What will our planet look like fifty years from now? The shape of things to come will inevitably be defined by the breathtaking growth of the great cities, a contemporary phenomenon which is already a number one concern for the international community.
Since 1950, urban populations have grown at a furious pace and are expected to increase further in the next 35 years to the point where, in the year 2025, 5000 million people will be living in cities. In less than ten years, by the year 2000, no fewer than 24 urban agglomerations will each have over ten million inhabitants; fie of these, including four in developing countries will exceed 15 million.
People from the countryside migrate towards the town, to the detriment of the quality of life there, since they are already bulging at the seams and unable to cope with such an influx; meanwhile the countryside itself is drained of its life blood, and risk being left behind the race for development.
In many countries, hasty efforts have made to provide the urban populations with such vital matters as lodging, job opportunities, and social and health services. The public authorities often have to face insurmountable problems to deal with proliferating slum settlements, and to prevent any further deterioration of the environment as well as of health and social welfare.
Moreover, the concentration of productivity in cities; one extreme example is the case of Thailand, where 10 per cent of the inhabitants of Bangkok provide 80 percent of the whole country gross domestic product. This means that certain number of residents enjoys a far higher standard of living and better health services, than is the lot of their rural compatriots or of their less favoured fellow citizens.
Every possible effort has to be made to ease this gross discrepancy and bring about equality of access to services. In view of the complexity and the degree of interdependence of all the factors contributing to this situation, the primary health care approach and intersectoral cooperation combine to form the strategy of choice to confront these daunting problems.
Action at the local levels is also to be encouraged to the full. The healthy cities project is one example of the effort being made to convince countries to put health firmly on the political agenda of communities and local governments. Once again, it’s a matter of thinking globally and acting locally. Local action is by far the most effective approach, all the more so if it takes place within a national, regional and even a worldwide framework.
The interdependence of human beings with their physical, social and economic environment must now more than ever be taken into account in health related activities. Local power act must therefore be reinforced, and local authorities must be convinced of the important role of health in development efforts. Furthermore, all sectors that have an influence on health must be integrated into a collaborative team. The planning and carrying out of strategies must be flexible, to take into account the wide diversity of towns, countries and situations. Enlightened leadership is called for, to encourage the participation of everyone. And, finally it must never be forgotten that health for all is a common, shared objective, which alone can allow us to hoe for eventual justice and equity in ensuring, the fundamental right of every human being; the right to health.