Equitable and Healthy City Planning: Towards Healthy Urban Governance in the Century of the City

Abstract

This chapter highlights that city planning is a crucial aspect of human health since it is a discipline and professional practice that shapes the political processes, institutions, and discourses that generate policies, rules, and physical plans that shape where we live, learn, work, and play. City planning acts as a structural determinant of health through its formal and informal institutions, its micro and macro politics, and how these intersect with our day-to-day activities, from access to employment and food to the qualities of our neighbourhoods and housing to the allocation and distribution of social and health care services. This chapter offers a brief review of modern city planning history, suggesting that in the nineteenth century planning emerged as a profession and discipline with close ties to public health initiatives, including tenement housing reforms, the construction of urban water supply and sewerage systems, and the design of parks and playgrounds. Yet, I also show that the work of city planning and public health professionals diverged throughout the twentieth century, which has contributed to the persistence of health inequities for many poor and minority urban populations. Throughout this chapter, I identify at least three lessons from each field’s modern history that present challenges for reconnection related to the structural determinants of urban health inequities, including an overemphasis on (1) physical changes for improving social conditions, (2) scientific rationality, and (3) professionalization and fragmentation of the disciplines. Building on the historic review and these themes, the chapter suggests a set of reconnection strategies and practices for moving towards ‘healthy and equitable city planning’ that will require continued critical engagement with the histories of the fields along with new issues and problem framings, investigative and analytic techniques, and inclusive and deliberative public processes that together can generate new norms, discourses, and practices for greater health equity. In short, healthy city planning will require new commitments to inject health and social justice into urban governance. Healthy urban governance will mean that the decision-making processes and institutions that shape places are altered to focus on equity, and that new decisions ensure a more equitable distribution of the positive physical and social characteristics of places that promote urban health.