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Trevor Hancock: Making healthy cities takes holistic approach

At the Urban Thinkers Campus on Healthy Cities in Kuching, Malaysia, there were ideas and lessons from all over the world about how to create healthier cities.

At the Urban Thinkers Campus on Healthy Cities in Kuching, Malaysia, there were ideas and lessons from all over the world about how to create healthier cities. Here are a couple that I found particularly useful, one about the education and practice of urban professionals, the other about how to develop and apply the power of civil society.

One breakout session involved urban professionals, mainly urban planners and public-health staff. We agreed that a gap has opened between these two great fields of practice since their closely linked origins in the 19th century, to the detriment of both disciplines and of the citizens they serve.

We discussed how to work more closely together, and concluded that part of the answer lies in education, which needs to be much more interdisciplinary.

But it’s not just about being aware of each other’s field of knowledge; we need to learn together, to think holistically and to understand cities and communities as complex, adaptive systems. Because the complex challenges faced by cities and societies in the 21st century will not be solved by specialists working in isolation, or even in interdisciplinary teams, although that will help. We need a new form of specialization, if you like — the generalist, or the holist.

In this age of specialization, even hyper-specialization, generalists have been looked down on, in my own field of medicine as elsewhere. The “lowly GP,” for example, was often put down by specialists, devalued and paid less, for decades, while the plight of the even more generalist public-health physician was worse, almost seen as “not real doctors” because we don’t see patients.

Yet in reality, a holistic approach is every bit as sophisticated and specialized as that of the specialist. Family practice and public health require both a much broader field of knowledge and — most important — the ability to think holistically and see what Gregory Bateson called “the pattern that connects.”

We need to train many more people in these skills, not just in the health field or in urban planning, but throughout society.

This has broader implications; universities, like society as a whole, have become heavily siloed, and we don’t easily reach across or teach across disciplines, let alone learn and teach holistically. There are also implications for government, which is if anything worse than universities in its siloed worldview. We need to establish the mechanisms and structures within governments at all levels that enable them to work across the different disciplines and sectors and to develop and implement holistic policies and programs.

The power of civil society was well illustrated in a presentation by Dr. Siddharth Agarwal, a physician and executive director of India’s Urban Health Resource Centre. He described the work of this inspirational organization — whose mission is “to bring about sustainable improvements in the health conditions of the urban poor by influencing policies and programs and empowering the community.”

One way they do this is by training and empowering women’s groups in urban slums, creating clusters of these teams of women and supporting them to organize to address the issues they face, often pitted against local, state or national governments. Indeed, a crucial part of their success lies in the fact that they see slum-dwellers as playing an important role in the city, contributing to better urban governance.

In one two-year campaign, they increased the number of people with proof of address and government picture ID — key to accessing a range of government services and benefits — by 20,000.

Among other things, these empowered women’s groups have gained greater access to health services, acquired skills to care for and support their families and neighbours, and promoted savings and girls’ education. In some communities, they fought successfully to shut down the illegal gambling and alcohol dens that were preying on their families.

But perhaps most important — and certainly most inspiring — is the approach they take in dealing with officialdom. Agarwal described it as “gentle, tactful, negotiation through collective petitions.” They insist on their right to participate, maintain a paper trail and persevere with tact rather than confrontation — tea, biscuits and a polite “thank you” works best, he says.

Clearly it works, and provides important lessons for us all.


Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.