When public health integrates urban planning policies

With his treatise “On air, water and places”, Hippocrates already wanted to draw the attention of his contemporaries to the impact of our environment on health. In the 5th century BC, he was convinced that diseases came from “everything we introduce into our body: the air we breathe, the food we eat, the drinks we swallow,” says architect Albert Lévy. in his work “City, urban planning and health, the three revolutions”. This link between health and – what was not yet called – town planning was distended for a long time, before re-emerging in the 19th century in London. The British capital was then ravaged by a cholera epidemic, until a doctor, John Snow, made the connection with the city’s water fountains.

In turn, Paris was hit: 18,000 died in 1832. Doctors like Dr. Claude Lachaise sounded the alarm, blaming the narrowness of the streets and the crowding of households into cramped housing. Place, then, at the beginning of sanitation networks, the ventilation of cities with the creation of parks and wide arteries as Haussmann did in Paris. Major epidemics disappear at the moment when scientific medicine takes off, crystallizing all expectations. The urban planning and health couple weakened again, until the early 2000s. The World Health Organization (WHO) then described the “social determinants of health”. In other words, “the personal, social, economic and environmental factors that determine the health status of populations”. A nod to Hippocrates and a way of reminding us that health is not just about care and the absence of disease: if, at 40%, our condition actually depends on the health care system and genetic factors

half is explained by our social and economic environment. And 10% of our health is linked to our immediate physical environment.

Preventive urban planning

“This shows the prominence of the space in which we live and of prevention,” summarizes Cyrille Harpet, researcher at the School of Advanced Studies in Public Health (EHESP). “Today, with the health crisis, these two materials are coming back to us like a boomerang,” adds Sandrine Delage, project manager at Grand Paris development. To the point of legitimizing the contributions of an urban policy integrating health issues, both at the level of strategic documents and on the ground? The trend is emerging but remains to be confirmed by an acculturation of city builders to what we now call environmental health. Or how elected officials can take care of their fellow citizens… And, ultimately, retain them in big cities at a time when the urban exodus in favor of the countryside and smaller towns seems to be looming.