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This concern with cities as a theoretical and Further Readings real object of study is found in his presidential Hawley, Amos H. 1941. “An Ecological Study of Urban address for the Population Association of America, Service Institutions.” American Sociological Review “Population Density and the ” (1972). Here 6(5):629–39. Hawley makes the point that social density and ———. 1944. “Ecology and Human Ecology.” Social spatial density are increasingly separated, with Forces 22(4):398–405. emphasis on the increasing importance of social ———. 1950. Human Ecology: A Theory of Community density. This emphasis keeps with the theme of Structure. New York: The Ronald Press. the primacy of organizational over spatial ———. 1963. “Community Power and aspects. Success.” The American Journal of Sociology This work also suggests Hawley’s increasing 68(4):422–31. interest in the study of change itself, which culmi- ———. 1968. “Human Ecology.” In International nates in his 1978 Presidential Address at the ASA, Encyclopedia of Social Sciences, edited by David L. “Cumulative Change in Theory and in History.” Sills. New York: Crowell, Collier and Macmillan. Here Hawley carefully explicates types of change ———. 1971. Urban Sociology: An Ecological Approach. and argues that the study of change in social sys- New York: The Ronald Press. tems should focus on patterns that are nonrecur- ———. 1972. “Population Density and the City.” ring and irreversible because these two patterns Demography 9(4): 521–29. lead to accumulation of further change. ———. 1978. “Cumulative Change in Theory and Although retiring in 1976, Hawley continued to History.” American Sociological Review serve actively as mentor and adviser on theses, dis- 43(6):787–96. sertations, and independent study, shaping several ———. 1984. “Human Ecological and Marxian generations of students. His scholarship continued, Theories.” The American Journal of Sociology 89(4):904–17. unabated, resulting in additional explorations of ———. 1986. Human Ecology: A Theoretical Essay. human ecological theory (see “Human Ecological Chicago: University of Chicago Press. and Marxian Theories,” 1984) and a number of ———. 1992. “The Logic of Macrosociology.” Annual influential edited volumes. These volumes brought Review of Sociology 18:1–14. together macrosocial researchers to encourage, shape, and expand ecological approaches on such topics as the analysis of social change, nonmetro- politan change, metropolitan trends, and environ- mental issues. He a l t h y Ci t i e s During this time period, Hawley pursued his final sociological book, a culminating work of Healthy Cities is a worldwide movement devel- the essence of his approach to ecological theory: oped by the European office of the World Human Ecology: A Theoretical Essay (1986). In Organization. It has been implemented formally his more recent reflective essay, “The Logic of through WHO in many cities, and others have Macrosociology” (1992), Hawley notes the adopted the model. Grounded in 11 qualities that completion of his neo-orthodox revolution in range from housing to economy and social human ecology shifted interest from spatial pat- characteristics such as a supportive community, terns to the change, functioning, and structure Healthy Cities goes well beyond the definition of of the social system in environmental context health as an absence of disease. This entry looks and as a result, “Human ecology takes its place at its development and implementation around as one of several paradigms in the inclusive field the world. of sociology.” Michael D. Irwin Historical Context

See also Factorial Ecology; Human Ecology; Urban Population health and have been insep- Sociology arable twins since the dawn of humankind. Cohen, Healthy Cities 349 in his 1989 masterpiece of paleo-epidemiology, approaches by the World Health demonstrates that the shift from nomadic to seden- Organization (WHO) and a decade of innovation in tary and eventually urban lifestyles impacts on Canadian health policy (the Lalonde Report); its occurrence of disease. Still, rural etiology and pop- leaders had the ambition to take a radical stance on ulation pathology differ considerably from urban the health of city dwellers. patterns. Urban organization, on the other hand, The model was quickly taken up by the European allows for different types of interventions, and it is Office of WHO, engaging Duhl and Toronto no surprise that the emergence of modern entrepreneur Hancock to launch an urban health can be traced back to urbanization (from health demonstration project. In collaboration public toilets in ancient Rome to sewage systems in with a small group of European cities, they devel- industrializing Britain, and from city-state “Health oped 11 qualities a healthy city should attempt to Police” in medieval Germany to surveillance sys- achieve: tems in contemporary megacities). In the late 1990s, Porter and Hall even maintained that the 1. a clean, safe physical environment of high shape of twenty first-century cities is dictated by quality (including housing quality) health considerations. 2. an ecosystem that is stable now and sustainable Clearly, they find that modern public health is a in the long term direct result of sanitarian programs emerging in 3. a strong, mutually supportive, and mid-nineteenth-century industrializing nations. nonexploitive community The Health of Towns movement in Britain (estab- 4. a high degree of participation and control by lished in 1844) is a direct precursor to Healthy the public over decisions affecting their lives Cities. Modern cities, however, seem to have failed 5. the meeting of basic needs (food, water, shelter, to recognize the most recent shifts in health and income, safety and work) for all people disease patterns and their unique potential urban 6. access to a wide variety of experiences and assets to address these. resources, for a wide variety of interaction The etiological shift has moved from predomi- 7. a diverse, vital, and innovative city economy nantly parasitic to microbial infectious and cur- 8. the encouragement of connectedness with the rently chronic diseases; public health interventions past and heritage of city dwellers and others have moved from surveillance (such as quarantine) 9. a form that is compatible with and enhances via high-tech pharmaceutical and other clinical the preceding characteristics interventions to addressing social determinants of 10. an optimum level of appropriate public health health (e.g., inequity and community develop- and sick care services accessible to all ment). Urban environments are uniquely impacted 11. high health status (high levels of positive health by such social determinants but are also in a his- and low levels of disease) torically unparalleled position to deal with them. This was recognized as early as 1963 by Duhl The original ambition of WHO to run a small- and colleagues. In describing what would later scale demonstration project exemplifying the become the Healthy Cities movement, they laid potential of urban administrations to deal with down the tenets for analysis and intervention in, late twentieth-century health and disease demands for, on, and with social, natural, economic, and was quickly challenged by its enormous popular- built urban environments for the promotion of ity. Within the first five years, hundreds of European human and ecosystemic health. cities had expressed an interest in joining the proj- ect, and cities outside Europe used guidelines to establish their own. This put a demand on WHO Foundations at a global level. In Europe, a small group of The first city to truly adopt these principles became WHO-designated cities (meeting strict entry Toronto, more than two decades later (1984). In a requirements into the project) were to be hubs serendipitous confluence of global and local devel- for national, language-, or topic-based networks opments, the city celebrated emergent emancipatory of Healthy Cities. 350 Healthy Cities

International Exemplars synergy between enhanced (public) mobility, pov- erty reduction, and primary education. Wonju City The initiative continued to be popular in Australia (Korea) has established innovative programs in and Canada; in Central and South America, it eas- health promotion financing, just as Recife (Brazil) ily linked with WHO policy on SILOS (Sistemas has. Noarlunga (South Australia), one of the lon- Locales para la Salud—Local Health Systems) and gest running Healthy City projects in the world, the Healthy Cities equivalent in the Americas has effectively addressed health inequity, multicul- became Healthy Communities. Japan has had a turalism, severe environmental degradation, and long-standing relation with Healthy Cities, with sustainability issues. Several cities around the Tokyo taking an early lead in the 1980s. A broad world are involved in approaches such as commu- range of groups, agencies, and communities associ- nity gardening, walkability, , safety, ates itself with Healthy Cities, from national net- and the informal economy. Virtually all cities look works and Agenda 21 initiatives mostly in Europe, at equitable access to services reaching far beyond the Civic League in the United States, a global the health sector alone. An additional illustration International Healthy Cities Foundation (www of the range of activities that can be undertaken .healthycities.org) providing a clearing house func- by a Healthy Cities initiative can be found in the tion, and the Asian–Pacific Alliance for Healthy directory of projects of the 199 members of the Cities (www.alliance-healthycities.com). In some “Réseau québécois des villes et villages en santé,” counts, there are close to 10,000 Healthy Cities one of the oldest networks of such initiatives in the worldwide, the smallest reputedly being l’Isle Aux world situated in the province of Québec, Canada Grues (Canada, population around 160) and the (see www.rqvvs.qc.ca/membres/realisations.asp). largest metropolitan Shanghai (China, population Healthy Cities also has become the vanguard of in excess of 20 million). other settings-based health initiatives with which Ever since the initiative was formally launched the project connects locally: Healthy Marketplaces, in 1986, it has been subjected to an evidence-based Prisons, Workplaces, and Islands; Health Promot­ health paradigm, asking whether Healthy Cities ing Universities, Hospitals, and Schools. In itself, actually deliver health. This is a highly contentious this is an important proxy of the effectiveness of issue, as a core tenet of the paradigm that embeds the approach, inspiring actors and communities at the movement is that health is not the absence of many different levels and domains to be engaged disease but a resource for everyday life. It is cre- with a social model of health. ated by individuals and communities and heavily Quite apart from the formal Healthy Cities determined by public and corporate policy. It is movement, there is increasing attention to the therefore no surprise that the 11 qualities listed impact of urban and design on parame- above have been translated by Healthy Cities into ters for health. This increase could be attributed to an enormous range of actions, themes, and inter- Healthy Cities, but more important, it will provide ventions. Sofia (the Bulgarian capital) was a member new impetus to the movement: The evidence that of the movement for a short while in the late 1980s physical activity is directly affected by urban and used its designation to upgrade the public design parameters has become a high political pri- transport system. Liège (Belgium) addresses the ority in the early twenty-first century, when the high prevalence of antidepressant use by tackling obesity epidemic is predicted to decrease future general practitioners’ prescription behavior while population life expectancy for the first time in his- at the same time running programs in community- tory. There is general agreement that the belief that driven neighborhood cleanups. Kuressaare the epidemic can be tackled in behaviorist manners (Estonia) uses the Healthy City label to restore its is untenable now and that community-based, inte- tsarist-era reputation as a great spa town on the grated, institutional, systemic, and hardware solu- Baltic. Accra (Ghana) aims to coordinate the inter- tions must be sought—precisely the Healthy Cities national aid industry’s attempts to clean up its tenets launched over 40 years ago. heavily polluted Korle Lagoon under the Healthy Cities banner. Curitiba (Brazil), positioning itself as Evelyne de Leeuw, Len Duhl, an ecological city, is highly successful in generating and Michel O’Neill Heritage City 351

See also ; Urban Climate; Urban from previous generations and is of special value Planning and thought worthy of preservation. Who con- trols this preservation and valuation process and what relationship such heritage has to the city— Further Readings spatially, culturally, and symbolically—are of increasing concern and debate. The commodifica- Cohen, M. N. 1989. Health and the Rise of Civilization. New Haven, CT: Yale University Press. tion of heritage assets creates economic benefits de Leeuw, E. 2001. “Global and Local (Glocal) Health: that accrue to property interests and the heritage The WHO Healthy Cities Programme.” Global tourism industry. Heritage has, therefore, moved Change and Human Health 2(1):34–53. from a benign, specialist concern to a central role Dooris, M. (2006). “Healthy Settings: Challenges to in city branding and the promotion of the city to Generating Evidence of Effectiveness.” Health its citizenry and to the outside world. Promotion International 21(1):55–65. Selectivity is key to heritage planning. A dichot- Duhl, L., ed. 1963. The Urban Condition: People and omy exists between the original positivist preser- Policy in the Metropolis. New York: Simon & vation and the normative heritage, which implies Schuster. a process of selection and conservation of history, Hall, P. 1998. Cities in Civilization: Culture, memory, and relics, as well as their interpretation Innovation, and Urban Order. London: Weidenfeld for contemporary consumption. The concept of & Nicolson. heritage, which encompasses all historic and style Marmot, M. and R. Wilkinson. 2005. Social periods without exception, is different from tradi- Determinants of Health. Oxford, UK: Oxford tion, which is only a component of the former University Press. and requires a choice be made by (or more often, O’Neill, Michel and Paule Simard. 2006. “Choosing on behalf of) the public and by certain social Indicators to Evaluate Healthy Cities Projects: A classes. Heritage in both of these senses is socially Political Task?” Health Promotion International produced. 21(2):145–52. Heritage as represented in art and Porter, R. 1999. The Greatest Benefit to Mankind: A is also subject to assessment and valuation by the Medical History of Humanity from Antiquity to the scholarly canons of art history and through codi- Present. London: Fontana Press. fication and curation and the symbolic impor- tance attached by heritage experts. Although such designation has been dominated by classical and iconic styles represented by historic monuments, He r i t a g e Ci t y castles, churches, cathedrals, palaces, museum quarters, and their collections—grand projets of The notion and designation of the Heritage City the past—more recent heritage has begun to conflates two distinct concepts: city and heritage. appear in designation and preservation move- City status involves not just size but symbolic ments. The importance of visible clues that anchor importance as well, with the latter a function of the development of cities to the past typifies the history and institutional and political processes. current desire to reconcile modern development Royal charters, cathedral cities, provincial and and change with remnants of the city’s past. This administrative cities, and capital cities are all also reflects the wider democratization of social examples. Heritage, on the other hand, is a more history or urban archaeology; that is, the heritage recent and fluid concept open to contestation. It of ordinary citizens and the everyday, for exam- involves interpretation of a legacy from the past ple, houses, workplaces, and leisure pursuits. and therefore requires the identification and valori- Industrial and twentieth-century heritage is now zation of an authentic provenance. This is commonly subject to the preservation and value judgments manifested in terms of buildings, monuments, the applied previously to the historic. Consequently, physical environment, and artifacts and occurs the heritage question and heritage city branding through individual and group collective memory. have been applied to a wider range of sites and Heritage, therefore, is sometimes passed down typologies.