Author: Chaitawat Boonjubun. 23rd March 2020.
In summer 2018, a medical doctor phoned me to discuss the issue of the city and public health. As he knew from a friend of mine that I was studying for a doctoral degree concerning urban studies, he asked me, ‘What is urban about public health?’ In other words, what are the linkages between ‘urban’ and public health? Arguably, one of the most convenient ways to define ‘urban’ is by distinguishing ‘urban’ from ‘rural’. In the case of Thailand, according to this doctor, statistical data regarding the number of patients with diabetes, heart disease, for example, did not show much difference between those who live in urban and rural settings. The doctor and I agreed that statistics alone seemed to be a challenge to persuade policymakers to draw up special measures in dealing with urban health issues. We thus discussed a wide range of factors that would make ‘urban health’ differ from ‘rural health’ including density, size of the population, health care facilities and services, governance, and the way of life. It is important to note that this discussion focused solely on the case of non-infectious diseases.
Keil and Ali, in their essay ‘Governing the Sick City: Urban Governance in the Age of Emerging Infectious Disease’ (2007: 848), published in Antipode, argue that the 2003 SARS outbreak was a result of ‘increased connectivity’ in the globalised world influenced by transportation technologies. They pointed out that urban areas were more vulnerable to infectious diseases due to high-density and accelerated land use. Furthermore, especially because of the ‘globality’ of cities, it was difficult to contain the outbreak within a city and by merely local health authorities.
In the wake of the on-going novel coronavirus outbreak, large cities have been hit harder than smaller cities in terms of: the number of affected citizens, for example, IS 438 cases in Uusimaa (including Helsinki) out of the total of 686 across Finland (Helsingin Sanomat, 23 March 2020) and 297 affected people in Bangkok Metropolitan Area out of 721 cases throughout Thailand (Department of Disease Control, 23 March 2020); the healthcare system becoming overload when the affected cases continue to rise abruptly; the severe impact of the outbreak on the city’s economy and employment as the majority of companies, stores, shops, and restaurants have shut down and workers have been laid off; and, the loss of urban life since public places are closed down and mobility is restricted. There are also unintended consequences, both negative and positive: a rural ‘exodus’ launched by the present situation might cause the city dwellers to carry the infectious disease with them to rural areas where health facilities are insufficient, but cities may become less polluted due to less commercial and industrial activities.
By looking at current official measures and orders used in many cities to tackle the outbreak, it shows complex power relations of jurisdictional responsibilities between state and city government/municipality in preventing, treating, and curing the disease. In most cases, cities/municipalities cannot implement emergency laws by themselves if a state of emergency has not yet been issued by the central government. Also, it is usually the role of state authorities (and of cities/municipalities for some cases) to redress the economic effects of the outbreak, for instance, to suspend mortgage and rent payments or to reduce electricity and water fees. This is the time for states and cities/municipalities to show their consolidation, and at once to place the lives of citizens above the economic growth of the city.
References
Department of Disease Control, Thailand (2020). Coronavirus Situation. Available from: http://covid19.ddc.moph.go.th/
Helsingin Sanomat (2020). Finland’s Corona Virus Status. Available from: https://korona.kans.io/?language=en.
Keil, R., & Ali, H. (2007). Governing the Sick City: Urban Governance in the Age of Emerging Infectious Disease. Antipode, 39(5), 846-873. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1467-8330.2007.00555.x
Dear Chaitawat,
Your blog post is timely, novel, and inspiring.
I welcome the opportunity to use it as a point of departure to re-emphasise the relevance of the Helsinki School of Critical Urban Studies.
Following your own research, I take it that the coupling of the local and the federal/central state that you discuss also implies embracing the rich insights from ‘commoners’ such as earth priests, traditional healers, monks, and abbots for whom the earth and its spirits are the source of wisdom. That connection is crucial because of the experience during the fight against the Ebola Virus Disease. At the time, the UN put in place a global governance framework that recognised both national and local institutions, but it was only after it recognised traditional healers, who remain the closest to communities both in urban and rural contexts, that we began to see important positive results.
Australian researchers and others who appeal for landlords to be begged or bribed to empathise or sympathise with tenants who fall back on their rental payments can usefully consider our research. As it is fiendishly difficult to receive any meaningful and sustained support from private, for-profit rentiers, Sa’s work proves that social housing providers whose tenanted housing might generate profit, but is not necessarily for profit, might hold some promise for such interventions; not rentiers. What I learn from your post is that what we need to use this opportunity to seriously reconsider is the exclusionary model of housing (as Ozlem and Mika’s work shows in a different context), systematically develop public housing, as Anne Haila’s research has firmly established, and, even more fundamentally, go beyond the public and the private binaries by also developing social/co-operative housing. Our Alternatives Project aspires to do so and Daisy’s current research is a firm step in that direction. Based on alternative financing, alternative land tenure system (as also Tauran, David’s work shows), and alternative conception of the social that stresses the intersectionality of the economic, social, and ecological, Daisy’s research complements your fine piece.
As a School, our conception of urban land is transnational, multiscalar, and multipurpose. We have always been interested in water, as Jani’s work shows, so we are also holistic in our conception of land. Clearly, now is the time for us to seriously question landlord states like France. Not only does it continue to extract rent from its ex-colonies in Africa, French TNCs continue to monopolise the provision of water in Cote d’Ivoire. The French state, which helms a transnational propertied class, extracts rent in much of Francophone Africa. This rentier imperialism, along with French neocolonialism, creates and recreates slums where access to water remains limited. Clearly, then, the issue, contrary to what UN SDGs suggest, is not just about access to, but also control of, water. How do people wash their hands regularly when they have no reliable and affordable water supply? How could underdeveloped tenant states – and impoverished tenants more generally – implement WHO guidelines when they do not control their own source of water ?
This outbreak clearly shows that our work is at the forefront of global political economy. Your piece is an important reminder. But would the world listen?
Perhaps, all we can do is to show that ‘another world is possible’.
Franklin
Thanks for the excellent article.
I agree with the importance of inter-municipal collaboration not only regarding physical support but also mitigating fake news and hatred.
Korean media have reported a high level of infection among certain social groups and regions with some provocative words, which I believe leads to new stigmatization. Today I felt sorry for the stigmatized city mayor who apologized and appealed to the public not to blame his citizens who suffer most from the virus. No neighbor cities expressed support for overcoming this difficult situation.
Using a scapegoat in these crises might be tempting but hurt unprevilledged people.
This is a timely contribution at the time of an urban crisis, as you pictured it well. I am also trying to follow the pandemic crisis as an overview of how the state (central/regional/local) acts, make decisions in different parts of the world. The decision making processes of different countries, as all the decisions are made at the national level in this case, surely carry its contingencies, which reveals how the state works, how the state and the society interacts, to what extent the state responds to the interest of the market (including housing, trade etc).
I hope we will all be in good health and share, discuss, and act on the possible consequences of this crisis in the near future around a table.