Dr. Rozlan Ishak, Dr. Mohd. Taha, Arif, Dr. S. Sarojini Disease Control Division, Public Health Department Ministry of Health
ABSTRACT
Rapid urbanisation as a result of rapid economic growth especially in the Asian Region has greatly affected the cities environment. The changes in thecities are quite similar to those cities in the western countries in theearly developmental stages where social and physical problems were the main agenda for the cities' authorities. Lack of land , infrastructures and basicservices for the urban communities created unsanitary and unhumane urban living such as squatters, outbreak of infectious diseases and rise in crime rate.
Malaysia is rapidly expanding and is aware of the difficulties faced by cities throughout the world with regards to human development. Therefore,Malaysia is trying to improve housing for of its population , managing everchallenging traffic problems through expansion of roads and reducing the flow of traffic into the cities. Upgrading of the basic facilities such aswater, electricity and telephone, reducing pollution in the air , water and noise within the cities.
The task to tackle these problems is enormous and a step forward is necessary and the Healthy Cities Programme is one of the tools available for Malaysia. The programme needs support and to achieve such a task, strong leadership by the cities administrators and the multi-agency support is required.
It is hoped that the joint effort taken by various agencies and departments in solving the cities' problems based on the concept and philosophy of healthy cities will be able to provide a more sustainable and effective solution. This will enhance the quality of life in the cities and minimise health hazards ,promoting a better and healthier behaviour, life style and habits, and directly improve the health services in Malaysia.
Key Words
Healthy Cities, human development, Malaysia
2.Director for Disease Control, Ministry of Health, Malaysia.
3.Assistant Director of Health (Workers' and Environmental Health),Ministry of Health, Malaysia.
INTRODUCTION
Urbanization is a process of expansion in size and population in urban areas. It is associated with changes in economic, social and physical environment of the urban areas. It is also related with the migration of people from rural to urban areas. This has resulted in the increased demand of land for houses, industries, recreational facilities, schools, health centres and offices block.
Globally, during the forty-fourth World Health Assembly, May 1991 it is noted that between 1950 and 1990, the world's urban population rose from 734 million to 2,390 million which is more than triple growth in population. About 45% of the total world's population resides in urban areas and this will continue to increase.
Most of the increase in population occurred in cities of developing countries especially in the Asia Region that is, from 286 million in 1950 to 1,515 million in 1990. By the year 2015, the 5 biggest cities will be Tokyo, Bombay, Lagon, Shanghai and Jakarta.
THE MALAYSIAN SITUATION
Malaysia's population is estimated to be about 18.5 million in 1995. The average annual population growth rate for Malaysia between 1970 - 1980 was 2.3% increasing to 2.6% between 1980 - 1991. The average urban population growth was about 4.7% between 1970 and 1980 and 6.2% between 1980 - 1991.
It was estimated that by the end of 1995, the proportion of urban population would reach 45%. After reviewing the present statistics, it is projected that by the year 2000, 60% of the nation is population will be living in urban areas and this is more than world's average of 45% urban-rural ratio.
It is expected that certain areas would have faster urban population growth than the normal average.
URBANIZATION ISSUES
The increase in the level of urbanization has exerted pressure on the provision of housing, infrastructure, utilities, and community and recreational facilities for the urban population. Persistent concentration of development in major urban areas in the Klang Valley, Pulau Pinang and Johor Bahru has brought about road congestion, environmental pollution and the phenomenon of new social and health problems in these areas.
a) Housing
In the Sixth Malaysia Plan, 573,000 unit of houses were planned for construction. By 1993, about 70.3% of this target was achieved.
The needs of housing among the urban population, especially among middle and lower in some groups is very critical. In adequate supplies of housing may contributed to the number of squatter settlements increasing despite more houses is being quitt.
In Klang Valley, squatter settlements and this comprise of 19% of the total population in Klang Valley. Although squatter areas provide cheap housing for urban poor, they also cause environmental degradation as there are no proper sewerage and drainage facilities. They are also potential sources of health and social problems.
Migration of illegal migrants to urban areas also further contribute to the expansion of squatter settlement especially along the boundaries of the cities.
b) Traffic and Urban Transportation
Traffic congestion is another major problem in Malaysia is urban centres.
Inadequate and inefficient public transport and increasing purchasing power of the urban population have resulted in an increase in private car ownership. Single occupancy vehicle (SOV) is a common scene in urban areas such as in Kuala Lumpur. Car Pooling Programme organised by Road Transport Department failed to increase the awareness or receive support among the cities residents.
Road Widening Programmes in inner urban areas, the construction of ring roads, new roads and other measures, have not solved traffic and transportation woes With major offices located in the inner core of the city and residential areas expanding away from the city centres, journey to work have also lengthened, travel time increased and stress aggravated. A network of Light Rapid Transit (LRT) has been implemented in Kuala Lumpur City that provide for faster and more efficient public transport and may help to reduce traffic congestion if the urban population support the system.
Efficient Highway network was planned and implemented as a means to extend urban amenities, and social and infrastructure facilities, to lagging regions and rural areas. Generally, highways have an immediate and profound impact on the pattern of urban development.
c) Community Facilities
As residential areas expand, provision of schools, kindergartens, creches, public libraries, clinic and health centres, hospitals, community halls, and social, recreational and sporting facilities, have been slow in meeting this demand.
Although planners provides for sites for these uses and developers set a side land for some of them, the responsible authority have not been able to cope with developing them for the use of the urban population.
In order to ensure that community facilities expand in accordance with demand, an effort should be made to clarify what facilities should fall within public responsibility to provide them Community facilities within residential neighbourhoods, particularly facilities for social and sporting activities, are important to the development of healthy neighbourhood programmes through friendly interaction, communal unity and cohesion and a sense a neighbourhood among peoples. Important venues such as community halls, libraries, playground, sportsfields and courts, swimming pools, park etc. should be made available and accessible to all people in the community. This will alleviate teenagers from induging unhealthy activities such as drug abuse, smoking, drinking, teenage pregnancy, truancy etc.
d) Utilities
The privatization of utilities such as power, telecommunication and water supply to meet domestic, business and industrial demand, has in general been sucessful.
However, the problem of proper sewerage still exist in many urban centres, but with privatization of sewerage services, it is expected that there will be an improvement and upgrading of domestic sewerage system throughout the country.
Solid waste disposal is also likely to become a major environmental problem as waste generatied by industrial and domestic sources is further increase as the country further develops and become an industrialised, affluent and sophisticated society.
In tandem with these changes and developmend a Recycling Programme should be planned to minimize the volume of solid waste disposed at the waste disposal plants and hence be an additional step forward in protecting our environment.
e) Historical Building
The conservation and preservation of buildings and areas of cultural, historical, heritage or architectural value should be encouraged so that urban centre will have its own identity and character. Besides the conservation of build-up areas, the conservation of urban jungles in Cheras, Ulu Langat, Kepong should be enhanced.
Public gardens and projects for the landscaping of streets, public buildings, open spaces in all major town and city centres should be planned.
The effect is not only to uplift the image of the Malaysian cities and towns but also to make them healthy places to live and work. (Healthy working and living environment).
f) The environment
Urban environmental issues are mainly concerned with air and water pollution and the disposal of domestic and industrial wastes.
Motorised vehicles is one of the major contributors of air pollution. The level of total suspended particulates is occasionally higher than the recommended acceptable levels of the World Health Organisation. It is more acute during dry seasons which usually occurrs in the months of March and August. Industrial activity and open burning further contributes to air pollution in the cities.
Water pollution in urban areas is a consequence of direct discharge of domestic waste, uncontrolled practices at land development sites, as well as animal husbandry activities upstream. Agricultural activities and utilisation of pesticide aggravate further the polluted river.
"Love Your River Campaign" organised by Department of River and Drainage could be incorporated in the Healthy Cities Project.
HEALTHY CITIES PROJECT IN MALAYSIA
Healthy Cities Project proposal was forwarded to Ministry of Health in early 1994. After several discussions the proposal was accepted by Ministry and the project initiation mission was undertaken in the middle of 1994 to discuss the proposal detail and ascertain the government endorsement of the project. Two cities i.e. Johor Bahru and Kuching were selected for the project.
Malaysia adopted WHO objectives on Health Cities Project and they are:- 1.To minimise health hazards in urban areas through integration of health and environment protection measures in urban planning and management processes;
2.To enhance the quality of the physical and social environment supportive of urban health;
3.To increase the public awareness towards healthier behaviours, life styles and habits;
4.To improve the provision of health services by developing appropriate health care systems; and
5.To upgrade the country's capabilities to improve urban health through better intersectoral coordination and participation.
Healthy cities in Malaysia focus on the to development of a more comprehensive programme to further enhance the quality life for the people.a. River and Drainage
Activities on river and drainage programme were focused to reduce siltation in the river by
-improving on the existing drainage facilities,
-building more "silt-trap",
-strengthening enforcement activities on developers,
-educate the public on "love your river campaign", and
-improving the effectiveness of solid waste collection
b. Housing and building
Issues were focused mainly on inadequate affordable houses and resettlement of squatters. Poor zoning of housing development and more enforcement by Johor Bahru City Councils will be done. Number of houses built and number of squatters resettled will be monitored.
c. Road and Transport
Air pollution and traffic jams will be the areas of concern. Johor Bahru and Kuching Healthy Cites Projects will focuse on improving and restructuring the road system, ensure reliable and efficient public transport and car pool programme.
For air pollution, total suspended particulate (TSP) will be monitored closely and the increase in the compliance of black smoke emission through effective enforcement and public education will determine the success of such a programme.
d. Industries
Illegal factories can be sources of fire hazard, pollution and toxic waste disposal. Malaysia Healthy Cities Project will focus on resiting such factories through effective enforcement between the City Councils and other relevant government agencies.
It will be monitored by the number of inappropriately located factory/factories and number of factories contravening the effluent discharge standards.
e. Solid Waste Disposal
Insufficient collecting system needs to be improved in the city. Proper and modern equipment for collection has to be followed strictly. Improper disposal of solid waste create nuisance among the public thus it needs to be monitored and the number of disposal areas coverted to sanitary landfills will be evaluated..
f. Community Safety
Crime on people and properties need to be looked into by City Councils through the implementation of public education programme towards crime prevention. Dialogue in schools, press release and community neighbourhood watch group will help to reduce unhealthy activities in the city.
The number of crime reported on people and properties will be monitored to ensure effectiveness of the programme.
g. Health
Inadequate Medical and Health facilities is a concern in urban areas. Activities will be focused to increase medical and health facilities in the city which is accessible to all strata of the population. These activities will be collaborated with city council and state planning unit. Number of medical and health facilities constructed will also be monitored.
Similarly, the incidence of communicable and non-communicable disease will be assessed regularly through timely notification of disease. Ministry of Health programmes will be incorporated together with the local authority structure plan to further reduce the incidence of communicable disease and the prevalence of non-communicable disease such as food borne disease, vector borne disease, sexual transmitted disease and hypertension, cardio vascular diseases, diabetes and obesity.
The changes in the incidence of communicable disease and prevalence of non-communicable disease will be used to evaluate the effectiveness on implementation of physical, economic and environmental programmes in the city.
h.Generally, healthy cities project will focus on 4 major dimensions ie; aesthetic and cultural dimension through "Bersih dan Indah Program" (Clean and Beautiful Programme), social and economic dimension, physical and environmental dimension and health and safety dimension.
ACHIEVEMENTS
Malaysia's Healthy Cities Project has been a challenging one and the achievements sofar has been fulfilling (remarkable).
(i)Healthy Cities Program in Kuching has managed to create an impact on all strata of their society as they had some understanding about the concept of "Healthy" during planning stage is self. Until now, they have able to organise 3 major conferences to discuss on issues pertaining to health and social, physical and economic issues etc.
Besides that, Kuching city has been invited to share her experiences in major seminars, workshops and conferences locally and internationally. Malaysia is very proud for this achievement.
(ii)While Johor Bahru Healthy Cities Programme was not very well publisized internationally, but they has also made a tremendous progress. They have organised a multi agencies conference on Healthy Cities in 1995. In October 1996, a Second Healthy Cities Conference will be organised with participation from Government Departments, NGO's and communities to evaluate the performance of the programme.
(iii)At the National Level, the 1st Healthy Cities Conference was organised between Ministry of Health, Ministry of Housing and Local Government, Kuala Lumpur City Council and WHO on 31st July - 1st August 1995. This conference has received very good response from all government agencies and departments.
We also celebrated World Health Day celebration on "Healthy Cities - Healthy Island - for better life" in Kuching City. This celebration was jointly organised by the Sarawak State and Ministry of Health.
Beside these promotional activities, Ministry of Health also made a proposal for a New Policy on Healthy Cities Project in Malaysia which means acquiring funds to subsidise the implementation and expansion of healthy cities programme in Malaysia.
Healthy Cities Project in Malaysia will be strengthened by the establishment of a good community programme either through government agencies and departments or through NGO's and community such as Bangsar Neighbourhood Programme etc.
Ministry of Health has taken great interest in the healthy cities project and a Cabinet Paper has been prepared and vetted by the honourable Ministry of Health. This paper was prepared to inform the Cabinet Ministers about the concept and progress of healthy cities project in Malaysia. A paper is also being prepared to brief and inform the Chief Minister of the states on this project.
Workers' and Environmental Health Unit, Public Health Department is trying to coordinate and expand this programme further by trying to gain support from the government agencies via strengthening the collaboration and cooperation at the ministerial level. Some of the projects organised at the national level, within the concept of Healthy Cities Project were:-
i) Healthy Working Environment
a)Studies has been conducted to assess the degree of stress among officers and staffs in the government department especially those in the Public Health Division.
b)Indoor Air Quality Monitoring Programme towards monitoring the incidence of Sick Building Syndrome in government offices was organised between Workers' and Environmental Unit with Institute of Medical Research (IMR), Engineering Division, Department of Safety and Health (DOSH) from Ministry of Human Resource.
c)Recycling Programme for A4/A3 paper within Ministry of Health will be organised in the Department of Public Health and will be embarked as a pilot project. This project if sucessful will then be expanded to all Ministry of Health offices.
d)Healthy Hospital Programme which was implemented in Sarawak will act as a pilot project for further expansion of this programme to all hospital in Malaysia. Similarly, Friendly Breast Feeding Hospital is also part of the Healthy hospital programme, besides the "Dengue Free/Aedes Free Hospital Programme in hospital compound.
ii) Community Programme
a)Malaysia will embark on Healthy Community Programme together with other relevant department, and so far have implemented "Dengue Free/Aedes Free Community Programme".
b)Besides that, Small Area Health Statistic Unit (SAHSU) will be proposed to incorporate healthy cities concepts and health indicators will be monitored in specific areas of interest. This will be jointly organised between the local authority, department of environment, local health unit and the community.
EXPANSION OF HEALTHY CITIES PROGRAMME
(a)To further strengthen this project, several officers from the state level were involved in the National Programme such as First National Healthy Cities conferences in Kuala Lumpur, World Health Day Celebration in Kuching and Seminar and conference organised in Kuching and Johor Bahru.
(b)Ministry of Health is going to organise a workshop on the implementation of Healthy Cities Project in the state. The objectives of this workshop are:-
i)To inform and create awareness on Healthy Cities project in Malaysia and Global.
ii)To identify and implement specific healthy cities project in their cities and towns.
iii)To identify indicators for monitoring and evaluation of healthy cities project.
With this workshop, we hope to provide guidelines on healthy cities project in Malaysia, identify healthy cities project to be implemented, indicators for monitoring and evaluation of healthy cities project and gather commitment from the participants for this project. The format for the implementation of the project is as enclosed in appendix.
(d)Director General of Health, Malaysia has made a suggestion to expose major city councils and relevant government departments and agencies, and NGO's by organising and arranging seminars, conferences and study tours at the local and international level. Intercity network at the national level will be strengthened through meetings among mayors to discuss current issues and problems in promoting and implementing Healthy Cities Programme in their areas.
(e)Database or City Profile need to be compiled by respective cities so that they will be able to evaluate the progress made by the programmes. At the national level, indicator will be identified to monitor the programme of each city. This information will be used to assess the change in social, health and economic status of the city and compare it with other cities in this region. Format for reporting have been sent to Kuching and Johor Bahru cities for monitoring and evaluation of their progress on the project identified in their earlier conferences. This will be the basis for allocation for funds and preparation for the Second National Healthy Cities Conference in Malaysia for 1997.
CONCLUSION
From the experience of Kuching, Johor Bahru and ourselves at the Ministry level, in implementing the Healthy City Concept, we would like more cities to expand and promote centres of excellence in planning and managing cities. The health and social problems are dealt professionally though multi agencies approach to ensure effective solutions and programme identified and implemented.
As the countries move toward industrialization, we will be able to further create and improve the social, economic and physical environments. The community will have more chances to undertake steps in improving their own life and the environment and be involved actively in the preparating, planning and organising healthy cities project within their local areas.
The impact of the successful project will be seen when people are able to swim in the unpolluted rivers, feeling safe from crimes and play in safe surrounding and breathing clean air, and enjoying high quality of life in the cities.
As we progress towards the 21st Century, the present social, health and economic issues and problems need to be addressed. In undertaking such a task, these is a need to develop a vision and mission for the cities and visualise the direction that we need to achieve. This is the challenge for us, and to be able to tackle such a challenge, we need strong commitment between government departments and agencies, private sectors, NGO's and the communities. The whole community has to be mobilised and the effort of all sectors and departments have to be combined and focused. Therefore, cooperation and collaboration should be enhanced rather than encouraging competition among government departments and agencies, private sectors and NGO's. Malaysia hope this idea of working together in promoting Healthy Cities Project will allow people to participate and promote a better quality of life in urban areas.
Thank You
REFERENCES