KUCHING, North Borneo
Fifty years ago this coming August, I arrived in Lundu, a small town about 80 kilometres west of Kuching, the capital of the Malaysian state of Sarawak in North Borneo. I was there as a volunteer teacher at the new public junior high school, fresh out of high school myself and not quite 18. It was a life-changing experience.
Today, I am back in Sarawak, but now as an international expert on healthy cities. In my opening remarks at a UN-sponsored conference on healthy cities, I focused on what I had learned then and have applied ever since.
Because I realized when I was last back here, almost 20 years ago, that many of my ideas about what makes a city or community healthy can be traced back to here.
When I arrived in 1966, Lundu was a six- to eight-hour journey by boat; there was no road in, in spite of being only 80 kilometres from the capital. Piped water and electricity were limited or non-existent in the villages outside the main town; there was no TV, radio was limited and the telephone service depended on a wireless link and was of poor quality. Only half the children completed primary education, and the junior high school where I taught (in English, the language of instruction and of government) had only just opened.
There was limited access to modern western medicine, with only a small hospital (opened in 1965) but no doctor for the 10,000 or so people in the district (but there were shamans, I attended a shaman ceremony). Basic public-health services included immunizations and water and food inspection, but not a lot more.
Yet in spite of this, people seemed generally happy and healthy. They had homes, there was enough food to eat, it was wholesome and fresh, life was physically active and community connections were very strong. Sarawak was, and is, about one-third Dayak (the indigenous people), one-third Chinese and one-third Malay, and they had generally evolved a tolerant society, respecting each other’s customs and getting along.
At the end of my year of service, I returned to the U.K. and entered medical school (a prestigious specialist-oriented London teaching hospital). But in retrospect, my experience made me question the contribution to health of medical care even as I trained to be a doctor, and turned me toward public health and to looking upstream.
In the early 1980s, inspired by such thinking, I helped create one of the first modern healthy-city initiatives in Toronto. I went on to be part of the planning group for the World Health Organization’s Healthy Cities Project and to co-author the foundational background paper in 1986 — and the rest, as they say, is history.
But it all began in Lundu. Because what I learned there is that health is not simply the product of medicine, but of many non-medical factors. In particular, I have been impressed by the power of education.
Many of the students that I taught — now in their 60s, retired and with grandchildren — have contributed to the transformation of their society as teachers and leaders in many fields.
Progress has not come without a price, however. Sarawak’s forests have been damaged by logging, especially illegal logging, and its ecological footprint has increased. Kuching has grown into a sprawling city of about 700,000 people, with North American style low-density housing and trendy shopping malls.
Traffic is a serious problem and public transit is weak. TV is everywhere, everyone is on their cellphones, and parents and grandparents share the same concerns about the sedentary life of their kids as do their Canadian counterparts.
And so, in the 21st century, the concerns of cities such as Kuching and Victoria are converging. There is much that we can learn from each other, but also from the past. How do we move to a healthier, more active way of life, with low-meat, wholesome diets? How do we design cities that do not sprawl and generate excessive, energy-wasting traffic? How do we build stronger, more-connected communities and enhance mental and social well-being?
These were important issues at the UN conference where I spoke. Next week, I will share some of what was discussed.
Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.