Sürdürülebilir gelişmede ?sağlık?: Sağlık göstergelerinin kentsel planlamada kullanılabilirliği üzerine Antalya Büyükşehir örneği
Health in sustainable development: Usability of health indicators in urban planning, case study of Antalya Metropolitan Municipality
Yazar: EDİP DİNÇER
Danışman: DOÇ. DR. ÖZLEM ÖZÇEVİK
İstanbul Teknik Üniversitesi / Fen Bilimleri Enstitüsü / Şehir ve Bölge Planlama Ana Bilim Dalı / Şehir Planlama Bilim Dalı
Derece: Yüksek Lisans, 2012
Konu: Allerji ve İmmünoloji = Allergy and Immunology ; Halk Sağlığı = Public Health ; Şehircilik ve Bölge Planlama = Urban and Regional Planning
Dizin: Kent planlama = Urban planning ; Kentsel fiziksel çevre = Urban physical environment ; Metropoliten kent = Metropolitan city ; Sağlık = Health ; Sağlık planlaması = Health planning ; Sürdürülebilir gelişme = Sustainable development ; Şehircilik = Urbanization

Özet:
Sağlık çoğu insan için her şeyden önce gelmektedir. Günümüzde sağlık artık sadece tıp bilim dalı disiplini içinde değerlendirilmekle kalmayıp, birçok disiplin arasında bağlantı kuran bir köprü olmuştur. Sağlıklı Kentler, Kent Sağlığı gibi konular da, bu köprüleri güçlendiren sosyal hareketler olmuşlardır. Çünkü sağlıklı kentin, tanımlanan geleneksel sağlık kavramından daha fazlasını içerdiği görüşünü benimsemişlerdir ve bu sağlık hareketlerinin yaklaşımlarında sağlık, sadece fiziksel değil, zihinsel, sosyal, ekonomik, politik ve manevi sağlığı da kapsamaktadır.Son 30 yıldır bireysel sağlıktan çok ?Kent Sağlığı?, ?Kentlilerin Sağlığı? gibi düşünceler ön plana çıkmıştır. İngiliz dili bilimsel makale değerlendirme süreci içerisinde yapılan bir literatür taramasında, kamu sağlığı dahilinde en çok tartışılan ve sağlığı etkileyen kentsel sorunlar olarak görülen başlıkların; nüfus büyümesi, nüfus yoğunluğu, etnisite, hassas nüfus, sosyoekonomik statü/fakirlik, afet tehditleri, suç, madde kullanımı, sağlık hizmetlerine erişim, çevre, sağlık ve sosyal servis ağı, gelir eşitsizliği ve uluslararası eşitsizlikler olduğu görülmüştür. Eşitsizlikler kaynakların kullanımı konusunda da öne çıkmaktadır. Birkaç yıl önce Birleşmiş Milletler komisyonu, sürdürülebilirlik ve sürdürülebilir kalkınma kavramına uluslararası ölçekte acil bir şekilde vurgu yapmıştır. Sürdürülebilir kalkınmanın karar verme sürecinde önemli bir yere sahip olması, karar verenlerin sürdürülebilir kalkınma göstergeleri üzerine yoğunlaşmasına neden olmuştur. Karar verme sürecinde sürdürülebilir kalkınma göstergeleri problemi ve problemin nedenini ortaya koyma; politika geliştirme ve uygulama konusunda yardımcı olmaktadır ve bu göstergeler sağlık göstergeleri ile birbirlerini tamamlayıcı özellikler göstermektedir.Günümüzde, kent nüfusunun sağlığı; tıp bilimleri, yardımcı sağlık hizmetleri, sosyal işler, kamu sağlığı, şehir planlama, sosyal bilimler, yasalar ve daha birçok disiplini içeren bir başlık altında toplanmıştır.Şehir planlama, kent sağlığını belirleyen etmenlerden biri olan fiziksel çevreyi kontrol etmektedir. Fiziksel çevre, sosyal çevreyi yaratacağından, şehir planlama; `Kent Sağlığı', `Kentli Sağlığı' ve `Sağlıklı Kentler' vizyonunun sağlanabilmesi için altyapıyı oluşturacak ve sağlamlaştıracak temel disiplindir.Tezin kapsamı pilot alan çalışmasında, Antalya Büyükşehir Belediyesi sınırları içerisinde kalan alanın varolan fiziksel durumu ve immün terapi sürecinde olan 300 hasta üzerinde yapılmış olan anket çalışması doğrultusunda literatür arka planını oluşturan kent ve sağlık göstergeleri karşılaştırılmakta, fiziksel ve sosyal çevre ile sağlık arasında anlamlı sonuçlar aranmakta ve değerlendirilmektedir.Tez sonuçları ile; sürdürülebilir gelişme göstergeleri içinde giderek artan önemi ile `kentsel sağlık göstergeleri'nin kent planlama süreci içinde `sistem yaklaşımı' ile kullanılabilirliğinin sağlanmasının, global ve yerel sağlıklı kentler girşimlerinin yanı sıra bireysel ve toplumsal yaşam kalitesinin arttırılması ve sağlıklı kentler anlayışının ve kimliğinin gelişmesindeki öneminin altı çizilmektedir.

Abstract:
Health comes first for most of the people. Today, health is not only a subject of the medical science, but it also lays bridge over numerous disciplines. Topics as Healthy Cities, City Health are the social movements that strengthen these bridges, because these movements acknowledge that healthy city comprises more than defined traditional health notion; moreover, according to their approach, health not only includes physical health, but also mental, social, economic, political, and spiritual health.For the last 30 years, movements like ?City Health?, ?Health of Citizens? have become more important than individual?s health. A research in the English language peer-reviewed literature shows that the most commonly discussed topics about the public health and urban conflicts that affect the health are: population growth, population density, ethnicity, vulnerable populations, socioeconomic status/poverty, disaster threats, crime, substance abuse, access to health care, the environment, patterns of health and social service networks, high levels and proximity of income inequality, and international differences. Inequality becomes prominent about use of natural resources too. A few years ago, United Nations urgently emphasized sustainability and sustainable development on an international scale. Because of sustainable development?s importance on decision-making process, decision-makers concentrated on indicators of sustainable development. On decision-making process, sustainable developments indicators assist the process of determining the problems and causes of problems, policy making and implementation and these sustainable development indicators have parallels with health indicators.As the time passes by, it is realized that sustainable development is reformed for people thus sustainable users outweigh sustainable development in importance. Sustainability of users is about health and public health. Healthy environment can be provided not only by health discipline but also with other disciplines by modifying users? environment. Urban planning is the most significant and effective way to modify the users? environment. Either sustainability of economical, social and natural environment or healthy society and healthy urban environment can be provided by the help of urban planning. Nowadays the process of providing healthy environments for users is in the form of taking action after specifying policies. Involving urban planning and planning discipline into the process will ensure the success of implementation of the policies.Today; medical sciences, allied health, social works, urban health, urban planning, social sciences, law and more are the associated disciplines about the health of citizens.At present, public health studies are complex efforts involving many actors such as local, regional, national and international governments, non-profit organizations, and users who will be affected by the taken actions. In order to solve public health problems, it is necessary to understand complex and full dynamic systems. Integrated approaches where planning and administration dealt well, and health sector and planning associated are needed. As the system approach handles events and objects as a whole, it can be employed to understand complex and multi-actor dynamics of health studies. Going over studies which explain different systems, we can understand that health is a system formed by structured relations, and how different approaches changed this system in time, and how we manage this system better with its dynamics. Urban planning controls physical environment which is one of the factors affecting urban health. As physical environment creates the social environment, urban planning is the basic discipline that is going to set up and stabilize a substructure to create ?Urban Health?, ?Public Health? and ?Healthy Cities? visions.Studies express that health is related to not only medical science but also many different disciplines. Both physical environment and social environment affect human health directly or indirectly. Physical and social indicators that affect urban users can be changed by urban planning discipline. Accordingly, urban planning is going to influence human health either positively or negatively. Organizing micro or macro scale places in which urban users live and the problems they experience in these places directly affect users? health.In addition, indicators such as level of income, consumption behaviors, accessibility to environmental facilities, education, social environment can be measured by inquiry technics. However, there are indicators that are really difficult to measure quantitatively without interdisciplinary studies. Sticking to only one discipline, especially in social issues, efforts for reaching the users can fail. Interdisciplinary study becomes necessary in order to measure indicators such as the state of health of the users, their interaction with the social environment, participation and social capital. For the purpose of providing healthy cities, it seems that only medical science or only urban planning is not sufficient to work alone. Instead, it is required that many various discipline such as medical science, urban planning, social sciences, etc. work together and coordinately.In the context of the thesis, atopic asthma is discussed as an urban life disease and atopic asthma patients are questioned about their disease and their urban life. However, it is unlikely to eliminate the disease, study?s aim is to reduce prevalence of this disease by modifying urban environment through urban planning or urban design disciplines. The reason that district of Antalya Metropolitan Municipality were picked as case study area is high rate prevalence of atopic asthma because of warm and moist climate in the city.Moreover, the problem of increasing prevalence of atopic diseases in recent years thought to be connected with the urban life. Recently, more studies try to relate health topics with urban settlements. Although recent studies indicate that there are connections between atopic diseases and urban living, there are many other factors other than urban living which have great impact on atopic diseases.Based on the subject of the study, the city of Antalya, where there is rapidly growing population and planned urbanization, however still shanty settlement is seen and also which has agricultural production and industrialization in provincial borders and in addition has an important role in terms of coastal and cultural tourism, is chosen for the study. The district of Antalya has a climate that contains various kinds of herbs, plants and trees which are known to cause allergic diseases. Besides, its warm and humid climate creates an ideal atmosphere for mites and cockroaches to live.In case study of the thesis, literature background on city and health indicators are compared in accordance with present situation of the area of Antalya Metropolitan Municipality including built-up and natural environment which have impacts on health maps created through GIS. Moreover, questionnaire study on 300 patients who are still in immune therapy process is made by cooperation with Akdeniz University Medical Sciences Division, Department of Internal Medicine, Allergy- Rheumatology Immunology Discipline. In line with the questionnaire analysis through SPSS, significant results between physical and social environment and health are determined.Cities are extremely complex systems. A change which is applied to one section of a city may create unpredictable changes on another section of the city. Public health is the product of a great number of factors which can change the human health and also these factors have interactions with each other. There are direct and indirect dynamic links between city, subsystems, components of sub-systems and external environment. We can figure out, by assessing studies which explain different systems, that health is a system formed by structured relations, and how different approaches changed this system in time, and how we manage this system better with its dynamics. In this context thesis suggests that usage of qualitative and quantative indicators in urban planning should be increased by implementing systems approach. Indicators should have an important role in urban planning and sustainable development approach that is implemented in urban planning, and also in policy-making process and monitoring the implementation process. However health seems like a social topic in sustainable development indicator, it is shown in the thesis that health is affected by both social and physical environment.Results of ?Health In Sustainable Development: Usability Of Health Indicators In Urban Planning, Case Study Of Antalya Metropoitan Municipality? research project shows evidence-based data about healthy urban policy-making. Also project emphasizes the need of systems approach, in addition to medical approaches for immune system weakness, for increasing the quality of life and development of healthy city approach in urban planning discipline.It is expected that the thesis to be a guide to form sustainable healthy cities by the assistance of using measurable parameters in the process of local spatial planning.