“If the purpose of urban planning is not for human health, then what is it for?”
Dr. Maria Neira, director of the World Health Organization Department of Environment, Climate Change, and Health, posed the question in her introduction to the sourcebook, “Integrating Health in Urban and Territorial Planning,” crafted by the WHO and United Nations-Habitat.
The sourcebook stresses the need for health and planning practitioners to put health at the heart of urban and territorial planning.
The question highlights the need to look at one aspect of development planning, which may appear to be given the least emphasis, but is in fact one of the main reasons urban planning is done.
For City Planning and Development Officer, Arch. Donna Tabangin, the city government has been responding to the WHO’s question for years now, manifested through the current administration’s seven-point executive agenda.
She shared the WHO’s view that urban planning should put public health a priority.
“The reason urban planning exists is public health. If we look at history, pandemics, such as the Black Death, were traced to poor sanitation. This is why we now have zoning and are building sanitation facilities – to ensure public health,” emphasized Tabangin, whose office is at the frontline of implementing programs and policies geared towards achieving a livable Baguio.
To ensure public health, Tabangin said issues and concerns brought about by unmanaged migration, such as the movement of people from the rural to urban areas like Baguio City must be addressed. At the same time, the public must comply with the measures implemented by concerned offices.
Unmanaged population, she said, is the major culprit of the problems faced by cities and urban areas, such as crowding, problematic sanitation, and dwindling natural resources.
Urbanization and public health
The WHO has reported because urbanization has a significant impact on health, there is a need to guide urbanization and other urban development trends in a way that protects and promotes health.
“This is important, not least because the health and well-being of citizens is perhaps a city’s most important asset,” the WHO said.
“Most of the 4.2 billion people living in cities suffer inadequate housing and transport, poor sanitation and waste management, and air qua-lity that fails WHO guidelines. Other forms of pollution, such as noise, water, and soil contamination, so-called urban heat islands, and a lack of space for walking, cycling, and active li-ving further combine to make cities epicenters of a non-communicable disease epidemic and drivers of climate change,” the global health agency added.
Aside from being incubators for new epidemics, the WHO said zoonotic diseases can spread in a more rapid manner in megacities and urban areas and become worldwide threats.
This was proven when the Covid-19 pandemic hit, where cities and urban areas saw the highest number of cases.
The minimum public health protocols, such as observance of safe distancing and having a good ventilation highlighted the importance of having enough open spaces. Maintaining good hygiene starting with the most basic – hand washing – also highlighted the importance of having enough water to minimize the spread of the virus that causes the infection also proved to be challenging in congested areas, which often struggle from lack of water supply.
Urban infectious diseases
Covid-19 aside, the top 10 leading causes of sickness in Baguio in 2020 is a combination of contagious and non-contagious diseases. Based on the 2020 City Epidemiological and Surveillance Unit (CESU) data, upper respiratory tract infection ranked first in the top 10 leading causes of diseases in the city. Others include hypertension, dermatitis, pneumonia, diabetes, flu-like illnesses, bronchitis, urinary tract infection, and asthma.
Dr. Donabel Panes, head of the CESU of the Baguio City Health Services Office, said urbanization also brings about concerns on non-infectious or non-communicable diseases.
Globally, the WHO reported non-communicable diseases kill 41 million people each year, which is equivalent to 71 percent of all deaths.
Aside from the recorded non-communicable illnesses, there is one phenomenon created by urbanization that requires medical attention: burnout.
Panes said burnout should not be disregarded as it affects not only people’s physical, but especially their mental well-being.
In an urban set-up, the stress of coping with the demands of a fast-paced life, contributes to burnout, which can take a toll on one’s mental health.
For workers, Panes said transportation woes, particularly traffic congestion, contribute to their stress and burnout.
This is true for employees belonging to a workplace that does not practice flexible working hours and is strict with the 8 a.m. to 5 p.m. schedule. Workers have no option but to endure congestion during the rush hours to arrive to their offices on time.
There are no readily available data on the number of people who developed mental health concerns due to stress or burnout, but according to the WHO’s International Disease Classification – the global standard for recording health information and causes of death – burnout is one of the factors or reasons people seek health services or medical consultations.
The lack of open spaces as a consequence of urbanization also affects a person’s physical and mental health, especially if this deprives them the opportunity to exercise or go outdoors for leisure.
“With limited open spaces, people will have limited access to (an environment) conducive to exercising, which can lead to obesity and heart diseases,” she said.
Air pollution, which is also a major environmental concern in urban areas, contributes to the development of non-communicable diseases and other health concerns.
“Pollution has been found to be a risk factor for heart diseases, respiratory infection, and risk factor for premature delivery or spontaneous abortion,” Panes said.
“These concerns that are tied with urbanization cannot be disregarded as they are risk factors for non-communicable diseases.”
Response to urbanization’s impacts on health
For some infectious diseases, concerns brought about by urbanization can be addressed through the basic fundamentals of public health, which is provision of sanitation facilities, according to Panes.
“Access to safe water and sanitation facilities is a plain and simple solution to addressing infectious diseases. We need to ensure that everyone has access to toilets and handwashing facilities, with flowing water,” Panes said.
Another way of preventing outbreaks in diseases is putting in place proactive policies and strategies.
For Baguio City, which has had its share of unfortunate experiences in dealing with outbreaks in diseases, the continuous monitoring of the trends in illnesses, through the establishment of the CESU, has been a good policy response to health concerns.
Disease surveillance plays a huge role in the detection of emerging and re-emerging diseases and provides the information needed to guide decision-makers in crafting their response.
“Monitoring is important because it helps us see the trend in diseases. Through surveillance, we can detect illnesses that were not recorded in the past, like what happened with the Covid-19 when there was an abnormal increase in pneumonia cases in Wuhan, China. It is also through surveillance that we can detect re-emerging diseases or those that were eliminated, but are again affecting the population,” Panes said.
How the Covid-19 highlighted Baguio’s response to outbreaks
Among other diseases, Baguio has dealt with the first dengue outbreak in 1998 and the cyclic outbreaks that ensued, the Severe Acute Respiratory Syndrome threat in 2002, the outrbreak in meningococcal disease in 2005, the series of outbreaks in measles and pocket of outbreaks in food poisoning, and H1N1.
The 2005 outbreak in meningococcal diseases in Baguio gained the attention of the WHO, which at the time tied up with the Global Outbreak Alert and Response Network (GOARN) to assist the Department of Health and the city government address the concern.
Among other major assistance, the WHO and GOARN helped in strengthening the city’s epidemiological surveillance or disease monitoring capacity and laboratory capacity to detect and confirm the reported meningococcal cases.
The 2005 outbreak has further strengthened the ability of Baguio health workers to conduct an aggressive contact tracing, aside from highlighting the importance of vaccinating those who were directly involved in managing the cases in the bid to contain the spread of the disease, still with the assistance of the WHO. The experience and capacities built during the ‘meningo’ outbreak have somehow helped the CHSO manage the Covid-19 pandemic.
It, however, further tested the city’s ability to respond to outbreaks in diseases due to the unprecedented high number of cases that overwhelmed the health system, especially during the first year of the pandemic.
Panes said the limited number of personnel at the CESU who were initially doing the disease surveillance was one of the challenges to the city’s Covid-19 response at the onset of the pandemic.
She said when the Covid-19 hit, health workers, who used to handle hundreds of cases at the most, had to manage thousands of cases.
“The cases jumped to thousands already; they were no longer in the hundreds, and this was challenging for us.”
“But at the same time, we have again proven our response ability when the mayor (Benjamin Magalong) asked the national task force to allow members of the Philippine National Police to be tapped for contact tracing,” Panes said.
The involvement of the PNP, who helped in the triage and contact tracing and the Bureau of Fire Protection, who helped in the swabbing, and the mobilization of the barangay health emergency response teams in the Covid-19 has been one of Baguio’s best practices in dealing with the pandemic.
While Covid-19 cases are going down and more people are being vaccinated against the disease, Panes said these should not be reasons to be complacent as variants and other diseases are emerging.
Baguio’s contact tracing should not end even after the Covid-19 pandemic, Panes said, adding this is helpful in other existing communicable diseases, such as tuberculosis.
She also emphasized vaccination remains one of the most efficient ways to manage and prevent outbreaks of infectious diseases and some non-communicable diseases.
Since Baguio continues to attract people – young and old – Panes said emphasis on the importance of vaccination, not only against Covid-19, but other illnesses, should remain.
As for Tabangin, addressing the health and other concerns brought about by urbanization should not be left with urban planners and health professionals alone.
She said aside from the government, addressing the adverse impacts of urban planning is a two-way relationship.
Having been at the receiving end of indifference, criticisms, and complaints due to the strict measures implemented by the current administration in its bid to address urbanization woes, Tabangin said public cooperation is needed for Baguio to remain a livable city.
“Aside from the physical approaches we are doing to make urban planning work, we also need behavior change; and that should start with everyone of us,” she said.
Tabangin said Baguio will be left with nothing to support a decent life if the people remain lukewarm and non-compliant with the policies being put in place to make the city a livable place.