Amoy Gardens is a cluster of 19 tower blocks in Hong Kong, home to no fewer than 19,000 people — enough to populate several rural villages.
In 2003, it became the dramatic focus of the world’s attention when 321 residents were diagnosed with severe acute respiratory syndrome (SARS).
The rapid accumulation of cases, particularly in Block E, caused panic.
Hong Kong police and medical staff in protective suits were stationed at the entrance to prevent anybody leaving or entering. The entire block was quarantined. The outbreak was a conclusive riposte to anyone who still believed that infectious diseases were history, or that they were restricted to impoverished or conflict-torn countries. And it showed how cities can be terrifying incubators.
From bubonic plague in the Middle Ages to bird flu or SARS in the 21st century, infectious diseases have spread horrifyingly fast in cities, where people live in close proximity and sometimes crowded together.
For all that face masks have become common apparel in Asia, city dwellers simply cannot guard their own health independently of their neighbors.
On the contrary, cities need careful planning for health. While infectious and contagious diseases are the most obvious hazard, it is now recognized that the urban environment also has a major part to play in chronic illness.
Heart disease, stroke, diabetes and cancer rates are rising, fueled by unhealthy lifestyles; fast food restaurants proliferate in cities; convenience or fear of busy roads prevents cycling and walking; and there is little green space for active leisure or children’s play.
The Amoy Gardens outbreak also pointed to another factor that even rich cities find hard to master: sanitation.
The official investigation found that the breeding ground for the SARS coronavirus in the Amoy blocks was the toilet system. Each block had eight vertical soil stacks to take waste from toilets, basins and baths, but too little water was passing through to flush it all away. Contaminated water droplets were blown back in by the bathroom air-extractor fans.
Sanitation is a huge issue for cities in low and middle-income countries and the Amoy Gardens experience shows just how important and difficult it can be even in the rich world.
Manchester Urban Collaboration on Health director and WHO expert Arpana Verma says that because monitoring and surveillance of infection is so good in the UK, many British people feel a fundamental human right to clean water and sanitation — which indeed is something the WHO’s next set of millennium development goals may set out.
“Even though we have a high population density i n the cities, we have the infrastructure in place to monitor and prevent and control the outbreaks that happen elsewhere and we used to see,” she says.
Key to this are good hospitals and labs to test the contacts of people who fall ill.
In the slums and shantytowns that have mushroomed around every major city in the developing world, it is a different story.
Half of Mumbai’s 11.2 million people live in slums. Most must use public toilets or defecate in the open. Because those who live in makeshift housing have little space, no money and no right to the land they live on, there is no chance of a conventional sewage system being built — certainly nothing to match the one in the richer part of Mumbai that was constructed by the Victorians in the 1860s.