Cities for Life: Lesson from Medellin - Takeaways from a seminar with former Mayor Aníbal Gaviria

Source: Photo by Marisa Asari 

The UC Berkeley Center for Global Healthy Cities and the Institute of Urban and Regional Development hosted a semester long seminar facilitated by Dr. Jason Corburn, professor of City and Regional Planning and Public Health, and Aníbal Gavíria, the former mayor of Medellin (2012-2015) and former governor of Antioquia, Colombia (2004-2008). The seminar took a comprehensive look at the transformation of the city of Medellin, once known as the most dangerous city in the world, to now a global example of equitable and inclusive planning.

Guest speakers included Jorge Pérez Jaramillo, former Dean of the school of Architecture at the University of Antioquia and Director of Planning for the city of Medellin (2012 – 2015); Diane Davis, Chair of Urban Planning and Design at Harvard’s Graduate School of Design; Carlos Cadena, Professor at EAFIT University; and Magdalena Cerdá, Associate Professor of Emergency Medicine and the Vice Chancellor’s Chair in Violence Prevention at UC Davis. The seminar was structured around a series of lectures by professor Corburn, former mayor Gavíria and guest speakers, focused on specific projects and processes that contributed to violence and poverty reduction in Medellín. Topics included the city's affordable and integrated transport system, increased spending on education and culture, alter­native conflict resolution mechanisms, youth programs, and participatory forms of planning and budgeting.

A city transformed

The city of Medellin is located in the Aburra Valley, in the department of Antioquia in central Colombia. It is bisected by the Medellín River that flows south to north through the valley, and has been an industrial and manufacturing hub for the department and country since the 1800s. This ideal setting and economic success is contrasted by Medellín’s alarming homicide rate, reaching its height in 1991 with nearly 400 homicides per 100,000 inhabitants. In the last two decades, the city has lived a tremendous reduction in violence; by 2015, the homicide rate decreased by 95%, at 20 per 100,000 inhabitants.

Homicide rate in Medellín 1978 - 2015 (Source: Alcaldía de Medellín)

As a result of this impressive social transformation, Medellin has received a tremendous amount of global recognition, most notably the Lee Kuan Yew World City Prize in 2016, and as host of the 7^th World Urban Forum in 2014.

Cities for Life

Throughout the seminar, Mayor Gaviria walked the students through several of his administration’s greatest achievements, most notably Unidades de Vida Articulada (UVAs), the River Parks Project, and vast investment in education, as well as critical contributions of past administrations and collective work on behalf of Medellín’s citizens including the Metro and Metrocable system, library parks, and public escalators in Comuna 13. Through investing in the populations with the greatest need, mayor Gaviria and his predecessors were able to regain public institutional trust, and improve safety for the residents of marginalized neighborhoods. These programs were part of his administration’s goals to create a city for life, where strategic interventions were implemented through multidimensional strategies to reduce violence, increase education, and promote inclusivity for all.

UVA de Los Sueños (Source: ArchDaily)

Source: Photo by Marisa Asari

The ongoing conversation

The seminar ultimately revealed an imperfect story of a city that has reemerged out of a period of violence and trauma, one that offers valuable lessons for global cities but continues to grow and learn as it grapples with issues of inequality and poverty. 

Challenging the common narrative of utopian success surrounding Medellin’s transformation, the seminar also addressed the city’s continued challenges. Hazardous pollution levels, heavy traffic, environmental degradation, and socioeconomic inequality are at the forefront of the municipal agenda, and are key focus areas of a new Metropolitan Plan for Medellín and the nine surrounding cities, currently being drafted by the Metropolitan Authority. Seminar participants raised concerns and discussed future development in the metropolitan area, adding to ongoing research at IURD that supports the metro area planning process and the evaluation of proposed urban interventions. 

“I believe that all the good practices and experiences of Medellín are interesting to study and analyze, but these “recipes” always have to be adapted to be relevant to the other societies, to other territories, and to other cities. I see the innovations of urban development in Medellín not as photocopies that can be taken to another site and simply printed there, but I do believe that all the innovations of Medellín can provide a source of learning for other cities with geographical similarities or even differences. “

                                                                                               

                                                            Anibal Gaviria, former mayor of Medellin

Anibal Gavíria Correa, former mayor of Medellín (Source: Photo by Marisa Asari)

Beyond the seminar

The Institute for Urban and Regional Development, directed by Professor Jason Corburn, is continuing its research and assisting the Metropolitan Authority of the Aburra Valley and the city of Medellin, with its Metropolitan Plan for Territorial Organization (PEMOT). The planning process, led by Jorge Perez Jaramillo and his team of researchers in Medellin, will continue the legacy of mayor Gaviria’s Cities for Life concept and continue to promote inclusivity, equitable transportation, environmental conservation, continued investment in education, and health equity.

For more on the seminar outcomes and updates on ongoing work, visit iurd.berkeley.edu

By Marisa Asari & Matthew Palmquist

Stopping the Urban Epidemic of Gun Violence: Advance Peace

I'm proud to partner with Advance Peace in to stop gun violence in cities. We are committed to  improving the health and well-being of those most affected by gun violence and putting an end to this crisis that is plaguing our urban communities.  Check out the latest video that appeared on the Daily Show with Trevor Noah last night, January 4, 2018, below:

Also, a recent article about the up-coming launch in Sacramento: 

http://www.sacbee.com/news/local/article187438548.html

Community Engaged Infection Control: Ebola

In an article recently published with collaborators from Africa, we outline ways the global response to infectious diseases must include community members as engaged experts.  The article appears in the journal Health Promotion International.  A blog post at Oxford University Press outlines our proposal.  In short, we suggest an eight step process to better address disease outbreaks through early and sustained community engagement. These steps include ensuring that outside health care workers familiarize themselves with a community (its customs, beliefs, and informal leaders) before entering; that they enter accompanied by a respected local leader, and with “cultural humility” (showing respect for the community’s knowledge and assets); that they listen and learn, not simply give orders and take unexplained and fear-producing actions. A meeting in the community, called by local leaders and to which outside health workers are invited as guests, is another important step; it allows outsiders to share what they know while promoting reciprocal learning, and establishing trust and respect. Community meetings also provide a good platform for assessing “community readiness” to work with health care workers in identifying aspects of the standard infection prevention and control (IPC) protocol that might be adjusted to improve their cultural congruence, without compromising safety. 

Health in All Urban Policies - new publications

We recently published our work in Richmond, CA, detailing our Health in all Policies (HiAP) strategy and ordinance. The Ordinance was singed into law by the Richmond City Council in April 2014. We have detailed the processes and content of our work in two papers:

"Health in All Urban Policy: City Services through the Prism of Health," from the Journal of Urban Health &
"A Health-In-All-Policies Approach Addresses Many Of Richmond, California’s Place-Based Hazards, Stressors," from the journal Health Affairs.
We hope to share our experiences with other cities aiming to incorporate Health Equity in all decision making.

Health Equity in Paris

With all the attention to inequalities in Paris and Europe more generally, I am co-leading a collaboration between University of Paris X, Nanterre, and UC Berkeley focused on reducing health inequities in the Paris and San Francisco metropolitan regions. This collaboration started in Fall 2013 and continues into February 2015.  During February,  I brought a team from Richmond, California, to Paris to share our experiences with the Richmond Health Equity Partnership and Health in All Policies and to learn from collaborations between the University Paris and Ile de France, Conseil Regional. We heard from students from the Sante pubique et territores laboratory about their term projects researching the determinants of cancer disparities.  We also met with with Marianne Auffret, vice Mayor of Paris 14^th, in charge of Health.  We plan to continue this collaboration through a comparative study of the health equity implications of the "Suburbanization of Poverty" in Paris and the San Francisco Bay Area.  Stay tuned. 

Source: http://www.nytimes.com/2015/02/13/world/europe/paris-tries-to-embrace-suburbs-isolated-by-poverty-and-race.html

Climate Justice planning in California

http://www.prweb.com/releases/2013/11/prweb11356751.htm?PID=4003003

International Conference on Urban Health - Manchester

The 11th International Conference on Urban Health begins runs from 4-7 March in Manchester, UK.  The theme is Partnerships for Global Urban Health and papers and delegates from around the world will be presenting on interesting urban health research and policy issues. I'll be keynoting and co-Chairing the section on Urban Planning and Architecture and giving a talk on Planning the Healthy and Equitable City.

Collaborative Slum Mapping for Political Power in Nairobi

National Public Radio (NPR) is running a feature story today on the work of our collaborative between Slum Dwellers International (SDI), Muungano Support Trust, the University of Nairobi, and our team at the University of California, Berkeley.  The story nicely describes the importance of mapping as a process of recognition and increasing political power for slum dwellers.  The water project mentioned in this story emerged, in part, from community planning that our team facilitated.  I provided some examples of maps for the NPR story which can be listened-to or read here:

Both of the maps that appear in the NPR story were generated by our collaborative that includes slum dwellers from Mathare in Nairobi, our NGO and University partners, and UC Berkeley students from the Departments of City and Regional Planning (DCRP) and School of Public Health.  

One of our maps of the Mathare slum in Nairobi published by NPR today

Since 2008, I have lead a team of UC Berkeley students and researchers to support data gathering, map making, planning and advocacy to improve the lives and living conditions of Kenya's urban slum dwellers.  The reflections and insights from the tens of students that have participated in my Nairobi Studio can be found on the blog, http://nairobistudio.blogspot.com

Much of the material we have generated in collaboration with our Kenyan partners, including maps, detailed survey data, and planning and design proposals to improve infrastructure, housing, economic opportunities, health and environmental conditions in Mathare and other slums in Nairobi can be found on the web site of the Center for Global Healthy Cities at UC Berkeley.

Urban Health Equity in All Policies: Toward a new science of the city

I just published a new opinion piece in the UK Guardian about the need to integrate Health in All Policies with urban equity.  The idea is to re-orient science-policy in fundamental ways to ensure social justice is that the center of new city, state and national policy making.

http://www.guardian.co.uk/sustainable-business/urban-health-equity-policies-city

Slum Surveys: Making the Invisible Visible

Our work with Slum/Shack Dwellers International and Muungano Support Trust in Kenya was recently featured in the Guardian Weekly.  The article focuses on the detailed enumeration and surveying work by slum dwellers around the world, organized by such organizations as our partner, SDI.

In the Mathare informal settlement in Nairobi, Kenya, UC Berkeley, the University of Nairobi the federation of slum savings groups called Muungano wa Wanavijiji and Muungano Support Trust, have worked for the past five years surveying and mapping residents and their living conditions. Importantly, these are not surveys to only document the unjust living condition, but more importantly help build local power by organizing residents and providing them with one important tool to negotiate for improvements with government.  What the community surveying work also reveals is that local people are experts that must be trusted to drive policy and investments, not merely act as researchers or respondents.  Our collaborative informal settlement upgrade plan for the entire Mathare valley in Nairobi, which emerged in-part out of local knowledge from slum surveys, is one example of the type of outputs slum dwellers are capable of producing from this work.  No longer capable of ignoring the urban poor, international organizations, donors, governments, academics and NGOs should take note: slum surveys build power for lasting change.

Slums, justice & health: From Neighbourhood to Nation

In Buenos Aires, Argentina, the government has established neighborhood "justice centers" where residents of the city's poorest areas can get legal assistance to gain access to government services, including health care, housing and other life-supporting programs. The model is similar to what the Asian Development Bank is supporting in Bangledesh, where a network of community health centres that provide comprehensive and integrated services, from legal and land rights to ambulatory care, for the urban poor. Improving unjust living conditions is at the heart of both these programs: “Poor living conditions leave the urban poor, especially women and children, more exposed to health problems than the general population,” said M. Teresa Kho, Country Director of the Bangladesh Resident Mission.
Brazil remains one of the world's leaders in linking neighborhood-based, integrated and comprehensive services to health equity for the urban poor.  Brazil's Family Health Program (PSF) and related clinics, staffed by clinicians, nurses, lay outreach workers, social workers and others, is increasingly seen as a one of the most significant reasons behind the health gains being experienced by the urban poor in Brazil, as discussed in this recent Lancet series. What is important to note about the factors of success in Brazil (and granted they still have much progress to make) is that public health officials are acknowledging that reductions in morbidity and mortality for the least well off are the result of an integrated set of economic, social, and place-based policies, along with national leadership but local (municipal and neighborhood-scale) priority setting and implementation.  As a government worker in the slums of Buenos Aires noted in the below referenced article, there is no one-size-fits-all or single intervention that will change entrenched inequalities that contribute to health inequities. Rather, what is needed are integrated strategies with the power of the national government but with the accountability of neighborhood organizations: “There are economic, social, cultural and geographic barriers standing in the way of everyone having access to the same rights. For that reason, rather than sporadic interventions, what we are seeking at the centre is to provide a stable state presence.”

Making Healthy City Planning Work

Here is a recent article on some of the work we are doing in Richmond, CA, promoting Healthy City Planning. Importantly, the article emphasizes that it takes leadership and action on multiple levels to make healthy city planning work -  not just in the planning or health departments.  The City Council and Mayor have made this part of their agenda, as has the City Manager and multiple city agencies. Contra Costa County Health Services, the public health department for the city of Richmond, is also playing a leading role.  While the article rightly notes that moving toward a healthier and more equitable Richmond is not about health care alone, improving access to and affordability of clinical services is important.  To support this, the County-run health clinics, including school-based services, as well as Kaiser - the largest health care provider in Richmond - are taking an active role in linking prevention programs with essential basic care.  Perhaps most important, community-based organizations are leading the way - - organizing residents, proposing and participating in projects and holding the government and industry (such as Chevron) accountable.  One sign of growing community accountability toward health, is the resubmission on May 23, 2011, by Chevron for a Conditional Use Permit to upgrade its Richmond refinery and a commitment to address the environmental issues the company ignored and Communities for a Better Environment and others successfully sued the company to address. 
Making healthy and equitable city planning work demands action and leadership on multiple fronts, and Richmond is increasingly moving in the right direction.  

Community-led water service: Kosovo village, Mathare slum, Nairobi

Our UC-Berkeley-University of Nairobi and Muungano Support Trust (MUST) collaboration in 2009 resulted in many positive outcomes for the residents of the Mathare Valley informal settlement.  In one village, called Kosovo, we helped plan and design for piped, 24-7, water access for each household. The Nairobi Water and Sewer Company eventually installed new water pipes and community members, through Muungano, are managing and maintaining the service by supporting residents to obtain meters and assist them in paying water bills.  While a comprehensive evaluation of this intervention is ongoing, here is an article by SDI describing some aspects of this community-level utility management .  Importantly, we are SCALING UP lessons from this project in our current Mathare Valley Zonal Plan, which aims to offer a comprehensive and integrated plan for improving infrastructure, economic livelihoods, housing, land rights and essential services, such as health care for all villages and over 150,000 residents of the Mathare Valley.

$300 slum house? Worthy but Worthless

The Economist published an article last month on the competition to build a $300 house intended to improve the lives of slum dwellers.  The article came from a blog post in the Harvard Business Review by Vijay Govindarajan, of Dartmouth College’s Tuck School of Business, and Christian Sarkar, a marketing consultant, who set out to explore the possibility of Govindarajan's idea of  'reverse innovation' - or an idea that starts in the Global South and makes its way to more wealthy nations (many of us know this already happens through stolen intellectual property, but that is a topic for another post).
What is the problem you ask?  Well, for starters, the response, Hands off Our Houses, in today's NY Times captures why this is fundamentally a bad idea for the urban poor - it doesn't include those intended to live in these houses in the design process.  This is a also a BAD idea because it fails to grapple with the complex relationships in informal settlements between housing, land rights, economic opportunities, gender rights, health and safety and a host of other issues.  With worthy intentions, this idea is likely to redirect resources toward a worthless outcome - a rational and nice looking house that will not improve the lives of slum dwellers.   
A fundamental error here is that design alone is NOT the solution - despite what green builders, architects, entrepreneurs and others continue to say.  The solution is an urban planning process where:
(a) slum dwellers drive the process;
(b) designs are not one-size-fits-all - but flexible to accommodate different uses, can expand and improve the existing social and cultural fabric of a community;
(c) donor & private sector resources support improvements to basic infrastructure (i.e., water, sanitation, roads, electricity, etc), schools, health care facilities AND housing, and;
(d) the process offers jobs, new skills, and builds community power.

Well, this isn't easy either, but it is being done.  Slum/Shack Dwellers International (SDI) has been doing just this in tens of countries around the world.  As I've mentioned in previous posts, our team at UC Berkeley has been working with one SDI-affiliated network, Muungano WA Wanavijiji, since 2008 to support community-led planning in the Mathare Valley informal settlement in Nairobi, Kenya.  Our process aims to act as an alternative to other planning and housing improvement schemes in Kenya, particularly the Government of Kenya's slum upgrading project in Kibera - -  where the government built housing for the urban poor, but local people prefer to rent out the housing rather than live in it! 

We must avoid the boutique design and technological quick-fixes promoted by business schools and the global elite in the donor and entrepreneurial community and invest in complex, messy, people-centered, locally-driven processes.