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THE CITY – April 2018

Max Muller THE CITY - April 2018

Understanding Cities through Metaphors

Written by Max Muller

Although I have never been to an Alicia Keys concert, I imagine it must go something like this: first you excitedly wait in line, eagerly waiting for the moment you’re allowed to enter the sold-out stadium. After you and your friends have found your seats, you share some food and thoughts on her latest album. Then, the lights fade. The buzzing noise of chatting people immediately follows suit. A few seconds later, a roar from the crowd breaks the silence: she has arrived. You sing and dance your heart out to her classics, including “If I Ain’t Got You” and “No one”. You get a sore throat and you’re exhausted from the intense experience. And yet… something is missing. Until you realize she has saved her best song for the finale: “Empire State of Mind (Part II)”:

“Baby, I’m from…

New York, concrete jungle where dreams are made of

There’s nothing you can’t do”

You finally find closure, as she has put the cherry on the cake.

Well, at least that’s how I imagine the experience. To me, that’s her best song. Her beautiful voice and talented piano playing notwithstanding, there is another element of the song that appeals to me. It’s the lyrics: they’re clever. The comparison of New York with a “concrete jungle” strikes me as particularly insightful.

Transformations of Meaning

In 1980, George Lakoff and Mark Johnson wrote their now seminal book Metaphors We Live By. Until their work, the role of metaphors in philosophy and linguistics had only been deemed of peripheral interest. Lakoff and Johnson made huge swathes of people realize that metaphors are not just stylistic devices to spice up a mediocre novel. They showed, on the contrary, that they’re essential ingredients for people to concoct an overarching view of reality. In other words: people largely understand the world through metaphors.

Consider, for instance, the metaphor ARGUMENT IS WAR. This conception of arguments or discussions is deeply entrenched in our understanding of the concept. Our language betrays it. For us it is completely natural to say things like:

  • Your claims are indefensible.
  • His criticisms were right on target.
  • I demolished his argument.
  • I’ve never won an argument with him.

Chances are you haven’t even realized that we use ideas from wars to metaphorically speak about arguments. Moreover, Lakoff and Johnson point out that we do not just talk about arguments in terms of war. We actually win and lose arguments. The idea of war thus gives us an indispensable tool that allows us to understand the concept of having an argument.

Throughout their book (which I heartily recommend) they give countless other examples of metaphors we use to grapple with complex phenomena, including IDEAS ARE RESOURCES (“he ran out of ideas”, “don’t waste your thoughts on useless projects”), LOVE IS MADNESS (“I’m crazy about her”, “she drives me out of my mind”), and SEEING IS TOUCHING (“I can’t take my eyes off him”, “he wants everything within reach of his eyes”).

Perhaps that is why Alicia Keys’ lyrics stuck with me. Though I sympathize with her fondness for New York in particular, I think it wouldn’t be much of a stretch to view all cities as forests, or, within an even wider perspective, ecosystems.

Let’s confine ourselves a bit and stick with the metaphor CITIES ARE JUNGLES. Obviously, the buildings are trees in this regard. It is perhaps for this reason that the English expression “to climb up the stairs” exists. In addition, hints of organic perceptions of cities can be found in sentences like “these are the world’s fastest-growing cities” and “Beijing is expanding rapidly”.

The process of incoming and outgoing commuters bears some similarity to the rhythmic movements of lungs filling and releasing air. Just like photosynthesizing trees that convert carbon dioxide into oxygen, the buildings of the city can breathe people in and out. Antonio Gaudi’s “La Sagrada Familia”, a church that seems to have grown organically from the ground upwards, epitomizes this conception of buildings.

Illustration by David Fleck, 1972

Baucis, the tree city from Italo Calvino’s “Invisible Cities” , as illustrated by David Fleck. The motif of the city as a forest also appears in Calvino’s book “The Baron in the Trees.”

Modern man has thus linguistically incorporated cities as a natural place to live, just like early humans discovered that they could find a safe haven away from the savanna and into the forest. The trees provided shelter against the rain and their height proved very useful for evading predators. The higher and bigger the tree, the more protection it could provide.

Joseph Campbell in his book The Power of Myth, points out that one can tell what’s informing society by what the tallest building is. In medieval towns, it was the cathedral. In an 18th century town, it was the political palace. Whereas in modern cities, the tallest buildings are the office buildings. We attach great significance to our centers of economic life. This is consistent with the cultural value “Bigger is Better”, which in turn is coherent with Lakoff and Johnson’s metaphor GOOD IS UP (“we hit a peak last year, but it’s been downhill ever since”, “he does high-quality work”).

Another metaphor that pervades our languages and myths is that of Mother Nature. Thus we undoubtedly attribute nature with feminine characteristics. It is a bringer of life. The ancient Greeks, who coined the term “metropolis”, highlighted the nurturing character of cities as forests in particular. The word is a combination of the words mḗtēr (mother) and pólis (city). From their perspective, the city lied at the very heart of the origins of life. Since then, cities have only become more and more important. Nowadays, more than half of the world’s population consists of urban dwellers.

If cities are so important to us, it is perhaps not so surprising that the CITIES ARE JUNGLES metaphor is not the only one that has entered our collective subconscious. Concepts that are at once important to us and difficult to understand require multiple ways of viewing them.

This is because when we focus on one aspect of the concept, we necessarily leave out or ignore many others. Take love, for instance. Not only do we take the above-mentioned metaphor LOVE IS MADNESS into consideration when we speak and think about it. We also have the metaphors LOVE IS A PATIENT (“they have a healthy marriage”) and LOVE IS MAGIC (“she cast her spell over me”) in our mental repertoire. These other metaphors enable us to look at and think about love from different angles.

Berlin is, like, a pretty cool guy

So where does that leave us with regards to our beloved cities? Again, Lakoff and Johnson provide us with a hint, as they explain that personification is a widely employed metaphorical device. We could say, for instance, “his theory explained to me how tidal movements work”. In this case, the theory of tidal movements is personified. We conceptualize the theory as a person, or perhaps more specifically as a teacher.

Cities, too, are seen as people. Each of them has its own, distinct personality. Evidence of this is found in the adjectives to describe them. We use words such as “charming”, “rebellious”, “enterprising”, and “endearing” to speak about them. In turn, they reveal how we think of these places.  

Who wouldn’t agree with me that Amsterdam is a rebellious, free-spirited, slightly scruffy but also strong, experienced, and battle-hardened guy with a mustache? He’s a man of extremes: both a party-person and a sophisticated art-lover, at once a rich business man and a poor, single father with a kid.

On the other hand we have Chartres, the medieval French town with the beautiful cathedral. She is more of a charming woman with long, brown hair and an elegant ocher dress. Whereas Amsterdam is tall and heroic, Chartres is petite and endearing. If Amsterdam is bustling and vibrant, Chartres is calm and composed.

Of course, cities are often too big to be described as having monolithic personalities. Amsterdam, for instance, is composed of a mosaic of different neighborhoods, each with its own personality traits. Amsterdam Zuid is old, rich, cultured, and of high stature. But Noord is more like the Wild West: adventurous, enterprising and experimental.

Some neighborhoods harbor multiple personalities. As a result of the quick gentrification process, the Pijp is hip, upcoming, and expensive. Its trendy restaurants and cafés act as magnets to young urban professionals hailing from all over the country. But it used to be the true Amsterdammers who lived there.

A glimpse of Amsterdam’s topographically
distributed personality types, by Nomad List

A while ago, I saw the words “Alle yuppen de Pijp uit!” (“All yuppies – young, urban professionals – should leave the Pijp!”) sprayed on a wall on the Albert Cuyp market. Viewed from a metaphorical perspective, the words signified a clash of personalities to me. It was also an expression of frustration about what kind of personality or image the neighborhood ought to have.

I hope this description of metaphors gives you some insight in the way we perceive our cities, and that it can aid you as a conceptual tool for greater understanding of all sorts of things. Considering cities in particular, we might wonder where the branches of the trees are in cities, if they are jungles. And if they are people, how do they relate to one another? How do their personalities change? Are there any other metaphors that characterize cities? I leave these questions for you to answer.

Contributing Writers THE CITY - April 2018

Who you calling a bitch?

Female rappers on the sexual dynamics of street culture

Written by Dorothy Carlos

“Instinct leads me to another flow

Every time I hear a brother call a girl a bitch or a ho

Trying to make a sister feel low

You know all of that gots to go”

In Queen Latifah’s Grammy award-winning song “U.N.I.T.Y.” off her 1993 album Black Reign, she speaks out against street harassment which is pervasive in cities. In the song, she responds to being groped by a man passing her on the street by punching him in the eye. Catcalling, as well as other acts of sexual harassment, are often criticized by female rappers from the late 1980s to now. In fact, the gendered experience of the city – a field of sexuation one has to navigate – has been one of the major themes of female rap since its beginning.

Everyone from Monie Love to Roxanne Shante has explored the mistreatment of women in the streets through their music. Salt N Peppa discusses the issue on the track “Tramp” from Hot, Cool, and Vicious, warning fellow women that if they respond to a catcalling they might become a “victim of circumstance” and be subject to harassment.

The cross-street proposition of the catcall communicates little else but a crude libidinal drive. What could possibly prompt someone to pursue a romantic/sexual interest via catcalls? One couldn’t possibly expect a positive reaction from yelling at a stranger on the street.

Female rappers articulate the fundamental antagonisms of social life, both gendered and class-based. They serve as a counter to what is going on in male hip-hop culture: a hypersexualization of women in order to gain social capital. Because of the way young men from impoverished neighborhoods, especially young black men, are forced to navigate a power structure which will be largely against them, they grasp at power by means of the social domination of others via catcalls and additional forms of sexual harassment.

Personally, I don’t know any rap songs about a love that isn’t broken or perverted. Slum Village’s “Fall in Love” from 2000 is exemplary of the way love is navigated in hip-hop music and in poor neighborhoods:

“Don’t sell yourself to fall in love”. Although one could argue that love in our society, in general, has been replaced with sexuality, the vulnerability of love is not easily found in rap music, which is often an expression of the hardness and resilience of an individual who comes from a broken environment.

Photo by Robert Katzki

While there are factors that are unique to our historical epoch, such as the building and subsequent neglect of segregated housing by the US govt, this is a broader issue of capitalist modernity. In the Metropolis and Mental Life, Georg Simmel discusses the blase attitude of individuals living in cities at the beginning of the twentieth century. The manifestation of this is the reduction of social interactions to capitalistic exchanges between city dwellers. For example, in smaller communities you might have a personal relationship with someone who produces a product for you such as a baker; in a metropolis, a personal relationship is unlikely to develop because of the fact that consumers are unknown to the producers. Interactions become matter-of-fact and people of the metropolis develop a hardness towards others.

Simmel did not live long enough to see the crushing effects Robert Moses had on the socio-economic landscape of cities all across the United States, but perhaps his essay was a prophecy of what is to come for modern cities. In the 1930s the imperious approach of Moses prompted a radical reorganization of cities; concentrating poverty in housing projects as a means to abolish it from the city as a whole. Areas with housing projects, such as the South Bronx in New York City, which was directly impoverished by Moses’ construction of the Cross Bronx Expressway, are extremely underserved by the state and harassed by police.

In the aftermath of the famous Brown v. Board of Education case in 1954, Northern states, where the biggest cities were located, believed the ruling did not apply to them and made no attempt to desegregate. Even though de facto segregation was just as prevalent in the North as it was in the South, there were no laws enforcing it. There were schools for black neighborhoods and schools for white neighborhoods and this was a just product of the city structure, making it easy to perpetuate the lack of support for poor neighborhoods.

In an environment where individuals with little social and economic power are constantly in survival mode trying to make ends meet, love is compromised, and sex gladly takes its place. This is obvious if one pays attention to the explicitly sexual lyrics that make up a lot of contemporary hip-hop.

Many of the more contemporary female rappers sexualize themselves as part of their rap persona—reinforcing this idea of sex as a means to gain social capital; consider rappers such as Trina, Nicki Minaj, and Cardi B, to name a few.

When asked about how to gain self-confidence, Cardi B told Hypebae: “If you feel you’re ugly just walk around the projects or something and see how many niggas holla at you.” Cardi B herself is from the Bronx and her community most likely began to experience the effects of the construction of the Cross Bronx Expressway decades ago. Although parts of the female rap community have accepted the culture of sexual harassment, I believe this to be almost inevitable if you come from an impoverished, urban environment.

Within the sexual maze of the metropolis, women are caught somewhere in the middle as men try to navigate their sexuality. Because women are not as bound to heteronormative standards, they aren’t controlled by the system in the same way as men, largely due to the fact that women as a whole are often oppressed for being sexual regardless of whether or not they operate within heterosexuality. Although artists like Trina, Nicki Minaj, and Cardi B have succeeded in gaining power via their sexuality, they compromise their own identity by hyper-sexualizing themselves in order to do so. Ultimately the women caught in situations of urban poverty are oppressed by the state in the same way men are. However, when women try to grasp at power via sexual domination they are likely to face oppression from their own communities, as well.

Contributing Writers THE CITY - April 2018

The Reality of Mixed-Income Housing

Written by Rosalie Lucretia Ekstein, M.Sc.

Over time the development and growth of cities has been largely organic in nature. People are drawn to other people and resources. Especially when there are lots of pull-factors, this can lead to large concentrations of people in one place. That this might result in problems is no new insight. In Medieval times, for instance, the elite often perceived the poor as a risk simply because they lived nearby. On one hand this was sometimes ideological and political, but on the other hand, there was an objective threat as well, due to their poor hygiene. Living together in impoverished conditions, allowed diseases to spread easily amongst the poor, with many of these diseases being life-threatening, it’s not hard to imagine that the elite was worried about staying safe. Further, the concentration of different social groups on tight space led the elites to worry about their valuables and upcoming criminal behavior amongst the poor. Early forms of urban planning and healthcare hence focussed on combating disease and crime to protect the elites. Later, with the beginning of the Industrial Revolution factories and housing for workers had to be built. This posed new challenges for urban planning as novel threats arose.

There are multiple ways to deal with a growing population and both the real as perceived problems that come with it. Urban planning is still very much alive. Gentrification, mixed-use development, and mixed-income housing are important concerns faced by urban planners today. Just like in the Middle Ages, one can question which individuals benefit from which forms of urban planning, as well as the motivations behind the plans that currently change the face of our cities worldwide. Mixed-income housing, the focus of this article, refers to the process of building an area with houses in different price ranges in order to attract people from different socioeconomic groups. Policy makers and public administrators seem to only focus on the sunny side of mixed-income housing. Let’s have a look at the motivations and the social reality of it. 

One motivation for mixed-income housing seems to be countering segregation. Segregation, on the other hand, refers to the process of people with a similar demographic and socio-economic background grouping or being grouped together, either willingly or forced. In the United States, for instance, this has happened to the African American community, who was forced into segregation through institutional racism.  Also in the Netherlands racist implications of certain housing regulations are slowly coming to the surface. Another factor that contributed to segregation is the “white flight” a term that originated in the U.S. during the 1950’s and 60’s and refers to whites migrating from the city center to the suburbs. The definition has evolved and can adopt different connotations depending on the context, but it always refers to a change of population from whites to people of color. These trends have led to the emergence of relatively homogenous neighborhoods in bigger cities around the globe.

Evidence shows that economically deprived segregated neighborhoods had higher numbers of crime, noise, and litter. Often only neighborhoods with people from low socioeconomic status are considered problematic, according to many policymakers, politicians, and people from high or even middle socioeconomic status. It is true that in those areas one will find a different situation than in richer areas. One of the problems is crime. Yet, the crime rates might be heavily influenced by structural forces, such as institutional racism, and hence shouldn’t be seen as an actual reflection of what is going on. For example, the rate of incarceration for African Americans is far higher than for any other ethnic group in the U.S. The reason for this is not an objective feature of African Americans that leads them to be more prone to commit crimes, but an implicit racial bias of American institutions, specifically amongst the police forces. Another problem is the neighborhood effect and the resulting lack of certain forms of social capital. The neighborhood effect is a concept introduced by William Julius Wilson in 1987, which supposes an effect on individuals as a result of the neighborhood they live in. There is quite some research that shows us that where you live, influences your chances in life, whether it be health, voting behavior, or chances for upward mobility, and plenty of research that criticizes this idea as well. Social capital, a concept introduced by sociologist David Émile Durkheim in the 19th century, can improve an individual’s position within a network, or neighborhood. Just like economic capital, can influence an individual’s well being, social capital similarly affects one’s chances in life through social ties, networks, knowledge etc.

Photo by Vladimir Chuchadeev

A quick anecdotal comparison might better illustrate this point: When I was at university, there was a young man in my class whose family moved here from Afghanistan. Nobody in his family spoke Dutch and there were few social ties to local people with resources. He made it to university, but struggled with financing, language, skills and even health. For me, my parents financed my entire education. When I struggled with math, they knew someone who could tutor me. When I was sick, my parents knew a specialist, while this young man, on the other hand, had great troubles simply being understood by his physician and was forced to miss classes due to health problems that in my case, would have been resolved the next day. Up to this day, I think he was smarter than me, but he didn’t have the chances that I was granted. He couldn’t pass the first year, while I received my master’s degree. After all,  living a segregated life can severely influence the chances of an individual in a negative way. Of course, this hasn’t gone unnoticed by social scientists, politicians, and policymakers who try to intervene.

But there’s another side to this story, which focuses more on the experience of people from outside. It has been suggested that individuals who haven’t lived in segregated areas, lack the first-hand experience and also might be biased in their interpretation of the existing problems. People often interpret the world from a value specific standpoint that they take as being universal. However, if one would take a look at other cultures, times, or meta-ethics, the conclusion would be that there is no such thing as a universal set of norms and values. Instead, it seems to be a pragmatic notion that enables a person to judge others. What I find ‘unacceptable’ could be totally fine for you, and I have no right to tell you that what you’re doing is ‘antisocial’. If you are in a rich area, it will tend to look tidy and be quiet. If you go you a less privileged area, you are likely to hear music, see more damaged houses or vehicles,  and people sitting outside, talking louder than what you might be used to, and perhaps even drinking. It never bothered me that much. However, it does bother other people a lot. Dutch people have all kinds of nasty words for inhabitants of areas like that, including some racial slurs. In the U.S. as well, for example Harlem and The Bronx, have had bad reputations not only due to objective criteria, but due to many subjective ones as well. The idea is that ‘deprived’ neighborhoods have more ‘problems’. I could write a whole paper on what these perceived problems are and why they might not be problems, what matters is that in the minds of policymakers and politicians these neighborhoods are problematic. The fact that there are complex social forces at work here which play a large part in this, is easily overseen or simply unknown (even though within social science, there is so much research regarding these topics!). Also, in these deprived neighborhoods, a term which in itself speaks volumes about this bias, social control, social ties, and cohesion still exist, but in different forms. Research usually doesn’t focus on things like the ability to get non-European hair done, or how residents might share food with each other, or how peers support each other emotionally. So the question here is determining which factors play a role in the life quality of inhabitants and which factors might be biased towards a subjective and value specific norm. The idea that these neighborhoods are just problematic and have nothing valuable in themselves and therefore should be torn down to make room for new houses and new people, might be crude. There’s a risk of tearing down social cohesion and ties, which still matter a lot for people and could even contribute to their welfare, well being, safety, and chances in life.

Mixed-income housing is an idea based on the exchange of social capital between groups, and the possibility for those problematically called lower socioeconomic groups to elevate themselves. This is the recipe: you take one piece of land, you put in some cheap flats, some nicer apartments, and some bigger houses. The first would be for rent and the latter for buying. What happens is that the people that used to live there, are being forced out of their homes. Only a small portion of them can move back, due to a significantly smaller amount of cheap housing. So instead of being surrounded by your peers, you will be confronted with different people for once. Then, of course, you will start to mingle with them. Friendships are formed and people can learn from each other (i.e. the rich will elevate the poor, by increasing their social capital). Sounds neat huh? Guess what: it hasn’t happened so far. It seems to be mere wishful thinking because the sad reality is that even if people live on the same street, they are still segregated. In the Netherlands, sociological research shows that the average income of the neighborhood does go up after establishing mixed-income housing, however, those individuals who came from a low socioeconomic status are not being elevated into said status.

Even though residents’ chances for a better income does not rise, many politicians and policymakers still believe in the supposed neighborhood effect. Between 2008 and 2012, the Netherlands invested hundreds of millions in neighborhoods which were deemed ‘highly problematic’. There was a top 40 of problematic areas, called the ‘Vogelaarwijken’. I have lived in number two on that list during my own sociology study, after growing up in quite a rich area, and I have never been in a warmer, friendlier, and yes even safer area. The people knew each other and took care of each other. Then the whole block got restructured and the prices doubled. The social fabric of that place has been torn down. In the U.S. as well, there is plenty of research pointing into this direction. For example, the work of Ellickson (2009) shows that mixed-income projects in Boston, Chicago, and San Francisco, did not bring about the desired outcome. He concludes that “the benefits of social integration are seldom as great as advocates of mixed-income projects suppose. The high costs of producing these project thus can rarely be justified on this basis”. Sociological research has not only shown that the neighborhood effect does not seem to exist, but that people with low socioeconomic status might actually be worse off after moving into areas characterized by mixed-income housing. Instead of exchanging social capital, people in the social housing are confronted with the social and economic distance they have from their neighbors.

It seems that there are many flaws in the assumptions underlying mixed-income housing policies and the results are by no means successful enough to justify the fact that these policies are still being used worldwide. The rise and continuation of these policies can be explained by the political influence of those who gain from supplying these developments, and not by positive results for the population inhabiting the area. Too often it seems to be the case that the underlying assumptions of policy and planning are ideological instead of factual, and only seem to represent the view and needs of the already privileged.

THE CITY - April 2018 Valentina Gianera

Out of Breath

Written by Valentina Gianera

It was an everyday morning in Tehran. The sky was grey, sparked with clouds of snow and smog. Cars and motorbikes rushed in masses along the highways dividing the city into hundreds of parcels, turning it into a big, messy hive. The fruit dealer, sitting in his white plastic chair, watched over the stock of dusty oranges piled in front of his shop window. Long gone were the times when he used to clean them with his feather duster.

“It’s better to leave it than to breathe the dust,” he thought, and stayed lingering in the white plastic chair. He squinted at the missing sunlight. A few lost snowflakes were blown through the air.

Photo by Valentina Gianera

Not far from there, a middle-aged man with sparse grey hair and cloudy eyes walked into a sporadically furnished living room.

“Tea anyone?”

The students shook their heads; maybe later. He shrugged his shoulders, stepped to the only window and looked down onto the chalky street leading to his apartment.

“You’ll have noticed”, he slowly began, “that there’s no clean air in this city. We cannot breathe. Our lungs and hearts grow heavy from the dust we inhale. And while the city grows, and bears new buildings and roads, every minute we speak the people in it die. It’s the extinction of a species.”

A month earlier, in December of 2017, the municipality of Tehran had ordered the closure of all schools due to excessively toxic levels of air pollution in the city. Elderly people, children, pregnant women, and people with heart issues were advised not to leave their homes. This event was not the first. Over the last few decades, Tehran has increasingly faced some of the worst pollution levels in the world. As cooler temperatures make their way into Iran, the temperature inversion can create a layer of warm air above the city. Exhaust gases from over eight million cars and motorbikes, and other sources, are trapped by the warm air and leave the population choking under a layer of thick, yellow clouds. In 2014, air pollution left nearly 2000 people in need of medical treatment from heart and respiratory issues. In 2012, the health ministry estimated the number of premature deaths caused by pollution as nearly 4500.

Surprised by the middle-aged man’s dramatic opening, the students exchanged quick glances.

One cleared her throat and asked cautiously, “How are you, and your organization, trying to change these unbearable living conditions?”

“Change the living conditions?”, his clouded gaze quickly caught hers before continuing. “We don’t change anything… A few years back, when the government eased its grip on the NGOs, my colleagues and me, my friends, all of them artists, decided to put our efforts together to work on something that we deeply cared about. We set up this environmental organization to show our care and compassion for those we loved that aims at drawing attention to the issues this city is facing through art projects.. Still, my nine-year-old son, when walking outside, asks me to lift him up, so he can taste the air ‘up there’, he says. But the air up there is just as thick and polluted as on the ground. So no, we are not as foolish to hope that we can change the conditions that this city, humanity, finds itself in.”

To the question of whether he was a pessimist he vehemently shook his head.

“No”, he mumbled, “not a pessimist. But hope is a terrible vice. It’s good to lose hope sometimes, by losing it we can finally stall the engines of change. You see, the government runs this country to achieve maximum economic growth at all times and at all costs. They do so much and they think so little. And all of that at the expense of the environment, the nature that surrounds us. But it’s not only our government, it’s all the governments of this world. And it’s not just the governments, but the population’s striving towards limitless progress, and our reluctance to give up any of the comforts that we gained through the rapid economic and technological development we experienced.’

Photo by Valentina Gianera

Over the past 200 years, the Iranian capital has witnessed steady economic growth, swelling to become one of the biggest cities in the world. Yet, with the growing concentration of people and resources, the social and environmental issues faced by the city have been piling up as well. High living costs, lack of adequate housing, and overcrowding go hand in hand with impoverishment and social polarisation. Water, air, land and noise pollution have led Tehran to join the pantheon of the most polluted cities on earth.

“Of course, there are those pushing for change, proposing sustainable solutions – to what I call a humanitarian disaster – in order to sustain the way of life we have now. But it isn’t as simple as that. Recycling or electric cars alone are not a solution. They merely invite further consumption, hide the symptoms of capitalist destruction for a while… Changing the social structure, actively striving for political utopias is a Sisyphean task. Every change we strive for will come back to us one way or the other. We must stop wanting to change the system, and accept that we must change ourselves, our motivations and desires. And thereby, by not doing much, we would actually do a lot”, he finished with a disenchanted smile. “So no, I am not pessimistic about the future. We are at a turning point, an environmental crossroad in time. Change will come, a change of our perspectives, our comforts and desires.”

For a brief moment, a deep silence filled the living room as the students pondered the sparkle of truth that had been conveyed by this middle-aged man with the clouded grey hair. Then the first hands began to raise and some questions were asked, answered or found.

Meanwhile, the fruit vendor was sitting in his white plastic chair, following the white flocks that drifted down from the sky. Doing not much. In fact, nothing at all.

Floris van Dijk THE CITY - April 2018

E-HEALTH: The end of the urban/rural divide?

Written by Floris van Dijk

In Aesop’s fable “The Town Mouse and the Country Mouse”, a proud town mouse invites his cousin from the countryside to visit the city and get a taste of urban luxury. While sitting down to a feast, the rodents are attacked by a couple of dogs. The rural mouse decides to return home, preferring gnawing on a bean than being gnawed by the fear now synonymous with the city lifestyle.

Historically, living in a city usually meant living a shorter life. The dense population favored the spread of diseases, the concentration of industry lead to more pollution. But since the 20th century and the widespread implementation of sanitary programs, like sewer systems, the life expectancy of the urban population has surpassed that of the rural population. In the US the gap increased fivefold in the last 40 years. Despite the increased risk of pulmonary diseases that accompany air pollution, living in urban areas appears to now lead to a longer life. The cause: the unequal geographic distribution of health facilities.

With an aging rural population and the refusal on the part of the rural elderly to put an end to their current lifestyle, this becomes pressing. In just the last 8 years, the European population older than 80 has grown by one percentage point (from 4.5% to 5.5%). By 2050, the European old-age dependency ratio is set to double. Since a 100% urban population is unlikely, states have to find ways to reduce the costs of healthcare in rural areas. One promising solution for this is e-health.

E-health refers to the use of information and communication technologies to improve health and the healthcare system. E-Health has been utilized for telecare, the installation of sensor-technology, the creation of online self-help courses, education programmes and apps, and other digital tools to reduce the number of health professionals required to take care of the elderly and increasing their ability to live autonomously.

Photo by Samuel Zeller

The Dutch are highly digitalized, with 97% of Dutch households having access to the internet, and internet traffic growing 22% annually. The government clearly has the means to digitize its public services, so it did. In the Netherlands, each and every person is required to have health insurance and the process is made easy. Registration takes place online, along with the application for subsidies for low-income households, and numerous Dutch healthcare apps are available to make things even easier. The Dutch government also has grand plans to cut costs through e-health.

An important step in this reduction of costs is ensuring that each citizen has his/her own personal digital healthcare environment, allowing each to manage to a certain degree a personal health record. Although the sharing of personal data has lost of its attractiveness in the wake of the Facebook data-scandal, this could allow caretakers to know more about their patients and adapt their services accordingly.

Long-term innovation within e-health is also ensured. The Dutch Ministry of Health, Welfare and Sports organize training programs to change the attitudes and behaviors of health professionals in both public and private organizations towards innovative healthcare. One example of this is the foundation of the Health Innovation School in 2017, the first of its kind worldwide. In more practical terms, the Dutch government wants 75% of the highly dependent population – the chronically ill and vulnerable elderly – to be able to independently monitor their own health by 2019, and to ensure quality by making on-screen communication with a care provider available 24/7.

Naturally, e-health is no miracle solution. Numerous sub-problems are yet to be resolved.  The obvious difficulty is training the elderly to use new technology, but a lack of public funding is another issue. The 2017 government coalition agreement stated that a mere €40 million – in a country of 17 million – will be invested in innovative e-Health projects for healthcare over the next 4 years. If the state is supposed to play a role in the innovation of its public services, then this amount is a little disappointing. Finally, and probably most importantly, the previously mentioned problem of data-confidentiality has not received a clear-cut answer when it comes to medical information. It has yet to be decided how exactly a centralized digital platform, which gives access to all medical information of virtually everyone should look like.

Nevertheless, e-health represents an opportunity. With an aging population, e-health offers a way to preserve social achievements of the healthcare systems in Western countries. Furthermore, developing countries will face a similar problem in a couple of decades as well, and with a less financial means. By 2050, China’s GDP per capita is estimated to be roughly half that of the US, yet it will allow its healthcare system to allow equal access to all, over an area of 9.6 million km².

In a word, e-health could contribute to ensuring that healthcare services can be provided to all citizens, not only citadins.