borhoods also have 1,000 times
fewer libraries and report teenage
pregnancy and mortality rates that
are nine and 14 times greater than
in wealthier ones.
Such inequalities are increasingly considered unacceptable,
and an emerging movement is
aiming to achieve greater urban
health and justice. The movement
is powered by social participation
and the concept of healthy governance: integrated urban planning
initiatives in public health, environment, education, transporta-
tion, economic activity, education,
and culture based on partnerships
between governments, the community and the private sector.
Several programs in Latin America have pointed the way. In Brazil,
the Programa de Saúde da Família
(Family Health Program) reaches
100 million people, the majority
in poor areas. It is working with
urban residents in at-risk areas on
issues such as degradation of green
spaces and public spaces, waste
disposal and recycling, sanitation,
and home hygiene and ventilation.
Grassroots groups such as the Rede
de Comunidades Saudáveis (Healthy
Communities Network) in Rio
de Janeiro have helped empower
citizens by promoting dialogue
between communities and the
government. In São Paulo and in
20 other cities that make up the
Rede Brasileira de Cidades Justas e
Sustentáveis (Brazilian Network of
Fair and Sustainable Cities), citizens and nongovernmental organizations are demanding transparent
and egalitarian governance based
on verifiable goals. Urban planners are beginning to rethink the
design and planning of cities, and
are favoring walkways and bicycle
paths. New initiatives in the favelas are beginning to invest more in
participation and in social actions.
In Colombia, citizenship and
governance programs have radically changed the face of cities such as
Bogotá and Medellín over the last
10 years, resulting in an improved
quality of life.
For this movement to expand,
we need new leaders who are open
to a style of governance that is
both participatory and fair. Governance that places health, sustainability and quality of life at the
center of its actions can go a long
way toward correcting inequalities
and building cities that are more
just and environmentally healthy.
Daniel Becker, MD, MPH, is
a public health researcher and
practitioner and is a director at
CEDAPS, the Center for Health
Promotion in Rio de Janeiro, Brazil.
