Chapter 1
An Anarchistic Spatial Organisation of Society, its Current Proponents and its Current Status
Health is 'a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity' ( http://www.who.int/en/, 2002)

Introduction
This research is the first to place Eco-village development within the context of being a salutogenic form of spatial organisation in society. The research presents evidence on the pathogenic impacts of the current capitalist spatial organisation of society with a particular focus upon transport, housing and food systems. It analyses ways in which the spatial organisation of transport, housing and food systems, as primary determinants of health, can be improved to become salutogenic. It focuses upon the health of communities and the individuals within them in relation to local, regional and global influences.

Chapter one starts with a description of the determinants of health and the importance of spatial organisation in society for our health. It outlines anarchist ideas on the subject within a geographical context and highlights some of the current proponents and practice of these anarchist ideas.

Chapter two provides background on Eco-villages and the Eco-village movement. It highlights methods of community healthcare and relates them to systems of localisation. It introduces several new government organisations in Britain that may encourage the salutogenic transformation of society before discussing some barriers to Eco-village development and the salutogenic transformation of society.

Chapter three maps the current capitalist spatial organisation of society with a focus on three primary determinants of health, transport, housing and food systems. The section on transport focuses on car use and the role of planning in transport. The section on housing focuses on the British governments housing policy, the importance of home location and the benefits of community owned housing developments. The section on food analyses our modern food system with particular emphasis on fast food, social exclusion, the majority world and the meat industry.

Chapter four reveals the pathogenic influence of our current transport, housing and food systems. The section on transport presents evidence on accidents, air and noise pollution and community severance. The section on housing places a particular emphasis on home ownership. The section on food highlights the industries enormous influence from the individual to the global levels.

Chapter five draws together the conclusions from research into the pathogenic nature of our current transport, housing and food systems. It summarises the evidence gathered and from this proposes the possible salutogenic spatial re-organisation of society.

The Determinants of Health
You can't build healthy individuals in a sick community. If you want to fight disease, you have to build healthy communities. Health care practitioners need to re-frame their mission from curing disease to creating health, and then one step further, to building a healthy community. The factors that combine to create a healthy community are much broader than medical care, hospitals, doctors, or health insurance. The people in a healthy community are safe and feel safe, are well informed, feel that they have the power to make choices, have lasting bonds with one another, and a sense of meaning in their lives. Other major determinants of well being - such as good housing, a good transport system, a sustainable food system, strong social networks, adequate community facilities, safe sexual relationships, fulfilling jobs, a strong economic base, good nutrition, responsible behaviour, and a relevant education - dwarf the medical aspects of healthcare.

Examining the spatial organisation of transport, housing and food systems is of vital importance to geographers who wish to investigate the influence of our environment upon our health. I have chosen to look at these three particular primary determinants of health as they can be either pathogenic or salutogenic depending upon how they are spatially organised.

The Spatial Organisation of an Anarchist Society
The anarchists Elisee Reclus and Peter Kropotkin were the two main figures responsible for institutionalising geography (Johnson, 1991). They were both particularly interested in the human aspects of geography and their work resulted in the development of the concept of social geography which was later adopted into school and university syllabuses. They presented theories on the relationship between people and their environment and encouraged the developing discipline of geography to encompass considerations of people's interaction with nature rather than the study of nature alone. From their studies on the interaction of people with their environment they concluded that, small-scale economic activity within more or less self-sufficient regions, composed of freely federated communes, which in turn are federated with other regions, would bring about the highest standard of physical, mental and social well-being for all peoples. They were also known for their opposition to Darwin's concept of the survival of the fittest. Instead they highlighted certain species dependence upon mutual aid for success. They saw humans as being particularly dependant upon mutual aid for the success of their species (Holt-Jensen, 1988).

Philosophy
Since the institutionalisation of geography different approaches to it have emerged. The humanistic approach is probably more closely related to the original approach of Reclus's and Kropotkins than any other. It took its philosophy from the social sciences as opposed to the natural sciences. It seeks to understand people according to their subjective realities rather than through objective laws. It sees people as free thinking and therefore not entirely predictable. Humanistic geographers argue that through drawing upon and presenting the unique milieu of an individual's personal geography, geographers can empower people and enable them to improve their conditions much more successfully themselves, through their own knowledge, than through a knowledge imposed upon them. This concept is commonly known as bottom-up development as opposed to top-down development. Top-down development is the concept where by knowledge is imposed from an authority. This authority is based on a scientifically definable system of absolute laws. The advocates of top-down development see society as predictable and composed of mechanical components that react in specific ways to specific stimuli. These concepts are integral to the positivist approach in geography.

The fundamental difference between the humanistic approach and the positivist approach is that while the humanistic approach has no explicit criteria by which it can be assessed, the positivist approach quantifies and measures everything in order to analyse it scientifically. Thus one system of evaluating research cannot be employed for both approaches. The practice of positivist geography is aimed at creating predictive models through which social engineering can be employed to manipulate society towards predetermined goals. The practice of humanistic geography is aimed at improving understanding of personal geographies so as to aid personal improvement. Communicating the results of humanistic research can therefore be problematic. It is argued, however, that to diminish the ambiguities of humanistic research hampers its development and use and that the confining influence of set boundaries within research disallow changes to our epistemology (Johnson, 1986). Humanistic geography seeks to understand the interaction between the individual and their environment as represented by the individual, this kind of research does not rely upon universal laws, it is more concerned with anecdotal evidence. Humanistic geography explores the relationships between people and their environment in a spatial context with the aim of helping people understand their predicament, thereby increasing the depth of their knowledge and thus empowering them to improve their own lives.

The knowledge gained through geographical research is not 'the' correct presentation of the world; it does not accurately represent truth or the world as it 'really' is (Johnson, 1986). The subjective nature of researcher and researched, accompanied by numerous filtering processes, limits the findings of geographical research to helping us decide how to change the spatial organisation of society in order to improve our lives. Geographical research in the humanistic approach is therefore socially relevant and aimed at addressing the social and spatial inequalities suffered by the socially excluded and is directed towards just policy developments. The radicals and the political-economists do not recognise geography as being purely academic, they see it as being politically active and involved in the creation of a just society. These radicals follow in the footsteps of Kropotkin and Reclus as they try to construct alternative environments based on anarchistic models of community control in place of the present centralised bureaucracies of capitalism, allowing communities to design desirable spatial organisations in their own fashion.

Radical geography is united with postmodernism in its rejection of positivism. The post modernist paradigm arose in response to the homogenizing force of modernity and its positivist approach, its empiricism and analytical science. Post modernism asserts a heterogeneity that allows for personal uniqueness and disallows universal truths derived from generalisation to dominate as a grand theory. This anarchic representation of truth disallows any theory to dominate the interpretation of any given predicament and therefore geography can be practiced in different ways in different places.

The Socio-Ecological Model
The socio-ecological model of health incorporates the physical and social environment from an individual level up to the cultural level and ultimately the global level. It sees health as being determined by public policy and the activity of commercial corporations. Health inequalities therefore originate outside of the communities sphere of influence and tackling pathogens such as poverty becomes troublesome.

The kind of socio-ecological research that the eco-village movement needs would be

* Salutogenically orientated

* Subjective

* Socially aware

* Concerned with the process as much as the outcome

* Enabling and empowering

* Policy relevant

* Action orientated

* Community controlled

The research would be reflexive at every stage and the definition of success would be agreed upon by both the provider (community) and the interpreters (researchers).

Unfortunately this kind of research runs counter to the dominant research paradigm and there is thus a lack of academic interest in researching and evaluating health promotion activities such as Eco-village development in its anarchistic form. This is even though WHO stated in Ottawa that

"Health promotion works through effective community action in setting priorities, making decisions, planning strategies and implementing them to achieve better health, at the heart of this process is the empowerment of communities, and the ownership and control of their own endeavours and destiny" (Davies, 1993, p56).

The redistribution of resources and power towards the community as proposed by the humanist geographers is based upon qualitative research that has no claim of objectivity and yet challenges the status quo. It therefore receives scant political interest from those whose power is threatened. The research currently undertaken is in regard to protecting vested interests rather than with a desire for social justice or giving the socially excluded and underprivileged groups influence in either research or policy development. Political expediency also plays more of a role in policy development than research of any kind does (Davies, 1986). This explains the lack of academic research into anarchistic eco-village development and the eco-villages preference for direct action over the laborious task of research and policy development.

The relativist doctrine of the Healthy Cities Project that is mirrored by the eco-village movement does not recognise modernist, scientific, rational endeavours as being capable of finding an ultimate solution to health problems. They reject the notion of society as a static system that can be manipulated to reach specific goals. Instead the relativist doctrine of humanist geographers believes in a chaotic mixture of immeasurable subjective factors which disallow the possibility of scientific investigation imposing definitions of well-being as more valid than the definitions of well-being made by individuals and communities. This approach to health is political and moral and not scientific, it believes the knowledge of ordinary people should be able to have as much weight and be acknowledged as much as the knowledge of professional health practitioners and urban planners.

Chapter 2
Background on Eco-villages, Their Stance on Health and Their Current Predicament
What is an Eco-village?
The Technical Research Centre of Finland developed the EcoBalance model in the early 1990s which has been used several times to evaluate the ecological impacts and ecological sustainability of different forms of community development. A paper by Harmaajarvi published in the Environmental Impact Assessment Review concludes that "eco-villages are not necessarily very sound from an ecological point of view" (Harmaajarvi, 2000). While the author admits that the application of sustainable technology in eco-village developments, such as compost toilets that halve water consumption, do have a positive environmental impact he rejects the eco-village concept as a whole on ecological grounds. Unfortunately Harmaajarvi does not define the term eco-village and therefore it is impossible to apply these conclusions to eco-villages as a whole, only those which Harmaajarvi has investigated. The Eco-village Network UK (EVNUK) defines eco-villages as 'citizen initiatives to model sustainable, low-impact, human settlements' ( http://www.ecovillages.org/uk/network/, 2002). This is bottom-up development as advocated by the radical humanist geographers. This definition offered by EVNUK is not the only definition and EVNUK does not have a monopoly on the terms definition. Positivist geographers also use the term as part of a top-down development, these projects are not citizen led and are therefore different forms of community development. Unfortunately two forms of community development share the same name. This can and does cause confusion.

Takeuchi advocates the use of eco-village designs in the revitalisation of Japanese rural areas. This social engineer offers a definition of an eco-village as "a key word for establishment of sustainable human settlements internationally" (Takeuchi, 1998) and as "a self-supporting area in which, with the support of environmental conservation technologies, both a productive economy and the maintenance of semi-natural environmental systems can be realised" (ibid.). Takeuchi highlights the Natural Environment Redesigning Project in Agricultural Land run by the Japanese Ministry of Agriculture, Forests and Fisheries as resolving problems in the eco-village concept before it will impose the final plans on existing villages. The aim of the Japanese project is to re-address the imbalance between the over concentration of people in cities and the dwindling workforce in rural areas. It in no way aims to empower people to design and lead their own desired form of community development. This project would not, therefore, be classified as an eco-village development by EVNUK.

The construction of the Grand Shandu Eco-village System (GSES) in China has resulted in an 83.07% increase in economic benefits and an increase of 163.49% in the gross profit for the villages that comprised GSES (Hu, 1997). GSES applied principles of ecological engineering to the village systems of agriculture, industry and even its culture and consciousness. Agricultural and industrial output was increased through 'effectively protecting and reasonably exploiting' the land. Sustainable technologies such as a biogas-engineering project were implemented. The dung of chickens, pigs and people was used to create biogas with an equivalent energy of 5 tons of coal but at a lower production cost. The remaining sludge and liquid was applied as a successful fertilizer and also as fish fodder. A complete ecological chain involves the pig dung being used to fertilize mulberry plants that feed silk worms whose chrysalis is fed to the pigs. The amount of silk, grain and pork produced increased by over 58% since the introduction of the eco-village project (ibid.).

Eco-village developments, whether top-down or bottom-up, can have very positive environmental impacts; according to Harmaajarvi they may also have negative ecological impacts. The two methods employed in eco-village development illustrate the difference between two approaches. The approach advocated by EVNUK encourages individuals within communities to define their own goals and realise these themselves. The approach advocated by governments encourages experts to manipulate society towards the government's goals. A reflection of the difference between the practices of two separate approaches to geography.

GEN
"Eco-villages are citizen initiatives to model sustainable, low-impact, human settlements. They are applicable to both rural and urban settings and accessible to all. Eco-villagers utilise renewable energy technology, ecological building techniques, and human-scale design to reduce exploitation of natural resources, facilitate community self-reliance, and improve quality of life. They are about the creation of new settlements as well as retrofitting existing villages and urban areas. An eco-village is designed in harmony with its bioregion instead of the landscape being unduly engineered to fit construction plans. By thinking in terms of bioregions, sustainable settlements are planned considering water availability, the ability to grow food, and accessibility. Many projects use the principles of permaculture for creating integrated, interactive and efficient systems for structural planning, food production and social needs in their community." ( http://www.ecovillages.org/uk/network/, 2002)

The European eco-village network wrote the following as part of a joint proposal along with others involved in the Gaia Trust to the UN in the Habitat 2 Summit in Turkey in 1996.

"Though the current focus of the eco-village movement is on rural living, consideration of existing mega cities is obviously required. Policies which would allow people within these cities to connect in practical ways to their immediate environment would be an enormous step towards sustainability. Incentives for people to grow their own food, buy from farmers markets, or link with nearby small farmers through CSAs (Community Supported Agriculture), as well as to compost and recycle waste would shorten the distance between producer and consumer. The reduction in long distance transport would localise the cycles of production, consumption, and waste and thereby reduce pollution as well as unemployment." (Gaia Trust, 1996. P16)

The entire proposal entitled 'The Earth is Our Habitat' was for $100 million over a four-year period to build a series of between fifty and seventy human-scale examples of fully functioning eco-villages across the globe with each village being home to between fifty and two thousand residents. These sustainable communities would be in both the North and the South and encompass examples of both urban and rural projects. The funding would be given in support to the projects that already exist with the most experienced, eager and willing people and would be aiding them to come to grips with the practical problems of implementing Agenda 21 on the ground. The $100 million would be allocated to an international UN committee that would in turn allocate funding to regional committees who would allocate between $1.5 million and $0.5 million to individual projects that designed eco-habitats as living examples of Agenda 21 planning. The role of the regional committee would be to ensure that the existing projects chosen would be the ones that have the potential of being the most beneficial to the region. That the projects are wide ranging in that they forfill the most criteria of what it is to be sustainable. And that the projects chosen also include all the aspects of their region, being in different countries, climates, cultures, religions, encompassing as many variables as possible. The proposal includes a section on planning for the home recommending

* The integration of a renewable energy system

* On site waste water treatment

* On site food supply

The proposal also puts forward the argument that 80% of the health costs in the North could be saved by adopting the healthy lifestyles as encapsulated in the eco-village concept as individuals and communities would be taking responsibility over their own health (Gaia Trust, 1996. p28).

The Eco-village Movement
The eco-village movement has, as yet, not entered the academic world as such. It is, however, closely associated with the Healthy Cities Movement in its ideals. The healthy cities movement arose from the 'new public health' as part of an increasing emphasis on 'health promotion'. WHO formally acknowledged the importance of community participation in improving health in 1978 in its Alma-Ata conference (Davies, 1993). The emphasis has since shifted away from bio-medical treatment of disease to salutogenesis, that is environmental improvements that increase well-being. By 1986 the WHO conference in Ottawa saw a more effective community participation in salutogenesis with the formal launch of the Healthy Cities Project (Davies, 1993). This project for community empowerment aimed at redirecting the focus of health practitioners towards environmental factors and wider social issues. This gave birth to socio-ecological methods of research into public health and urban planning. The research base of the new public health is, however, in its infancy. There is as yet no single existing academic field that can provide the breadth of vision, scientific theory or methods that can cope with the vast array of complex issues. This new concept of public health is exceedingly difficult to measure and relies upon anecdotal evidence. This has resulted in a tension between practise and research. The Healthy Cities Project is practitioner led rather than research led which has resulted in the rejection of traditional administrative and scientific principles and an attempt to adapt and transform current socio-spatial structures. The post-modern focus upon a moral and subjective view of health has meant that health practitioners have moved beyond considerations of the bio-physical alone, they have entered the socio-political domain. The 'new public health' political programme of changing power relations can only fail if it works within the old framework of traditional applied methods of the social and natural sciences. New methodologies and relevant academic research into health promotion have not arisen as yet. This can be attributed to the movement being led by community activists who are more concerned with action than research. Indeed the WHO definition of health as 'a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity' is impossible to measure beyond the individuals perceived state of well-being at any given point in time.

The Eco-village Emphasis on Community Healthcare
Ekins (1992) refers to David Werner as one of histories greatest health educators. Health, as encouraged by Werner is a non-monetary variable, it is something that everybody is responsible for. Autonomous healthcare by informed ordinary people is considered to be cheaper in treating health problems as well as being able to treat problems earlier and in many cases better than by a doctor. Informed self-care is only limited by its current status, it being given much less support than costly institutionalised medicine. There is a preconceived bias against autonomous healthcare, professional physicians are generally unwilling to give up their dominance and resign themselves to being on call as opposed to their current status of being in command. Due to this relationship between the doctor and the patient informed self-care is not as widespread and successful as its potential is. The informed self-care as encouraged by Werner and practised across the world is only viable with the provision of a suitable education. This is not the concentrated, lengthy and costly education of physicians although their role is vital. It is instead an education in widespread primary healthcare founded upon an holistic and community led approach to preventative healthcare. It includes, amongst other factors, lifestyle, sanitation, hygiene, diet, transport systems, food systems and housing. It would also be beneficial if education included 'learning the art of horticulture [and] finding in physical exercise, the health and strength which so often weakens in cities'. Creating a picture of 'the labour of the fields [not as a] slavish drudgery but [as] a pleasure, a festival, a renewal of health and joy.'(Kropotkin, 1970,p.196).

UKPHA - The Organisation Advocating an Emphasis on Increased Community Healthcare in the UK
The UK public health associations (UKPHA) mission involves promoting sustainable development along with environmental and social regeneration in order to improve general health and well-being. They have helped to push back the boundaries of policy development and have carried out a range of projects on sustainable development, transport, food, housing and primary care amongst other things. They have successfully advocated for health promoting policies at local, national and European levels, which accept widespread, holistic, approaches to primary healthcare to a greater degree. ( http://www.ukpha.org.uk/ (September 2002).

Eco-villages and Localisation
Changing the spatial distribution of production towards more or less self-sufficient regions has come to be known as localisation. It involves the individual understanding their place, being rooted in a community that occupies a specific area defined by distinctive environmental and cultural characteristics. These areas are known as Bio-regions. The local area or bio-region is limited to human scale economies that are subsumed to ethical considerations. Isolated communities that strive towards self-sufficiency with the absence of trade, technology and comfort are not a part of the localisation agenda. Trade and technological development are vital aspects of the localised society although they are of secondary importance when compared to safeguarding and improving people's well-being through the use of local resources. Indeed, strong local economies have successfully served humanity in many parts of the world throughout history and although they are being destroyed some local economies still support their communities (Norberg-Hodge, 1999).

Certain groups have modelled the successful communities within the Bio-regions of a localised society as eco-villages. These eco-villages aim to free themselves from dependence on the global economy through reliance on renewable energies, the use of local resources and the development of co-operative local economies. A model of development for both the global North and South. The economic sense of localisation can be demonstrated by the fact that a local corner shop employs one person for every £50,000 spent whilst multi-national supermarket chains employs one person for every £250,000 spent (Norberg-Hodge, 1998). The implications of localisation cannot be entirely evaluated by a positivist approach to geographical research. The sense of well-being derived from a local economy that provides more jobs in a more pleasant environment is hard to quantify and is probably better understood through humanistic research. The aim of the eco-village "is not to live in a closed society, but to create a lifestyle where we combine new technological knowledge with sustainable values in a setting where many people can imagine themselves living" (Christensen, 1999). The Los Angeles eco-village project is creating a sustainable community through improving the spatial dynamics of a pre-existing population in a multi-cultural and low-income area of the city. There is, however, no established analytical approach that can measure the effectiveness of the eco-village approach to community development as its values, beyond those of minimal detrimental environmental impact and the development of a viable human scale economy, are locked within the subjective realities of the community residents.

The 'box schemes' in Britain are an example of the human scale economy operating within a local area. Farmers create jobs through diversified local food production and their business is secured through a direct relation with the consumer. It is argued that the closer ties between farmer and consumer develop a stronger sense of community and a deeper understanding of place. And that this allows the community to become rooted in its place, which in turn encourages a sense of belonging and an increased psychological and emotional sense of well-being.

New Government Organisations and their Implications for Eco-village Development
Since 1970 community orientated work and non-medical activities aimed at improving health had been discarded as public health was moved out of the remit of local authorities and into the mainstream NHS. Public health thus became a professional specialism within the public health department of the NHS and the bio-medical approach to healthcare expanded and consolidated its dominance. The situation has recently changed, public health is now recognised by government as not being solely an academic discipline, practice restricted to medicine is becoming a thing of the past as health authorities are leading the development of local health improvement plans working alongside other organisations. The new boundaries of public health are being expanded by current government policy and the medical departments of public health cannot achieve the new aims encompassed within the practice of public health care alone. This section looks at the recent developments within public health, focusing on the new organisational structures and how they encompass non-medical, community based, broad, approaches to health care.

Primary Care Trusts
Several new organisational structures have been created to improve health and reduce inequalities. The local health improvement programme (HImP) is the strategic framework used by the health authority. HImPs are the main vehicle for health authorities and local authorities to work collaboratively with other partners. HImPs are devised within Primary Care Groups (PCGs) / Primary Care Trusts (PCTs). PCGs are collections of GP practices that function to improve the health of the local population, commission healthcare services and develop primary and community care. PCGs are a sub-committee of the health authority and can become PCTs. PCTs can be led by a collective of community nurses rather than doctors. These new organisational forms offer new opportunities for community groups to have a presence at the policy high table and influence the commission of health services and the development of primary care investment plans. PCT/PCG committees have representatives form amongst others, nursing, social services, community groups and lay people. They recognise agencies outside of the NHS as having an equal role in improving the health of the local population and work in partnership to create the HImP. The committee is expected to make strategic decisions about the services provided for the whole population and give consideration to local schooling, transport, shops, industry, housing and employment. It can not only improve the health of the local population through its direct actions but can also act as a powerful lobbying force promoting healthier practice in other organisation and empower communities to take action, raising their esteem and motivation.

The health profiles held by community nurses can be used to create a picture of specific community needs and direct the focus of PCG/PCT activity. The current emphasis on service delivery can be shifted towards catering for the communities needs in a much broader sense. Focusing on specific groups and their related health problems such as the socially excluded can develop new styles of service. PCGs/PCTs have to take the national plans of joint working between agencies and tackling social exclusion into account when prioritising resource allocation.

Working within the PCG with a persuasive real life depiction of a community can be more influential than carefully researched data. Helping to shift the focus away from a purely bio-medical prescriptive approach towards healthcare. PCG requirements are combined into one block contract for provisions. The consumer behaviour of the joint PCGs can therefore alter the delivery of health services to ensure that they are relevant to community (client) needs (Gough 2000).

Primary Care Act Pilots
The NHS Primary Care Act of 1997 was passed as a result of nurses influencing the central policy making process. Nurses presented the challenges facing them along with their proposed solutions to Mps, civil servants and the professional bodies representing them. Primary Care Act Pilots (PCAPs) can be run by nurses instead of Gps. The rational for this is that the time 'wasted' by doctors on 'inappropriate' tasks could be more effectively spent if nurses took on these tasks. Working with social services to ensure benefits and housing for a patient thereby reducing anxiety, depression and despair is much more likely to be successful if done by a nurse with a community focus who 'cares' rather than a doctor who's bio-medical training has given him skills to 'cure'. Nurses are not driven by cash incentivised tasks in the same way as Gps are and so are more willing to undertake time consuming non-paying tasks such as securing housing or benefits for patients. Nurses are also much more flexible and able to change their tasks by renegotiating their targets to include non-medical health factors such as pollution, housing, diet recreational facilities etc. S28a of the NHS act of 1977 gives health authority's powers to transfer money to voluntary organisations for social service functions where better value would be achieved than by the equivalent expenditure within the NHS. This can encourage alternative and more appropriate models of care, improving health in the community (DoH 1998).

Health Action Zones
In 1997 the then Secretary of State for health, Frank Dobson, stated that he wanted 'to develop a health strategy in cooperation with community groups'. Health Action Zones (HAZs) are test beds for finding new ways of directing healthcare; they should be innovative models of public service. The objective of HAZs is to tackle inequalities and the factors that lead to ill-health. They can receive funding for healthy living centres and local community initiatives. Each HAZ can be different and the scheme is flexible enough to shift the emphasis towards a broad proactive approach to healthcare. They are experimental and as such existing rules and regulations have been made flexible. Sandwell HAZ procured a 50 acre site to build 1000 new homes as part of an 'eco-friendly' urban village which included a food co-op and healthy living centre (LGA, 1999). The Healthy Living in Luton scheme, led by Bedfordshire Health Authority, consists of a wide variety of activities offered in eight primary districts. Community health workers and volunteers' liase with local people and coordinate the centres work that includes cookery clubs, exercise classes, a food co-op, a community radio project, a music suite and holistic therapy sessions.

Community and Non-Medical Issues in Health
Health-Care resources for the mentally ill are concentrated upon the most severely ill people which has left an absence of a strategy for dealing with the social stresses that contribute to the ever increasing tide of mental illness. Social issues can be 'invisible' aspects of regeneration but research evidence has proven that they are as important as the 'hard' issues such as housing. The environmental impacts on health come from three primary sources. Personal biography, material conditions and social conditions. These are separate factors that have a considerable overlap with each strongly affecting the other. Mediating the environmental impacts on health occurs through the agency of the individual and the community, how instrumental they are in shaping their environment can be linked to how healthy they are. The home is of crucial importance in this respect but no more crucial than the community or neighbourhood. When residents have been involved in the planning process of regeneration the physical improvements to housing have had a real impact on individual well-being induced by a sense of ownership. Agency is essential for the health of the individual and the community. It gives them the power to affect what may seem minor but which are vital decisions that influence daily life. Effective community agency is dependant upon strong and diverse social networks. Social networks contribute vitally to an individual's mental health. Poor networks induce ill health, which in turn exacerbates the individuals 'network poverty'. Community development has to repair and strengthen the social fabric, without it material improvements such as improved housing will prove to be unsustainable (Hoggett 1999).

The Involvement of Community Groups in the Governments Public Health Bodies
The new organisational structures allow the possibility of radical changes to take place and are a financial and legislative gateway to financing new innovative community development and health care schemes. Any community groups wishing to influence policy through being a committee member would have to have a strategic view of health care and be able to dedicate a lot of time, presenting strategies to people who may not be entirely receptive and be able to present evidence based research in a captivating way. It is important that partnerships with other agencies are not chimerical. Non-medical, community based, broad, approaches to health care include food co-ops, healthy living centres and community based nursing as well as eco-friendly urban village development such as that in Sandwell HAZ. These 'caring' strategies can be more successful than 'curing' strategies due to their preventative approach. Future Eco-village developments could benefit from being involved in these new government organisations.

Barriers to Eco-village Development
There are numerous barriers preventing healthy community development operating on all scales. The centralised global economy acts as a barrier preventing the development of healthy communities through its systems of usury, taxation and land use. The institutions behind the centralised global economy are increasingly being seen as an undemocratic and unhealthy world government. The World Trade Organisation (WTO) is one of these institutions. The WTO emerged out of the 'Uruguay Round' of General Agreement on Tariffs and Trade (GATT) talks. The fundamental provision of the WTO is that it acts to protect 'free trade'. Any country can, through WTO mechanisms, challenge the laws of any other country if they see them as restricting 'free trade'. Any case brought before the WTO is decided upon behind closed doors by a three man tribunal. The WTO can therefore be seen as a global economic institution that has been granted the sovereignty to decide laws that relate to trade. The three man tribunal has the final decision on all cases, there is no appeal, all documents are secret, no person involved has to disclose conflicting interests and no media or citizen groups are allowed to observe any of the cases. The tribunal also has the power to enforce sanctions on countries that do not remove WTO-illegal laws (Jackson 2000).

American lawyer Ralph Nader and his colleague Lori Wallach have investigated the WTO and have commented that-

"Approval of these agreements has institutionalised a global economic and political situation that places every government in a virtual hostage situation, at the mercy of a global financial and commercial system run by empowered corporations. This new system is not designed to promote the health and well-being of human beings, but to enhance the power of the world's corporations and financial institutions" (Nader, 2000. p93). "At risk is the very basis of democracy and accountable decision making that is the necessary under girding of any citizen struggle for sustainable, adequate living standards and health, safety and environmental protection"(Nader, 2000p94). "The agreements promote the elimination of restrictions that protect people but increase protection for corporate interests"(Nader, 2000p95)

The European public is aware of American MNCs using their government to object to Europe's restrictions on the use of Bovine Growth Hormone in 1999, but the Americans are at risk themselves.

"Here is a sampling of targeted US laws: The Delaney Clause which prohibits carcinogenic food additives; the Nuclear Non-Proliferation Act; the asbestos ban; driftnet fishing and whaling restrictions; the Consumer Nutritional and Educational labelling Act; State recycling laws; and limitations in lead in consumer products."(Nader, 2000 p98).

The WTO, on behalf of privately owned profit orientated corporations, is limiting access to land. Across the world private corporations have taken over ownership of essentials such as water and aim to make profit from the provision of them.

In response to recent criticism the WTO has stated that "The goal [of the WTO] is to help producers of goods and services, exporters, and importers conduct their business." ( http://www.wto.org/english/thewto_e/whatis_e/10mis_e/10m05_e.htm (2003). In regards to health they state that "the agreements are also designed to prevent governments setting [health] regulations arbitrarily in a way that discriminates against foreign goods and services ..... these actions [setting health standards] are disciplined, for example to prevent them being used as an excuse for protecting domestic producers - protectionism in disguise." ( http://www.wto.org/english/thewto_e/whatis_e/10mis_e/10m04_e.htm (2003). They admit that "An overlap does exist between environmental agreements and the WTO" (ibid.). Adding that "it's not the WTO's job to set the international rules for environmental protection. That's the task of the environmental agencies and conventions."(ibid.).

In the UK, on national and local levels, plans, policies and programs often favour top-down development and big business as opposed to bottom-up development led by the community. Planning laws, subsidies and finance are used to help big business more than the community. There is a lack of cooperation and coordination between government agencies. 'Curing' often overshadows 'caring' due to the dominance of the bio-medical approach in healthcare. Within communities and between individuals there is a lack of communication and interaction, which weakens cohesion and the ability and the will of people to actively engage in community development. The health of a community depends on its inter-connectedness. Bergthold's healthy community would be "dense with empowering organizations at the local level, a community that has identified its own priorities and set out to build them." For "anti-economist" Hazel Henderson, "this means shifting our value system away from compulsive individualism toward re-balancing the needs of communities." In the same vein, Tom Chapman said that the people of a healthy community would have a "collective understanding of their interdependency." Health futurist Clem Bezold calls a healthy community "one in which the community has a shared vision, and is able to make that a significant part not only of public policy but healthcare and commerce." ( http://www.well.com/user/bbear/hc_how_to.html#RTFToC4 (2002)

The capacity for businesses to survive and grow is tied directly not only to the health of the population they serve, but to the true vectors of their health: their economic success, the safety of their environment, their level of education, and the quality of their diet, housing and transport system. Not assessing and acting on the health needs of community has higher economic costs in the long run. The business community should commit itself to the task of building healthy communities, not as a marketing edge, but as a fundamental strategy.

"It's very difficult for my colleagues to invest in community building," says Tom Chapman, " if they have to do it by themselves. It's a competitive disadvantage and a risk. You can't take it on alone and sustain it in the long run unless it becomes a value in the whole [business] community. It's an issue that cannot be allowed to remain in the hands of the providers. It has to be opened up to the citizens and the leaders of the community." (www.well.com/user/bbear/hc_how_to.html (2002).

A healthy community is a better place to do business as it has a better labour force. In order to build a healthier community the community has to lead business and the pubic sector into catering for their needs with a broad holistic approach to health improvement.

Chapter 3
Current Capitalist Spatial Organisation of Transport, Housing and Food, Three Primary Determinants of Health.
There are numerous essential components of a healthy society. Transport, housing, and food supply are just three of these essential components of society. Examining the spatial organisation of transport, housing and food systems is of vital importance to geographers who wish to investigate the influence of our environment upon our health. I have chosen to look at these three particular primary determinants of health as they can be either pathogenic or salutogenic depending upon how they are spatially organised.

TRANSPORT
The Car
Transport in the 20th century has been enormously transformed by the introduction of the motorcar. The effects include a heightened personal expectation of instant mobility, enormous loss of life and morbidity, the huge depletion of the planets finite resources, pollution, climate change and the spatial reorganisation of society through the transformation of the built environment.

The car is both, to some extent a personal liberation, and at the same time a very real social menace. The widespread personal liberty attained through individual car ownership has destroyed the viability of alternative social solutions that could cater for our collective transport needs and desires by taking away public support and funding for other means of transport. We lose part of what we have gained through the invention of the car by discarding other inventions and transport systems that could be used in conjunction with it.

Cars confer a perceived freedom, flexibility and social status upon the individual owner. Joy riders are a typical example of attaining heightened social status through car 'ownership' (Ward, 1991). Limiting car use is commonly seen as undemocratic, curtailing personal liberty and as such policies of limiting car use have been avoided by politicians wishing to remain popular and in power. The car as a solution to transport needs has, however, been described as the consecration of egoism, undermining the economic viability of public transport systems. The economist E.J. Misham has concluded through cost benefit analysis that the personal car is a great diseconomy due to the innumerable social costs its use incurs. He also describes the car as "one of the great disasters to have befallen the human race" (Ward, p11, 1991). Even when petrol is in short supply, such as during the Second World War, the car persisted being fuelled by wood in Germany, peat in Ireland and methane in the UK. An illustration, if one is needed, of the fact that the car will never willing be abandoned.

Planning and Transport
According to the principles of sustainable development property developers should minimise travel between properties, provide public participation in the planning process, provide social equity in access and avoid social exclusion. Large new properties are, however, being built out of town where the infa-structure for travel is predominantly based on the existing road network. 1/3 of retail turnover also comes from out of town developments (Lucas, p14, 2000). These out of town developments cause increased traffic, undermined economic vibrancy in town centres and increases the social exclusion of the car-less. These phenomenon are also caused by the migration of commuters to suburbs and satellite towns. 93% of British people in suburbia drive private cars to work. Suburbia and further retail developments out of town are expected to increase car use by 50% by 2026 (Lucas, p16, 2000).

David Bayliss the former director of planning for London transport suggests that "the basic daily needs of people should be met by travel on foot, cycle and public transport or other multi-occupancy vehicles." (Lucas, p16, 2000). High density, mixed-use developments close to the centre of town are more sustainable, economic and socially stable. They offer more opportunities to cycle and walk but take up potential car parking space which developers are reluctant to give up while adequate public transport is not available (Lucas, 2000). In order to encourage developers to build in a more sustainable way the requirement of public transport has to change from providing a back up facility for those who cannot use a car to providing access to all people.

The growth of transportation and demand for private cars cannot be met in cities that are trying to ensure an acceptable air quality. Instead the use of private cars has to be restricted and public transport put in place as a viable alternative. Unfortunately rail and bus fares have risen in the UK by over 70% in real terms over the past 20 years while the real cost of privately owned cars has fallen by 2% (Royal Commission, 1997).

According to the LGA many people feel that they have no viable alternative to the car, especially those living in rural areas or due to preferred lifestyles. Many people from rural areas are unwilling motorists seeing driving as a necessary evil due to the lack of an alternative. Poorer people have to make painful sacrifices to other parts of the family budget just to keep the car running in order to reach vital services. 1/4 of rural households in the UK live in or on the margins of poverty. Those rural and suburban dwellers that do have cars have more cars, drive more often and for longer distances (Huby, 1998). 75% of rural communities in the UK now have no daily business service, the fares are also more expensive than the urban equivalent (LGA, p31 1998). And the vast majority of rural communities no longer have services and so village residents have to drive in order to reach essential services in the city.

Very little research has been directed towards informing transport policy or assessing the effectiveness of transport policies in action. The reason for this can be traced back to 1971 when the Lord Rothschild reforms were introduced into government practice. Lord Rothschild recommended that the government should limit the research it funded to clearly identified customers who commissioned and specified the terms of research projects. He completely omitted the need for an evidence-based approach to policy formulation. The result was a complete absence of research outside of the current policy framework and the agendas of the politicians in power at the time. The scope of research was thus constrained to investigate the problem of improving roads rather than more efficient transport systems (Davies, 2000).

The British government spent its transport budget on the roads to attract voters who considered a bigger and better road infa-structure an increase to their personal liberty and mobility. Another reason for this spending was the maintenance of the car and construction industries even though the equivalent spending on public transport is better value for money and creates more jobs. The government used traffic forecasts to justify the 'unquestionable need' for more roads thereby relegating planning enquires to choosing routes rather than as a valuable tool for formulating policy. The cost benefit analysis used by the government was restricted to comparing the financial cost of road building with savings in journey time, the operating costs of the entire road network and the financial costs of accidents. This methodology has recently been modified but the new approach has yet to be evaluated or used to devise a comprehensive sustainable planning policy (Davies, 2000).

Housing and Health
Policy and Research
In the 1980s the government curtailed direct links between policy formulation and academic research (Davies, 2000). Political ideology and expediency emerged as overt engines of housing policy with the government neglecting the accumulated research evidence on the links between housing and health. The government now funds research that is reactive and evaluative of current practice rather than pro-active and innovative of policy (Davies, 2000). It has become rare for research to impact directly on policy as only a poor channel of communication for the transfer of ideas and evidence exists between academics and policy makers. Most of the contact between government policy makers and researchers is ad hoc and on an individual basis (Davies, 2000). A regional plan devised by the local authorities for the housing expansion occurring in the south east has been reviewed and assessed by an economist from central government rather than a housing specialist who could assess the environmental and health impacts of the development. This serves as an example of the convergence between the political parties who collectively consider housing as a commodity catered for by the market as opposed to housing as a public good and social service. This individualism results in less state intervention and no options for voters who want structural reforms. The rolling back of the state not only results in more privatised housing through housing associations and right to buy but also curtails new investment in council housing. Those in housing need are blamed for their own misfortune as the market is believed to cater for demand (Davies, 2000).

After the slum clearances of the 1930/50's housing provision and policy was used as an instrument of health care. Housing schemes were packaged with some consideration of health care and social support. The current housing policy, which is, used as an instrument of national economic management compromises attempts at integrating housing and health policies. There is also currently a deficiency in housing policy as it uses ambiguous terms such as 'decent' and 'affordable', which are not clearly defined by government. Government also fails to adequately specify how the ill-defined objectives of decent and affordable housing are to be achieved.

Some research has also been deficient as it has not included considerations of 'cost-benefit' analysis and 'effectiveness' to the degree that government demands. Although research is improving its deficiencies it still has little direct impact on housing policy formulation. Research requirements for funding have resulted in the majority of research into housing concentrating on management issues for housing associations and government.

The link between health and housing has not yet been identified to the extent that it can be quantified in accordance with government demands and thus influence spending priorities and have targets set for improvement and progress monitored. Another effect of the governments demand for quantification of health problems caused by housing is an insufficient ad hoc link between the health, housing and social service agencies.

Home Location
An 'inverse care law' has been established as resulting from the market led deployment of resources within the NHS whereby the most disadvantaged residences with the worst social conditions have the least accessible healthcare provision. This law operates at all levels from the national to the individual (Smith, 1991). The existence of this law illustrates that housing is not just a matter of bricks and mortar but directly effects well-being. The unhealthy are less able to compete in the housing market and are therefore more likely to live in unhealthy areas with the least healthcare provision. People who are least able to exercise a choice and who are in desperate need of housing often receive the worst housing. This results in concentrations of poor households in less desirable areas, which cut people off from work opportunities and send them into a 'spiral of decline' due to the spatial segregation. Not only does this directly increase social expenditure it also exacerbates the cycle of poor health, unemployment, poverty, drugs dependency and other social ills. And as derelict land is often unsuitable for property development due to past industrial contamination pressure for housing, often deprived, is increasing. The concentration of poor households in certain areas is characterised by the poor environment, dereliction, property in need of repair, poor lighting, lack of green space, being located close to industry, suffering from intrusive noise and air pollution from traffic railways and aeroplanes as well as having a problem with litter.

Rural inhabitants have expressed concern over the extra health risk of agricultural activities such as crop spraying. Gentrification also pushes the rural poor into housing problems and all the associated health risks.

Housing and Sustainable Development
4 million new homes are expected to be built within the UK (Balchin, 1998). Can this be sustainable? Sustainable development is ill defined and is a contentious issue, especially as "it may be necessary to make difficult compromises between potentially conflicting objectives"(Lucas, p10, 1990 UK Round Table Annual Report on Sustainable Development).

There are four generally agreed objectives of sustainable development

o Protection of the environment

o Prudent use of natural resources

o Social progress

o Maintaining economic growth

(Lucas, 1990 UK Round Table Annual Report on Sustainable Development).

An energy efficient suburban home is no more environmentally sound than an old 'energy hog' house in the centre of town. The energy saving gained in the suburban home is more than cancelled out by the poor location of the home and the subsequent overuse of the car. Current planning guidance does not include consideration of energy efficient buildings, resource use in the building process, local employment issues or greater public participation in the decision making process. 60% of the local authorities that responded to a questionnaire on the level of sustainability within their strategies thought that developers should be given finance and other concessions in order to further promote sustainable development within their area (Lucas, 2000). The Rees Jeffrey Road Fund initiated a major programme of research, promoting consideration of 'New Realism' within the strategic transport policy. It recognised the role of sustainable land use in reducing car use and further road building and has encouraged investors in future developments to change their attitudes and practice in order to make it possible for sustainable development to be market led.

Tenant Controlled Housing
"In many countries, recent decades have furnished clear lessons about how areas can regenerate themselves .... We have learned that communities themselves need to 'own' strategies for renewal. And we have learned that the public sector can't work alone: it needs to bring in business to provide jobs .. and services that create a living economy .... Housing mobility is key to combating social exclusion ... geographical mobility for taking up work, is the key to upward social mobility ... No strategy for social exclusion will be credible that does not shift the balance of resources toward stimulating the supply of housing choices for the poorest households and reducing the price of housing"(Christie, p7, 1997).



The local government association (LGA) argues that the provision of affordable housing is the obvious key to tackling poverty. Only a few local authorities still have development land of their own and therefore the provision of affordable housing has become much more dependant upon suitable planning policies. The LGA has recommended that housing policy has to be integrated with transport policy and training initiatives. With all strategies involving a multi-agency body whose targets are set and the progress monitored by the local authority. In 1997 the Norfolk Youth Build Partnership supported by the North Norfolk District Council started a range of self-build and community build projects that were key to creating a healthier community. The partnership helped build 51 units of high quality affordable 'green' housing with community facilities. Employment and training was an integral part of the project, which has been seen as a model for sustainable development by the LGA as it effectively, linked economic, social and environmental issues into a single integrated package (LGA, 1998).

Anthony Mayer, the then chief executive of the housing corporation, spoke of a publication on tenant controlled housing as

"expos[ing] the myth that people in greatest housing need lack the motivation and personal resources to control their own homes. It also demonstrates how tenant control can meet both housing need and empower people traditionally seen as the most disadvantaged, and create active communities" (Williams, p iv, 1993).



The Housing Corporation and some local authorities have provided Housing Association Grants to reduce the cost of housing provision. Established housing associations can build homes in partnership with housing co-operatives, transferring complete ownership to the co-op when the project is complete.

Landridege hosing co-op in Middlesborough is a tenant-managed organisation that runs both council and housing association properties together. The co-op recently expanded, building 12 new homes. It employed a construction company that employed local trainees who primarily came from the co-op members. 20 long term unemployed people received 6 months employment training that also developed management and communication skills. 12 trainees and 3 skilled workers built the 12 houses. 6 other members of the co-op had employment training on a scheme that surveyed the wider community and resulted in the Landridge Initiatives Centre. The centre houses a laundrette and cafeteria, meeting rooms, pre-school playgroup, 3 workshop units, job match scheme and a volunteer bureau. Training is offered in business skills, management and communications. Since the community development people talk of 'camaraderie' and feeling safe. Burglaries used to occur up to 6 times a week but have since fallen to 1 in total since the project was completed.

Greenwich Self-Build (GSB) in conjunction with CHISEL has illustrated the possibility for tenant organisations to build their own homes and communities even when the people involved have no available funds. The housing project used the Walter Segal design for their houses, which is speedy, simple and requires few building skills. The council provided land and a list of applicants that showed a commitment to complete the project (whole community) and rent the facility on its completion. The savings in public subsidy for GSB were around 25% (Williams, p37, 1993). 'Sweat equity' allowed the co-op members to receive a payment equivalent to their labour if they decided to leave the project. The use of their own labour also resulted in lower rents for members as the need for private finance was reduced.

In the Abeona co-op, which started its life as a squat, the members' nominated residents (who they also consulted on the design of their houses) as the council nominations procedure was inadequate and referral agencies were not needed.

These examples serve to show that people with nothing except commitment and determination can be successful in producing networks of community support and more caring neighbourhoods through a tenant controlled structure. Tenant groups can also have control over design therefore providing for their needs and aspirations. Tenants' needs are met more efficiently and the sense of home ownership not only confers pride and belonging, which leads to greater participation in community improvement and responsibility, but it also has proven health benefits. Evidence exists (Marsh, 1999) of the positive effects of owner occupation which is much more pronounced for children from low-income families. Housing co-ops also remove barriers to interaction, which people living alone are subject to, and which often cause depression (Ewalt, 1998). Tenants get out of housing need, develop new skills and training and gain more confidence and control over their future. Housing co-ops can offer suitable and unique solutions to housing and environmental and health problems. They do not just fill voids but have to choose their new neighbours and work colleagues, which makes the selection and nomination procedure different to that of the council waiting list by being more sensitive to personal needs.

FOOD
The Modern Food System
The Structuralists sought to understand food as a cultural system. They saw food as being culturally shaped and socially controlled. Food and eating are seen as symbolic of a particular social order. Food, therefore, can never be merely 'just food' and its significance encompasses more than just nutrition. Our food consumption patterns have been compared to language. Teenagers eating junk food may do so because, although they may be aware of the health risks, they are resisting adult norms. To be free from parental constant and share fun times with their friends (Caplan 1997).

The contemporary food system has evolved since the Second World War. Being predominantly developed, managed and promoted by western, rich and powerful commercial institutions. There have been five main societal changes that have influenced and enabled our current food system to develop as it has (Tansey, 1995).

* Urbanisation has extended the food chain that links farmers and consumers. Supermarkets have spread and grown at a spectacular rate. This has fuelled the growth of a consumer monoculture in most countries, which are dominated by large intensively run farms. The centralised buying of supermarkets has led smaller producers to become uncompetitive and they have been squeezed out of the market.

* The globalisation of the food market has enabled only a few MNCs to dominate and monopolise the food system on a global scale. These MNCs have endeavoured to draw even the most self-reliant peasants into the global market, thus only a handful of people have been invested with enormous power. The centralisation and globalisation of food supply has created a new hazard. The opportunity for food borne pathogens and toxins to infect and poison large numbers of consumers. Food contaminated in one country can be traded to another and spread food borne illness internationally creating a pandemic. New food Bourne pathogens have emerged such as E coli 0157 and Salmonella enteridis phage type 4, which is present in one fifth of all poultry (Sanders, 1999). Almost 90% of the fossil fuel energy used in the world's food system is used in transporting food to supermarkets (Tansey, 1995). The average distance that food travels from plough to plate in the US is 2000 kilometres (Germov, p39, 1999). Consumers having to drive to out of town supermarkets further increase the amount of food miles.

* The emergence of biotechnology has allowed public property, such as a seed, to be patented and hence transformed into private property. Research into new methods and technologies in food is almost entirely carried out by MNCs, with much of their money being concentrated in biotechnology. As such the possible benefits of the research is kept secretive, with new developments being patented to protect profits rather than for the common good. The continued use of antibiotics as growth promoters in livestock has resulted in the emergence of multidrug resistant strains of pathogenic bacteria such as Salmonella enterica serotype tymphomurium DT104 (Sanders, 1999). And it is common knowledge that BSE in cattle has been transmitted to humans. The safety assessment of genetically modified foods poses a new challenge. There may be hazards associated with the method used to transfer the gene, the genetic modification may not be stable, the processing of the food may not denature the genes, and there may be new allergens. Although few genetically modified foods have been approved for use within Britain they have entered the food supply after years of use in the US and Canada. The corporations that privately own seed varieties are also the owners of agro-chemical industries. The seeds that have been newly developed are dependant on some chemical input and thus the sale of agro-chemicals has been ensured. In 1983 the British government passed legislation that made it illegal to sell unregistered seeds. The registration process takes two years, costs $500 with another annual payment of $800 and a minimum of 5000 packets must be sold annually (Jenkins, 1991). This has meant that rare seed varieties are excluded from the market and thus large scale monoculture replaces traditionally used local seeds. Food supply relies more and more on fewer crop varieties, those that are common are privately owned by massive corporations and are dependent upon the use of agro-chemicals. Between 1950-86 pesticide use in the US rose by 500%, in latter years one fifth of US crops were lost to pests. The same amount as in 1950! (Goodman, P243, 1991). Billions of pounds, raised through water rates, have since had to be spent on purifying drinking water of chemical residues. The most important element for crop growth, apart from water, is nitrogen, most of which comes from urea a substance that does not have to be produced by a multi-national chemical industry.

* Marketing psychologists are used to devise advertisements that associate certain food products with the pre-dominant values and attitudes in society. Allowing 'whitewashes' and 'green washes' to subdue public discontent with the commercial giants. The food industry has also targeted the health conscious, taking full advantage of the market opportunity for 'niche' products. The health 'niche' is particularly good for the industry as it allows it to process the food less yet still add value to it. Water is commonly used as a makeweight in conjunction with E450 (b), which helps to increase the water carrying capacity of foods. Apart from water adding value it is also used to turn butter into a 'low-fat' spread. Food accessories such as vitamin and mineral supplements are completely artificial and can be detrimental to health. They are targeted towards the health niche all the same. The hazards of toxins leaching into food from its packaging are currently being assessed.

* The traditional housekeeping role has all but vanished in the west, especially in Britain. The food industry has repositioned itself into supporting the emancipation of women. They encourage women to be independent and free themselves from the 'drudgery of food preparation'. As whole families entered the labour market the time, energy, motivation and even the skills to prepare food have been lost and replaced by processed convenience foods. Consumers are generally eating a bad diet because of the lack of accurate information provided for them and their reliance on manufactured foods. Processed food is in direct competition with fresh food, healthy food with unhealthy food. It is more profitable, albeit at the expense of health, to sell processed, pre-made, pre-packaged food. Therefore the food industry concentrates research into this area and not on healthy methods of producing healthy food.

The Fast Food Industry
Americans now spend more money on fast food than they do on higher education. Fast food has become so accepted that it has been compared to routine social customs such as showering in the morning. One quarter of the American population buy fast food every single day. The implications of this go beyond that of diet alone. Enormous changes have had to occur in the landscape, economy, workforce and popular culture. Since 1975 one third of mothers with young children have joined the workforce. Fast food outlets have adopted their traditional role as family cook.

In the US McDonalds employs one out of every eight workers sometime in their life. More than any other business. It is the largest purchaser of beef, pork and potatoes in the world and the world's largest owner of retail property, it may be surprising that most of its profits come from collecting rent.

The standardised, homogenised products and centralised purchasing decisions of McDonalds have allowed it to have an unprecedented power over food supply. Wiping out small businesses and regional differences through its control over agriculture. Our agriculture and eating habits have changed more in the last forty years than in the last 40,000 years due to the influence of fast food. Employment demographics and trends have also changed enormously. In the US restaurants are the largest private employer and they also pay the lowest wages. No other workforce is so dominated by adolescents; two thirds of fast food workers are under twenty. As such they are inexperienced, without unions, part time, unskilled and are prepared to work long hours for low wages. The leading equipment systems engineer at McDonalds said "the easier it is for him [the worker] to use, the easier it is for us not to have to train him."(Schlosser, p71, 2002). Teenage workers are, however, injured twice as much as adults. There is also a high level of violent crime in fast food outlets with more workers being killed on the job than in the police.

The economic, social and political system that has culminated in the spread of the fast food industry has taken precedence over more important democratic values such as safeguarding workers, consumers and nature. The price of fast food does not reflect its real cost. The cost of obesity on society alone is larger than the revenue of the fast food industry. Obesity has recently doubled in Britain, so too has the number of fast food outlets (Schlosser, 2002). The British now eat more fast food than any other nation in Western Europe. The British have also had the same food supply system imported from the US in order to ensure the homogenised quality of the diet.

French fries are the most profitable commodity; bought for 30 cents a pound they are sold at $6 a pound. Profits from french fries do not reach the farmer though. For every $1.50 paid at the counter only 2 cents goes to the farmer. The farmers are subject to an oligarchy where three major MNCs exert power over all the producers. Farmers are thus pressured into getting bigger and more intensive in order to be competitive and ensure a revenue from selling potatoes. If the producers are not competitive the MNCs may shift their processing plants to areas with lower prices and leave vast tracts of potato fields behind.

Social Exclusion
Food poverty is a unique factor in social exclusion. Meals are imbued with social and cultural meaning, they are the fabric around which socialising and family life revolves. Those who are poorly nourished become ill and are less successful in school and work. As basic cooking skills have declined within the population home cooked meals have been replaced by pre-made processed foods. As poor people generally have to buy cheaper less healthy food, the resulting poor nutrition can be blamed on social exclusion rather than ignorance. Since the eighties the free market economy in the UK has favoured superstores on Greenfield sites on the edge of towns. The result has been the closure of small retailers within the town and an increase in the social exclusion of those who cannot travel to the new supermarkets. 84% of the poorest households cannot get to the supermarket, unlike their car owning counterparts (Christie, p27, 1997). The poorest 30% of the population only account for 12% consumer spending which explains why superstores do not locate in low-income neighbourhoods (Christie p27, 1997). The poor, due to real physical isolation and constraint, shop locally. Small retailers can cost up to 60% more than supermarkets forcing the poor to pay more for their food which is less likely to be healthy due to the lack of fresh fruit and vegetables.

Due to government policy being shaped by the food industry the responsibility for healthy eating has been placed on the consumer. The governments policy advocates a version of 'health promotion' which places an emphasis on educating individuals so that they can make informed health choices, even though their may not be any choice, especially for the socially excluded.

Even when the Health Education Authority does try to educate the public it has a limited impact. In 1996/7 the HEA received £700,000 in funding for nutrition education. At the same time £551 million was spent on food and drink advertising through an array of mediums. Some of the large food manufacturers have gone as far as to produce their own material on food and health which they distribute to schools and health authorities (Caplan, p179, 1997). Maintaining a healthy diet has increasingly become a question of consuming the maximum acceptable amounts of fat, sugar, salt etc. As opposed to the minimum requirement or even the optimal amount.

A study by Anne Keane (Caplan 1997) in south London on people's perceptions of information and advice on healthy eating revealed that the majority do not take notice. Instead Keane found that people relied more on informal sources of information such as friends and family. These sources are based on the needs of the people involved and are not tainted by the interests of the food industry. The information and advice provided by the government and the food industry is seen as being biased and motivated by purely commercial interests. This perception of government bias is confirmed for some by the fact that 78% of its appointed independent advisors on food and health receive money from Multi-national food and chemical firms (Caplan, p262, 1997).

The basic human need of nutritionally adequate food is not catered for in the western world. Even though billions are spent on expensive treatments to prolong life the socially excluded do not even receive a decent meal every day of the year. In the US those elder people who have been lucky enough to get on the meals on wheels waiting list are only entitled to 260 meals per year (Action Against Hunger, p308, 2001).

Famine
The western born modern food system has become global, undermining other food systems from the majority world through a process of cultural and political homogenisation and not just western economic supremacy alone. The refashioning of nature that has occurred in order to acquire financial profit has only been possible due to social, cultural and economic restructuring. These changes have had detrimental effects upon the health of many people in the world.

Most of the world's hungry are landless peasants who used to be subsistence farmers. The majority of these are African whose land is owned by only 3% of the population (Germov, p39, 1999). In regions such as Sub-Saharan Africa and Latin America it has been estimated that only one fifth of potential arable land is currently being cropped (Dyson, p115, 1996). 15% of the world's population are undernourished; most of these people live in Asia and Sub-Saharan Africa (Dyson, p37, 1996). The famines we witness in the majority world are often attributed to natural disasters, climatic conditions, overpopulation and a general 'underdevelopment'. The truth, however, is that famines are generally created by human action and inaction. Food problems do not occur in countries that are at peace and where farmers can operate under conditions of relative security. The Democratic Republic of Congo is infinitely better endowed than Burkina Faso in terms of available land, an ideal growing climate and the Congo is not densely populated like Burkina Faso but it suffers greatly from severe food problems due to war.

Countries that suffer from food problems and famine generally have the majority of their productive land owned by colonial descendants who use it to export cash crops. Recent African famines have been accompanied by record harvests in cash crops in the continent. In the 1984 drought tobacco and cotton crops were harvested for export in large tracts of the most fertile and irrigated land (Germov, 1999).

War and armed conflict create famines as hunger is used as a weapon by the regime in power against rebels. Food aid is often misappropriated in the cities enriching merchants and being diverted to those closest to the government and the military. Those most vulnerable are often in rural areas where rebels are active and they often never see the food aid. Sanctions that are imposed in the name of 'peace-keeping' are another major source of man-made famine. The international law that imposes famine overrides any human rights to food. Currently there is no positive law that guarantees a legally enforceable right to food (Action Against Hunger, 2001).

There is enough grain produced in the world to provide each person on the planet with 3000 calories per capita per day (Germov, p14, 1999). This is equal to the average American calorie intake (which is more than the minimum requirement) and it should be noted that this is only in relation to grain and no other food stuffs. Grain is, however, distributed according to profit motives and entitlements rather than on a fair and equitable basis. 25% of grain is lost due to poor storage and decay (Action Against Hunger, p252, 2001). EU subsidies for grain production that mirror those of NAFTA has meant that poorer countries have imported grain rather than investing in their own production potential. This problem has been further compounded by grain aid, which has often been misappropriated and sold for profit. The energy and nutritional value of grain is also lost according to how much processing the food goes through to make value added foods such as breakfast cereal. Ten tons of vegetable protein, mainly grain, fed to livestock converts into only one ton of animal protein, a net loss of nine tons of protein available for human consumption (Goodman, p246, 1991). This simple calculation does not even include the other loses incurred in converting vegetable protein into animal protein. The loss of time, energy, land and of other inputs. The world food problem today is primarily defined in terms of dietary energy deficiency, or under nutrition. Cereal grain, which contains significant quantities of protein, has been described by Dyson (1996) as the single most important element in the human diet.

The Meat Industry
It has been argued that humans, in general, have eaten what was good for them. Concentrating on three basic food types, complex carbohydrates such as potatoes, flavour foods to make the carbohydrates more palatable and protein carrying plants such as beans. It has been argued that this general trend has only changed dramatically on a global scale after the industrial revolution in Britain. After imperialism the global diet has changed to include an enormous amount of animal fats and sugar thus detracting from our nutrition. This change in diet was accelerated by the merging of the chemical industry and agriculture and through advertising has been accepted as being 'naughty but nice'.

In the UK we produce food for 24 million sheep, 13 million cows, 8 million pigs and 125 million chickens. As our consumption of meat has increased so too has the amount of land used for homing and feeding these animals. Agribusiness has also been changing the diet of these animals, up to the point where now they are eating the same diet as humans, be it in a less palatable and concentrated form. We are now in an entirely new historical predicament where farm animals, through deliberate human intervention, have become direct competitors with humans for food and the land on which the food is grown. 38% of grain produced is consumed by livestock (Dyson p46, 1996). Further more, the land overgrazed and compacted by livestock is degraded. The soil being physically deteriorated and made unsuitable for arable use.

A strategy of MNCs is to integrate operations vertically, monopolising the food source. This can be seen most clearly with the patenting of GM seeds that has allowed MNCs to completely monopolise the food supply industry from seed to plate. MNCs are interested in shifting human consumption away from vegetables to factory farmed animal products as these can be processed and be value added allowing greater returns on investments. Due to the continuous industrial production systems that operate like fordist factories, MNCs also guarantee a return on investments in the meat industry as the harvest is no longer dependant on an unreliable climate and the change of seasons.

Chapter 4
The Pathogenic Influence of the Current Capitalist Spatial Organisation of Society in Regards to Three Primary Determinants of Health, Transport, Housing and Food.

TRANSPORT
Health Effects of Motorised Transport
There are many health effects related to motorised transport. They are generally negative and hit the socially excluded much more and in more ways than wealthier people. They include injuries and death, pollution (from particulates, Nox, CO, hydro-carbons, ozone, lead and benzene amongst other toxic chemical compounds). Noise and vibration causing stress and anxiety, severance of communities, loss of opportunity for physical activity that is linked with coronary heart disease. Reduced access to affordable and healthy diets, healthcare services, employment and social and recreational activities. The car also causes reductions in non-traffic street activities and loss of land available for other healthier uses.

Accidents
There are more than 300,000 casualties on the road yearly, 3000 people die and 30,000 people are seriously injured every day across the world, this means that traffic crashes are rising to third place in the world ranking of burden of disease. Traffic crashes are also the leading cause of death and hospital admission for people aged under 45 in the EU. A steep social class gradient has been identified amongst victims with the poorest children being the most likely to die or be injured on the road. Half of all accidental deaths in the UK are caused by traffic (BMJ, 11/05/02).

Air Pollution
More than 24000 deaths have been induced by air pollution in the UK and more than 2400 people are admitted to hospital every year due to air pollution (HEA, p4 1998). Traffic is the main source of air pollution, which has been increasing dramatically, and inducing more and more respiratory problems, heart disease and cancers. 63% of Nox emissions in Europe come from transport (European Commission, 2000). Air pollution also damages crops and wildlife and produces acid depositions that destroy buildings. The rate at which emissions are absorbed by the body is highest for people on a poor diet. Children, the elderly and unborn children suffer most from traffic emissions, they are also the least likely ones to drive (Huby, 1998).

Noise Pollution
59 million people complained about noise traffic in 1993/4, which has been related to ishaemic heart disease, poor performance and mood in work and school and to several psychiatric disorders. Two thirds of noise pollution is caused by traffic (HEA, p4 1998).

Community Severance
In the city, severance of communities by roads not only destroys neighbourliness and social support but also has the worrying impact of reducing physical activity amongst children. Poorer people are more likely to suffer from severance and all of the negative impacts of increased traffic, they are more likely to live in areas of high traffic with its pollution, noise and inherent danger. Poorer people are also less likely to own motorised transport and thus be less able to get to vital services in areas beyond walking distance.

HOUSING
There is extensive evidence on the relationship between housing and health and the link between housing inequality and health inequality. The influence of housing on health has been thought of being most pronounced with homelessness and thus much research has focused upon this. In 1991, however, 1 in 14 houses in the UK were seen as being unfit for human habitation (Griffiths, p68, 1999). Housing costs account for the most significant proportion of expenditure and as such can lead people into poverty and employment traps. Heating is also a significant cost, accounting for over half of domestic energy use, which directly effects health and which is often limited in poor households thus increasing the health risks of the poor. The immediate surroundings of a home can exert a powerful influence on health such as adding to the risk of the list below but researchers have paid very little attention to this factor. Poor housing, both inside and outside and in relation to the accessibility of support services such as primary health care has been associated with the following impacts on health

* Heart disease

* Mental health problems

* Respiratory problems

* Home accidents

* Digestive system disorders

* Restricting child development

* Increased rates of cancer

(Griffiths, p70, 1999).

Housing policy, which is dominated by the individual consumption of private property increase these and other health problem as the market fails to provide the 'goods', required.

Home Ownership
The link between poor health and low income is well attested but does housing have a health impact beyond its relation to low income? It is sometimes difficult to isolate the independent effect of housing conditions on health from other areas of social disadvantage. The most frequently employed indicator of housing conditions is overcrowding which can be responsible for respiratory problems, stomach cancer and heart disease in adults who grew up in overcrowded housing (Marsh, 1999). A recent study, however, has found that people from a low socio-economic category who suffer multiple housing deprivation increase their risk of severe ill-health by 25% when compared to people from the same socio-economic category who have reasonable housing (Marsh, p58, 1999).

The accumulation of health risks in childhood and adolescence create significant health problems in adulthood. People who grew up in an owner occupied house are much more likely to rate their own health as excellent/good in comparison to those who moved from owner occupied housing to the private rented sector in childhood. Overcrowding during childhood has been identified as a cause of delayed depression that can manifest itself up to 20 years later. Self-rated health shows a dramatic contrast between 'well-off' and 'other' neighbourhoods with social class at birth and housing tenure during childhood being responsible for morbidity in later life. Marsh (1999) carried out a life course approach to epidemiology discovering that health risks can accumulate through the decades and act to increase the overall health risk in later life. Marsh identified non-home owners living in non-self contained accommodation who had a dissatisfaction with the area as having an increased risk of severe/moderate ill health.

Housing problems usually take priority over health related problems for the individual (Barrow, 1997). Solving peoples housing problems therefore improves their ability to tackle other problems effectively and improve themselves. It is clear that a wide range of ailments including coughs and colds, aches and pains, asthma, digestive disorders, stress and depression are seen by residents of poor housing to be caused by their home (Barrow, 1997). A survey over 150 days in areas that used to be slums before clearance such as Tower Hamlets found that deprived areas had an average of 2.62 episodes of illness per household compared to 0.36 episodes in healthy controls (Barrow, p8, 1997). Much of the costs of poor housing on health does not fall on the health service but on the individuals themselves and often in unquantifiable non-monetary ways. The financial cost of the 150-day survey on the health service was £515 per household compared to £72 in the healthy control (Barrow, p9, 1997). Non-home owners with expensive health problems may be restricted to council housing due to their reduced opportunities for work and the inherent extra living expenses incurred due to their morbidity (Barrow, 1997). Or they may be marginalized into poor housing in the private rented sector, which is inappropriate as it provides less security. Their health problems may also lead to a poor state of repairs leading to poor heating, damp and mould and insufficient ventilation thereby further impairing their health. There is a causal relationship between ill-health and the ability to secure reasonable housing which results in the concentration of poor quality housing in areas suffering deprivation being occupied by those suffering from ill-health. Inadequate housing may further compound health problems; bad cooking facilities may result in accidents and an unhealthy diet, to offer just one example (Balchin, 1998).

Illegal drugs are used to dull the reality of an unhappy life of which poor housing is commonly a part. Those who have been through drug rehabilitation programs prefer not to return to their previous accommodation for fear of relapse. A typical drugs unit has an annual budget of £300,000 to treat approximately 440 people per year for which an extra £2000 is paid for each client by the health authority (Barrow, p9, 1997). Those living in deprived housing are the most common clients, even more so than the homeless. GPs and nurses often spend time listening to complaints about housing as opposed to specific ailments. It seems that good housing conditions encourage self-care and self-organisation.

"Many of the physical characteristics of the housing and living environment have a major influence on mental disorder and social pathology through such stressful factors as noise, air, soil or other forms of pollution, overcrowding, inappropriate design, inadequate maintenance of the physical structure and services, poor sanitation, or a high concentration of specific toxic substances."(WHO in Huby, p71, 1998).

The benefits of home ownership for those with mental health problems include them attaining an enhanced status and esteem, having the security of tenure and a financial investment as well as an increased independence and choice. When owner occupation is shared those suffering from mental illness also receive mutual support from living close together even though they may have self-contained accommodation. Housing also becomes more affordable with shared ownership sometimes being cheaper than renting (King, 1998).

Good quality, secure housing is key to tackling poverty and social exclusion. Once the problem of a 'decent' home is solved the individual is much more likely to improve themselves and have better health. Tenant controlled housing has shown the benefits of better health and a 25% reduction in public subsidy. Tenants who self-build receive many more benefits such as employment, training, sweat equity and control over design.

FOOD
Food and illness
Food related illness is a leading cause of premature death, coronary heart disease and certain cancers. There is also a rise in cases of food poisoning and other less well-defined problems such as allergies to additives in processed food and the build up of pesticide and anti-biotic residues.

The heavily subsidised modern food supply system has cut down the amount people spend on food from 30% of total income in 1950 to only 10% in 1990. This is except for the socially excluded who still spend 30% of their income on food (Griffiths, p52, 1999). The cost of the public and environmental health problems caused by modern food production has, however, been externalised. The Department of Health's 'Burden of Disease' (1996) calculated that bowel cancer costs the nation £1.1 billion per year and diseases of the circulatory system cost 12.1% of the total health and social services budget. The costs of disease range from lost working days, invalidity benefits, lost production in industry and direct treatment (drugs and medication). The British Heart Foundation estimated that treating coronary heart disease cost £10 billion in 1994 (Griffiths, p50, 1999).

In the US 200,000 people are sickened by a foodbourne disease every day, 900 are hospitalised and 14 die. More than one quarter of the US population suffer food poisoning every year. Many foodbourne diseases precipitate long-term ailments such as heart disease, inflammatory bowl disease, neurological problems, auto-immune disorders and kidney damage. That is after they suffer the initial gastrointestinal upset that makes them feel like they are going to die.

The rise of this type of morbidity has been attributed to the recent shifts in food production. The industrialised and centralised processing of food that happens on an enormous scale (fifteen packing houses provide most of the beef consumed across the US) often acts as a vector in the transmission of serious disease to perhaps millions of people across the globe (Schlosser p195, 2002).

The food industry, after criticism, changes. Usually only producing technical fixes such as 'low fat fat' products that still contain lots of fat but less than their generic equivalents. This technical fix and type of advertising has been criticised for encouraging people to retain their unhealthy eating habits by buying the lower fat alternative as opposed to changing dietary habits completely. And while the food industry may be suggesting to us to take more exercise, shifting attention from the potential negative effects of their products, it is actively encouraging a more sedentary lifestyle. We have to drive to the supermarket to get our healthy food, and our petrol.

Food in the Majority World
Algal toxins can clump together in tides and accumulate in the marine food chain. They create paralytic and diarrhoetic shellfish and neuropathy, which can be fatal. This type of food poisoning has been estimated to infect 9.4 million people a year in England alone. People in the majority world are at a greater risk from toxicants as they have a limited diet, they may have to eat food unfit for consumption out of necessity and they may lack the resources to process it effectively into a safe form. 3 million children under the age of 5 die from diarrhoea in the majority world after consuming contaminated food or water. (Sanders, 1999).

'Diseases of civilisation' associated with diet such as obesity, diabetes mellitus, coronary heart disease, appendicitis, haemorrhoids, varicose veins, deep vein thrombosis, various cancers, gallstones, dental caries, hyper tension and angina have emerged when simple agrarian societies of the majority world have changed their diet to that of industrialised nations (Jenkins, 1991).

Another cause of morbidity and mortality is the indiscriminate use of agrochemicals without public education on safety. This increases the risk of foodbourne outbreaks of poisoning. This may seem an obvious statement but the use of deadly toxic organophosphates has been fiercely pushed onto the majority world where many farmers have not been educated on the safe use of these chemicals and who may be illiterate, unable to read the instructions.

One instance of this kind of poisoning affected 60 Indian men who sat down together for a communal lunch. Within three hours of starting their meal they all developed nausea, vomiting and abdominal pain. Three men lost the full use of their muscles, suffered respiratory distress and reduced consciousness. One man developed miosis, sweating, impaired consciousness and hypotension. His muscle power and reflexes reduced to the extent that he could not raise his head from the pillow he was resting on. He developed respiratory insufficiency and failure with paralysis of the diaphragmatic muscles. He later had a cardiac arrest and died.

The chapatti the men ate was contaminated with an organophosphate pesticide. Whilst the first three men had only eaten three chapatti the forth had eaten eight. Since the introduction and widespread use of agrochemicals in the majority world the incidence of foodbourne poisoning has increased. The World Health Organisation estimates these poisonings to number over one million every year. The indiscriminate use of agrochemicals without appropriate public education is increasing and so too is the potential for more outbreaks of food poisoning. It is a continuing and growing hazard (Dhawan, 1998).

Chapter 5
From the Pathogenic to the Salutogenic Spatial Organisation of Society

TRANSPORT
The individually owned car is the preferred method of transportation. Unfortunately this lifestyle results in a diseconomy where the socially excluded suffer the majority of the enormous range of impacts on our collective health. Nobody, no matter how wealthy, can avoid the negative impacts of our current transport system. The environment is severely impacted upon along with Nature and human health. Our current planning system along with poor public transport systems makes car use necessary and therefore creates unnecessary mortality and morbidity. Evidence based research into healthier alternative transport systems and a national Strategic Environmental Assessment could be used to devise informed local plans and a national transport policy that can be integrated with a sustainable planning policy to create a healthier society. Local authority schemes of traffic calming have given substantial gains in noise abatement, air quality and pedestrian safety despite the lack of help and encouragement from central government (Davies, 2000). Local authorities cannot remedy the transport problem themselves though. The transport sector is inextricably linked in with every economic sector but the current national transport policies result in severe environmental impacts. A Strategic Environmental Assessment of transport is needed on a national level in order to improve policies, plans, and programs. As the transport sector is multi-modal, multi-scale and multi-actor Environmental Impact Assessments on a local level would not provide enough accurate information and could even be deceptive of the true entire impact of national, regional or even local transport policies.

It is unrealistic and undesirable to resign the car to history. Instead the car should be used more responsibly. The notion that individually owned material possessions, such as the car, and personal liberties, gained through such things as the car, increase social well being as a whole still prevails even though the evidence shows that this is obviously wrong. The impact of individually owned motorised transport is not cost effective for society as a whole. The car should only be used when it is truly cost effective. The most important factor, along with sustainable planning and healthy government policy, in changing traffic patterns is individual choice. The diseconomy of the car cannot be rectified until people change their attitude towards the elite's choice of transport from envy to derision. In 1951 cycling accounted for 25% of all traffic now it only accounts for 1% (Huby, p97 1998). This is partly due to the lower social status associated with the bicycle as a means of transport.

Freight transport by road has increased enormously as more goods are being sold further and further a field. Local economies reduce the need for the transportation of consumer goods. Any transport policy, which does not aim to severely impact the health of society, should therefore be integrated with a planning policy that ensures all vital services are within walking or cycling distance. Residential streets should remain areas of community interaction where pedestrians and cyclists have priority. Spending should be diverted away from the car towards a viable public transport system. Out of town developments and existing villages should have all of the essential services within easy access and the economy, production and consumption, should be localised. The distance between production and consumption should be the minimum possible. People should be fully informed about the detrimental impacts of the current transport system thereby allowing them to adapt their personal behaviour and the spatial organisation of society.

HOUSING
Current housing policy is reactive to practice and directs research into management issues. Policy makers neglect the accumulated evidence on the link between housing and health in order to use housing as an economic instrument rather than providing it as a basic human necessity. There is an argument that the link between housing and health is hard to isolate and that the health effects of housing are unquantifiable and so therefore policy cannot change. There is, however, a clear link between the market led consumption of private property and the inequality and lack of provision suffered by the poor and those afflicted with ill health. Home ownership has been proved to be valuable for the health of the individual, especially the child. But current house prices and the lack of available 'decent' homes marginalize those in poor health and housing need into deprived areas. Unfortunately for them these deprived areas are poorly catered for by the health system due to the 'inverse care law' of the market led distribution of services.

Local authorities and other bodies have highlighted the need for concessions, financial and other wise, for developers in order for them to make sustainable development and healthier communities a reality. The sustainability of current construction methods is, however, not evident. A house built in the UK will not only have a detrimental environmental impact in the UK. CO2 emissions will add to global warming. The mining and logging of the majority world for construction materials will not just have a local and global environmental impact but may create war and repression.

Good quality, secure housing is key to tackling poverty and social exclusion. Once the problem of a 'decent' home is solved the individual is much more likely to improve themselves and have better health. Tenant controlled housing has shown the benefits of better health and a 25% reduction in public subsidy. Tenants who self-build receive many more benefits such as employment, training, sweat equity and control over design.

It is not enough to insert health policy piecemeal into housing planning (or visa versa). What is needed is real integration where the different agencies embark upon joint planning, joint funding and joint working between staff. Economic, social and environmental issues have to be considered in terms of which policy would increase the health of people the most.

In order to be sustainable the construction process and building design need to address the following issues

* Energy use in construction process

* Embodied energy in the building

* Amount of re-cycled material used

* Energy used in transport of materials to building site

* Re-cyclability of materials used

* Environmental damage caused in extraction

* Energy use in manufacture of materials

* Waste produced as a by product of construction and during construction

* Amount of water used in construction and during buildings use

* Economic, social, political impact

FOOD
It can be seen that the modern food supply system creates a lot of ill-health and mortality across the world. From pandemic infections of foodbourne pathogens, cancer, famine, mal-nutrition (both over and under eating), food poverty and social exclusion, inequitable land distribution, pollution of land and water to wasted time, energy, food and land and the production of inappropriate crops in inappropriate ways to inappropriate sections of society.

Dividing all of the agricultural land in the world by the world's population leaves 1/3 of a hectare of arable land and 2/3 of a hectare of land for pasture a total of 100sq. metres of agricultural land for each person (Jenkins, 1991). 100sq. metres of land can provide enough vegetables for a person throughout the year. The cost of home grown food is cheaper, for every £1 spent on producing home grown food an extra £8 is spent for the equivalent from a supermarket (Hessayon, 1989). Baring all these facts in mind it is obvious that any alternative health policy has to take our diet into consideration. Not only our nutrition but also the entire food supply system. In order to ensure a healthier society any new food policies should be concerned with encouraging a localisation and decentralisation of food production, a land distribution away from the current corporate domination of agricultural land to an organic regionally based system. More people have to be employed in rural areas to provide unadulterated predominantly vegetarian food on a more equitable basis. Food crops that provide food security should take precedence over cash crops whether they are for use within the region or for export. The ownership and control of the food supply system should be public so as to prevent the monopolisation of food supply and the subsequent unhealthy search for profits at all costs. Only then could we as a society receive the full health offered to us by nature.

SUMMARY
This paper looked at transport, housing and food systems as primary determinants of health. The section on transport concluded that a SEA is needed on our transport policy and that any new transport policies be fully integrated with planning policy. The distance between producer and consumer and the distance people have to travel in order to reach essential services should be the minimum possible. It is healthier to walk and cycle. A transport policy which encourages people to walk and cycle will not be effective unless there is joint working on a planning policy which puts the essential infa-structure in place. The role of personal behaviour and attitude was highlighted as being a vital factor in determining the health of society. It was argued that the public needed an education that emphasises the different health implications of the different transport systems in order that they could adapt their behaviour and take control of their health through a healthier spatial organisation of society.

An eco-village project underway in Devon is creating an integrated settlement which it is hoped will ultimately provide the economic and social needs of the villagers whilst having a minimum impact upon the environment. Living on site eliminates their need to drive to work. Additionally, they reduce their food-miles (and further reduce fossil fuel use) by buying local produce and growing much of their own food.

Walking and cycling meets most of their local transport needs. However, for the foreseeable future, they will continue to make longer trips or carry large loads, using motorised transport, with their communal minibus (the only motorised vehicle in the village) or public transport. By mixing the use of their land to include employment, retail and residential uses they effectively reduce the need for travel, especially with motorised transport. They also use locally produced bio-diesel to minimise the pathogenic impact of their minibus (www.stewardwood.org (2003).

Another eco-village in surrey has a three point transport strategy which aims to create a healthier and safer environment by reducing the need to travel, promoting public transport and offering alternatives to the private car ( http://www.bedzed.org.uk/main.html (2003).

The section on housing concluded that housing developers need concessions in order for them to adopt sustainable practices. Good quality, healthy and sustainable homes are essential for health. Tenant controlled housing is more beneficial both financially and in health terms. The causative relationship between housing and health is clearly recognisable and thus any health policy has to be fully integrated into housing policy.

The architecture of Bed ZED eco-village has received praise from the Royal Institute of British Architects as being the best example of sustainable construction. There are also other middle-class eco-villages such as those in Hockerton and Sherwood which employ professional architects. More economically accessible eco-villages such as those in Devon are more likely to employ self-build methods where straw-bale buildings and yurts are common sights. These buildings are less pathogenic and more sustainable than those which use concrete and plastic.

Health policy also has to take the entire food system into consideration. A decentralised, localised predominantly fresh, vegetarian food system is healthier. Plants for a Future (PFAF) is an aspiring eco-village of approximately twenty people. It is a resource centre for rare and unusual plants, particularly those which have edible, medicinal or other uses such as fibres for clothes, rope and paper, oils for lubricants, fuels, water proofing and wood preservatives, dyes, construction materials etc. The primary purpose of PFAF is to gather information on, to grow and to demonstrate the vast range of useful plants that can succeed outdoors in Britain. They practice vegan-organic permaculture which places an emphasis on creating an ecologically sustainable environment using perennial plants within a holistic approach.

Their ultimate intention is to demonstrate that one person can obtain all their food, plus various other commodities such as clothing, fuel, medicines etc. from just one acre of land, and that this land will also be able to support a wide range of other creatures. By emulating a woodland and carefully selecting the species of plants used they hope to produce a wide range of edible fruits, seeds, leaves and roots throughout most of the year and eventually be able to supply produce to the wider community.

There are several reoccurring themes that emerge from looking at these three primary determinants of health. The first is the need for policy integration between sectors. Any sustainable transport policy can only be effective if it is fully integrated with planning policy. Housing policy needs to be integrated with health policy and any health policy needs to be integrated with a policy for a sustainable food system.

Another reoccurring theme is the need for decentralised, community led development. In the transport sector a policy is needed to encourage all services to be localised to reduce the present systems detrimental health impacts. The construction materials used by the housing sector need to be locally sourced to prevent environmental degradation, morbidity, mortality and conflict elsewhere in the world. The food system has to be localised to avoid the excessive impacts of the current globalised system. Community healthcare only works with the active involvement and empowerment of the local community.

There are other determinants of health not covered in this paper such as sexual relationships, the workplace, family structure and others. 70% of homeless cases in Britain are caused by intimate relationships falling apart (The Times, 21/08/02). Not only do these people suffer the emotional and psychological distress of a failed relationship but increase their risk of morbidity further due to being homeless. Although the extent to which these other factors impact upon health has not been looked at in this paper it is fair to hypothesis that inter agency integration, relevant and comprehensive education and localisation which empowers communities would not further impact upon health in a detrimental way.

The new government organisational structures such as HAZs allow for interagency integration. These new organisational structures are by no means adequate. There are still barriers to the development of healthier communities existing from global to individual levels.

PROPOSED SPATIAL REORGANISATION OF SOCIETY
An eco-village is a community unit that has fully integrated policies for transport, housing, food supply and other health determinants. It brings together the community into a strongly bound active group that is concerned with improving the health and well being not only of themselves but the wider society as well. Eco-villagers fully integrate considerations of housing, autonomous health, transport, food and other health determinants into their structure and daily running. Eco-villages are a force for wider bottom-up community development. But they need to receive subsidy and finance and develop a network that can bring local builders, local business, local healthcare practitioners, local farmers and others into healthy community development projects.

The following developments need to occur in order for any given community to be healthier.

Community's need

* Access to land for food, recreation and building materials. Equal land distribution would allow each person access to one hectare of land. This land could be collectivised and policies devised by stakeholders.

* Help to design and build their own homes

* Tenant controlled housing

* Predominantly vegetarian food co-ops that sell local produce

* All essential services have to be within walking distance

* The local business community needs to collaborate on setting objectives for healthy community development

* Government agencies need to aid bottom-up community development through inter agency co-operation, providing finance and networking between relevant sectors

Capitalist State led economic growth is intended to improve general well being. The link between State led economic development and increased well-being is not straightforward. One indicator of economic growth is the level of car ownership amongst the population. Increased car ownership amongst the population results in a down turn in well-being especially for the socially excluded. This paper has illustrated how the spatial organisation of our current capitalist society is pathogenic. Instead of economic growth being a precursor to well being health policy should take priority. Considerations such as the 'health' of the economy should be subsumed to the effort of maximising general well-being directly. The development of eco-village federations within localised economies (Bio-regions) would be a salutogenic reorganisation of society. The anarcho-syndicalist ownership of land, production and distribution within eco-village federations would ensure community ownership and control over the determinants of their health. This would ensure that the spatial organisation of society would transform the primary determinants of health from being pathogenic to salutogenic.

Unfortunately a specific, ideal, eco-village working in accordance with the principles of a localised economy does not exist. Many communities around the world are aspiring to the ideal but few are close. A study of the health impacts of an existing eco-village upon its members and the wider community would still, however, be of value.

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