Abstract
Policies regarding public health, the environment, and urban planning present in many European countries today are still mostly partitioned, as are the economic resources made available by the central governments. It is necessary to change the paradigm and integrate all the different aspects of health and quality of life of residents and city users to define the physical space of the city and ensure that financial resources from different sources can be integrated. To do this, it is necessary to understand the factors that influence an individual’s state of health and, more broadly, the health of a community or population, and how urban space relates to them. Briefly, the so-called “determinants of health” need to be understood. Experimentation should be considered as a necessary action to increase awareness of the relationships between urban planning and determinants of health, along with evaluations of the impact of urban plans and projects on health and the quality of life in cities. Experimentation in the URBACT II PIC Program “Building Healthy Communities” has moved along these lines.
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Notes
- 1.
In 1974 the Working Paper by the Canadian Federal Government, “A new perspective on the health of Canadians” (the Lalonde Report), stated that modifying the lifestyle and physical and social environment would probably lead to improving health more than investing money in existing health services.
- 2.
This model focuses attention on inequalities in matters of health. In fact, significant inequalities regarding the state of health of the population around the world cannot be explained by individual or genetic differences. Dahlgren and Whitehead represent this concept through a graphical representation of the determinants of health organized into four levels of influence around the factors of human biology. The model is expressed in a series of concentric layers, each corresponding to a different level of influence. At the centre there is the individual, with his or her biological characteristics: sex, age, genetic history, i.e., the determinants of health that cannot be modified. The modifiable determinants, those that can be corrected and changed, are organized in layers from the inside to the outside: individual lifestyles, social and community networks, living and working environment, the political, social, economic, and cultural context. This is a conceptual model that both reflects the European culture of the welfare state based on “right to health” and adopts the “multi-sector” vision of the protection of health contained in the Declaration of Alma-Ata.
- 3.
The conceptual framework of health and its determinants according to the MSSS model (2010) outlines a more detailed vision with respect to the Dahlgren-Whitehead model. It describes health (overall, physical and mental, psychosocial) as a variable that is susceptible to change over time and according to the place. It identifies four large families of determinants (global context, systems, living environment, and individual characteristics) as well as subfamilies (biological and genetic characteristics, personal and social abilities, family, school, and childcare) that influence the state of health of the population. The model also allows the importance of territorial planning choices for public health to be considered.
- 4.
CSDH (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the commission on Social Determinants of Health. Geneva: World Health Organization.
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D’Onofrio, R., Trusiani, E. (2018). Criteria of Healthfulness in Urban Environments: From a Theoretical Debate to Some Early Experiments. In: Urban Planning for Healthy European Cities. SpringerBriefs in Geography. Springer, Cham. https://doi.org/10.1007/978-3-319-71144-7_3
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