Cuando en 1962 se publicó “La
Condición Urbana”, a partir de una reunión de la Asociación Americana de Ortopsiquiatría,
no sospechaba el psiquiatra Leonard Duhl, uno de los ponentes, que aquel
trabajo que pretendía modificar las condiciones de vida en las ciudades para
prevenir problemas psiquiátricos, sería el germen de un movimiento mucho más
amplio en el ámbito de la Salud Pública, una forma de comprender la ciudad como marco de mejora de la salud, que
en la década de los 70 a través del programa “Ciudades Modelo”, se intentó
aplicar verticalmente por la administración americana, con escaso éxito.
Pero en 1985, con motivo del
décimo aniversario del informe Lalonde, Duhl, ya profesor de salud pública en
la universidad de Berkley (California), presenta su idea de “Ciudades
Saludables” considerando a la ciudad como un todo y como un elemento de
prevención y promoción de la Salud. El planteamiento debe ser el contrario al
seguido hasta entonces, se trata de reunir intereses de distintas profesiones,
distintos sectores (gobernantes, sanitarios, empresarios, movimientos
comunitarios, etc) y establecer objetivos sobre la ciudad que desean, o sea,
desde abajo hacia arriba. Las cuestiones en materia de salud no están solamente
a cargo de los servicios sanitarios, sino que el proceso de participación
ciudadana es crucial.
Pronto la Oficina Europea de la
Organización Mundial de la Salud cogió este testigo, con Duhl como asesor, y se
difundió al resto del mundo en forma de un movimiento que agrupaba a las
ciudades bajo este modelo de gestión sanitaria.
En 2001, el profesor Duhl estuvo
en la “Reunión Municipio y Salud” celebrada en Segovia, algunas de sus ideas
las recoge José Ángel Gómez de Caso en el artículo “El Dr Duhl y la
Ciudad Saludable”, en aquellos momentos la propuesta de los organizadores
era animar a que ciudades como Segovia, con gran potencial por ofrecer calidad
de vida debido a su tamaño, servicios, circunstancias ambientales y
sociológicas, se sumaran a este movimiento.
Varios años después, la Asociación Andrés Laguna para la Promoción
de las Ciencias de la Salud, rememora aquel evento, con una Jornada similar
denominada “CIUDADES
QUE TE CUIDAN”, comprobando lo que se ha avanzado, que muchas cosas han
cambiado y algunas otras aún no, pero con la vista puesta en los objetivos de
conseguir un mayor grado de salud en el primer nivel de convivencia –después de
la familia- como es el municipio.
De la publicación resultante de
aquella “Reunión Municipio y Salud”, podemos extraer algunas de las principales
ideas que transmitió en profesor Duhl:
HEALTHY CITIES: THE
CONCEPT
During the last 15
years there has been a major shift in thinking about health. Before most
thinking and planning was linear. That is, we looked for a simple cause of an
illness and then found a “cure”. Over the years, the problems in heath have
become more and more complicated. There is no simple solution.
Every problem is
complex, involving not just medicine and physicians, but more and more the
community. We are affected by problems elsewhere in the world, which we have no
control over. One example is fuel prices in the Middle East, and how they
impact daily living. Nothing we can think of, does not impinge on our health.
The concept of
Healthy Cities was not created by me or any other person. It evolved because
the problems, now defined complexly, needed a new way to respond. We are now
changing the way we ask the question. No longer, is it just how to treat a
patient. Now, we impressed by the Ottawa Declaration on Health Promotion are
asking how to put all the pieces together to improve the quality of life and
the health of our people.
This now demand
working together. It means active participation of everyone involved, to search
through the complexity for new answers. That is all that Healthy Cities is
about. Experts are available in specific areas. It is the people, however, who
working with every group in the community, that can say what is most important
to them. Thus Their vision of the future is important. So is a willingness to
work with others.
We are in a time full
of chaos. Only by being involved will we find new patterns of the problems and
our responses.
The meeting is geared
to ask questions about our apparent truths, and see if our communities can find
new solutions. Slowly, we will build up competence to cope with whatever comes
up and affect the quality of our lives.
Healthy Cities is a
process of improving the competence of people, institutions and communities, to
deal with their quality of life. To do so requires leadership and ability to
understand issues in all its complexity. Systems thinking in an ecological
framework are critically important. It is not the result of a single person or
action, but of collaborative endeavors.
However, more than a
technique, is the leader’s ability to mobilize a community to action. The
techniques are those of a “social entrepreneur”, a person who can pull all the
pieces and people together to deal with all the complexity and confusion. It is the ability to lead by facilitating and
catalyzing, rather than giving orders. The leader must be skillful in human
relation, organization and the consultation process.
Each person who
participates, actually changes as they are involved in the group process. There
is a turning from “self interest” to the “Common Good”. It is learning to share
working in a team, conflict resolution and more. Thus, the leader is an
educator-psychologist rather than a boss. The participants become active colleagues
and equals in designing and implementing any change. Their perception of the
issues, gradually changes. Even, the initial question gets modified, as one
works within a broader framework. Values becomes central to thinking and
acting.
Personal and social
change are intimately connected. One must work in both areas. Indeed, unless
there is also an awareness of the economic issues, the process will not work.
It has been said a “True Capitalist” is one interested in the
inter-relationship of economic, social and personal capital.
We learn who we are,
who are our communities of interest, and what we value
Leonard Duhl in
“Reunión Municipio y Salud”. Asociación Andrés Laguna para la Promoción de las
Ciencias de la Salud. Segovia. 2002
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