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Authors: Françoise Barten1, Marco Akerman2, Daniel Becker3, Sharon Friel4, Trevor Hancock5, ... - page 5 / 47





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Interest in the role of governance and its impact on quality of life in urban centres is not new. During 1337-1348 in Siena, Italy, Lorenzetti painted the frescoes of the Allegory and Effects of Good and Bad Government. The allegory of good governance reflects peace, trade and wellbeing in the city, while the representation of bad governance underlines crime, disease and drought17.  

Second, the history of urbanization in Europe suggests that urban governance, information and social organization were essential to addressing the extreme ill health associated with urban poverty. The history of urban health in 19th century Britain is that rapid urbanization and economic growth were associated with increasing mortality rates for the country’s poorest groups, who were increasingly concentrated in urban slums. Health improvements, according to Simon Szreter, only came when political shifts supported progressive urban governance, including sanitary improvements, and addressing the most critical public health threats in the urban slums (Szreter, 1997, 2003, 2004; Szreter and Mooney, 1998).

Although Szreter’s analysis is limited to the situation in British towns in the 19th century, important policy lessons can be drawn. Emphasis is placed on the importance of information systems as well as of civic and political institutions in influencing the health development process. Britain, for two centuries before the start of the Industrial Revolution, had a well-organised social security system, the English Poor Law, which ensured the registration of citizens and accordingly “the right of identity” and some form of support in hard times (Szreter, 2006). An important historical lesson was the role played by empowered and organized groups and citizens in creating healthy social change in the face of the ravages of industrialisation in Victorian England. Although the Health of Towns movement in the 1840s and the Sanitary Idea had resulted in the first national Public Health Act in 1848, national legislation was not nearly as important in the causal story of improved mortality rates in Britain as the widening of the electorate in local government affairs in 1869. This proved to be decisive in changing context of the late 1860s and 1870s as it enabled municipal-wide action and facilitated implementation of new municipal policy for urban improvement and public health (Szreter 2005; Szreter and Woolcock 2004). It is worth noting that in Birmingham, UK, in the late 1800’s, the purchase of sewage works by philanthropist Joe

17 It is worth noting that these frescoes are often referred to as representing good and bad governance (the conduct of government  in that historical period). The pursuit of good governance for health by the Boards of Health and their Health Officers in the city-states of Renaissance Italy has been described by Cipolla (1976).

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