The philosopher and geographer Glenn Albrecht coined the term solastalgia to designate “sadness for the environment”. That is what a Bogota citizen or an inhabitant of any city in Colombia can feel in the face of the deterioration of the environment, the accumulation of garbage and the degradation of the environment. This means that the person may feel symptoms of anxiety and depression due to the environmental damage of the surrounding environment.
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In Bogotá, the mental health of its inhabitants has been deteriorating. According to data from Saludata, from the Ministry of Health, the suicide attempt rate is increasing: “In the first semester of 2021, cases higher than what would correspond to half of the cases last year were observed, so If this behavior continues, the year 2021 would end with more cases than in recent years. For the total number of cases notified in the first semester of 2021 (359), 73.8% are found in young people between 14 and 17 years of age ”.
The relationship between the quality of the environment in which we live and people’s health is increasingly evident. It is known that it is healthy that the city is walkable, not polluted and that people do not have psychosocial stressors due to insecurity, violence or segregation of populations.
The new POT of Bogotá makes a commitment to the densification of the city, but what implications does ‘densification’ have for people’s health? A lot! In the new POT, the Mayor’s Office is proposing densification as the main planning strategy in Bogotá. Densifying is the opposite of expanding and is using urban land in a more intensive and concentrated way. If the city is expanding, citizens take longer to get to their place of work, study or social and health services. If everything is closer, they will spend less time on transportation and will reduce psychosocial stress; in turn, the more time the person spends in transportation, the more risks of exposure to air pollution and social insecurity. All this affects physical and mental health, especially the most vulnerable people such as schoolchildren, pregnant women and the elderly, as well as people with underlying diseases.
In the city of Paris, for example, the idea of a “city of 15 -20 minutes” began to develop in which everything is close by and the use of land mixes between residential, commercial, recreational, educational and production. This idea has emerged as a response from large cities to Climate Change. The POT proposal establishes: “The strategy to contain urban expansion on the edges of the city”
However, there is still a lack of evaluation of how densification can affect people’s health, for example, by having fewer green areas per inhabitant for physical activity. It should be remembered that chronic non-communicable diseases are the leading cause of morbidity and mortality in Bogotá.
The Territorial Ordinance Plan-POT also has great health implications, because the way in which the territory is organized and occupied, its forms of production and consumption constitute the main determinant of the health of Bogota citizens. For example, the dependence on fossil fuels, the obsolescence of the automobile fleet, the high informality and precariousness of employment in Bogotá, especially in the young population and women. It should be considered if the health factor was taken into account in the formulation of the POT by the district administration.
Densification and health
A risk of densification not well carried out implies the loss of ‘effective public space’, which is made up of green areas, parks, squares and squares. The World Health Organization (WHO) has established an optimal indicator between 10 m² and 15 m² of green areas per inhabitant. This space allows interaction between public areas, as well as is a meeting place, recreation and physical activity, and enables the improvement of mental health.
According to the Bogotá Public Space Observatory, the city indicator is 4.62 m² / inhab of effective public space and the towns with the highest values are Barrios Unidos, Teusaquillo and Santa Fe; Los Mártires and Bosa are among those with low values below 3 m² / hab.
Densification can further reduce this indicator and become a risk factor.
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What does the POT say about health?
In the POT proposal there is no specific health chapter in the POT text; however, the issue is mentioned in the following sections:
A. In the compilation of the felt needs of the citizens it is mentioned “how the facilities in Bogotá generate around 10% of the trips that are made daily related to health (6.0%), study (4.0%), procedures (4.0%) ”. It also talks about how there is a perception of the citizen need to have health units closer. A 2018 study by the health care physician of the University of the Andes, Samuel Barbosa, showed how in Bogotá there is a greater risk of infant mortality in localities with a lower concentration of health services, and how the distribution of health services is unevenly presented ; In this study, it was recommended to implement health policies that allow a better distribution of services for the pediatric population.
B. The proposal of the new POT recognizes for Bogotá a “deficit of basic equipment (health, education, social and cultural well-being)”. According to data from the same Ministry of Health, in the public network regarding hospitalization services, 32% are located in the Centro Oriente subnet; 27%, in the North; 23%, in the South, and 19%, in the South West. Regarding emergency beds: 33%, in the North; 25% in the South West; 21%, in the South, and 21%, in the Central East. Without a doubt, the towns of Chapinero and Usaquén have the highest number of health service providers, while in towns like Ciudad Bolívar, Usme, Bosa and Kennedy they are more limited.
However, the POT proposal does not have an explicit health model based on Primary Care or decentralization of the health sector. By 2021, there are four health services subnets, but their respective managements do not perform a decentralized function of local Secretary of Health, but are more oriented to the coordination of the public network of their jurisdiction. These subnets are not the guides or lead the fulfillment of the territorial or local health plans. The function of the health authority at the local level is more limited to the sanitary surveillance of establishments and epidemiological surveillance with teams by subnetwork and not by localities.
The POT does not make a commitment to decentralize health at the territorial level or in a Bogotá-Region approach. It continues with the concept of a district health authority more as rector of the public network attached to the Bogotá Health Secretariat and not as a modulator of the entire public-private health system, including health training schools.
C. The POT proposal speaks of the “District Care System”, defined as “a set of networks that articulate social facilities and services to recognize, redistribute and reduce the time dedicated, especially by women, to unpaid care work. Its objective is to give caregivers time for rest and respite, training, income generation, enjoying a life free of violence and promoting their autonomy ”. It is mentioned there that the equipment and services of the care system are made up of “kindergartens, schools, parks, libraries, community development centers, health centers, hospitals, equal opportunities houses, care centers for the elderly and with disability and happiness centers, grouped in blocks of care in UPL, mobile units in rural and urban areas ”. However, there is no articulation with a Master Plan of Health Equipment for Bogotá, which must be linked to a Model of Primary Health Care, including basic services oriented to family health and home care throughout the city, emphasizing actions promotional, preventive and low complexity care, as well as complementary care.
The recommendation of the Bogotá Chamber of Commerce to recognize and include the health cluster as an initiative of public-private networks of health services that allows better access to services is key. It is necessary, for example, that the social enterprises of the State or public hospitals of the network attached to the Secretariat that today are organized in four sub-networks of services begin a process of agreements with the EPS to offer health services to the contributory population, which is 77% of Bogotá, and allow improving their social and financial efficiency, since many of these providers are underutilized, while the vertical integration of insurers increases to the detriment of the public network.
According to data from the report carried out by the Universities of Los Andes, Javeriana and Corpas with Bogotá Como Vamos, in Bogotá, by 2016, there were 14,335 hospital beds for a population of 7,980,001 inhabitants, which is equivalent to a rate of 1.8 beds per 1000 inhabitants. The total number of beds increased until 2019 to a total of 14,500 beds for 7,592,871 inhabitants, which is equivalent to a rate of 1.91 beds per 1,000 inhabitants. However, for the year 2020 there is a decrease in the total number of hospital beds (n = 14,186) equivalent to a rate of 1.83 beds per 1000 inhabitants. In terms of distribution of beds by legal nature, it is observed that of the total hospital beds for the year 2020 (n = 14,186), 29% correspond to beds in public entities and the remaining percentage to beds in private entities. Since 2017 the number of public hospital beds has been decreasing.
The POT also does not recognize the aging of the population that is taking place in Bogotá, coupled with an additional demographic bonus of the young population, which are Venezuelan migrants, which has not translated into a change in the morbidity and mortality profile since they continue to persist and the 3 disease burdens coexisting: chronic non-communicable diseases, communicable diseases such as acute respiratory diseases and covid-19, and the complex trauma of violence that affects especially the adolescent and young adult population.
Cardiovascular disease is the leading cause of morbidity and mortality in Bogotá, according to the Bogotá Como Vamos report already mentioned between the years 2016 to 2020, a total of 7,368 deaths from chronic conditions have been presented in those under 70 years of age. During 2020, there were 1,524 deaths with a rate of 19.2 per 100,000 children under 70 years of age, which shows an increase to the immediately previous year and the trend of increasing cases since 2018 persists.
The POT must recognize the weight of chronic non-communicable diseases in Bogotá-Region and formulate interventions that positively affect social and environmental determinants, such as inadequate diet, sedentary lifestyle, psychosocial stress, cigarettes, alcoholism and air pollution.
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LUIS JORGE HERNÁNDEZ