The new public health paradigm: theoretical foundation
In order to understand the intersection between the two disciplines of public health and urban
planning better, it is important to gain insight into the new public health paradigm and its
theoretical underpinnings. This information provides the framework behind the need for
collaborative efforts among multiple disciplines, specifically public health and urban planning,
which result in healthier neighbourhoods, towns and cities.
Health can mean many things to different people. One of the most useful definitions of health is
that from the Constitution of the World Health Organization (17):
Health is a state of complete physical, mental and social wellbeing and not merely the absence
of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the
fundamental rights of every human being without distinction of race, religion, political belief or
economic and social condition.
Not only does this statement define health, it is evidence of the public health pendulum swinging
away from a medical model and back towards a social model – the new public health paradigm.
The medical model focuses on the individual and on interventions that are used to treat disease.
By contrast, a social model considers health as an outcome of the effects of socioeconomic
status, culture, environmental conditions, housing, employment and community influences. In
1986, the First International Conference on Health Promotion in Ottawa declared that “the
fundamental conditions and resources for health are peace, shelter, education, food, income, a
stable ecosystem, sustainable resources, social justice and equity. Improvement in health requires
a secure foundation in these basic prerequisites” (Annex 1) (18).
Stemming from these definitions of health, the new public health paradigm has six major guiding
tenets. These tenets convey the breadth of public health and the need for health, in the broadest
sense, to be considered in urban development and urban planning policy-making. The tenets are
1. Health is not merely the absence of disease or disability.
2. Health problems are defined at the policy level.
3. Health is a social issue.
4. Improving health status requires a long-term focus on policy development.
6. Improving health status requires involving natural leaders in the process of change.
The field of public health is currently shifting its focus to one that embodies these principles, but
no direction can develop without theoretical underpinnings.