Tag Archives: Health

Of refugees and post-earthquake responses

Natalia Garcia Cervantes, Jessica Roccard and Cathy Wilcock (University of Manchester) write about an international conference that took place two weeks ago in Manchester …

The third part of the series ‘Ambivalence in the city’ at the HCRI/GURC sub-conferences for the 11th International Conference on Urban Health continued with the session ‘Urban humanitarianism III: Refugees, inequalities and humanitarianism’. Participating in the plenary was our colleague Cathy Wilcock, from IDPM at the University of Manchester, and Jorge Inzulza from the University of Chile.

Cathy Wilcock started the session with the presentation ‘Institutional Resistance to the transnational political activities of refugee groups: The anti-politics of refugee NGOS towards Sudanese activists in Manchester’. Cathy explores how the political activities of Sudanese refugees in urban centres in the UK are affected by the political environment of their new place of residence. She analyses the systems of power relations, both actors and processes, of the refugees’ political environment in relation to their transnational activities. She does this by exploring three key questions: What transnational activities are taking place? How do UK-NGO’s relate to those activities? And, what are the implications of this relation?

In this context, refugees NGO’s aim to support and empower communities to establish strong organizations; nonetheless, these NGOs appear to be extremely concerned with the possibility of lending support to political activists based in the UK, such as the anti-Bashir movement. As a result, political activism is seen by NGOs as a menace for the refugees’ community development and an ‘institutional resistance’ emerges whereby NGOs become reluctant to form relationships with transnational political activism groups. Additionally, an obvious support for cultural, as opposed to political refugee organisations, on one hand, and resistance to political activities on the other, sends the message that ‘There is an ideal type of refugee that we will support’, namely those who are victims of conflict, and not embroiled in the contentious politics which espoused conflict, those who bring over cultural memories of their place of origin and not political ones. In short, it results in the legitimisation of cultural activities and the delegitimisation of political activities. She asks whether, in reality, it is sensible or possible for those to be separated.

To continue with the session, Jorge Inzulza, from the University of Chile presented a very engaging topic; ‘Tremors and large waves: loss of memories and threat in the context of the Chilean reconstruction’. Dr Inzulza introduced the urban planning policies issues regarding post-earthquake reconstruction using the case of Talca and Constitucion. He argued that, natural disasters and gentrification are processes that commonly increase poverty and social inequality; they often displace residents and change the urban landscape in cities, particularly at intermediate size cities in Latin America. Dr Inzulza suggested that, the lack of appropriate post-reconstruction planning policies results in a gentrification of the city, where the loss of infrastructure and consequent sense of place amounts to the loss of citizens’ legitimacy and identity. He highlighted the dissonance between the existent normative and guideline documents that work at different levels and the pressing needs that surge from the earthquake; and there is an explicit disconnection between normative aspects and socio-economic, government management, territorial investments and a spatial-physical approach to planning for reconstruction.

This was indeed a very compelling and exciting session. Thanks to both participants!!

All change please: climate in urban areas

The third day of the conference ICUH 2014, started with a plenary session led by Prof Hancock, Prof Sir Gilmore, Prof Hickman and Prof Rao. First, Prof Hancock presented the impacts of climate change on urban areas. Pointing out the three parameters that have influence on urban areas and public health (environment, people and economy), he argued for the need for “healthy democracies”. Secondly, Prof Sir Gilmore introduced the disastrous effects of alcohol on urban population. Hence, he claimed that we are currently witnessing a shift of the behaviour of the population: from enjoying a glass of alcohol to binge drinking. This change poses a serious threat for public health as a significant increase in alcohol-related injuries and disease and death is observed. Then, the third speaker, Prof Hickman, talked about the issue of hepatitis C in urban areas among the injection users with a very cost/effective approach by addressing the effectiveness of the possible interventions depending on the prevalence of the disease among this population. The last speaker, Prof Rao, described the health problems of the urban poor in Indian and Bangladesh cities. She pointed out the link between health and urbanisation emphasising the importance of the urban areas. Indeed, cities are powerful drivers of economic growth, but they are also the witnesses of social inequity between low-income and higher-income communities, being a major issue to address.

Is climate change THE PRIMARY concern or is it a new characteristic of development issues?

The documentary presented by Dr Dodman entitled “Climate Bites: Disease”, of the hot cities series, was supported by the Rockefeller Foundation for the purpose of being broadcast by the BBC. It presented the exacerbation of public health issues related to climate change. The examples of Jakarta and the increasing epidemics of dengue, Paris and the heat wave which occurred in 2003, and Chicago and its solutions strategies such as green roofs and surveillance system were examined.

This interesting video raises numerous questions. First, the documentary emphasises that climate change is the cause of the public health issues. However, is climate change really the main cause of the disease epidemics, or does it simply exacerbate existent issues of urbanisation of the city? In this case, what is the degree of importance of its impacts on these inherent urbanisation issues? Is climate change a development issue?

Furthermore, the case of Jakarta addresses gender issues. Indeed, while fogging is undertaken by the authorities, prevention campaigns and insecticide distribution are also carried out by a women’s organisation. Hence, could measures to face climate change impacts be implemented along with women’s empowerment strategies? However, while focusing on this organisation, further questions are raised. Who provided the insecticide to the women’s organisation? How was their organisation set up? Would it be efficient in a low-income community, also often lacking of basic knowledge?

In this context, it can also be noted that the strategy implemented by the authorities is short term. It eradicates the vector but it does not address the underlying issue of water and sanitation. Hence, the sustainability of the strategy is questionable as the deeper causes of the epidemics are not addressed. On the contrary, long-term strategies such as the building of green infrastructures and designed of surveillance system of the most vulnerable people have been implemented in Chicago. However, could these long-term strategies of Northern cities be possible to be implemented in the cities of the Global South as these latest are already facing heavy and different urbanisation burdens?

Finally, regarding both the heat wave in Paris and dengue in Jakarta, it can be noticed that the authorities and sanitary actors were unprepared to face the hazards. Learning from these experiences, responses have been elaborated. However, do we need to witness deaths to prepare for the coming changes?

All’s well that ends well: Closing plenary

The closing session of the HCRI/GURC sub-conferences was chaired by Dr Tanja Muller, with the contributions of Professor Diana Mitlin, from GURC at the University of Manchester and Dr David Dodman from IIED.

Professor Mitlin started by offering her observations on ‘Urban Risk and Humanitarian Response: reflecting on urban realities and specificities’, where, in order to understand urban risks,  she scrutinized what the terms ‘urban’, ‘risks’ and ‘humanitarian’ mean. An ‘urban’ environment is among other things, characterised by high density areas, a dependence on labour markets influenced by public investment management and potential of urban space.

Dr Dodman explored the topic ‘Climate change and its health impacts on the urban poor’ and pointed at the pressing need for new urban systems for resilience, and to develop preventative measures for the implications of climate change in health.

The session ended as an invigorating exchange of ideas between the audience and the panellists. We discussed the significance of humanitarian response to the current and future challenges posed to urban health, by risks such as violence and climate change.

Overall, the HCRI/GURC sub-conference of the 11th International Conference on Urban Health delivered a thought-provoking and dynamic symposium. It brought together some fascinating research from both established and emerging academics with insights from some world-leading practitioners.

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Asking the right questions: What kind of research will actively serve to improve urban health?

Natalia Garcia Cervantes, Jessica Roccard and Cathy Wilcock (University of Manchester) write about an international conference that took place two weeks ago in Manchester …

The second morning’s opening plenary (6 March) featured keynotes by Dr David Satterwaite (International Institute for the Environment and Development) and Professor Ana Diez Roux (Drexel University). Both focus on the role of research in improving health.

Professor Satterwaite was asking ‘Why is health so poor in the Global South after 60 years of humanitarian interventions?’ Despite over half a century of development assistance, in many countries in the Global South, 1 in 5 infants are still dying before the age of 5. In light of this lack of progress, Professor Satterwaite asks why most of the research into ‘causes of death’ is conducted with the aim of being able to make global comparisons, rather than generating localised, relevant knowledge. Without this specific local information, there is no way development practitioners, urban planners, or local governments, can target the right policies at the right areas of their locality. He proposes that the way forward is to garner the unique knowledge of the poor themselves to form the basis of local partnerships between community organisations/ social movements within poor urban areas and their local governments. We wonder can participatory research work in areas where the power relations between government actors and non-state actors are abusive/oppressive? Does participation, as a policy-relevant research method, focus too much on the agency of the poor themselves, therefore initiating policies which are blind to the structural inequalities actually keeping people in poverty?

Following on from this, Professor Roux’s keynotes called for innovations in research methodology in health research. She demonstrates that a lot of health research is ‘linear’ – it aims to reveal or demonstrate a causal relationship between one variable and another, often through data-gathering in experimental settings. In contrast to this so-called ‘reductionist’ method, she makes a compelling case for a ‘systems approach’ in health research. Less concerned with proving a causal relationship between two variables, a systems approach is sensitive to the multitude of factors which affect health and can present findings which are demonstrative of feedback (as opposed to causal) relations between the numerous components in the system. Especially within the context of a conference where the somewhat vague subtitle of ‘crossing boundaries’ has not really shone through so far, this refreshing keynotes provided a clear strategy for change rather than a business as usual approach.

Whose role is it anyway? Sharing responsibility for the urban poor’s health

The keynotes speeches had left me wondering about the question of responsibility – who is responsible for improving the health of the urban poor. Is it the poor themselves? Their local governments? National governments? International NGOs? Local NGOs? If it is a combination of any of the above, how can that shared responsibility be managed? The session on ‘Stress in the City’ provided some interesting approaches to this question.

Women in Informal Employment: Globalising and Organising (WIEGO) presented on their work with market traders, street vendors, home based workers and domestic workers in urban townships in South Africa. Following that Dr Selmin Jahan spoke about water and sanitation facilities for the urban poor in Dhaka. The session closed with Dr Helen Elsey speaking about a ‘Healthy Kitchens’, an initiative which identifies interventions to improve health in urban slum kitchens. All of these presentations were about projects seeking to improve the health and safety in informal, unregulated urban settings where people are exposed to a multitude of risks including lung disease, gastrointestinal disease, burns etc. All three projects are asking how do we extend health and safety policies to urban informal settings? How can they be included in urban planning? How can we minimise health and safety risks in informal settings? In WIEGO’s case, they have developed a piece of research in partnership with the market traders which outlines a zonal health and safety plan for their workplace. As well as providing education and training, they have overseen the installation of a risk management sub-committee among the traders. For the healthy cities initiative, the targeted intervention is to replace open fires and gas in kitchens with a safer alternative.

These projects placed a lot of the responsibility for improving health and safety on the urban poor themselves – the aim of these projects was to empower the urban poor to take the appropriate actions and establish the appropriate systems for improving health and safety using the resources available to them. However, they also recognised that these measures can only go so far without the local governments also taking responsibility to protect their citizens. In WIEGO’s project in particular, the difficulty of making this shared-responsibility work shone through. They recognised the need to negotiate the unequal power relations between governments and their poor citizens and interestingly, have themselves developed strategies to tread this contentious path towards partnership. These presentations about three fascinating projects demonstrated how small, inexpensive measures can be implemented by the urban poor themselves to improve their health and safety. However, unequal structures loom large: how can the poor empower themselves effectively in a broader context of disempowerment?

Climate Change: a universal threat?

During the session about climate change (CC) and urban insecurities chaired by Dr Dodman, three presenters, Mr Umamaheshwaran, Mrs Dang Thu and Dr Rais introduced their work. Their interesting speeches raised different issues caused by climate change impacts on urban areas. On the one hand, it can be understood that impacts such as flooding and/or the increase in temperatures (among many others), are faced by every city within every country. And within these cities, they severely affect particularly the health of the most vulnerable: the low-income communities. However, not every city has to face existing burdens that CC only exacerbates. For example, New-Delhi faces extreme problems of drinking water access, sanitation systems and air pollution caused by the dense traffic. Moreover, the health policies are not always being adequately implemented and the reaction time of the authorities when an epidemic occurs is too long.

Nevertheless, there are attempts underway to address these problems. Indeed, strategies to face climate change impact are implemented by NGOs such as ‘Challenge to Change’ (Mrs Dang Thu), by providing support to the most vulnerable groups in Vietnam to implement strategies to mitigate and adapt to these impacts. On the other hand, more technological solutions such as projects from Taru (Mr Umamaheshwaran) are also being implemented in Indore. By supporting a new management system and software for the health practitioners, this organisation helps to monitor the spreading of disease and allows following in real time the epidemics.

The second session about climate change, chaired by Dr Alfredo Stein, also introduced some very interesting topics. Starting with the presentation of Dr Jemery Carter from the University of Manchester, the session first focused on climate change impacts and adaptation responses in Greater Manchester. Dr Carter pointed out the existing connections of the previous concepts with people health and well-being. He emphasised the creation of green infrastructure as a solution to face impacts such as flooding and heat wave. However, the infrastructure promoted might be efficient in a context of Manchester, but would not benefit from the same efficiency in Indian cities, for example.

Mr Brown and Dr Dodman propose a different approach of climate change. They argued that climate change research has been often considering it as top-down approach and focusing on hazards themselves. Hence, challenging this view, the vulnerability of the urban poor is the focus of their research.

The last presentation, given by Vikai Desai, focused on her experience in Surat city, which experienced strong flooding. As an impact of flooding, the city witnessed the arising of a new disease: leptospirosis. Facing this new challenge, an innovative monitoring and control system had to be implemented. Not only people, but cities as a whole have also to adapt to the new challenges arising from climate change direct and indirect impacts!

Finally, these sessions allowed the understanding of the multi-disciplinarity of climate change and multi-faceted impacts. CC creates strong challenges for urban health and development actors, as well as for the inhabitants of those cities. Practitioners and academics must work together to build a brightest and healthiest future.

Aiding violence? Urban violence and humanitarian responses to it

One of the HCRI/GURC sub-conference sessions was ‘Urban violence and conflict: Exploring the response to urban violence’ with the participation of Elena Lucci (via skype), Verena Brähler, and Dr Melanie Lombard.

Elena Lucci opened the session with the intervention ‘Humanitarian Action in the context of urban violence’ drawing on the lessons emerging from case studies based on humanitarian aid in urban settings experiences. She started by asking the question ‘What is urban violence and why is it important for humanitarians?’ She defined urban violence and then asserted that the characteristics such as dynamism, density and diversity or urban centres, can create enabling environments for violence. There are important lessons from her experience in humanitarian aid. For example: ensuring clear aims from the beginning must a priority; also, acting strategically to develop capacity and linkages in the community that is being served; thirdly, taking a localised approach to violence and to developing the specialized skills that are needed to respond to urban crises.

Following this, was Verena Brähler from UCL, with ‘Inequality of Insecurity in Rio de Jainero, Brazil’. Verena presented the results of her PhD Research. She used a mixed methods approach and, on this occasion, she talked about the quantitative part. Her analytical framework is based on the concepts of inequality and security. Additionally, she measured social cohesion and perceptions of insecurity through a series of surveys in the ’favelas’ and compared the security provision between low and middle-income neighbourhoods. To end such an interesting discussion, the audience contributed to the dialogue with questions about the role of the state in security provision in Brazil. She argues that in the absence of the Brazilian state as a provider of security, poor people have to accept to live side by side to criminals, respecting a silence code in exchange for minimal security provision.

Last but not least, Dr Melanie Lombard explored urban land conflicts with a case study from provincial Mexico. Dr Lombard provided key concepts about land disputes, and conceptual differences between conflict and violence; in Santa Lucia –the case study– the situation of many urban settlements in Mexico is exposed: land is available but unaffordable. As a result, colonias populares or peri-urban settlements arise from the illegal subdivision of previously community-owned land (ejidos). Conflict appears when, under the absence of state presence and a normative dissonance (since the land was neither claimed to be rural nor urban), the interests of key actors, including the state, urban political leaders and local associations clash. She concluded asserting that ‘When violence is used as a tool by actors struggling for political or economic power, conflict over land is more likely to escalate and the urban poor communities are more likely to be adversely affected’.

This was indeed a very intense and stimulating session. Thanks to all the participants!!

 

International Conference on Urban Health 2014: Welcome to Manchester! ‘He who has health, has hope. He who has hope has everything’ (Martin Luther King)

Natalia Garcia Cervantes, Jessica Roccard and Cathy Wilcock (University of Manchester) write about an international conference currently underway in Manchester …

The 11th International Conference on Urban Health opened this morning with a thought-provoking and dynamic opening ceremony. Welcome speeches from Professors Caiaffa, Vlahov, Jacobs, Sir Howard Bernstein and Andrew Gwynne MP all praised the city of Manchester’s pioneering role in public health, and referred to the legacy of the industrial revolution as a key factor in the city’s present day public health issues. Keynotes speeches from Dr Howard Koh, Assistant Secretary for Health in the US, and Professor Sir Michael Marmot, both brought the social determinants of health into sharp focus.

Risky business: Violence, fires and toilets

The HCRI/GURC opening plenary session for the sub-conference on ‘Urban Risk and Humanitarian Response’ started with a presentation by Professor Moser on the inter-relations of urban violence and health. Human, financial and social capital are eroded by violence and this has a huge impact on individual health (both mental and physical) as well as on the general well-being of communities.  Professor Moser suggests that, ideally, reducing violence should centre around six inter-sectoral approaches. Public health, she argues, should play a central role in this strategy. Does public health have the most effective preventative power in reducing violence?  Is poor health best understood as a cause or effect of urban violence?

Next up was Steve Jordan from Greater Manchester Fire and Rescue Services and Operation Florian. He talked about his experiences of fire-fighting in Manchester and also of training brigades in different parts of the Global South. He has seen how fire can destroy lives and livelihoods because simple, inexpensive preventative and/or responsive measures have not been used in the cities of the Global South. He insisted that developing the institutional capacity of governments and communities, along with raising awareness, and conducting more research should be the main targets for improving fire safety across the board. This interesting presentation poses the question of the role of governments in the implementation of emergency response to disasters such as fires.

Barbara Evans from University of Leeds and Chair of UN Joint Monitoring Programmes on Sanitation brought her experience of water/sanitation projects to the table. In spite of the obvious consequences (1.7 million die from diarrhoeal disease per year) in many urban environments, she has observed a systematic failure around water and sanitation. Infrastructure is completely lacking, as is human capacity in many places. Demotivation among the government actors to address the underlying issues stems from a sense of overwhelming futility in the face of such huge problems: they often only act in periods of health crisis. Her talk reiterates the question raised in the previous presentation: What is the role of governance institutions in water and sanitation responses?  How can the issues of water and sanitation be tackled in those cities with little or no infrastructural planning?

Risky business: Violence, fires and toilets

After lunch, Emma Maclennan, Eastern Alliance for Safe and Sustainable Transport presented on the health impacts of global road safety in the first of the ‘Stress in the City’ sessions. Her organisation focuses on building local capacity and expertise. 1.3 million are killed annually in RTAs (road traffic accidents) and 90% occur in low and middle countries. RTAs cost an average 1-3% of GDP and they are a major drain on health insurance costs. Safer vehicles, road-users, roads and post-crash responses, as well as building capacity are five key action points for making roads safer.  The statistics she presented demonstrate the extent of the issue: RTAs actually kill almost as many persons as the diarrhoeal diseases stated previously.

Following on from Emma, three members of the Fire Service recounted their experiences of working in non-UK contexts. Together they demonstrated how the Fire Service can provide assistance in areas of prevention, response, and research-based strategy.  Keith Trotter of Tyne and Wear Fire and Rescue presented about a community safety project in Mitjana, Uganda which aims to educate on fire safety in schools in Uganda where many people use candles in their homes in the absence of electricity. Following this, Neil Pickersgill of Greater Manchester Fire and Rescue Service spoke about his experience of responding to the Japan tsunami. His team had to adapt their strategy because they were not prepared for the fact that their work involved recovering bodies, rather than rescuing people. George Bryant from Gloucestershire Fire Service worked on permanent refugee camps in Kenya. They conducted participatory research in the camp to identify hazards and also to identify the most at risk demographic. They then devised fire safety strategies based on their findings and attempted to oversee their local implementation in the face of the Government reluctance – for them the camps are transitional and non-permanent (even though they are, for all purposes, permanent). These presentations demonstrated the various skills these units have to acquire to be efficient – in Steven Jordan’s words, the fire service is not just about sitting and waiting for a bell to ring! From prevention strategy, to research, to education and training, to liaising with policy-makers, as well as emergency responses, these various lines of work must be able to adapt to different situations and cultures. Plus, again, the role/responsibility of governance came through strongly.

In the first of the ‘Ambivalence of humanitarianism’ sessions, Mateja Celestina and Prof Bertrand Taithe discussed different aspects of displacement. Mateja Celestina was presenting findings from her PhD fieldwork in Colombia. She raised issues around the sense of ‘belonging’ which she has observed being constructed by IDPs in relation to both (or, in some cases, neither) their new place of residence and their place of origin. Also, a key finding of hers was that the ways in which the IDPs and the non-displaced population related to each other (for example as competitors for land and resources) affected the IDPs’ sense of ‘belonging’.  Integration is clearly an issue here – how can the re-location of people be implemented with minimum disruption to both the host community and the displaced? Are economic and cultural tensions between displaced and native groups inevitable or preventable in the process of displacement?

Professor Taithe then provided a rich analysis of the conditions in the refugee camps in Thailand housing Cambodian refugees from 1975-1996. Given that the camps provided good ‘experimental conditions’ for longitudinal research on ‘trauma’ and other health issues, Professor Taithe shows how the camps became ‘epistemic communities’ where scientific knowledge was being produced.

And breathe…

After a full day of presentations and discussion, Tai Chi in the foyer.

 

 

Collectivities matter: The ‘hidden’ geographies of urban energy deprivation

Professor Stefan Bouzarovski, Professor of Geography and Director of the Centre for Urban Resilience and Energy, University of Manchester, writes about his research based on his on-going work on energy vulnerability and urban transitions  …

In the UK, the onset of winter regularly stokes public concerns about the social impacts of rising energy prices. Reports about the predicament of ‘fuel poverty’ – often described as a condition where households are unable to achieve adequate levels of energy services in the home – abound in the media and political debates. The extent to which the government needs to intervene in the market so as to lower energy prices has become a major talking point, and a bone of contention among political parties, utilities, and the government. Similar dynamics can be observed in other European countries – high electricity prices, for instance, recently became a key electoral issue in Germany; and widespread popular unrest over austerity and energy bills was one of the main reasons why the Bulgarian government was forced to resign in 2012.

Storage of fuelwood for heating in an apartment building. Kyustendil, Bulgaria. Photo by Stefan Bouzarovski

Storage of fuelwood for heating in an apartment building. Kyustendil, Bulgaria. Photo by Stefan Bouzarovski

The relationship between energy affordability and poverty is complex and contingent, involving multiple factors related to the energy efficiency of the home, everyday fuel consumption practices, residential occupancy patterns, as well as broader dynamics of power and recognition (Bouzarovski 2013). Yet many public discussions and media discourses collapse the issue to a limited set of state policies at the energy price-utility regulation nexus. The archetypal image that accompanies this reductionism is one of a pensioner sitting in front of a poorly functioning gas fire or electric heater. This is often contrasted with representations of wind farms or solar panels, whose allegedly high costs are pushing increasing numbers of people into fuel poverty.

In part, the prominence of pensioners and older people in media discourses on fuel poverty can be attributed to the political agency of this group, and the severe fuel-related hardship that many of its members face – a reality uncovered by a significant body of academic research (Wright 2004). However, the prioritization of older people over other groups in society has led to the marginalization of other households and individuals who are vulnerable due to their demographic, economic or residential circumstances. Further exacerbating the situation is the normative emphasis on private home tenure in many fuel poverty amelioration policies. The requirements of the UK’s Green Deal, for example, are intimately tied with property ownership, which means that this policy is generally outside the reach of households in the leasehold, private rented or social housing sectors. The main French fuel poverty policy (Habiter mieux) has likewise chosen to focus on homeowners living in rural areas, thus resulting in an approach that favours older people over other groups (Dubois 2012). As a whole, therefore, the current state of affairs confirms the argument made by a number of academics: that how and where fuel poverty is addressed by the strongly depends on the interrelation between dynamics of procedure and recognition (Walker and Day 2012). This is counter to earlier understandings that emphasize the distributional aspect of the issue (Boardman 1991).

The disadvantaged position of private rented and younger or more transient populations within current fuel poverty policy is further exacerbated by the regulatory and pricing mechanisms associated with the ongoing transition to a low-carbon economy. This emergent policy regime entails the re-allocation of environmental externalities away from fiscal systems onto final consumption, accompanied by a broader shift from income redistribution toward environmental taxation. Its consequences are particularly felt by fuel poor households, who may be subjected to, inter alia, increased prices for energy – either because companies indirectly pass the cost of ‘carbon taxes’ to the final bill, or due to direct levies on energy service-paying customers. In many European countries, such processes primarily affect households who use electricity for heating, as this fuel is seen as the best medium for passing on the cost of broader energy and low carbon policies onto the final consumer.

High rates of household electricity use, however, are disproportionately present in cities, as is non-private housing ownership. This means that the emergence of new energy-related forms of deprivation and inequality is inextricably tied to the planning practices and spatial morphologies that define urban areas. But the lack of adequate policy to address such difficulties is supplemented by an almost complete absence of research on the topic. It remains unclear, for example, how the socio-spatial patterns created by the lack of adequate energy services in the home – and the broader inability to access infrastructural networks – map onto existing geographies of segregation. The agency of built forms is of particular importance in this context, as an additional determining factor to conventional poverty-inducing dynamics (such as incomes and prices). Also unclear is the manner in which the background context of ‘austerity urbanism’ is influencing dynamics of domestic energy deprivation, both via the exacerbation and deepening of existing inequalities, and by ‘residualizing’ and moving the responsibility for the delivery of fuel poverty policy away from conventional support structures.

It should also be noted that the city of today is a site of far-reaching demographic and cultural change. This involves new forms of friendship, kinship and community affiliation under the influence of processes such as the ‘second demographic transition’ (de Kaa 1987). How one conceptualizes and practices collectivity in the built environment of city thus becomes paramount; this is both because new forms of inequality are closely linked to communal forms of residence (houses in multiple occupation, apartment buildings), and due to the opportunities for alternative practices of sustainable living offered by innovative joint housing arrangements.

The ‘hidden’ geographies of deprivation that arise at the interface of energy use, collective living and urban formations are one of the main research themes of the newly formed Centre for Urban Energy and Resilience at the University of Manchester. We intend to break new academic and policy ground in addressing the numerous unknowns that exist in this research domain. During the past week, for example, we organized a stakeholder roundtable on energy efficiency, fuel poverty and houses in multiple occupancy in London, and a workshop on energy vulnerability in European cities in Brussels. Watch this space!

References

Boardman, B. 1991. Fuel Poverty: From Cold Homes to Affordable Warmth. London: Bellhaven.

Bouzarovski, S. 2013. Energy poverty in the European Union: landscapes of vulnerability. Wiley Interdisciplinary Reviews: Energy and Environment http://onlinelibrary.wiley.com/doi/10.1002/wene.89/abstract.

Dubois, U. 2012. From targeting to implementation: The role of identification of fuel poor households. Energy Policy 49: 107–115.

De Kaa, D. van. 1987. Europe’s second demographic transition. Population Bulletin 42: 1.

Walker, G. and Day, R. 2012. Fuel poverty as injustice: Integrating distribution, recognition and procedure in the struggle for affordable warmth. Energy Policy 49: 69–75.

Wright, F. 2004. Old and cold: older people and policies failing to address fuel poverty. Social Policy & Administration 38: 488–503.

Urban health and the challenges it faces

By Adam Reekie, Research Assistant, Manchester Urban Collaboration on Health (MUCH)

Centre for Epidemiology, Institute of Population Health, University of Manchester

In 2010 there was a demographical shift whereby, for the first time in history the percentage of people living in an urban environment was greater than the percentage of people living in a rural one. The health of these people is one of great importance as the health inequalities for urban residents are much more extreme than those living in the country. This is due to wider socioeconomic determinants affecting the education and income opportunities of urban communities which lead to the urban poor typically living in polluted and isolated areas.

Within cities, influences and decisions on people’s health does not just lie with the health sector but with local authority, education, urban planners, engineers and those who determine physical infrastructure and access to social and health services.

This coupled with an increased prevalence of infectious diseases (such as HIV/AIDS, TB and pneumonia), non communicable diseases (such as asthma, heart disease, cancer and diabetes) and, violence and injury (including road traffic accidents) make it very difficult for the urban poor to stay healthy.

The severity and magnitude of these issues cannot be easily addressed, which is why international collaboration and knowledge exchange is fundamental to public health enhancements.

The International Conference on Urban Health (ICUH) offers the perfect forum for such interaction. The 11th International Conference on Urban Health will take place between the 4th and 7th March 2014 in Manchester, United Kingdom.

For more information on ICUH 2014 visit https://www.icuh2014.com/ or www.facebook.com/icuh2014.

You can also follow ICUH and find out more about urban health problems on twitter at www.twitter.com/icuh2014/  

Grid, Health and Advertising: A Story of New York City 1811-2011

by Andrew Irving, Social Anthropology, University of Manchester

Weber and Heilborner - Photograph © Frank Jump

Weber and Heilborner – Photograph © Frank Jump

This piece tells two stories, that of New York City and its obsession with money, advertising and rebuilding over the last 200 years; and the story of Frank Jump, a teacher and photographer who has dedicated much of his life to documenting the gigantic, hand-painted, advertisements that line the city’s long straight avenues.

New York City was in large parts founded upon immigration, trade and the distribution of goods and its infrastructure and buildings are the outcome of a complex relationship between the vulnerability of the human body to infection and disease and the forces of money and merchandise. Throughout the 1790s and early 1800s disease was rife throughout the city, including regular outbreaks of yellow-fever caused by mosquitoes thriving in the island’s stagnant swamps and pools, and whose symptoms included skin eruptions, black vomit, incontinence, jaundice, and eventually death. After the terrible epidemics of 1794, 1795, 1798 and 1805, it became apparent that action needed to be taken. Would it be possible—the city’s commissioners thought—to combat disease and facilitate the body’s well-being by building health into the city itself through the physical alteration of its layout?

It was not known to medical science at the time that yellow-fever was caused by mosquito bites and the disease was instead attributed to the foul smelling air and odours of a population living cheek-by-jowl in dirty streets. What if a more orderly city, purposefully designed to encourage the “free and abundant circulation of air” and the regulation of physical space, could prevent disease, contagion and “promote the health of the city,” (Morris, De Witt, Rutherford 1811). Action was imperative because New York’s population was increasing at an incredible rate, having tripled in just twenty years, from the 33,111, sometimes feverish, souls registered in the first census of 1790, to 96,373 in 1810.

The commissioners engaged twenty-two year old surveyor, John Randel to survey the entire island, with the purpose of transforming its woods, swamps and grasslands into a place “composed principally of the habitations of men, and that straight-sided and right-angled houses” (Morris et al. 1811). Randel spent three years painstakingly measuring and mapping Manhattan’s entire topography, with a resulting 7 feet 8 inch-by-2 feet 1 inch map, which offered unprecedented levels of detail about the island. However, Randel’s does not simply map Manhattan’s topography, streets, and buildings of the time, but also imposes a design for the island’s future, in that a grid-system is laid over the land, determining where future streets would be built. The grid proposes that all roads should be straight and sequentially numbered rather than named. Streets ran horizontally across the island and were numbered 1 to 155, while avenues ran vertically and were numbered 1 to 12, with an additional A, B, C, and D covering the swell of land on the Lower East Side. It was decided that no consideration was to be given to natural variations in the land, existing roads or property divisions.

The map’s official ratification in 1811 marks the point at which the city council confirmed that they would try to build reason, rationality and bodily health into New York by transforming its topography and in doing so they created the city that is known today. The grid is New York’s nervous system upon which the city’s essential operations and street-life are built, and like the human nervous system is never in the exact same state twice but is in a continuous process of renewal and regeneration over time.

Manhattan’s population expanded beyond all expectations of Randel or the city commissioners from a mere 33,111 in 1790 to 2,284,103 in the 1920 census. As such a new sense of industrial scale and materiality emerged, against which individuals, born when farmland still covered the island, could compare their muddy agricultural practices and desires. Construction expanded rapidly northwards and the thousands of buildings constructed along the grid’s long straight lines began to form a set of highly visible canvasses for businesses and advertisers to sell their goods, services and dreams. A new industry emerged that used size, scale, and colour to convey its message to the people below. Huge, hand-painted, advertisements were painted in bold attention-seeking colours on the sides of many buildings, up to fifty feet tall and twenty feet wide, and designed to stir New York’s citizens from their reverie and make them lift their eyes from the grid. The majority of advertisements have now disappeared: they either perished when the building they were painted upon was knocked down or were covered over by the endless procession of bigger, newer buildings being built as part of New York’s restless desire to reinvent and remake itself.  However, the destiny of some advertisements was more gradual and much less dramatic. For regardless of the thickness of their original paint or intensity of their colours, their fate has been to slowly fade out of existence while exposed to the city’s scorching summers and freezing winters: remaining open to the relentless cycles of sun, rain, snow and ice in a dense urban climate of pollution and humidity. What remains are the faded remnants of the these gigantic advertisements.

For the last twenty years, New York teacher and photographer Frank Jump has spent his evenings and weekends roaming the city’s streets capturing and archiving these disappearing giants before they completely fade into oblivion. Jump has photographed and archived, somewhere in the region of 5000 signs across New York’s five boroughs, of which perhaps only 1000 can still be seen today. Mostly they advertise products that can no longer be bought, made by companies that no longer exist, painted on buildings whose original occupants are forgotten, by men long since departed and were often considered eyesores in their day.

Zaccaro Real Estate, Bendix Home Laundry Kenmare & Elizabeth Streets.Photograph © Frank Jump

Zaccaro Real Estate / Bendix Home Laundry, Kenmare & Elizabeth Streets. Photograph © Frank Jump

Radway’s Ready Relief-Delancey St (painted circa 1890) Photograph © Frank Jump

Radway’s Ready Relief-Delancey St (painted circa 1890) Photograph © Frank Jump

Omega Oil: West 147st (painted circa 1910) Photograph © Frank Jump

Omega Oil: West 147st (painted circa 1910) Photograph © Frank Jump

When Radway’s Ready Relief (1890) and Omega Oil (1910) were first painted, tens of feet high in bright marine blues, they suggested to the aching bones of the commuters walking below, that the solution to their discomfort could be found in the simple purchase of their magic elixir. At the time, the world was a very different kind of place: many people did not travel at more than the speed of horse drawn cart and the average life expectancy at birth was around 43. Medicine, as we know it, had not been developed, women were unable to vote and colonialism was still in the process of subjugating vast swathes of the world’s population. It is no exaggeration, therefore, to claim that the course of a single advertisement’s lifespan, was not just an extraordinary period in New York’s history but also the world’s.  Some of the advertisements Jump has documented were painted in the 1860s and in the time they have stood there proudly advertising their goods and services to successive generations of New Yorkers, the world has undergone unprecedented social, cultural and technological changes. Indeed a single advert may have witnessed the invention of the film camera, the automobile, the first airplanes, two world wars and the great depression, television, the jazz age, the jet engine, the rise and fall of Nazism and the Soviet Union, McCarthyism, JFK, the discovery of DNA, The Beatles, nuclear fusion, the civil rights movement, space travel, Picasso, the first men on the moon, punk and hip-hop, post-modern architecture, portable computers, the Internet, 9/11, the gentrification of Times Square, Obama and much else besides. Who would have thought a simple advertisement would endure the rise and fall of empires and nations as the world changed beyond recognition. Certainly not the men who painted it, whose livelihoods depended upon their ability to make citizens look up and desire the goods and services on show to the extent that they became convinced that their lives would be a better place with that particular soap powder, those particular shoes, these particular garden shears.

In the mid-1980s, some two centuries after the city’s yellow fever outbreaks, New York once more found itself throes of a citywide epidemic. This time it was called, in a terrible and macabre coincidence, GRID (Gay Related Immune Deficiency) later to be renamed HIV/AIDS. By the 1990 census, exactly two hundred years after the city’s first census, people with HIV/AIDS filled 8.5% of all New York hospital beds and there had been 72,207 known deaths from AIDS in the city (including almost 10,000 infants) out of 116,316 people diagnosed: a figure nearly four times the entire population in the city’s first census.

In the summer of 1986, when Frank jump was twenty-six years old, he too found out he was one of the many New Yorkers diagnosed with HIV/AIDS and was told he had “a couple of good years left.” Consequently, the long commerce-lined streets built on the grid, shouting out their assorted messages of pensions, retirement homes, medicines and other aspects of a long healthy life, ceased to have any meaning for Frank and many others.  Ordinarily, the grid enables New Yorkers to look far into the distance and guides the eye toward a vanishing point on the horizon: a destiny distant in time and space that seemingly provides an effective metaphor for the promises of capitalism: look to the future, work hard and save for your pension your retirement awaits.

In New York alone, many thousands of men and women were thrown out of the straight lines of capitalism by HIV/AIDS and instead confronted a destiny of impending death. Frank took himself out of the workforce and filled in all the offers for new credit cards and bank accounts that came through his door, thinking “I’ve never got to pay any of this back.”  But Frank was lucky and did not die and instead lived to see the advent of anti-retroviral medications in the late 1990s that re-opened time and space for thousands and thousands of New York men and women living with HIV/AIDS: triggering a massive shift of mind, body and emotion away from death and back toward life.

Bankrupt Frank re-enrolled in college, became a school-teacher and got back on the straight lines of capitalism. He remained acutely aware of the fragility of the human body in an urban landscape. A body which, like the painted advertisements that surround was fading and not supposed to last long but somehow remained part of the city. Accordingly, Frank sees his reflection not in the mirror but in the fading advertisements that line the vast surfaces produced by New York’s grid. They continually provide him with evidence of his existence and provide us with a visual record of the ongoing effects of time on the city and the body. To date, Frank has been living with the disease for half of his life and still hasn’t documented every fading advertisement in New York.

To see more of Frank Jump’s work and archives see his book

Jump, F 2011. The Fading Ads of New York City. History Press.

While his Fading Ad Campaign can be found here:

http://www.frankjump.com/

Drawing a square upon the ground: the complexity of memory in a changing environment

Guest blog by Annie Harrison.

This article draws on the work Annie is doing for her MA by Research in Art Practice at MIRIAD, Manchester Metropolitan University and an associated artists’ residency at Lime, an arts and health organization. Annie also works as a Project Assistant in the School of Medicine at the University of Manchester.

My art practice is concerned with place and memory.  Both contribute to our sense of belonging, which in its turn plays a part in social cohesion.  I am particularly interested in how memory is affected by the loss of place, and how the visual arts can aid memory in a rapidly changing urban environment.  In my MA, I am researching the site of the recently redeveloped Central Manchester Hospitals and working with hospital staff to recover what the Swiss artist Christian Boltanski calls ‘small memories’, the memories of ordinary people.

Dickens knew all about small memories. I recently came across this quote from the final chapter of The Old Curiosity Shop. Kit takes his children to the site of Little Nell’s house, demolished in the slum clearances of the mid 19th century.

The house is gone, but he has the need to locate, not just remember it.  Placing the memory gives it substance, and he wants to pass on the whole memory, not just the story.  I recognize this from my own history.  Whenever our family travelled along the M6 to Birmingham, my mum would point out Frankley Service Station and tell us about her grandfather who worked for the water company and lived in a tied cottage at Frankley Beeches.  The memory was only ever recalled and retold in its proper place.

The locating of visual images in particular places has long been used as a memory aid. In traditional memory techniques, a familiar environment is recreated in ones mind, and inhabited with visual triggers. For this method to work, a pre-existing relationship between place and memory is not important, because the connection is established by the method of remembering. However in his book, ‘How Modernity Forgets’, Paul Connerton writes that the pace of modern life and the rate of change of our surroundings is causing a crisis of memory because our lack of deep familiarity with place makes this technique more and more difficult.  (Connerton, 2009)

It is not only in such specialist techniques that place is an important trigger to memory.  In the documentary, ‘The London Perambulator’ Russell Brand describes returning to the place he grew up and seeing a wall next to an ambulance station.  He suddenly remembers walking along the wall as a child, holding his mother’s hand and says ‘it was as if the memory had been left there … as if it was an object rather than something that had been carried in my mind.’ (Rogers, 2009)

Last remaining hospital corridor from the 1908 building

In my research I take people to the remaining parts of the original 1908 hospital site, and show them photographs of places which have now been demolished.  These actual places and photographic representations of place elicit not only rehearsed memories about the site like my mother’s story about Frankley Beeches, but other memories, forgotten in the interim, which are discovered as if they had been left in the place, rather than carried in the mind of the interviewee.

I interviewed a retired nurse who trained at the hospital and went on to have an extraordinary career, nursing in ward zones across the world.  Nevertheless, visiting the site triggered a small memory, more than 50 years old, of looking through the hospital railings and seeing policemen arresting prostitutes working on the other side of the road.

Sketchbook drawing of the hospital railings

The ‘new’ memories that my interviewees discover are triggered by particular places but when the places are gone, and there are only photographs to rely on, the possibility of unrehearsed memory is limited, whereas every stone, every view, smell, light condition, sound of the original building, could have been the trigger for some new memory. The loss of place leads to the loss of memories and weakens the sense of belonging, of being connected to a wider community.

Dickens suggests that when place changes, it leads to confusion. Certainly, people who suffer from memory impairment are often confused and distressed by being moved away from their familiar environment. Even a new kitchen or redecorated room can dislocate them from the past memory that they use to guide them in the present.

When I interviewed a psychiatric nurse whose association with the hospital stretched back almost 30 years he confidently showed me the place where the old unit used to be, where they used to play football with patients, where the patients used to run a car-wash as part of their therapy. But later we met his colleague who identified completely different locations for the same sites.

Manchester Royal Infirmary Outpatients Department (1948)

Visiting the post graduate training centre, the receptionist knew that round the corner, you could see the façade of the old Outpatients Department, but had no idea that the new entrance where she was sitting was built on the side of that very same building and that the lecture rooms she directed students to, were where people queued for treatment.

Returning to Dickens’ novel, Kit not only needs to find the exact place where the house stood, but he attempts to memorialize it by marking out its shape. The urge to describe memory by some physical manifestation in place is also a common experience. For example, people are drawn to leave flowers at an accident site – sometimes with a photograph or a poem. This same impulse inspires me to create work that memorializes lost sites. In my artwork, I, like Kit, am attempting to draw ‘a square upon the ground’, and in the process, I am insisting on the value of small memories, and their importance to people and to society.

For more examples of Annie Harrison’s art work, see her website: www.annieharrison.co.uk.

References

Connerton, P. (2009) How modernity forgets. Cambridge: Cambridge University Press.

Rogers, J. (Writer) (2009). The London Perambulator. London.