Trade, foreign policy, diplomacy and health

6. Public Health Infrastructure and Knowledge

John Powles, Flavio Comim


3. Physical infrastructures

  • Industrialisation increases wealth but with an ‘urban penalty’ - reduced health
  • Overcoming this requires political, not market, mediated reconfiguration of the physical infrastructures of cities (e.g. sewers)
  • Countries industrialising now can draw on this experience to foreshorten their ‘urban penalty’
  • Typically this ‘infrastructure’ is not part of ‘health’ spending, what one ‘has’ in the way of public health institutions may be more than what one ‘sees’

Industrialisation increased wealth but, initially at least, reduced health, with rapid urbanisation associated with rising mortality levels. Overcoming this 'urban penalty' required a deliberate (i.e. politically, not market, mediated) reconfiguration of the physical infrastructures of cities. Sewers were laid, and safe water supplies secured. House construction was regulated with aim of making it more conducive to health. Later industrialising countries drew on this experience to foreshorten their 'urban penalty', and today mortality tends to be lower in urban, rather than rural, areas in low-income countries.

The means by which urban life has been made compatible with low transmission risks for serious food and water borne infection are an important component of public health infra-structures, but they are now so widely 'taken for granted' as to be virtually invisible: few, if any, countries today count spending on sewers and safe water supplies as part of their spending on health.

Successful measures to control the health risks associated with living in cities have thus been incorporated into the fabric of modernity itself and, paradoxically, have lost their salience as public health infrastructures. Analogous examples could be drawn from areas such as road safety, product safety and pollution control. It may, therefore, be salutary to remember that what one 'has' in the way of public health institutions may be rather more than what one 'sees'.

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