gms | German Medical Science

Background: Health inequity is a major issue of urban health as the urban population is very diverse in income, education, sexual orientation, chronical diseases and by attributes associated with racism. Different diversity dimensions are associated with unfair opportunities for health (eg. [1]). Simultaneously, environmental determinants of health like access to green or blue spaces, walkable neighbourhoods or exposure to air pollution, noise or heat are distributed unequally within cities [2]. If specific communities have less access to healthier environments and face more environmental burdens this is a distributional environmental injustice. Environmental justice is a vision following the goal of a fair distribution of environmental qualities as well as meaningful involvement in decision making.

During the transdisciplinary forum on urban health [3] at the Hochschule für Gesundheit, University of Applied Science in Bochum, one session focused on fair opportunities and environmental justice. The contributions of the session have highlighted various facets of urban green (see below).

Contributions: The contributions of the session consisted of the following presentations:

• Thomas Claßen Odile Mekel, Raphael Sieber, Division Healthy Settings, NRW Center for Health (LZG.NRW), Bochum, Germany: Intersectoral municipal public health action plans – wrapping up 10+ years of experiences.
• Katherine Ogurtsova, Barbara Hoffmann: Long term air pollution and brain – results from Ruhr area observational studies.

Overall discussion: After the two presentations, different questions were discussed in the plenum. The discussion included questions on existing knowledge, knowledge gaps and innovative approaches to action.

As the contribution by Katherine Orgutsova and Barbara Hoffmann showed we have clear evidence for example on the effect of air pollution and socially unjust distribution. We also know in general about multiple burden effects.

Most of all the group agreed upon an implementation gap. Therefore more knowledge on implementing goals, plans based on the models, evidence and community knowledge we have is needed. Facing the input by Thomas Claßen, Odile Mekel and Raphael Sieber it became once again clear that the implementation of innovative concepts and address mainly the needs of communities with less access to resources power of endurance (in German: Durchhaltevermögen) is needed.

The discussion agreed upon a lack of structures and processes to deal with fair opportunities. Due to silo mentality and different disciplinary backgrounds, a common language in administration is missing for joint action on the promotion of environmental justice and health. “How can the knowledge we have – for example on the effects of air pollution –be implemented in structures and processes?” was one open question in the discussion. The health action plan is one option, others, also mandatory ones, have been seen as essential. The role of politics and politicians was also seen as key for implementation. Therefore formats for transdisciplinary processes including politics have been required. For the implementation, the participation of different communities was seen as challenging, but essential.

The relation between sectoral plans, like the health action plan and integrated plans (like integrated urban development plans and/or land use plans) could be clarified including a debate on political decisions at different spatial levels from the region (Ruhr) to neighbourhoods as well as national settings.

How can the effect of the health prevention law be increased on urban planning/urban renewal?

In the final debate, different actions have been identified as relevant to follow:

• The empowerment of diverse communities as well as professional actors dealing with urban health, including politicians is needed.
• Transparency in accountability and data was required.
• Evaluation of implementation is needed including cost-effectiveness.