and what urban geographer Colin McFarlne terms the “right to citylife”.

A blog written by Étienne von Bertrab, Lecturer (Teaching) at The Development Planning Unit.

The original version of this text was presented at the seminar “Mexico’s 2024 elections and continuation of the Transformation” during the Latin America Conference 2024 on January 27^th in Hamilton House, London. DPU’s Étienne von Bertrab was joined in the panel by William Booth (UCL Institute of the Americas) and by David Raby and María Pérez Ramos from Mexico Solidarity Forum.

On June 2^nd Mexico will elect its first female president in 200 years as independent nation. It won’t be Xóchitl Gálvez, candidate of the opposition considered instrument of the country’s oligarchy, but Claudia Sheinbaum, an environmental scientist and social leader who has accompanied the political movement of Andrés Manuel López Obrador (AMLO) for over two decades. She is one of the founders of the Morena party and has admirably governed Mexico City this sexenio (six-year term) until stepping down last June to pursue the presidency.

Apart from this being a momentous event for Mexican society, the coming elections will be highly significant for the life of Morena after AMLO, as Claudia (for short) will be accompanied by five female gubernatorial candidates including leftist Clara Brugada who aspires to build on Claudia’s legacy in Mexico City. Indeed, as journalist Kurt Hackbarth puts it in his latest piece in Jacobin, “the next chapter in Morena’s history is set to be shaped by leftist women”.

The certainty I start with is founded both on AMLO’s remarkably high approval rates (unprecedented at this point in a presidential term) and on the numerous opinion polls that consistently give Sheinbaum a significant lead (20 to 30%) ahead of the opposition’s strongest candidate (Gálvez). But who is Claudia Sheinbaum and what could be expected from a second moment of Mexico’s Fourth Transformation?

There isn’t much space to elaborate on Claudia’s fascinating background and significant public life, but I would like to highlight some things from her trajectory and ways of thinking and doing.[1]

As a young student in the National University, UNAM, Claudia became an activist, first in movements of solidarity with workers and peasants and then as part of the wider student mobilisations of the 1970s and 1980s.  She took part in the Comité de Lucha of her university campus and became prominent in the Consejo Estudiantil Universitario (CEU), a movement in defence of public education, at a time when neoliberalism started creeping up in Mexico’s education system.

Claudia got her first degree in Physics and did a masters in Energy Engineering. She was the first woman to enter the doctorate in energy engineering at UNAM and to obtain, in this institution, a PhD in the field. As a young mother she moved with her family to Berkeley, California, to undertake her doctoral research, but even there continued her political activism. Together with other activists she bravely gave President Carlos Salinas de Gortari a hard time in a triumphalist visit to sell the North American Free Trade Agreement (NAFTA). She worked hard as student while nurturing her political awareness and social commitment towards marginalised communities in her work on energy.

As a climate scientist, Claudia was a contributing author to the IPCC’s Fourth Report. For this work the panel received the Nobel Peace Prize (2007). She is a respected scholar in the energy and climate fields, and academia is a part of her life that she never fully abandons (although her life might become even a bit busier for a while).

Due to her solid trajectory on environmental matters and their clear political affinity Claudia was invited by AMLO to be the environment minister for his government of the capital city, then called Distrito Federal, from 2000 to 2005. As minister, Claudia was entrusted with key projects and led significant initiatives.

She supported the struggle against the desafuero of López Obrador[2] and was fundamental in the documentation of the electoral fraud that stripped AMLO from the presidency in 2006 (his first attempt). We need to remember that, since then, Mexico’s government and the business elites worked closely in well-funded smear campaigns to portray him as “un peligro para México” (a danger for Mexico). After the 2006 fraud Claudia returned to her academic activities at UNAM, but never abandoned her political action alongside AMLO.

Claudia was key in the defence of energy sovereignty —a central component of the proyecto obradorista de nación that took AMLO to the presidency in 2018— and was a great mobiliser of women in defence of such sovereignty.

Once AMLO broke with the then leftist party PRD as it allied with the conservative alliance (PRI-PAN) when Enrique Peña Nieto took power, Morena was founded, first as a civic organisation, and later —after discussions in assemblies— as a political party. Claudia Sheinbaum was part of Morena’s foundational process. The rest is history. Morena competed electorally for the first time in 2015 and only 9 years later governs, together with its allied parties, 23 of the 32 states that form the Mexican federation. It could win a few more states in the coming elections.

As mayor of Mexico City, Claudia Sheinbaum’s government expanded fundamental rights to public education, health, housing, culture, dignified employment at a fair wage, sustainable mobility, and a healthy environment. It also drove significant innovation. For example the integration of a solar power plant (now the world’s largest in an urban area) in the city’s food market, and public and free Internet connectivity throughout the city. The accomplishments of her administration are impressive and long is the list of international recognitions and prices. Mirroring what occurs at the national level, public investment in infrastructure and social protection are unparalleled, achieved through republican austerity (not the neoliberal version) and good governance, including combating corruption, without incurring in additional debt. A recurrent argument of the opposition is that Claudia Sheinbaum is candidate because of being AMLO’s favourite (or its “handpicked successor” as it is often framed in the media).[3] This (also misogynist) trope neglects her outstanding leadership and the extraordinary results of her government, putting, for the benefit of all, the poor first.

Claudia Sheinbaum’s programme is under construction. An anachronic electoral law forbids candidates to spell out specific proposals until campaigns officially start in March. However, political documents and ongoing processes are useful indications:

1. Proyecto de Nación 2024-2030, consulted and written by a special commission of Morena (before the candidacy was determined). It addresses 19 themes considered major challenges of the Fourth Transformation. More than 15 thousand people participated in this process.
2. An initial diagnostic produced by Claudia’s closest team.
3. The ongoing Diálogos por la Transformación, a public, participatory process coordinated thematically by a team of advisors (a transition team of sorts).

The dialogues’ resulting document will be presented in March and will complement both Morena’s project (abovementioned) and the programme registered before the National Electoral Institute, INE, which already indicates a boost in the energy transition, a further impulse for women, and a National Guard of proximity oriented to ending violence in the country.

Challenges are many and Claudia Sheinbaum won’t have it easy, not least before a huge popular movement in mourning with AMLO’s full retirement in October. AMLO has been an extraordinary leader and political mastermind and is impossible to substitute him. Mexico’s oligarchy will continue working hard to try to end the political project in power and lawfare is likely to intensify in the next administration, including attempts to seek US intervention. But Claudia Sheinbaum has many things in her favour, not least the demonstrated success of the Fourth Transformation, the palpable results of her government in Mexico City and, above all, her personal integrity. Undoubtedly, a key goal is to achieve a two-thirds super majority in Congress (dubbed Plan C), as this would allow constitutional reforms needed to expand, extend and deepen Mexico’s transformation.

In sum, barring an unforeseen reversal of circumstances in the country, Claudia Sheinbaum will be Mexico’s next president, taking office on October 1^st, 2024, and this will be very good news for Mexico, for Latin America and for the world.

Footnotes

[1] For those interested in knowing more about her I recommend the recent documentary Claudia, and Arturo Cano’s book Claudia Sheinbaum: Presidenta.

[2]  A political manoeuvre aimed at stopping him from being candidate to the presidency in the 2006 elections.

[3] Claudia Sheinbaum became candidate after winning an internal, transparent process through national polling against five other contestants from Morena and allied parties.

References

Cano, Arturo, 2023, Claudia Sheinbaum: Presidenta, Grijalbo, Ciudad de México.

Hackbarth, Kurt, 2023, “MORENA’s Next Chapter Will Be Written by Leftist Women”, Jacobin, 22 December 2023 https://jacobin.com/2023/12/morena-claudia-sheinbaum-clara-brugada-mexico-women-politics

Raby, David, 2024, “Mexico’s transformation advances”, Morning Star Saturday/Sunday January 27-28 2024. https://morningstaronline.co.uk/article/mexicos-transformation-advances

Authors: Claudy Vouhé (L’être égale) and Nelly Leblond (DPU), with contributions from Penda Diouf (OGDS), Angèle Koué (GEPALEF), Astrid Mujinga (CFCEM/GA), Jeannine Raoelimiadana (SiMIRALENTA) and Mina Rakotoarindrasata (Genre en Action), and Adriana Allen (DPU)

//See online version published on OVERDUE website: https://overdue-justsanitation.net/?page_id=3514

According to Tatu Mtwangi Limbumba, a sanitation expert and member of the Tanzanian OVERDUE project team, traditional taboos surrounding excreta and toilets have been eroded in African cities. For example, in Kenya or Tanzania, the mixing of a mother-in-law’s excreta with that of her son-in-law, which once prohibited the construction of indoor latrines, is no longer an issue, and is being replaced by “modern aspirations” such as indoor and public toilets. Are these modern aspirations free from taboos?

 

When the feminist organisations CFCEM/GA (Coordination des Femmes Congolaises pour l’Équilibre dans les Ménages/Genre en Action) in the DRC, GEPALEF (Genre, Parité et Leadership Féminin) in Ivory Coast, SiMIRALENTA in Madagascar, and OGDS (Observatoire Genre et Développement de Saint-Louis) in Senegal interviewed women for the Voicing Just Sanitation campaign launched by OVERDUE with support from L’Etre Egale, few of these “traditional” taboos were mentioned. Instead, respondents spoke of :

• enduring social rules that silently organise sanitation practices along gender lines, distributing opportunities and constraints, often to the detriment of women,
• prejudices which surreptitiously relegate women to the end of the toilet queue, as well as to the very end of the list of employable people for paid sanitation jobs, in the private or public sector,
• multiple constraints, preventing their safe access to toilets in public spaces, especially in urban areas, and in particular during their menstruation,
• Above all, the women interviewed described the non-recognition of their contributions to sanitation from families and communities, but also from politicians and public authorities.

So what are we talking about?

Harmless or even positive (protective?) “modern taboos” for women, or prejudices that feed gender discrimination, rooted in social gender relations and endorsed by public authorities? On the basis of the testimonies collected and to open the conversation, we have drawn up an initial list of ten points (not prioritised) which articulate taboos, clichés and prejudices, that push intimate bodies and gender hierarchies into the field of public policy: 

 

1. Women’s digestive systems are different from men’s

This is what one might think when listening to Angèle Koué, a feminist activist in Côte d’Ivoire, talking about the taboos and prohibitions that surround women’s use of the toilet. In the courtyards of the concessions, women must not be seen too often around the toilets and must go after men. They should not make any noise or leave any smell when using the toilet. They can be repudiated for this. Women’s bodies, even in their most basic biological functions, must respond not to nature, but to patriarchal culture. However, the privacy and dignity of girls and women are often undermined by inappropriate facilities in both private and public spaces.

2. No one should know that a woman is menstruating

From the first to the last, menstruation should remain hidden, explains Emilie Tapé, a sex blogger in Abidjan. You shouldn’t stain yourself; you shouldn’t leave dirty towels lying around. Everything that revolves around menstrual blood is considered shameful, even for the many women and girls who have internalized these injunctions. And yet, changing in public toilets, especially, is a challenge, a feat and a risk! Inadequate facilities turn menstruation into a cyclical dread.

 

While toilet paper is considered a basic element of the toilet, sanitary napkins and bins for disposing of them are forgotten. As a result, women are singled out when pads clog septic tanks.

 

To stimulate engagement around this taboo, the OGDS in St Louis, Senegal, is countering with a short play illustrating what a caring and non-stigmatising handling of girls’ first periods in school might look like.

3. Sanitation work is too dirty and difficult for women

This prejudice is quickly invalidated by the fact that women overwhelmingly take charge of the maintenance of the sanitary facilities of the house, manually evacuating the family’s wastewater and excrement on a daily basis when the infrastructure is lacking or failing. This work is invisible and, of course, unpaid.

Prejudice also obscures the key roles of women in neighbourhoods as described by Mariam Bakayoko, a community leader in the Treichville neighbourhood of Abidjan, Côte d’Ivoire.

Nadia Ramanantsara, in charge of public sanitation in the Urban Municipality of Antananarivo, also tells how women are involved as agents but also through associations that pool funds to remove waste and wastewater. Although, she also describes a very standard division of sanitation work within the community: women in communication, men in the field.

4. Women’s sanitation practices contribute to the insalubrity of cities and neighbourhoods

Abdoulaye “Pelé” observes that women “carelessly” dump their wastewater in the street in his neighbourhood in Saint-Louis, Senegal. In response, Awa ba, a resident of Diamaguene in Saint Louis, explains that families do not have sewer connections, private toilets, or the means to access them. In fact, they manage as best they can when the infrastructure is insufficient, especially when they have little money.

Whereas women are often blamed for their “irresponsible” management of wastewater and family excrement, the fact that men use public space to relieve themselves is little questioned in the discussion on unhealthy urban environments, according to Félicité Naweza, Provincial Deputy Mayor for South Kivu, Democratic Republic of Congo.

5. Sanitation jobs are not for women

This cliché perpetuates the idea that women have no place in the paid sanitation sector as employees of companies or communities, or as company managers. This view is contradicted by the testimony of Véronique Randriaranison, manager of a waste disposal company in Antananarivo which deals in particular with mobile urinals.

Defying the stigma, Prisca tells why she accepted the job of “pee lady” at one of these mobile urinals and now wishes that her work would never stop. Solange Tiémélé, deputy mayor in the commune of Treichville in Abidjan, also advocates opening up sanitation jobs to women and calls for private-public partnerships to achieve this.

6. It is better to hold back than to risk infection or aggression in unsanitary and unsafe public toilets

Lack of hygiene and safety has given rise to this prohibition, a sort of “protective” taboo. In Abidjan, for example, the poor maintenance of public facilities in working-class neighbourhoods and their mixed accessibility generate a widespread fear of urinary infections, as noted by Emilie Tapé, a sex blogger; but also a fear of sexual harassment and assault, according to Brigitte Taho, president of a feminist NGO.

This “retention“, which women and girls have internalised “for their own good“, puts their health at risk. The fear of sexual harassment and assault weighs heavily on women’s peace of mind and well-being in public spaces, and therefore on their citizenship and rights.

7. Toilets at any cost

Access to toilets is a right, not a luxury. However, this right continues to come at a price, especially for women. Lanto, a cleaner and tenant in the Malagasy capital, tells how landlords turn the improvement of toilets on their property into power and profit. By threatening to raise the rent, they easily put an end to the demands of poor tenants, especially women who are alone with their families.

 

Having a “proper” toilet in the home becomes a symbol of social success. The lack of social and economic power keeps women and families in degrading situations and increases their dependence on paid public toilets, which are often non-existent or inadequate. It also increases dependence on toilets and bathrooms at workplaces, which then become a real bonus.

 

Félicité Nawaza, deputy mayor of a commune in Kivu (DRC), points out that in public spaces, women spend more than men to use the toilets because, unlike men, they do not undress to pee behind a pole! Paradoxically, due to a lack of options, they are forced to contribute to the profitability of companies or communities that are reluctant to employ them because they are women.

8. The toilet is for “relieving oneself”

Of course, but that’s not all it is! It is also a place that is often used for washing or changing (especially during menstruation). This multi-purpose use remains unthought of, as does the mixing of spaces.

Nathalie Musau, deputy spokesperson for the students of the Institut supérieur d’études commerciales et financières (ISECOF) in Bukavu (DRC) explains how, at the university, mixed sex toilets generate discomfort. Female students want to use the university toilets to change clothes or put on make-up, but they come across their (male) professors or fellow students.

Mixed toilets also encourage sexual assault. Women are encouraged to go to school and to attain higher education degrees, but the infrastructure and buildings are not adapting to their bodily needs. In schools, says Anjara Maharavo from the urban commune of Antananarivo, the issue of mixed toilets is starting to be taken into account.

9. You don’t fight over a toilet: well, yes you do!

Women and their associations play a decisive, but invisibilised role in the collaboration between communities and municipalities. The problem is that they receive little recognition and support for the work they do on a daily basis, sometimes with shame and without any social or economic reward, to make up for the lack of infrastructure and the deficiencies of states and communities.

Collective demands on sanitation issues revolve more around the issue of access to water. Toilets, symbols of (still taboo) bodily needs and intimacy, are struggling to find their place in community advocacy, with an impact that weighs even more heavily on women and girls. However, women are mobilised in the struggle, as in Saint-Louis, but everything remains to be done!

10. Toilets, a political taboo?

The reluctance of decision-makers to talk publicly about excreta, latrines and bodily needs keeps sanitation low on the agenda, according to Astrid Mujinga of the NGO CFCEM/GA. A double gender discrimination is in place:

On the one hand, limited investment in neighbourhood facilities to serve residents, as well as poor infrastructure in public space or educational venues, mainly affects girls and women. Why are they affected? Because they do not use the street as a urinal, they need privacy, security and appropriate spaces; and because they use toilets more than men for physiological, but also social, reasons (they are mainly the ones who accompany small children to the toilet, for example). This calls for gender-sensitive budgeting for sanitation.

On the other hand, when infrastructure is in place, employment opportunities in the private and public sectors are reserved for men, whereas women have sanitation skills (acquired at home), or can develop them. A political will to act in favour of professional equality and gender diversity in the workplace would enable women who so wish to enter this promising field of employment. This is what Fatoumata Djiré Ouattara, deputy mayor of the municipality of Koumassi (Abidjan), would like to see.

 

In cities, taboos and prejudices linked to gender are constantly being re-created. They feed political and technical blind spots and legitimise the unequal distribution of rights, benefits, advantages and disadvantages between women and men in the field of sanitation. By highlighting and deconstructing these gender issues, the feminist organisations of the OVERDUE project are lobbying for real gender equality around the toilet seat and throughout the sanitation chain.

 

• Join them by sharing your experience and adding your voice to the Voicing Just Sanitation campaign.

 

• Discover the films produced in Antananarivo, Bukavu, Saint Louis and Abidjan, presented during a webinar on 12 November 2021 titled “Toilets, seats of gender equality?” and discussed by OVERDUE researchers and guests.

 

There is an growing body of scholarship that supports the cultivation of green spaces in urban environments as a vital part of healthcare and wellbeing provision in cities and communities (Pearson and Craig 2014; Wyles et al. 2017).  According to the constitution of the World Health Organisation health is ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’. In other words, it includes both physical and psychological wellbeing. Good health then is not only the improvement of symptoms associated with chronic illness, but must also include the presence of positive emotions like life satisfaction, a sense of community and happiness (Soga, Gaston, and Yamaura 2017).

We have long known that urban parks provide sites for physical activity and that exercise reduces the prevalence of most chronic diseases and enhances healthiness in general. More recent evidence, however, has demonstrated the manifold positive associations between access to green spaces like forests, cemeteries, reserves, sports fields, conservation areas, and community gardens – and better health outcomes (Newell et al. 2013). For example, psychological wellbeing has been empirically linked to contact with green areas (Berto 2014; Bertram and Rehdanz 2015).  And according to research in environmental psychology simply being in a ‘natural’ environment can help promote recovery from stress.  Parks are said to provide a sense of peace and tranquillity and they can function as a locus of social interaction and play – both associated with positive health indicators. Evidence also suggests that green spaces increase perceptions of safety and belonging.  And Fuller et al. (2009) have found positive associations between species richness and self-reported psychological contentment. Louv (2005) has shown that children who lack access to urban green space can suffer from a wide range of behavioural problems; and that interaction with flora and fauna is crucial to child development. Gardens in care homes have been found to be beneficial for reducing the agitation and aggression linked to dementia, while hospices make use of the tranquillity of green spaces as part of end-of-life care (Triggle 2016).

What’s more, green spaces also support the ecological integrity of cities which is turn have health benefits for the people living and working in them. For instance, trees and plants help to filter air and remove pollution. In 2019 the World Health Organisation found that around seven million people die each year from exposure to polluted air. Vegetation also helps to attenuate noise pollution – another source of stress reported to be increasing in urban environments. And urban forests can moderate temperatures by providing shade and cooling  and thus helping reduce the risk of heat-related illnesses for city dwellers (Wolch, Byrne, and Newell 2014).

But it isn’t simply being present in green spaces that can aid better health. Producing and cultivating them is also increasingly being recognised as a crucial part of the story. Gardening has been linked to lower BMIs, reduced stress, fatigue and depression, better cognitive function, and also to the prevention or management of diabetes, circulatory problems and heart disease (Buck 2016; Soga et al. 2017; Thompson 2018; Van-Den-Berg and Custers 2011).

Speaking personally, I can attest that gardens and gardening undeniably provides a sense of solace. I have always enjoyed being outdoors and walking in beautiful settings but only very recently have I taken up gardening. Much of the academic literature on horticulture and cultivating green space simply asserts an empirical relationship between the act of gardening and its corollary beneficial outcomes. But very little research explores or explains precisely what the mechanisms of association might be. Below I want to examine some of the processes that connect the act of growing green things with the benefits that are ascribed to its practice.

Gardening – the cultivation of and care for plants and vegetables for non-commercial purposes – provides a different way to experience the natural environment: it is far more immersive and visceral than simply being present in a green space. What’s more, gardening is a process and never complete; it is an act of care and it is often hard work. However, I believe its rewards are many.

I felt tired simply looking at our own overgrown ‘cottage garden’ – at least that’s how it was described by the last estate agent. Shrubs and weeds had proliferated during years of benign neglect leaving only a slim pathway to the bicycle shed. Rather than a pleasant space to enjoy, it had been a reminder of another chore yet to address.

All this changed a few years ago and I began to tackle the tangle of vegetation. I hacked back gargantuan shrubs and removed well-established bramble and after a couple of days the hard labour was complete; I could then work on cultivating something resembling a garden in this newly revealed plot. Admiring the freshly made beds of soil I set about planting and digging. I had no idea what I was doing, but I was keen.

It’s become a cliché that gardening is therapeutic, but at that time I hadn’t appreciated just how helpful it could be. Gardening obviously involves effort and according to the Mental Health Foundation, exercise is not only beneficial for physical health it also helps psychological conditions like mild to moderate depression and stress (Buck 2016). There’s also something about its practice which I believe is salutary. At least it is in my own experience.

Digging and manipulating soil to plant bulbs and seeds is a hopeful act. That in itself is heartening, but when the first green shoots push through the earth it can be exhilarating too. It is an act of human agency to dig, plant and to nurture and yet one’s gardening success lies far beyond the control of the gardener herself, notwithstanding her commitment and expertise.

So much can go wrong: blight, poor weather, ravenous slugs – and a hundred other circumstances can conspire to thwart the gardener’s efforts. While plans may go awry, the co-production between gardener and the non-human garden assemblage can produce glorious outcomes. I have felt at once proud of the spring displays that have emerged in my tiny plot, and also humbled; knowing that the results were only partially of my own doing.

One can read-up and share tips with other enthusiasts but sometimes it just doesn’t work out as planned. I was disappointed that my tulip bulbs didn’t materialise into the plants promised on the packet, but I’ve been pleased that the ailing roses I got on discount at the garden centre have thrived.  Gardening knowhow is often more tacit than taught. It is acquired through seasons of practice, of hope and sometimes of frustration. Feeling stressed by the demands of everyday life can make us feel impotent so it’s perplexing that gardening, in which we have only a relative influence on the outcome, can be so satisfying. Or maybe that’s its appeal.

Perhaps it is the combination of endorphin-releasing exercise, surrendering control to serendipity and the slow tacit acquisition of practical know-how that makes gardening special. But there’s something about the rhythms, textures, sounds and scents of gardening too. The immersive and visceral experience of working with plants and mud encourages us to be mindful and present in our own bodies. Instead of worrying about work or the everyday stresses of life, gardening directs us to the tasks at hand: to pruning, repotting, weeding or digging.  Anxiety can worsen when we focus unduly on the past or worry excessively about the future, whereas gardening is an activity engaged in the ‘now’.  And since most plants and shrubs only flower for a short period, to enjoy them at their best we must be fully present.

And of course, gardens are sensual and sensory. Their beauty can’t be captured in a text or by a photograph they must be experienced. The feel of earth warmed by microbes and sunshine, delicate and textured vegetation that brushes the skin, foliage with thorns or stings, inhaling the musty smell of air in soil displaced by rain, or the aromatic scent of leaves and petals, the sound of breeze hissing through leaves. It is these incursions on our senses that can help relieve us of our existential angst and provide succour in difficult times.

In Britain, Hospital Foundations, mental health, homeless and dementia charities are beginning to offer not only access to green spaces as part of their efforts to improve the health of citizens, but also opportunities for publics to get involved in their cultivation. This seems like a very positive move in the endeavour for healthier cities (Soga et al. 2017). However, there are some caveats.  Some studies on green spaces and health reveal that access disproportionately benefits White, able bodied and more affluent communities (McConnachie and Shackleton 2010; Wolch et al. 2014). And enhancing natural amenities in cities has been shown to in many cities to paradoxically facilitate gentrification and increase property prices, further diminishing access to those constituents who might benefit the most (Newell et al. 2013).  Concerted effort needs to be made by urban planners and communities everywhere to keep this most valuable resource accessible and open to all for the good of healthy citizens everywhere.

 

Berto, Rita. 2014. “The Role of Nature in Coping with Psycho-Physiological Stress: A Literature Review on Restorativeness.” Behavioral Sciences 4(4):394–409.

Bertram, Christine and Katrin Rehdanz. 2015. “The Role of Urban Green Space for Human Well-Being.” Ecological Economics 120:139–52.

Buck, D. 2016. Gardens and Health Implications for Policy and Practice. Kings Fund.

Fuller, Richard and Gaston Kevin. 2009. “The Scaling of Green Space Coverage in European Cities.” Biology Letters 5(3):352–55.

Louv, Richard. 2005. “Last Child in the Woods: Saving Our Children from Nature-Deficit Disorder.” SCHOLE: A Journal of Leisure Studies and Recreation Education 21(1):136–37.

McConnachie, M. Matthew and Charlie M. Shackleton. 2010. “Public Green Space Inequality in Small Towns in South Africa.” Habitat International 34(2):244–48.

Newell, Joshua P., Mona Seymour, Thomas Yee, Jennifer Renteria, Travis Longcore, Jennifer R. Wolch, and Anne Shishkovsky. 2013. “Green Alley Programs: Planning for a Sustainable Urban Infrastructure?” Cities 31:144–55.

Pearson, David G. and Tony Craig. 2014. “The Great Outdoors? Exploring the Mental Health Benefits of Natural Environments.” Frontiers in Psychology 5:1178.

Soga, Masashi, Kevin J. Gaston, and Yuichi Yamaura. 2017. “Gardening Is Beneficial for Health: A Meta-Analysis.” Preventive Medicine Reports 5:92–99.

Thompson, Richard. 2018. “Gardening for Health: A Regular Dose of Gardening.” Clinical Medicine  18(3):201–5.

Triggle, N. 2016. “Gardening and Volunteering: The New Wonder Drugs?” BBC News Website.

Van-Den-Berg, Agnes and Mariëtte Custers. 2011. “Gardening Promotes Neuroendocrine and Affective Restoration from Stress.” Journal of Health Psychology 16(1):3–11.

Wolch, Jennifer R., Jason Byrne, and Joshua P. Newell. 2014. “Urban Green Space, Public Health, and Environmental Justice: The Challenge of Making Cities ‘Just Green Enough.’” Landscape and Urban Planning 125:234–44.

Wyles, Kayleigh J., Mathew P. White, Caroline Hattam, Sabine Pahl, Haney King, and Melanie Austen. 2017. “Are Some Natural Environments More Psychologically Beneficial Than Others? The Importance of Type and Quality on Connectedness to Nature and Psychological Restoration.” Environment and Behavior 51(2):111–43.

This blog is part of the health in urban development blog series – the full series can be found at the bottom of this post.

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Urban transport and mobility are critical instruments for development, health and sustainability. Transport is one of the most data-, land- and resources-intensive sectors in urban public policy, consuming often more than a third of public budgets in Global south cities and being explicitly linked with many of the UN’s Sustainable Development Goals. However, conventional transport planning lacks sufficient tools, policies and methods that make explicit the links between transport, liveable and sustainable cities, and health. This blog showcases a participatory methodology for drawing a baseline and developing future impact assessment on liveability and the social determinants of health in transport-driven large-scale urban interventions. The blog argues for the use of health-informed methods using our research experience in Cali – Colombia’s third largest city – in the implementation of web-based participatory mapping tools for a project in the implementation phase.

The centrality of transport to urban development trajectories

Transport is a very effective instrument for urban policy definition and delivery. As showcased by the rapidly increasing number of kms of Bus Rapid Transit (BRTs), cable-cars, cycling lanes and many such other projects built in recent years throughout Latin America, transport has claimed a central role in current urban development trajectories. For instance, out of the 170 cities that have implemented Bus Rapid Transit (BRT) systems globally, 55 (32%) are in Latin America, with 1,816 km of BRT networks built regionally (BRTDATA.ORG, 2018). Investments in mass public transport infrastructure have opened the door for urban transformations driven by transport developments via promotion of Transit-Oriented Development (TOD), reclaiming of public spaces, development of non-motorised infrastructure, and other transport-land-use integration strategies. Strategies such as the above have enabled sustainability and climate-change adaptation agendas to redefine some of the relationships between built environment and transport infrastructure across the region (1; 2). There is also larger awareness in the research and policy spheres about the health implications of transport, from a preventive medicine and physical activity perspective, to access to healthcare, environmental exposures and road safety (e.g. 3; 4; 5).

The Caliveable project

The Caliveable project (www.caliveable.com) is a research initiative led by Dr Daniel Oviedo at the DPU and funded by the Lincoln Institute of Land Policy. The project involves a multi-disciplinary team of UK-based and Colombian researchers seeking to develop frameworks and methods for baseline studies of liveability and the social determinants of health of nascent transport-centred urban projects. The project argues that by building on rigorous and tested frameworks such as liveability, which are cross-cutting to both the built environment and health, it is possible to construct tailored baselines for the design, monitoring and evaluation of the effects of transport-centred interventions on the social determinants of health. The project studies Cali’s Corredor Verde (CV) as the empirical context for the development and implementation of the study. The CV is a large-scale infrastructure and public space investment programme aimed at enhancing social, economic and regional integration with a regional train at the centre of urban interventions traversing the city from north to south.

The Corredor Verde project has a modern public transport system intending to serve as regional link with emerging poles of population and economic growth near Cali (e.g. Yumbo, Palmira). The corridor also intends to become an environmental anchor and axis for supporting urban biodiversity, linking interconnected biodiversity points and support structures – such as waste and recycling plans, nurseries and educational trails. The transport dimension of the project aims to promote active travel and urban transformations based on the notions and principles of TOD, which align with the overall objective of re-unifying the eastern area of Cali with the rest of the city. However, there is no evidence on how this is consistent with the implementation of measures that promote determinants of health and liveability neither on the guidelines or the project’s masterplan. Moreover, given the socio-spatial distribution of the population, the investment rises questions regarding its distributive effects. Will the citizens from both sides of the corridor be benefited equally? Could the CV create an increase in land value and consequently ignite processes of gentrification and expulsion of low-income residents?

Harnessing the links between transport, liveability and health

We aim to examine liveability in seven domains – employment, food housing, public space, transport, walkability and social infrastructure – linked with health and wellbeing outcomes (6). Two challenges emerge when approaching a project such as the Corredor Verde from a liveability perspective: the first is lack of purpose-built data for comprehensive analysis of the different dimensions of the concept, the second is lack of resources for collecting a sufficient sample that can serve in later stages for impact evaluation. The Caliveable project addresses these challenges using web-based geo-questionnaires designed for participatory mapping. We optimised resources available to deploy targeted field data collection campaigns in areas with lower income and access to technology and neighbourhoods with high levels of illiteracy and other restrictions for self-reporting. Using  Maptionnaire (www.maptionnaire.com) the team has designed a comprehensive 15-minute questionnaire dubbed The Calidoscopio, that allows building indicators based on numerical scales, Likert, multiple choice question, multiple choice grid and draw buttons. Drawbuttons are a feature of the approach of participatory GIS as it enables respondents to map out different features of their behaviour and their urban environment.

The Maptionnaire platform enables the construction of geographical-based features, making it possible to crowdsource mapping for different purposes. For example, a respondent is asked to draw the area of the neighbourhood they perceive as more polluted and then evaluate how they perceive how this contributes/affects their quality of life. The graphical result allows both the interviewee and the researcher to work with a superposition of georeferenced and self-completed information layers. The platform also allows mapping routes and points in the city, which are relevant for transport-specific analysis such as accessibility and walkability. The superposition of layers of analysis through easy visualisation is one of the key advantages of the web-based tool for participatory GIS.

Initial findings from the deployment of the liveability questionnaire in Maptionnaire have produced comprehensive information about behaviours, preferences, needs and perceptions, not often captured by traditional data collection methods applied in transport studies. The tool enabled the research team, even from the pilot stage, to add a spatial dimension to variables explicitly linked with the social determinants of health, informing location, distribution and characteristics of the built environment from an urban health perspective. This will inform not only planning and development of the Corredor Verde and other relevant transport infrastructure projects in Cali, as well as leaving a replicable methodology for monitoring and evaluation. The Caliveable project seeks to establish alliances with government authorities and researchers for the appropriation of the tool and scaling-up of the methodology for future health monitoring and impact assessments of the Corredor Verde.

 

Learning from the experience: transport equity and participatory mapping

Experiences with the use of alternative methods for data collection have been introduced in the DPU’s curriculum for years. Such practice has continued in the context of our Transport Equity and Urban Mobility module of the masters in Urban Development Planning course. Students have received training in the Maptionnaire tool and have had the chance of designing and deploying a small-sample test survey in the London Bloomsbury area. Students from across the DPU and the Bartlett have used participatory GIS questionnaires to address issues such as night-time mobilities, liveability and well-being related to transport, transport and security, and walkability. The experience with the use of innovative methods and technological tools for data collection have served for collective reflections about the role of data in leading to more inclusive and sustainable urban transport planning and the need for grounding innovative methods in rigorous conceptual frameworks and context-specific considerations as those covered during the module. The exercise also informed reflections related to research ethics, data management and privacy and the challenges of development research in the digital age.

 

References

1. Paget-Seekins, L., & Tironi, M. (2016). The publicness of public transport: The changing nature of public transport in Latin American cities. Transport Policy, 49, 176-183.
2. Vergel-Tovar, C. E., & Rodriguez, D. A. (2018). The ridership performance of the built environment for BRT systems: Evidence from Latin America. Journal of Transport Geography.
3. Sarmiento, O. L., del Castillo, A. D., Triana, C. A., Acevedo, M. J., Gonzalez, S. A., & Pratt, M. (2017). Reclaiming the streets for people: Insights from Ciclovías Recreativas in Latin America. Preventive medicine, 103, S34-S40.
4. Salvo, D., Reis, R. S., Sarmiento, O. L., & Pratt, M. (2014). Overcoming the challenges of conducting physical activity and built environment research in Latin America: IPEN Latin America. Preventive medicine, 69, S86-S92.
5. Becerra, J. M., Reis, R. S., Frank, L. D., Ramirez-Marrero, F. A., Welle, B., Arriaga Cordero, E., … & Dill, J. (2013). Transport and health: a look at three Latin American cities. Cadernos de Saúde Pública, 29, 654-666.
6. Badland, H., Whitzman, C., Lowe, M., Davern, M., Aye, L., Butterworth, I., … & Giles-Corti, B. (2014). Urban liveability: emerging lessons from Australia for exploring the potential for indicators to measure the social determinants of health. Social science & medicine, 111, 64-73.

 

Health in urban development blog series

How and in what ways can local-level risk information about health and disasters influence city government practices and policies?
By Cassidy A Johnson

Treat, contain, repeat: key links between water supply, sanitation and urban health
By Pascale Hofmann

Health in secondary urban centres: Insights from Karonga, Malawi
By Donald Brown

Gaza: Cage Politics, Violence and Health
By Haim Yacobi

 

If you are interested in DPU’s new MSc in Health in Urban Development, more information can be found on our website.

This blog is the fourth of the health in urban development blog series. View also:

Treat, contain, repeat: key links between water supply, sanitation and urban health
By Pascale Hofmann

Health in secondary urban centres: Insights from Karonga, Malawi
By Don Brown

Gaza: Cage Politics, Violence and Health
By Haim Yacobi

 

If you are interested in DPU’s new MSc in Health in Urban Development, more information can be found on our website.

 

Over the last few years there have been several initiatives to develop practical and policy-relevant ways to measure environmental risks faced by low-income groups. This has been in response to a severe lack of information about disaster and health risks available for policy makers to draw on in most low- and middle-income nations. There is a need for both detailed settlement-level data, particularly for informal settlements, as well as for aggregated data needed to inform city-level or national interventions[i]. In this blog, I discuss innovative methodologies that are being developed in cities of the Global South to generate much needed data for action.

Innovative methodologies for understanding health and disaster risks at the urban scale

Innovative methods developed for understanding and measuring these risks range from profiling and mapping informal settlements with community-led or co-production approaches, to detailed analysis of hospital, police and newspaper records. Other methods seek to build consensus based on perceptions and experiences of risk with communities and local governments. DesInventar is a collection of national, regional and city-level databases, which use newspaper reports, as well as police, hospital and accident records to create a detailed portrait of both large or intensive disasters and small-scale extensive disaster events. Other methodologies such as Slum/Shack Dwellers International (SDI) settlement profiling and Action at the Frontline use community-generated information about resident’s experiences of health and disaster risks in order to enter into dialogue with municipal governments about their needs. ReMapRisk uses community-generated risk information and offers a spatial analysis with maps to interrogate and visualise the information, there are maps for Lima (Peru), Karonga (Malawi) and Freetown (Sierra Leone).  Other approaches, such CityRAP, The City Resilience Index and 10 Essentials for Making Cities Resilient focus on the municipal government’s perspectives of risks and capacities for addressing risk at the city-level, and often in dialogue with communities.

 

Health and disaster risks faced by the urban poor

These studies have found that women, men and children living in informal settlements are disproportionally exposed to small and large-scale disaster risks such as flooding, landslides and fires, as well as everyday risks, such as water borne illnesses and poor air quality. For example, the AXA-funded research I have been involved in in Dar es Salaam in Tanzania, used Action at the Frontline methodology, with household surveys, focus groups and action planning Mtambani settlement in Ilala municipality and Bonde la Mpunga settlement in Kinondoni municipality[ii]. The communities identified crime, poor solid management, lack of storm-water drainage infrastructure, lack of wastewater and toilet infrastructure, lack of basic health services and hospitals, flooding, high living costs and drug abuse as the main issues in their settlements. Many of these are directly related to health problems, such as malaria, diarrheal disease and personal safety. While big disasters, such a major floods, earthquakes, tsunami and windstorms do affect the health and welfare of millions across the globe every year, it is actually the smaller events and everyday risks that impact the greatest number of people’s health and well-being.

 

These different methods of understanding risks have been employed in close partnerships between researchers, community organisations, municipal authorities and other research users in many cities across Asia, Africa and Latin America. While there are many innovative initiatives for understanding and measuring risks, the data still remains extremely patchy and limited in scope. Furthermore, and its uptake into municipal government operations and planning is not guaranteed.

 

Principles for the uptake of risk information in urban planning and policy making

Through the Urban Africa Risk Knowledge programme[iii], researchers have identified some principles related to the uptake of local-level risk information into planning and policy making: 1) It is important not just to provide the type of information that are assumed to be useful, but to work closely with partners in identifying data that will be useful for policy and practice[iv]. 2) The community-driven process can be more conducive to driving change in practice and policy in local government than expert-driven data. The use of local knowledge that comes through communities collaborating with local level decision-makers can capture the qualitative experiences of risks and measure the burdens arising from these risks, while enabling communities to engage with local governments/state about their needs[v]. 3) Small steps at collecting local data that are ‘good-enough’ can be valuable in the beginning.[vi] 4) Project-based risk measurement initiatives are rarely enough to make a difference in government practices and policies. What is required is long-term and sustained engagement with information that is regularly updated. 5) Improving official data collection, such as census, vital registration systems and healthcare records will be necessary to systematically address disaster and health risks in informal settlements[vii].

 

Many cities in low- and middle- income countries, and especially in sub-Saharan Africa, do not have functioning local governments, they lack a metropolitan structure or their resources are too meagre to take on new initiatives. While some progress has been made in developing methodologies that help us to better understand the everyday and small-scale disaster risks that underpin women’s, men’s and children’s health in informal settlement, there is still much more to do to scale up these initiatives and to enable local governments to take actions to address risks.

 

References

[i] Satterthwaite, D and Sverdlik, A (2018). Assessing health risks in informal settlements in sub-Saharan African cities. Urban Africa Risk Knowledge Briefing, No. 10. June 2018. Available from: https://www.urbanark.org/assessing-health-risks-informal-settlements-sub-saharan-african-cities

[ii] Osuteye, E. at al. (2018). Communicating risk from the frontline: projecting community voices into disaster risk management policies across scales. Urban Africa Risk Knowledge Briefing, No. 19. October 2018. Available from:

[iii] See www.urbanark.org

[iv] Dodman, D., Leck, H. and F. Taylor (2017). Applying multiple methods to understand and address urban risk. Urban Africa Risk Knowledge Briefing, No. 7. July 2017. Available from: https://www.urbanark.org/applying-multiple-methods-understand-and-address-urban-risk

[v] Osuteye, E. at al. (2018). Communicating risk from the frontline: projecting community voices into disaster risk management policies across scales. Urban Africa Risk Knowledge Briefing, No. 19. October 2018. Available from: https://www.urbanark.org/communicating-risk-frontline-projecting-community-voices-disaster-risk-management-policies-across

[vi] Spaliviero, M. at al. (2019). Urban Resilience building in fast-growing African Cities. Urban Africa Risk Knowledge Briefing, No. 20, January 2019. Available from: https://www.urbanark.org/urban-resilience-building-fast-growing-african-cities

[vii][vii] Adelekan, I.O. and D. Satterthwaite (2019). Filling the data gaps on everyday and disaster risks in cities: The case of Ibadan. Urban Africa Risk Knowledge Briefing, No 22. January 2019. Available from: https://www.urbanark.org/filling-data-gaps-every-day-and-disaster-risks-cities-case-ibadan

This blog is the third of the health in urban development blog series. View also:

Health in secondary urban centres: Insights from Karonga, Malawi
By Don Brown

Gaza: Cage Politics, Violence and Health
By Haim Yacobi

If you are interested in DPU’s new MSc in Health in Urban Development, more information can be found on our website.

 

In Dar es Salaam, Tanzania’s main economic and administrative centre, high population densities, the accumulation of informal lower-income residents, lack of access to clean water and poor sanitary conditions have been associated with a range of water and sanitation-related diseases. Cholera outbreaks are a frequent occurrence during the rainy season and some settlements in the city are among the worst affected in the country. In this context, I argue that urban water poverty needs to be tackled using a proactive rather than reactive approach at the local level to yield long-lasting health benefits.

 

Tackling urban water poverty and community health promotion

Internationally, the link between urban water poverty – i.e. inadequate access to water supply and sanitation facilities, and public health – is widely recognised whereby improvements in accessing water and sanitation are deemed crucial in tackling a diverse range of diseases and improving the lives of the poor.

Such thinking calls for integrated and consistent approaches, which, as emphasised by a UNICEF WASH specialist in Tanzania are evidently lacking in most policy-driven practices on the ground.

“Hygiene and sanitation awareness, behaviour change, communication and empowerment are maybe done in urban areas but erratically, not systematically. When the rains are coming and there is threat of cholera etc. then you will find people will announce:  ‘food vendors cover properly your food and make sure it is hot and whatever, please clean your surroundings, no solid waste should be seen and liquid waste, please drain it out completely’ etc. […] or there is a cholera outbreak in a certain locality in Dar es Salaam and it is feared that it might spread, so that happens but on a regular basis there is not a lot done” (quote from UNICEF WASH specialist).

During the recent cholera outbreak in 2015 government spending increased significantly to treat the affected population. While curative measures are vital, efforts to improve water supply and sanitation constitute essential steps towards future outbreaks. Similarly, some municipalities in Dar es Salaam have put continuous support into household fumigation programmes to impede the spread of malaria but fall short of investing in preventative measures to keep people healthy – i.e. reduce mosquito breeding sites through the provision of safe drinking water, improved sanitation and hygiene. Currently, the onus is predominantly on residents themselves to be pre-emptive in their everyday practices with regards to potential health implications but not everybody is equally aware or shares the same ability to act. In the absence of sufficient government action, those who can have invested in better access to water, improved sanitation facilities and even flood defences.

 

“In 2011 there was flooding and we lost our livestock and we had to start afresh. What actually happened is there has been increased silt in the Msimbazi river. At the same time, there is wastewater that comes from the ponds and where these meet, that impact pushes the water towards our land. […] we constructed this drainage channel jointly with my neighbour after the flooding to try and divert the water from coming in” (quote from a resident in an informal settlement in Dar es Salaam).

The need for a proactive, decentralised approach

Ward health officers are officially tasked with preventing water-related diseases and promoting environmental health in their jurisdiction through regular water quality tests at local water supply schemes and inspections of businesses and households with no equivalent paid staff at sub-ward level. However, with limited resources at ward level much of the action regarding water supply, sanitation and environmental health depends on voluntary efforts in the communities by residents themselves and facilitated through sub-ward committees, water committees and community representatives. Many health officers at the ward level understand the importance of sanitation, drainage and safely-managed water supply but struggle to influence the agenda at higher levels of government. The Decentralisation by Devolution Policy introduced in the 1990s transferred responsibilities to local government for service improvements but without fiscal decentralisation or devolution of decision-making power. Decentralisation should pave the way for bottom-up participatory planning processes but municipalities in Dar es Salaam focus on central government priorities while continuing to disregard lower levels of government and their efforts to address local challenges. Decentralised decision-making structures are therefore not a guarantee for more democratic processes.

The importance of engaging urban poor communities

To lower the burden of water and sanitation-related diseases, engagement of communities with the authorities (utility and municipal government) is crucial but often limited and slow. Until recently, one of Dar es Salaam’s municipalities prohibited low-income communities living near wastewater stabilisation ponds to use them for safe sewage disposal. A lengthy period of continuous interaction between the local community, the municipality and the utility, facilitated by a local NGO, eventually led to a pilot initiative that connects household toilets to the nearby ponds using simplified technology. This has reduced the number of pits being informally emptied during the rainy season and led to a safer and healthier environment for residents.

The utility seems keen to replicate the scheme elsewhere in the city, which shows potential that policy-driven practices can be transformed, scaled up and institutionalised in ways that are more integrated and sensitive towards the needs of the urban poor if sufficient consideration is given to the scope for scaling up and sharing the benefits more equally within a settlement.

 

Pascale is a Lecturer at the Development Planning Unit, UCL, where she leads the MSc in Environment and Sustainable Development Programme. Her current research is particularly concerned with the dialectics of urban water poverty, examining different policy-driven and everyday practices and their impact on everyday trajectories of the urban water poor. She is interested in generating knowledge towards developing feasible pathways out of urban water poverty.

This blog is the second of the health in urban development blog series. View also:
Health in secondary urban centres: Insights from Karonga, Malawi

If you are interested in DPU’s new MSc in Health in Urban Development, more information can be found on our website.

“I’m like a bird in a cage”, told Shaheen in an interview to Al Jazeera as she lay in bed at Al-Rantisi hospital. “Outside of my cage I can see water and food, but I can’t reach it. This is my condition right now.” Shaheen suffers from breast cancer, her condition has been deteriorating ever since she was denied exit from Gaza for treatment. The Gaza Strip does not have adequate resources to provide her with appropriate treatment, yet she cannot leave, as Israeli authorities rejected her permit three times in a row without explanation. But this is not an anecdote – current data indicates that 54 Palestinians, including 46 cancer patients, died in 2017 after their requests for permits were delayed or refused.

The case of Shaheen illustrates the ways in which health, death, life and space are entangled. It is not just about the crossing of the border between the Gaza strip and Israel, but also about being in a “cage”, an urban territory where electricity, clean water, sewage system and adequate housing which are basic conditions for ensuring a health – are absent. As already noted,  in 2017 more than 96 percent of groundwater is unfit for human consumption, and the forecast is that the damage would become irreversible by 2020; Due to chronic shortage in electricity operating pumps, there is a constant threat of raw sewage flooding residential areas. The beach areas of Gaza strip are polluted by more than a hundred million litres of raw sewage flowing into the sea every day. This matter was recently defined by Zeid Ra’ad al-Hussein, the UN’s High Commissioner for Human Rights as a “TOXIC SLUM”, claiming that Gazans “…are… caged in a toxic slum from birth to death”, a ghetto of 1.9 million residents (50% under the age of 18) living in one of the most densely-populated places on earth.

The spatio-politics of health, death and life goes beyond the notion of necropolitics; it is not just about the use of social and political power to dictate how some people may live and how some must die as Achile Mbembe suggests; rather it is also about the spatial dimension of “cage politics”. Within this context I argue that spatial organisation determines the right to kill as defined by Foucault; blocking Gaza, isolating its habitants, controlling the goods that can enter the strip (such as food, construction materials etc). Yet the question is not whether the organisation of space and health are linked, but why is space organised, controlled and destructed in certain cases so as to protect the right to health; What are the ideological forces and the political processes that promote or hinder the organisation of space?

The conditions in Gaza are not the result of any natural disaster, neither the outcome of the last few months events along the border. Rather, I would suggest to see it within the context of settler colonial political history, which prioritises territorial and demographic control over basic rights. As already noted the establishment of settler colonialism is based on “the will of erasure”, or at least the “systematic containment” of the original inhabitants. First of all, the refugees: close to 70% of the Palestinians living in the Gaza Strip are refugees. Most of them ran away, or were expelled from villages, towns and cities that are part of the State of Israel today.

Since then, Israeli political discourse focuses on the idea that this problem would disappear by itself. Yet, as the last few months demonstrate this is not the case: Young Palestinians who are demonstrating at the border are the third and fourth generations of the original refugees, and they are willing to die for the right to return, reminding us that 1948 is still with us, waiting for a political (rather than military) answer. Indeed, links between health, death, life and cage politics should be understood within a wider context, where freedom of movement, access to public services and infrastructure, as well as freedom from pollution and environmental hazards, are obvious rights linked to space.

Indeed, the case of Gaza illustrates the ways in which people who have been displaced experience “root shock” – the traumatic stress reaction to the loss of some or all of one’s emotional ecosystem. As the case of Gaza demonstrates, the very historical foundations of the root shock are the expelled of Palestinians after the 1948 war from Israel, the creation of the “refugees crisis” and the ongoing violence in the last few decades. Root shock is both personal and collective: on the individual level emotional trauma affect a person experiences when his or her environment is destroyed. It causes the risk for stress-related diseases like depression and diminishes social, emotional, and financial resources. Here, several reports point on the growing number of mental illness in Gaza, including a growing number of suicides.

Importantly this has also an effect on the community level; root shock is expressed by the loss of interpersonal ties that is vested in the collective connections and affect negatively a community resilience. A telling example is the aspect of the high rates of sexual assaults in Gaza resulted of the common addiction to Tramadol which is available in Gaza, and popularly traded as an illegal street-drug. According to Mansour, the Tramadol side-effects have an immense impact on the frequency of sexual assaults and other un-healthy sexual behaviours. In general, Mansour describes Gaza as a society in “a tremendous and accelerated disintegration” in which “people are losing their humanity”. Another aspect is gender-based violence. In 2016, more than 148,000 women were subjected to psychological and physical abuse. Studies show a link between violence against women and the worsening of living conditions. According to the UNFPA, ‘The structural, cyclical and hierarchal nature of violence… means women often become “shock-absorbers” of the crisis’ in Gaza.

To sum up, cage politics violence has two dimensions that affect health conditions in Gaza. Active violence stemming from direct military actions and explicit policy. This affects water supply, electricity, nutrition. It also causes a severe shortage of equipment, medicines (including antibiotics and morphium), and medical expertise. This, for example, means injured people with gunshot wounds to the legs are not always treated quickly, leading to amputation. But cage politics is also discursive, symbolic and implicit; this is expressed in the very de-humansing and demonising public discourse in Israel, that in turn justifies active state violence. A current example is the building of an underwater sea barrier that according to the Israelis aims to prevent Palestinian infiltrators from entering Israel by sea. The barrier will consist of three layers. The first will be below the water; the second will be made of stone; the third will be made of barbed wire. An additional fence will surround the sea fence. The effect of this project on Gaza is clear: fishing, mobility, health and economy is one side of it, but this also takes us back to the very argument presented today: cage politics of health, life and death are highly political and that access to water, electricity and services, or proximity to environmental hazards, are not neutral facts but rather the results of policy and violence.

 

Haim Yacobi is a Prof of Development Planning and the Programme Leader of the Health in Urban Development MSc Programme at the DPU. In his current research he focuses on the ways in which ideology, planning and health are entangled in conflict zones.

This blog is the first of the health in urban development blog series. View also:
Gaza: Cage Politics, Violence and Health

If you are interested in DPU’s new MSc in Health in Urban Development, more information can be found on our website.

They may be small, but don’t let their size mislead you. Secondary centres form a significant—though underappreciated—part of the global urban landscape. Drawing on my doctoral research in Karonga, a small town in Malawi, I explain why achieving a healthy urban future will depend increasingly on how urban growth occurs outside the largest cities.

 

It is widely proclaimed that we now live in an urban age, with more than half of the world’s population living in ‘cities’. While impressive, this statistic does not tell the whole story. It is widely assumed that most of the world’s urban population live in the largest cities and that they are the fastest growing. But there are relatively few mega cities (with more than 10 million residents) and they account for less than 10% of the world’s urban population. Many are also not growing especially fast.

Far more urban dwellers live in small and intermediate centres (with less than 1 million inhabitants), many in Asia and Africa. These ‘secondary’ centres constitute the bottom and middle of the urban hierarchy, where a large and typically growing share of the world’s future urban growth is expected to occur. But this is also where the capacity to plan and manage urban growth, provide services, and reduce environmental risks is so often lacking.

If the growth of secondary centres in Malawi and other sub-Saharan African countries is to contribute to a healthy urban future, research and action is required on several fronts:

The dynamics of in situ urbanisation

Most accounts of Africa’s urban transition have focused on the causes and patterns of urbanisation and peri-urbanisation. Much less attention has been paid to in situ urbanisation—the placed-based transition from a rural area into an urban one. These dynamics are of growing importance in sub-Saharan Africa given its low urbanisation level and moderate urbanisation rate, meaning that many small settlements have yet to emerge.

Karonga exemplifies the process of in situ urbanisation: it grew from a small trading post in the colonial era into a sub-regional service centre under the current national planning framework. The town’s population increased nearly four-fold from around 11,000 in 1966 (the first census year) to over 40,000 in 2008 (the last census year). Karonga is now the second largest centre in the Northern Region following Mzuzu.

Despite its size and growth, Karonga has no local government and so lacks the capacity to effectively plan and manage its growth. Numerous environmental hazards have subsequently emerged, ranging from poor sanitation, to seasonal floods, to large-scale disasters, posing major health risks.

The need for disaggregated urban data

Most demographic and health data is aggregated to provide averages for urban populations, obscuring widespread health disparities within and between urban populations. Basic health data is especially limited in sub-Saharan Africa in the absence of vital registration systems, disease surveillance sites and electronic health records, even though the region bears the brunt of the world’s deadliest epidemics, including HIV/AIDS, malaria and tuberculosis.

Where available, local information sources can be used to generate disaggregated data at the urban scale. Among the most valuable sources are hospital records, which provide information on the causes of disease in populations. To generate this information for Karonga, nearly 3,000 inpatient records from Karonga District Hospital (located in the town) were collected over a 12-month period (August 2016 to July 2017) to produces estimates of the prevalence of environmental disease.

While the sample is not completely representative of the town’s population, the findings reveal alarming patterns:

• 63% of all recorded diseases were environmental (i.e. related to factors in the physical environment);
• 64% of environmental diseases were infectious and parasitic; and
• cholera outbreaks during the rainy season are recurrent in areas with the poorest sanitation.

These observations support the longstanding suspicion that smaller settlements with limited capacities can be among the most hazardous places to live, highlighting the need for urban environments far more capable of preventing disease.

The dynamics of rural governance regime change

As in situ urbanisation unfolds, villages will grow into towns, towns will be reclassified as urban (raising the urbanisation level), and modern institutions will attempt to intervene in rural governance regimes that may be resistant to change. This process is creating new governance challenges for planning authorities attempting to intervene in towns once they have already emerged.

These challenges are heightened in Karonga in the absence of a local government, meaning the balance of power has not shifted from traditional to modern institutions in much the same way the planning system has not resulted in formal urban development. Instead, customary and modern institutions have intertwined in hybridised governance arrangements in which the authority and legitimacy of the state is contested.

Understanding the place-based dynamics of rural governance regime change in emerging towns such as Karonga is at the forefront of planning research on in situ urbanisation. Case studies of this kind have significant potential to reveal the possibilities and obstacles for planning healthy towns at the bottom of the urban hierarchy. This is where many of the future challenges facing public health will be increasingly concentrated, but where little scholarly or practical attention has been paid to this and other important urban development issues.

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Donald Brown is an urban planner and researcher interested in the nexus between urban development planning, public health and (disaster) risk reduction in sub-Saharan Africa and other urbanising regions. His doctoral research focused on environmental health in smaller African urban centres as increasingly important to overall urban population health.

Research in the age of the falling attention span

There is undeniably a great amount of social science research produced around the world. In the field of development, much of it aims to inform the public, perhaps even with the expressive aim of changing behaviours. Yet how can one produce engaging content when it is well documented that the general public cannot focus for more than seconds at a time? There has been substantial research on people’s decreasing attention span. In his 1985 book Amusing Ourselves to Death: Public Discourse in the Age of Show Business, Neil Postman advanced his thesis that television and the emphasis placed on entertainment has altered the way people consume information, and decreased their ability to concentrate on issues they do not find pleasurable[i]. Nicholas Carr focused his study on the advent of the Internet, arguing that our use of the Internet not only makes absorption harder, it actually impacts our ability to be engrossed in written material both online and offline[ii][iii]. Statistics seem to concur with this thesis. A 2008 study found that Internet users spent 10 seconds or less on any given page over 50% of the time, while the average time for a stay on a page was placed between 2-3 seconds[iv]. A 2015 study by Microsoft found that overstimulation through the Internet and smartphones has decreased our attention span from 12 seconds in 2000 to 8 seconds in 2015, jokingly compared to the attention span of a goldfish[v].

 

The evidence is all around us: news videos online last on average under 3 minutes. In development, the trend is very much the same. Most organisations – including DFID, WaterAid and ODI to name a few – now produce a mix of short videos and infographics to present their material. Information is distilled in bite size pieces which audiences can easily digest.

 

Conversely, when people are engaged, they can focus for longer. And this is where things get interesting. Coming up with engaging ways to communicate information can make all the difference. And what better way to engage someone’s attention than turning the subject into a game? Playing games de facto retains the player’s attention, and, for that reason, they have long been used in education. Whether it was through educational board games or through the use of computer games in school for math or physics modules, most of us were exposed to learning in game format.

 

Games can therefore be a great communicative tool, especially for complex information. Openspace, the organisation I am currently working with in Bangkok, has teamed with Dr Wijitbusaba Ann Marome from the Faculty of Architecture and Planning at Thammasat University, to translate the results of a 5-year international research project of the Coastal Cities at Risk (CCaR) on urban resilience into a game.

 

Urban Resilience and the CCaR research

Coastal Cities at Risk (CCaR): Building Adaptive Capacity for Managing Climate Change in Coastal Megacities is a research project financed by Canada, looking at climate change and urban resilience, with respect to flooding in Vancouver, Lagos, Manila and Bangkok. CCaR uses modelling through the VENSIM program, using data derived from City System Dynamic model, to input known variables and produce future scenarios for these cities. Interestingly, the causes of flooding are different in each city, which allows for a broad field of study.

 

Urban Resilience refers to the capacity of a city to bounce back after a shock. The most widespread definition, coined by the Community and Regional Research Initiative on Resilient Communities (CARRI), defines resilience as the “capability to prepare for, respond to, and recover from significant multi-hazard threats with minimum damage to public safety and health, the economy, and national security”[vi]. As evidenced by this definition, urban resilience has adaptability and complexity at heart. It views cities as adaptive systems, where the interactions of a wide set of factors need to be taken into consideration. Moreover, preparedness is key to achieving urban resilience, as anticipating potential future threats to urban settings allows for greater adaptability. This becomes ever more significant given the looming threat of climate change, which already brings an increase in the occurrence and severity of extreme weather phenomena around the world. While urban resilience involves more than natural disasters, these are considered a central aspect of the threats that need to be countered.

 

In Bangkok, it is very intuitive to focus on flooding. Bangkok floods severely every couple of years, and, with climate change, the intensity is worsening. 2011 witnessed the worst flooding in decades; the year remains engraved in people’s minds and imagination, and routinely comes up in conversation as the benchmark for all subsequent flooding. The numbers are staggering: 884 people died, while a further 13.6 million were affected. 65 provinces were classified as disaster zones, and the World Bank estimated the total economic losses at $45.7 billion, making it one of the five most costly natural disasters in history[vii][viii].

 

To a lesser extent, Bangkok floods semi-regularly. For example, it only takes a heavy night’s worth of rain during the rainy season to flood Lat Prao, the area where I live. The CCaR research concludes that flooding in the Bangkok Metropolitan Region (BMR) will intensify as both the intensity and frequency of heavy rain will increase.

 

Perhaps surprisingly, the prevalence of flooding has not been linked to climate change or urban resilience, be it at policy level or in people’s minds. It is also telling that there is no government agency responsible for dealing with it. “It ranks low on the scale of political priorities, far behind questions of economic and social development” remarks Dr Marome, the leader of the CCaR team for Bangkok.

 

Dr Marome stresses the importance of preparing society. “While investing in infrastructure can be very useful, it can only ever represent 70% of dealing with climate change. The remaining 30% needs to be done by people themselves, through preparedness. Japan is a great example of that. The state provides different measures to mitigate earthquakes, from law and regulations to earthquake resistant structures, but society has also adapted. Children are being taught from a very young age how to prepare for earthquakes”.

 

 

In Bangkok, there is clearly a gap between the people who have the relevant information on the one side, and the wider public and government agencies on the other. The Urban Resilience Board Game tries to bridge this gap, by making information easily accessible to a wider public, beyond the scope of academics and people in the field.

 

The Urban Resilience Board Game

The game is played by 4 or 6 players, each the mayor of a Bangkok Metropolitan Region (BMR) – Bangkok Metropolis, Nakhon Pathom, Pathum Thani, Nonthaburi, Samut Prakan, and Samut Sakhon – and a facilitator. Each region has distinct characteristics and conditions, all based on the CCaR research findings: some are more developed, some have issues with waste management, some have issues with social cohesion, or environmental protection. Overall, there are six different urban futures, each affected by four different drivers: socio-economic factors, housing and land use, environment and health, and flood management.

 

All players are allocated an initial budget, to be used for future investments. The players roll the dice to advance on the board and get handed an event that they need to deal with. Events range from anything between a drug problem among the area’s youth to the construction of a fast train linking this area to its neighbours. The player needs to identify the risk, the opportunity, and, where necessary, invest to deal with the event. Points are allocated for correctly identifying each, and all need to be relevant to the specific area’s profile. This urges players to link different issues and eventually identify necessary investments in the short or long term.

 

Rolling a six or completing two rounds triggers a flood round. Flood intensity varies each time, and affects each region differently. An area’s resilience ultimately depends on preparedness stemming from investments in the previous rounds. For example, should an area have a serious garbage problem, investment in clean up prior to the flood round would increase resilience, as refuse not only obstructs drainage, thus worsening the flood, but also spreads diseases. During the flood round, all investment proposals need to be voted on by the mayors of the other regions: players need to argue their case to seek approval. The game ends when any participant reaches the end of the board; the player with the most points wins.

 

The Urban Resilience Board Game thus has a double role: first, it raises awareness about flooding and resilience, allowing people to think about urban resilience and find linkages between different issues. Second, it brings people from different backgrounds together and opens a dialogue that would not otherwise be happening, and certainly not under these conditions. In June 2016, Thammasat University and Openspace organised a workshop with academics, policy makers and representatives from the local government, specifically from the Bangkok Metropolitan Administration (BMA). Many participants had no experience with these issues but all played the board game for two hours. The feedback was extremely positive, as they found the game both informative and entertaining. Interestingly, the game seemed to transcend political red tape, allowing people to consider flooding and urban resilience without the backdrop of the sometimes charged political considerations that happen in Thailand.

The appeal for planners is evident. The game opens a platform for people to discuss complex issues in an informal way. Instead of being confined by the structure and convention of a meeting or conference, participants can let their guard down and engage with the material in a new way. More importantly, the subject matter becomes accessible to people with no prior experience. In the guise of explaining the rules and aim of the game, facilitators are actually presenting the basic information for people to understand the core ideas of urban resilience. Yet all of this remains unthreatening; at the end of the day, it is only a game. The players are then pushed to really think about the issues, and see the connection between investments in infrastructure and cooperation with other regions, and achieving urban resilience. Their output is then fed back to the CCaR team and Openspace, who collect the documented actions that players took during the flood round. This is crucial, as it allows for a feedback loop into the research in a very direct way.

 

In the next months, more workshops will be organised. Moreover, Dr Marome and Thammasat University plan to train members of the public to be facilitators, allowing for greater exposure, perhaps even spilling to other Thai cities in the North. They are also working on having a workshop with urban policy planners from across Asia to play the game. The possibilities are endless, because who would not like to come play with us?

 

[i] Postman, N. 2005 [1985]. Amusing Ourselves to Death: Public Discourse in the Age of Show Business. London: 2005 Penguin Books

[ii] Carr, N. 2008. “Is Google Making Us Stupid?: What the Internet is Doing to our Brains”. The Atlantic. July-August 2008

[iii] Carr, N. 2010. The Shallows: How the Internet Is Changing the Way We Think, Read and Remember. London: W. W. Norton & Company

[iv] Weinreich, H., Obendorf, H., Herder, E. and Mayer, M. 2008. “Not Quite the Average: An Empirical Study of Web Use”. ACM Transactions on the Web, Vol. 2, No. 1

[v] Mcspadden, K. 2015. “You Now Have a Shorter Attention Span Than a Goldfish”. The Times, May 2015. Retrieved in September 2016 from http://time.com/3858309/attention-spans-goldfish/

[vi] Wilbanks, T. 2007. The Research Component of the Community and Regional Resilience Initiative (CARRI). Presentation at the Natural Hazards Center, University of Colorado- Boulder; as quoted in C. E. Colten, R. W. Kates, and S. B. Laska. 2008. Community Resilience: Lessons from New Orleans and Hurricane Katrina. Retrieved in September 2015 from http://www.resilientus.org/wp-content/uploads/2013/03/FINAL_COLTEN_9-25-08_1223482263.pdf

[vii] Emergency Operation Center for Flood, Storm and Landslide. 2012. Flood, Storm and Landslide Situation Report. Retrieved in October 2016 from http://disaster.go.th/dpm/flood/flood54/news/news_thai/EOCReport17JAN.pdf [in Thai]

[viii] Impact Forecasting LLC. 2012. 2011 Thailand Floods: Event Recap Report. Retrieved in September 2016 from http://thoughtleadership.aonbenfield.com/Documents/20120314_impact_forecasting_thailand_flood_event_recap.pdf

 

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Nausica is a DPU MSc Environment and Sustainable Development alumna. She is currently completing the DPU/ACHR/CAN Young Professionals Programme in Bangkok, Thailand. All images taken by Nausica Castanas