Preventative Health Care Practices in the Urban
Environment of London and Paris
Wiaam Y. Elkhatib
R497: Individual Readings in Sociology, Urban Sociology in London & Paris
Spring 2014
Indiana University School of Social Work
Indiana University-Purdue University Columbus
1
Preventative Health Care Practices in the Urban Environment of
London and Paris
The effects of global industrialization, lack of proper waste management, and
limited medical resources all can have a negative impact on the well-being of residents
living within an urban community. Increasing awareness regarding the lack of
preventative health practices in a community can serve as the precursor for sociological
change, but also provides information on quality of life, safety, gentrification patterns,
and ultimately economic prosperity. While it is already known that poorer health
conditions exist in impoverished communities and affects class system relocation, this
research initiative serves to reiterate understood concepts while providing theoretical
justifications with the hope of finding potential future solutions specifically in London,
England and Paris, France. Areas of specific focus for this observational research
excursion included health practices around food in restaurants, litter and waste
management in cities, resources available for the homeless, public health campaigns via
advertisements, and types of popular foods with regard to portion size and nutritional
value. Preliminary preconceptions regarding the nature of this topic formed the
hypothesis that London, UK would have an overall healthier and more sanitary
environment than Paris, France or even Indianapolis, Indiana in the United States. Such
conjecture was rooted in the simple notion that the United Kingdom’s economy was
much stronger than that of the financially declining France or USA. Objectives of
learning included gaining observational data to affirm this hypothesis in detail, reflecting
2
on methodologies, and justifying such data from a sociological perspective with the
ultimate goal of providing potential solutions.
Based on the nature of the research question, the methodology of attempting an
analysis was purely observational and would require supplemental literature reference for
affirmation of observational conclusions. Firstly, to address the concept of food
sanitation, the number of visible chefs wearing gloves and exercising sanitary
enforcement measures at visited eating establishments was recorded with previous
measures in mind taken by the Indiana State Department of Health and other related
Hazard Analysis Critical Control Point (HACCP) systems (McSwane 2000). Menu item
portion sizes and common dishes served among retail eateries were also taken into
account as often as possible. To address environmental wellness, counting of the type and
frequency of recycle bins, waste bins, litter by city region, and clues as to method of
removal were taken note of, along with what is being done about any present issues.
During official tours of the first settlement house named Toynbee Hall, various homeless
shelters, and famous tourist sites, informal interviews were given to many of the tour
directors while notes were taken on the surrounding areas. Close observation was also
carried out at metro stations since they are widely used as a form of public transportation
in Europe and parts of France. Lastly, a record of advertisements and billboards found on
road sides and predominantly within the underground metro stations was taken to assess
popularity of certain health products or fads. Aside from potentially being viewed as an
obvious tourist by locals, no harm or adverse effects on the surrounding people or
3
environment of study was done as a result of this research, as seen by the methods
previously described.
Total field time in each city of interest consisted of five days in London and two
days in Paris, establishing an immediate limitation of the extent of acquired information.
Among these limitations inherent in the methodology, others included not having the
time or resources to conduct meaningful surveys or to generate statistics to measure
exactly the magnitude of this research question. Also, the entirety of London and Paris,
along with their surrounding areas, was not visited due to time constraints and thus any
made observations may be descriptive of only small portions of the cities. Consequently,
observations by their very nature are subject to personal interpretation which is rooted in
past experience or cultural background. Observational data in general may also be subject
to construct, external and internal validity misconceptions, therefore potentially
misappropriating cause-and-effect justifications. Therefore, the collected data may be
subject to fallacies or bias, and more field time would be required to remedy these
limitations.
Despite any methodological shortcomings, a pool of observational data was still
acquired sufficiently large enough to provide reasonably detailed descriptors which seek
to develop the research questions at hand. Although a vast amount of written reflections
exists, only the most prominent ones were selected on the basis that they adequately
generalized other reflections recorded which were not specifically included in this
analysis. It should be noted that much more data exists for London than Paris due largely
4
to differences in field time between the cities. Both were compared with respect to five
overall subjects listed as follows. Firstly, with respect to waste management, only
Heathrow Airport, the location of arrival into the United Kingdom, had many recycle and
waste bins as commonly seen in the Indianapolis public areas. However, venturing
further outwards into the city, rubbish and litter in the form of fast food wrappers and
cigarette butts was prevalent across road sides, public spaces, and they even enveloped
the staircase leading into the British Museum. This observation held true for both higherclass and lower-class populated areas. With the exception of St. James’s Park, some
famous tourist attractions such as the London Tower and the Night Bridge were kept
cleaner than usual, but still had a minimal number of waste bins. The scenario did not
improve towards residential areas, where trash bags were nakedly tossed outside
doorsteps and roadsides for eventual pickup, increasing the chances of rodent or parasite
infestation. Despite such issues, the public seems quite aware, since signs on posts
threatening heavy fines for dumping rubbish and a few advertisements in public
transportation venues asking people not to litter were seen occasionally. In Paris, more
waste bins were seen, which consisted of clear trash bags supported by a large ring and
post. Concord Square was thus very clean, but while most streets are cleaned three times
a week, many richer areas get cleaned up to eight times per day. A bus guide
inadvertently mentioned that air pollution had been becoming an issue in Paris as well.
As far as transportation and recreation were concerned, 8.2 million residents in a
tightly packed and diverse community have to get around London daily. Cycling and
running were seen to be quite popular, as many residents openly partook in such activities
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in parks and sidewalks at all hours of the day. The London Underground metro system
and buses/taxis serve as great public transportation systems in contrast to Indianapolis,
for example, where most everyone commutes by car, thus limiting pollution and heavy
traffic. Help points and emergency stops at all metro stations showed good urban
planning with respect to concern for public safety as well. Location does affect
cleanliness though, as not all stations were equally maintained, a concept that becomes
more apparent in Paris.
The metros seen in France were ill-maintained, sporting large amounts of litter,
wall molding, seat stains, and at times unpleasant smells. They seemed less popular than
in London, and more commuters were observed since many workers had to get from the
outskirts of Paris to the center each morning. Drinking and smoking was done quite
publically and frequently by locals in both cities, while ironically there stood “No
smoking” signs on most buildings. Pubs were scattered as far as the eye could see, and
drunks passed by on multiple occasions at night (especially around the time of the Saint
Patrick’s Day Parade). Ash trays were as scarce as waste bins, which did not help the
litter situation. Advertisements protesting against pollution in poorer areas of the cities
(in the form of graffiti) were seen on occasion, but not many commercialized health
products were advertised to the extent as in the USA. Market Street in London was the
only one that had a single advertisement to drink less sugary products, and a few fitness
movement ads were seen once next to each other on a train station near the British
Museum. Alcohol ads seen were seen frequently in metro stations, though. Piccadilly
Circus and the Waterloo train station in London were the only two that had multiple ads
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for vitamin drinks and an L.A. Fitness Gym that recently opened. Parisians were seen
smoking even more frequently than Londoners and only a single gymnasium was
observed there during the length of stay.
Homelessness and public safety was the fourth subject of interest, but London
scored relatively well in comparison to Paris. The Aldgate and Embankment train stops
both had around 6 visible homeless people (mostly female) collectively each day, yet
most of London did not have many visible homeless people at night. East of Aldgate was
a more ghetto area with an Arab and black predominant population; not a very safe part
of town, considering that many shady strangers tried to openly stop people and lure
individuals out of groups, all accompanied by a non-apparent police force. Security
cameras could be seen everywhere, though, so close surveillance may be the trade-on.
The outskirts of Paris were also not very safe, as a mugging was seen there near our hotel
and the more dangerous environment was affirmed by an interviewed college student
living in that part of town.
Toynbee Hall historically was surrounded by poverty during the Industrial
Revolution, and until today still works to address debt and try to provide housing
resources for those in need (generally people living in social isolation). According to
Graham Fisher, Chief Executive of Toynbee Hall, the housing market in London is
currently severely inflated due to foreign investors, making it difficult for those in need to
maintain rent payments. Luckily, the National Health Service (NHS) provides care to
even the homeless, so large medical bills are not an issue; only the ability to seek
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employment. Shelters like St. Mungo’s (founded in 1970) provide housing for up to
1,700 single homeless people in select areas, but unfortunately do not address the heart of
the worsening housing issue. A trip to the famous London Tower revealed historically
that class systems and oppression of the poor was heavily reinforced in England, mirrored
again during the time of the industrial revolution in the 19th century, whose essence may
still linger in the political arena today (Macionis 2013).
Medically speaking, the British Museum had a medical exhibit called “Cradle to
the Grave by Pharmacopoeia,” an artistic textile of almost 14,000 drugs estimated to be
prescribed to the average person in their lifetime in England; something which surely can
affect well-being for the average person. According to another tour guide, Parisians are
even more of hypochondriacs (pharmacies were indeed prevalent on most streets). A city
tour of East London, by a woman who experienced prolonged homelessness herself,
explained that many common health issues for the homeless involve parasites, hygiene,
occasional attack by passersby, and most often psychological illnesses. Foot sores and
drug use infections are the next most common, but a supportive community amongst each
other helps spread information about resources for those in need like free meals or shelter
services. The state will often provide services to homeless families and children, but not
much for single people who are expected to find their own work (individual vs.
systematic aid).
Lastly, the eateries visited were taken note of. Pronto ‘A’ Mangai (near
Buckingham), which served small sandwiches, had floors that were clean and no visible
8
chefs wore gloves or hairnets. On the contrary, The Giraffe (near South Bank of River
Thames) had filthy flooring covered in dust, very expensive meals, no sugar packets or
condiments at tables, and no visible chefs, with food portions similar to in the USA. In
fact, most pubs and restaurants were comparable to those in the USA with regards to food
type and size. Small business eateries with few employees in a predominantly
Bangladeshi area had dairy or meat products on display without refrigeration, indicative
of lack of food safety regulation, as this promotes insect and rodent infestation (McSwane
2000). These observations help conclude that food safety regulation in London may not
be taken as seriously as in the USA. According to the bus tour guide, farmers in Paris do
not use inorganic fertilizers, meaning produce is likely fresher and arguably more
healthful. Very little data could be acquired regarding eateries in Paris, but portion sizes
were surely smaller. For example, the largest steak served on any menu was a mere 5 oz.
compared to the 8-10 oz. portions generally served in London or Indianapolis.
To supplement mere observed sociological behavior with hard statistics, the
World Health Organization reports as of 2013 that in Europe, 27% of people over the age
of 15 years smoke regularly, with rates even higher in France. These regions average
10.6L of alcohol consumed per person each year, causing 70% of all cancer and heart
disease deaths to be tied to tobacco or alcohol use (World Health Organization 2014).
Similar articles support the evidence that homelessness, waste management and pollution
are becoming serious problems as well.
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In order to analyze this myriad of observations in a sociological manner, one must
understand that social life is patterned. Only by this definition can sociologists make
sense of observed phenomena in the urban society and provide for solutions or useful
applications from that knowledge. Although there are quite a few differences between the
details of London and Paris, larger generalized theories already elaborated on in the past
seem to properly fit these descriptors into a predictable, sociological model. With respect
to homelessness, the main sociological dynamic is likely tied to gentrification or the
renovation of run-down neighborhoods by the influx of people from a higher
socioeconomic level (Macionis 2013). Gentrification is clearly at play between the two
cities, but with contrasting dynamics. In London, the lower class residents are being
replaced by upper class foreign investors and forced into different communities. Paris
sees middle and lower class residents (also known as bourgeoisie) being forced to the
outskirts of the city, because Parisians value architectural culture and prevent the upward
expansion of buildings past a maximum of seven stories high. London specifically
imbues the essence of globalization as well with the large amount of international
investors traveling to do business in the city, making it one of the largest global centers in
the world (Macionis 2013). Such movement of social classes leads to segregated
neighborhoods with high unemployment and poverty rates, otherwise known as ghettos.
Such areas account for the less safe and hygienic parts of London and Paris observed.
Urban sprawl has a lot to do with the urban structure of both cities, too. With
London having major business sectors spread out everywhere, coupled with a densely
situated population, the use of public transportation via the London Underground
10
becomes much more rational and requests good maintenance. Paris on the other hand has
all of its major business sectors near the center, with many working-class people spread
outside of the city. Use of public transportation theoretically would be less beneficial as
commuting becomes more prominent in such a model, which may explain the stark
differences in sanitation and upkeep between the two underground transportation
systems. With regards to the smoking and drinking epidemic, past interest in the health
environment of Britain tended to be explicitly theoretical, weighing the relationship
between society and nature against classical sociological perspectives on social class and
industrialism (Hannigan 2006). Arisen from this idea is risk assessment, where scientific
communities publish data or warnings against potentially harmful food types or health
practices to the public. However, scientific risk assessments may be ineffective under
certain circumstances as described above compared to the low cost, high popularity, and
secure corporate financial investment in smoking and alcohol business sectors of
European countries.
Environmental and urban sociological theory can also interpret how this research
fits into the greater societal model, and provides adequate analytical interpretation subject
to further reflection and provision of potential solutions. For example, waste management
is not simply an issue in London and Paris, but even more so in the United States, many
African countries, and various other regions of the world. “Living space or habitat
provides housing, transportation systems and other essentials of daily life. Overuse of this
function results in overcrowding, congestion and the destruction of habitats for other
species,” which does not exclude human beings (Hannigan 2006). With the waste
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repository function, the environment serves as a sort of sink for trash, industrial pollution
and other by-products inherently excreted by cities. “Exceeding the ability of ecosystems
to absorb wastes results in health problems from toxic wastes and in ecosystem
disruption,” (Hannigan 2006). Similarly, urban sprawl reduces the amount of usable land
that can be put to other uses, thus working against those peoples opting for increasing
recycling plants, property availability for the homeless or establishing those institutions
which may serve such purposes (Macionis 2013).
In recent years, speaking on a global scale, the overlap and therefore conflict
among these three competing functions of the environment has exponentially increased.
Such theories are now used to justify further environmental changes such as global
warming, where the competition of said functions compete simultaneously.
Environmental sociological studies often fall prey to skepticism, however, since alleged
scientific evidence supporting the magnitude and cause of such problems is sometimes
said to be misappropriated. Nevertheless, such argumentation often is nothing more than
aimless political babble and fails to provide any straight forward plan of action. The same
can be said for the incorporation of tobacco and alcohol taxation or other potential means
of further reducing related health epidemics, causing for a lack of solutions in this arena.
At least for urban sprawl, however, solutions can be implemented for future urban
planning based on a theoretical approach to reduce patterns seen not only in Paris, but
Indianapolis and other cities too. Smarter use of land space, partially based off of the
New Jersey Master Plan, can help solve the problem of sprawl, also known as smart
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growth. The most elementary concepts involve a social impact analysis and use of
environmental sociology in major building projects to assess how such projects can be
best optimized as not to negatively affect the city or environment/social organization. The
following lists major solutions for urban sprawl as discussed by Macionis (2013). Land
purchases can help prevent further urbanization in those areas, thus protecting wildlife
and preserving the land. Urban growth boundaries set limits to city expansion, which
isolates population growth to only where it is already dense, and keeping the surrounding
farms and parks preserved. Revitalization in the form of cleaning up environmental
pollution (such as in the Seine river) coupled with the government’s use of eminent
domain can keep already existing cities clean while optimizing use of space during
building projects (although the concept of governments seizing private property via
financial compensation is still highly controversial). Adding carpool lanes, synchronizing
traffic lights, and utilizing more expansive public transport methods can alleviate some of
the transit-oriented negative effects associated with sprawl in Paris. Lastly, “greening”
the cities is a method of adding more plant life to buildings and surrounding areas to
absorb more pollution and rain water that otherwise over-taxed sewage systems and the
air we breathe (Macionis 2013).
The effects of global industrialization, lack of proper waste management, and
limited medical resources all can have a negative impact on the well-being of residents
living within an urban community. Increasing awareness regarding the lack of
preventative health practices in a community can serve as the precursor for sociological
change, but also provides information on quality of life, safety, gentrification patterns,
13
and ultimately economic prosperity. Preliminary preconceptions regarding the nature of
this topic formed the hypothesis that London, UK would have an overall healthier and
more sanitary environment than Paris, France or even Indianapolis, Indiana in the United
States. Such conjecture was rooted in the simple notion that the United Kingdom’s
economy was much stronger than that of the financially declining France or USA, and
proved to be true following an overall analysis of observations. European diet was found
to roughly equate that of North American with respect to portion size and food type,
while Parisian diet seems more culturally afflicted and generally had smaller portions of
higher quality foods. Homelessness remains an issue, more prominently in Paris, which is
negatively affected by housing market inflation and/or lack of building space.
Environmental and urban sociology theories provided elementary insights on the nature
of many of these problems, but provided potential solutions to few. Increased field time,
generation of surveys and statistics, prevention of personal observational bias, and a
deeper literature review would be required in order to create more reliable data in further
research. Future research will need to be carried out in order to generate a more complete
observational justification and produce better solutions to benefit humanity, perhaps even
on a global scale.
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References
Hannigan, John. “Environmental Sociology.” New York & London. Routledge, 2006.
Print. 8 April, 2014.
Macionis, John J. “Cities and Urban Life.” Karen Hanson. 2013. Print. 5 April, 2014.
McSwane, David. “Issues and Concerns in HACCP Development and
Implementation for Retail Food Operations.” Journal of Environmental Health.
2000. Web. 11 April, 2014.
World Health Organization. “Tobacco and Drinking Cessation.” Regional Office for
Europe. 2014. Web. Retrieved March 30, 2014.
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RESEARCH PAPER RUBRIC
Perspective
Methods
Description
Analysis
Affectivity
Sophisticated
45
Topic is
sociologically
relevant and
clearly identified
as timely and
significant.
Methods are
described in detail
and explaining all
critical functions
of observations.
Limitations are
clearly explored.
Description is
punctilious and
interprets the
sociological
significance of the
observations.
Analysis is
thorough,
insightful, and
substantive
examples are
cited to support
conclusions.
Author shares
impressions and
personal feelings
of affect with
relation to the
topic.
Competent
35
Topic is
sociologically
relevant but not
clearly identified
as timely and
significant.
Methods are
described in detail
but no clear
explain of
functions is given.
Limitations are
clearly explored.
Description is
detailed but the
sociological
significance of the
observations is
not explored.
Analysis is
thorough,
insightful, but
substantive
examples are not
cited to support
conclusions.
Author shares
impressions but
not personal
feelings of affect
with relation to
the topic.
Mundane
30
Topic is not
sociologically
relevant and
clearly identified
as timely and
significant.
Methods are not
described but
most critical
functions of
observations are
investigated.
Unsatisfactory
27
Topic is not
sociologically
relevant and not
clearly identified
as timely and
significant.
No methods are
described and
critical functions
of observations
are not discussed.
Score
(Points)
Description is
vague and the
sociological
significance of the
observations is
not explored
Analysis is weak
and lacks enough
substantive
examples to
support
conclusions.
Description lacks
sufficient detail
for reader to
understand
observations fully.
9
Analysis is
thorough,
insightful, and
substantive
examples are cited
to support
conclusions.
Author does not
share their
impressions of the
topic and does not
share personal
feelings of affect
with relation to
the topic.
9
Author does not
share their
impressions of the
topic but does
share personal
feelings of affect
with relation to
the topic.
Total Score
16
9
9
9
45