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C h a p t e r 5 Design of Healthy Cities for Women Eugenie L. Birch Cities are places where women can live healthy or unhealthy lives. By definition, cities are large, are densely settled, and support heterogeneous populations. When properly designed, they provide clean water, efficient transportation, universal education, health services, personal and property protection, and solid and sanitary waste disposal. And in a perfect world, all their residents occupy affordable, durable, structurally sound housing that meets minimum standards with regard to the provision of light, air, sufficient living space, and basic services (e.g., water, electricity, heat). Their residents also reside in neighborhoods that accommodate or are proximate to jobs, community services, recreation , and fresh food. Finally, in a perfect world, cities support design practices that go well beyond the basic service provision just described to promote living habits that contribute actively to excellent health. In the developing world (or Global South), these practices may encompass implementing innovative water, waste disposal, and transportation systems, participating in mapping exercises to document new slum settlements and their populations for the purposes of service delivery, or supporting self-help or other cooperative ventures to develop standard housing and other efforts to modernize or fully integrate new neighborhoods into fast-growing cities. In contrast, in the developed world (or Global North), design practices attend to addressing the needs of areas of concentrated poverty but also include crafting land use and building codes that promote active living, such as New York City’s recent passage of a requirement that all new multifamily residential buildings have bike-storage rooms; employing competitive rating standards, such as the Leadership in Energy and Environmental Design for Neighborhood Development (LEED-ND) rating system, developed to produce districts that “protect and enhance health”; and implementing citywide sustain- 74 Eugenie L. Birch ability plans that incorporate women’s health-inducing elements, such as those of New York City, London, and Singapore (US DHHS 2009a). Although no city in the world meets all of the standards outlined at the start of this chapter, some are inching toward them. Cities in the developed world are often at a distinct advantage because they are in regions that are already highly urbanized and relatively prosperous and have manageable rates of urbanization and comparatively small city sizes, whereas those in the developing world are in generally less highly urbanized, economically poor regions, confronting runaway rates of urbanization, and have average city sizes that are much larger than those of the Global North—all factors making the provision of basic services, much less advanced design ideas, difficult (Spence, Annez, and Buckley 2009). Nonetheless, the cities of the Global South have the advantage of being able to avoid the settlement-pattern mistakes of the Global North if they so choose and/or can rally the resources to do so. More important, for both types of regions there are common design specifications for cities, neighborhoods, and homes that promote better female health regardless of the level of development. To explore these ideas, this chapter establishes the physical/social and economic foundation for pro-female-health design by outlining worldwide urban settlement patterns and the associated issues. It then reviews common design specifications for cities, neighborhoods, and homes and discusses their application in different developmental contexts. Worldwide Urban Settlement Patterns and Associated Issues As is well known, the world population crossed the “majority-urban” line in 2008; but not so well known are many other factors that characterize the urban environment in which women live and have important ramifications for their health. These factors include the distribution of the urban population between the developed and developing worlds; the location and population levels of different-sized cities; the relative rates of urbanization; current and future demographic profiles; the relationship between level of urbanization and economic development; and the nature of women’s labor force participation in today’s global, primarily urban economy. Location of Urban Populations, Rates of Urbanization, and Service Provision Of the 6.8 billion people in the world, 82 percent (5.6 billion) live in the developing world and half (3.5 billion) are city dwellers. Of the urban- Design of Healthy Cities for Women 75 ites, 74 percent (2.5 billion) live in the developing world, up from 54 percent (0.8 billion) in 1975. Demographers anticipate the urban population to experience an 85 percent increase by 2050 (rising to 6.3 billion , or two thirds of the world population), primarily in the developing world...


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