Town Planning & Health: A Rural Posting Lecture to NAU Final Year Medical Students.pptx

TOWN PLANNING & HEALTH
(A RURAL POSTING LECTURE FOR NAU FINAL YEAR MEDICAL STUDENTS)
Dr. Nkiru Ezeama MBBS, MPH, PhD, FWACP
Senior Lecturer | Consultant Public Health Physician
Department of Community Medicine
Nnamdi Azikiwe University Awka | Nnamdi Azikiwe University Teaching Hospital, Nnewi

Lecture outline
■ Introduction
■ What is Town Planning?
■ Public Health Origin of Town Planning
■ Aims and Objectives of Town Planning
■ Benefits of Town Planning
■ Health implications of Town Planning
■ Principles of Healthy Town Planning
Dr. Nkiru N. Ezeama: Town Planning and Health 2

Introduction
■ The urban world is rapidly changing in revolutionary
proportions in both developed and developing
countries
■ With mass movements to cities, population
explosions and demands on scarce resources, it is
vitally important to look at how cities develop and
how they are planned.

What is Town Planning?
■ Town planning is the discipline concerned with the managing and
regularizing the use and development of land and other resources
including air and water.
■ The design and development of the built environment and the
infrastructure passing into and out of urban cities such as
transportation, communications and distribution networks.
■ It deals with the physical layout of human settlements.
■ Town planning tries to balance the demand of land owners and
developers with the needs and concern of the community and policy
framework.
■ Its primary concern is the public welfare which includes
considerations of efficiency, sanitation, security, and the use of the
environment.

■ Its purpose is to find solutions for the use of land
and public domains, environmental protection,
infrastructure, supply network and many other
segments that make a town/city functional and
operational
■ Cities rapidly become small and need expanding.
They are also the greatest polluters.
■ Therefore because of the dangers of global climate
change and environmental catastrophes like
storms, floods, hurricanes etc., Town Planning is an
important field for creating safe and efficient
human settlements.

Public Health Origins of Town Planning
■ Historically, the practice of Town planning dates back as far as the
3rd millennium BC and the urban designs of the Mesopotamians,
Minoans, and the Egyptians as well as the Greeks and the Roman
Empire.

■ The intricate relationship between the disciplines of Public
Health and Modern Town Planning arose from the same
stimulus – that of the appalling conditions and devastating
death rates during the Victorian era.

■ The industrial revolution of the 19th century caused
rapid growth of coal, steel and manufacturing
industries.
■ In turn, this brought workers and their families from
the countryside to the cities in droves.
■ These exploding cities lacked sanitary
infrastructures to cope with the swelling masses.
■ Improvised and often crowded housing typically lay
adjacent to factories that discharged smoke and
other pollutants.

■ The alliance between public health and town planning resulted in
massive improvements in health and life expectancy over the
following century than medicine.
■ However as the two disciplines drifted apart, the medical model of
health gradually established its current hegemony.
■ Public Health and town planning are therefore intrinsically linked.
■ They both make reference to the fact that physical and social
environments play major roles in the health of communities.
■ The relationship between health and environment has been
reformulated in modern times in the shape of the social
determinants of health model articulated by Whitehead and
Dahlgren.
■ Town planning at its core tries to manage those very same
determinants of health – employment, housing, transport,
education, environment and so on.

Aims and Objectives of Town Planning
HEALTH
■ To create and promote healthy conditions and
environments for the population.
■ To make the right use of the land for the right purpose by
zoning
■ To ensure orderly development.
■ To avoid encroachment of one zone over another.
■ To improve quality of life of citizens
CONVENIENCE
■ To ensure provision of social, economic, cultural and
recreational amenities.
BEAUTY
■ To preserve the individuality of the town/city
■ To preserve the aesthetics in the design of all elements
of the town/city.
Examples of Land use
practices include:
1. zoning ordinances that
isolate employment
locations, shopping and
services and
housing locations from
each other;
2. low-density growth
planning aimed at
creating automobile
access to increasing
expanses of land.

Benefits of Town Planning
1. Helps cities to grow
■ The population of cities is growing due to more work opportunities and
better conditions for education and so on.
■ Cities therefor evolve regularly to accommodate increasing population.
■ Government should always develop a framework for town planning that
predicts the needs of the citizens, appropriate expansion of infrastructure
and create contingency measures for emergency situations.
■ Town planning enables a city to exploit its resources and develop
strategies to help grow its economy and increase liveability conditions.
■ It enables towns/cities grow responsibly, improving transportation,
health and other systems, expanding residential areas etc. without
negative impacts to the economy and its citizens

2. Anticipates disasters
■ Global warming and terrorism have created serious
and dangerous problems for the world and its
inhabitants.
■ Anticipating and managing disasters should be a
priority of government and town leadership.
■ Town planning is essential to managing risks and
ensuring better outcomes from all possible
catastrophes.

3. Improves quality of life
■ Employment and housing are major concerns for
inhabitants of towns/cities.
■ Cost of living is greater but so are the opportunities.
■ Town planning aids in the development and
implementation of policies and regulations for land use,
public spaces and arrangement of infrastructural services.
■ Arrangement of transportation networks including bus
stops and subways
■ Creation of attractive points of interest.
■ Regular upgrading and maintenance of the roads and
traffic regulation due to the constant increase in vehicles.

4. Has a positive impact on the economy
■ Economic requirements of cities increase as they grow.
■ If cities are not planned correctly, it can have a devastating
impact on the economy.
■ Town planning aids in opening up new job opportunities,
attracting investors, reducing the cost of living etc.
■ It also enhances expansion to neighbouring rural areas.
■ Town planning includes all the necessary investment and
locations for further development and exploitation of the
rural areas which will bring profit and economic growth to
the city.

5. Provides healthy and safe conditions to its citizens
■ Town planning includes public spaces like parks
and gardens which are intended to create a better
environment and provide necessary areas for the
citizens to exercise and spend their leisure time.
■ Town planning controls exposure to agents of
disease and other negative effects of
industrialisation and urbanisation. Includes refuse
and garbage collection, clean water supply and
sewage infrastructure.

■ Town planning contributes to prevention of illness through
ensuring living quarters have adequate light and
ventilation, minimizing exposure to toxins like asbestos and
lead. E.g. design of buildings to improve access to natural
daylight to prevent illnesses such as seasonal affective
disorder.
■ Town planning is concerned with measures to reduce
fatalities and injuries due to accidents. The accident-
reduction policies that are most traditionally aligned with
the concerns of town planners include such issues as
traffic control and planning, pavement standards, planning
for fire stations and standards for playground equipment.

■ Town planning is also concerned with the creation of safe
public places more especially with the increase in crime
and more people in fear for their safety. Town planning
seeks to improve the design, planning and management of
public areas so that they are visible, accessible and well
used by a wide cross-section of the population.
■ In the UK for instance, initiatives have been set forth to
communicate three basic principles in the planning and
development of public spaces: (1) to maintain a physically
clean environment; (2) to create a mixed-use environment
with a variety of activity generators; and (3) to ensure that
public areas are visible over longer distances, by installing
good quality, uniform lighting.

Health Implications of Town Planning
1. Safety
■ The safety of communities has vastly improved through
building codes and other policies.
■ Town planning contributes to creating safe environments
through laws that ban carcinogens (e.g. asbestos) and
toxins in building materials and those that seek to
minimize domestic accident through design.
■ Certain elements of design and planning can however add
to the poor safety conditions of community residents,
especially for women and children by exacerbating crime
risk

2. Pollution
■ Town planning contributes to air, water and other types of pollution and
at the same time plays a role in the prevention of it.
■ Urban development and planning have contributed to reliance on the
automobile which is a major factor in air pollution.
■ Besides outdoor air pollution, town planners and designers must also
consider indoor air pollution in developing housing and work spaces.
Urban populations and some of the most vulnerable people (the young,
the infirm and the elderly), typically spend more than 95 percent of their
time indoors.
■ Therefore, the designs of homes and office space must create structures
that are congruous with human activity and the needs of its most
susceptible occupants.

3. Housing
■ The importance of housing environments to health cannot be
overemphasized.
■ When considering healthy housing design, it is necessary to strike a
balance between the needs of the individual, of the family and of the
larger world community., appreciating the social and ecological
consequences.
■ Sometimes governments undertake initiatives to provide quality housing
and less oppressive conditions for the economically disadvantaged. This
practice is known as “slum clearance.”
■ An unintended consequence of slum clearance is the psychological
trauma and grief of the dislocated communities.
■ Dwelling types such as high rise apartment have also been linked to
feelings of loneliness and isolation particularly among the elderly and
women.

4. Violence
■ Increased urbanisation and community deterioration are
considered risk factors for increased acts of violence.
■ If a community does not have adequate health services,
schools, libraries, recreational facilities or access to food and
parks, the community loses a major buffer against violence.
■ Without these critical institutions, not only is a buffer missing,
but there is no community infrastructure and thus minimal
opportunity for community cohesion, resulting in intensified
fragmentation that promotes violence.
■ Town planning stresses the need for creating neighbourhoods
that foster pride, respect and friendliness and ensure
accessibility of services.

5. Fragmentation
■ Urban planning policies have led to an increased sense of fragmentation in urban
communities.
■ By emphasizing the needs of the individual over those of the community, thus making
it difficult for people to develop and sustain social support networks.
■ Urbanization and industrialization have decreased the likelihood that supportive social
relationships can exist, even though they have created the
■ The development of the suburb has contributed to disconnection and fragmentation
by denying residents the opportunity to interact with others outside the home or work
environment.
■ The coffee shop, the local grocery store and other informal gathering sites that foster
a sense of social connection have been zoned out of residential areas.
■ An overwhelming, and arguably dangerous, amount of attention has been paid to the
individual and family unit, resulting in aesthetically well designed individual homes
but no sense of community.

7. Ecology
■ As cities become more complex so do the related
environmental problems ranging from loss of open space
to climate changes
■ There is an urgent need for health town planning that takes
into consideration that human health is one part of the
larger global ecosystem and is sustained by this system
■ Damage to the ecosystem will both directly and indirectly
damage human health throughout the world.
■ The emphasis of town planning should not just be on
aesthetics and individualism but also emphasize
sustaining and re-establishing ecosystems.

10 Principles of Healthier Town Planning and
Development
1. Encourage citizen and stakeholder participation in development
decisions
Health Benefits: increases civic participation, develops social capital
and reduces isolation-related depression.
2. Make development decisions predictable, fair and cost-effective
Health Benefits: increases civic pride and sense of ownership in
communities.

3. Create a range of housing opportunities and choices
Health Benefits: decreases segregation by age, income, and
race thus developing social and cultural capital. In diversified
communities, automobile dependency is decreased as
residents spend less time commuting to jobs and family
members.
4. Provide a variety of transportation options
Health Benefits: increases physical activity and decreases
ailments associated with inactivity. More energy efficient
transportation options improve air quality and helps decrease
respiratory problems.

5. Strengthen existing communities and direct
development towards them
Health Benefits: keeps communities compact and
less auto-dependent, decreases segregation by age,
income, and race and thus develops social and
cultural capital. Residents spend less time
commuting to jobs and family members. Increases
physical activity and decreases ailments associated
with inactivity. Improves air quality and helps
decrease respiratory problems.

6. Preserve natural beauty, parks, farmland,
and environmentally critical areas
Health Benefits: Increases recreational activity
and decreases ailments associated with
inactivity. Concentrations of plant life improve
air quality and helps decrease respiratory
problems. Parks provide more opportunity for
formal and informal social interaction.
Farmland rebuilds a connection to place and
adds a component of social capital and
community identity.

7. Create complete neighbourhoods where daily needs are
close at hand
Health Benefits: keeps communities compact and less auto-
dependent. As a result, decreases segregation by age,
income, and race and thus develops social and cultural
capital. Residents spend less time commuting to jobs and
family members. Provides more opportunity for walking to
destinations, thus increasing physical activity and decreasing
ailments associated with inactivity. Improves air quality and
helps decrease respiratory problems. Supplies fresh, local
food for maximum nutritional benefit at a lower
environmental cost.

8. Create a safe, inviting environment for
walking
Health Benefits: provides more opportunity for
walking to destinations such as community
gardens and parks for more vigorous exercise,
thereby increasing physical activity and
decreasing ailments associated with inactivity.
Improves air quality and helps decrease
respiratory problems.

9. Foster distinctive communities with a strong sense of place
Health Benefits: increases civic pride and sense of ownership in
communities. Supports a strong public realm and helps develop
cultural and social interaction among citizens. Decreases
depression and sense of isolation and increases the perception of
safety.
10. Make efficient use of public investments in infrastructure,
schools, and services
Health Benefits: keeps communities compact and less auto-
dependent. As a result, decreases segregation by age, income,
and race and thus develops social and cultural capital. Residents
spend less time commuting to jobs and family members. Provides
more opportunity for walking to destinations and thus increases
physical activity, decreases ailments associated with inactivity,
improves air quality, and helps decrease respiratory problems.

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