Building Healthy Cities: the Experience and Challenges Faced by China
Total Page：16
File Type：pdf, Size：1020Kb
CITIES, HEALTH AND WELL-BEING HONG KONG, NOVEMBER 2011 a worldwide investigation into the future of cities Building healthy cities: the experience and challenges faced by China Bingqin Li is Lecturer in Social Policy and Research Associate at the Centre for Analysis of Social Exclusion (CASE) at the London School of Economics and Political Science. Cities are crucial for China’s economic development. level to the top to become a national level winner, as Further urbanisation is one of the key elements of do districts and rural townships participating in the post-central planning reform and is seen as the solu- ‘hygienic district/township’ campaigns. tion to rural poverty. However, as people concentrate The key motivation for participating is that offi- in cities, they face various health challenges. These cials in winning cities have a good chance of being concern not only the provision of good health care promoted. Outstanding individual performers may services but also the prevention of disease, improving be honoured and even rewarded financially. Partici- the quality of living environments and maintaining a pating cities also receive special grants from higher healthy lifestyle. government authorities. It is, therefore, not difficult Due to its long history of public health campaigns, for organisers to attract willing participants. By the there is a strong belief in China in the positive im- end of 2009, 118 National Hygienic Cities, 28 Nation- pact of city hygiene on public health. Public health al Hygienic Urban Neighbourhoods and 377 Nation- campaigns (PHCs) originated in the 1950s during the al Hygienic Counties and Towns had been awarded. Korean War as a means to fight the threat of chemi- The HCC helps to transform a city in many ways. cal and biological warfare, and were later institution- It motivates a greater investment in basic services alised as a civilian affair and continued regularly un- and public infrastructure than local governments til 1966, playing an important role in disease control would otherwise be likely to make and increases and health education. They were suspended during public awareness of hygiene issues. In order to win, the Cultural Revolution, but resumed in 1978 before city authorities need to choreograph wide-ranging being transformed into award schemes that encour- support from lower level officials, public and private aged cities to reach certain public hygiene standards enterprises and the general public. As a result, a large in 1989, under the so-called Hygienic City Campaign part of the campaign is about educating the public (HCC). and getting them involved. If run well, a campaign’s Cities wishing to become a National Hygienic City knock-on effect can be stimulating the public to de- have to go through a series of campaigns in order to mand better services from the local government in climb up the ladder, step by step. The campaigns fo- the future. The competitive nature of the campaigns cus on health education, city appearance, environ- helps to keep local officials accountable and dramati- mental sanitation, public hygiene, the cleanliness of cally increases their responsiveness while the cam- drinking water, food hygiene and infectious disease paign is in progress. control, among others. Taken together, there are Sustaining the benefits can, however, be a major more than 60 indicators to measure and hundreds challenge and the structure of the competition helps of targets to meet. Although central government sets in this regard. First, it takes many years to become a the indicators and targets, local governments do not national level winner: it took Guanghzou 18 years to have to follow a prescribed campaign model. Some finally be awarded the title, Xining 10 years, Nanjing cities in the less developed western provinces face less 14 years and Yichang 12 years. Second, some of the pressure from industrialisation and migration and indicators in the competition concern institutional or end up spending more on upgrading public toilets, governmental changes that are hard to reverse. Third, setting up modern sewers and improving the provi- the National Committee checks a sample of the past sion of drinking water, than on improving air quality. winners every three years and cities failing to meet Cities have to go through several stages from the local the standards are given a warning or stripped of their 1 title. Finally, new competitions have also been set up, porarily turned many unhygienic restaurants into such as the Civilised City Campaign, providing new bookshops or tourist agencies in order to avoid in- city-wide challenges to winners of the hygienic city spection. In another example, some small restaurants competitions. in Xining did not open their toilets to customers so In spite of these benefits, and the mechanisms put that they would remain spotlessly clean, while oth- in place to sustain efforts, the HCC is controversial. A ers stopped offering tissues to customers in order to single-minded focus on winning awards can disrupt prevent littering. regular services and have negative impacts upon lo- Given the drawbacks of the HCC, should it be cal businesses. In some cities, such as Kunming and stopped altogether? There are several reasons why Guangzhou, for example, government officials were a hygiene campaign of some sort should continue required to commit to deliver certain results. Fail- to exist. First, the HCC does lead to increased pub- ing to deliver meant they would lose their jobs. This lic awareness, which may make the possibility of method enhanced the responsiveness of officials but the public demanding a better environment and it also meant that they became ruthless in the face improved hygiene in the future more likely. During of obstacles. In Kunming, for example, officials de- campaigns, people use Internet forums to expose the manded that all small businesses remove anti-theft fraudulent practices of the local governments, as well protection to make the markets look nicer but no as to show their appreciation of improved cleanliness compensating efforts were made to improve safety. and new facilities. They were also more outspoken The ensuing tension between the public and policy and dissatisfied when standards dropped again after enforcers culminated in a riot in 2009. In a bid to re- the campaigns. Second, concerns about sustainabil- duce litter and waste accumulating in public spaces, ity may be of second order in comparison to taking businesses in Xining and Lanzhou were required to action in the first place. Indicators and management decrease opening hours to align with the guidelines style can then be improved in order to avoid creat- set by policy enforcers. ing perverse incentives. However, whether people can In addition to receiving grants from higher gov- rely on government officials to make such improve- ernment authorities, cities also try to raise funds ments themselves is questionable. from district governments. Sometimes, businesses, It is, however, important to point out that cleanli- public sector organisations and individuals have ness is only relevant to some of the health problems been coerced to contribute, through direct financial faced by China’s urban residents. In 2009, a health contribution as well as through providing materials survey was carried out in 589 cities with nearly one and committing their own time. In order to increase million interviewees. The average age of people suf- accessibility to public toilets and drinking water, for fering from high blood pressure, high cholesterol and example, state enterprises in Xining were required to high blood sugar was found to have dropped from open their facilities to the public and school terms over 50 to just 30 to 40 years. Such results are not were cut short in order to secure student volunteers just a problem of unaffordable health care, but also for the effort. reflect dramatic changes in lifestyle. Unhealthy eat- As a secondary source of revenue increase, some ing habits, long and stressful work, irregular sleeping local governments focused on urban regeneration to patterns, over-indulgence in Internet surfing and fre- improve the city’s appearance. Xining and Kunming quent business banquets, are all possible contributors wanted to attract more tourists and cities in the Jiang- to urban health problems. The survey shows that the su province wanted to attract more investment. These richer a city becomes, the poorer the health profile of efforts create situations where cities might plant grass the population gets, with Beijing, Shanghai, Guang- to quickly increase their green areas, without think- zhou and Shenzhen faring worse than less prosperous ing about the impact on increased water consump- cities. tion. Influenced by the World Health Organization’s Above all, the top-down approach of the HCC (WHO) ideas about healthy cities, some second-tier tends to invite cheating. Some local governments re- Chinese cities, such as Suzhou and Hangzhou, have sort to fraudulent measures in order to make a good made an early start in exploring a broader conception impression on inspectors. During their inspection of healthy and liveable cities. In 2007, the Ministry of period the city of Jiaozuo in Henan Province tem- Health set up a task force dedicated to promoting a 2 healthy lifestyle throughout China and a number of cities and urban districts were selected as pilots for ‘Healthy City’ schemes. As the country becomes increasingly urbanised, health challenges increase. Rapid growth of urban population and unaffordable housing, in particular in megacities, generates poor and overcrowded hous- ing conditions in suburban slums and urban villages. These neighbourhoods do not always receive equal basic services and suffer from poor infrastructure. According to the WHO, the proportion of China’s urban population using shared sanitation has grown from 25 to 30 per cent between 1990 and 2008, while the proportion defecating in the open has risen from 3 to 6 per cent.