Just like their dwellers, cities can get sick.
When that happens, each citizen experiences multiple and dramatic symptoms affecting daily life: crime and insecurity, pollution, traffic jams, sanitary and waste management problems, air, water, damage and loss of property, property value, broken schools, ailing infrastructure, high taxes for poor quality services and quality of life in a seemingly endless sequence of calamities.
Treating symptoms, however, can be treacherous. Self-medication and turning to emergency rooms can end in even more dangerous treatment-borne complications, making the recovery more difficult and relapses more likely.
Adopting partial “solutions” that maximize a specific subsystem –being it tourism, housing, security or commerce- can create new, more complex and challenging problems.
Fighting crime without considering its causes and context –such as the reciprocal interactions between unemployment, poor education and inadequate housing and transportation- can end clogging courts and filling jails with increasing number of inmates that return to the city more violent and organized, spiraling up the cycle of violence –as the cases of Colombian and Mexican cities dramatically show-.
Experience shows that building public housing without addressing unemployment, crime and security issues often ends with squatters living in “vertical slums” such as Chicago’s Cabrini-Green. A prosperous, money-making logistic hub can turn into a “container town” that blue and white collar employees flee for safer suburbs before darkness falls.
A careful review of the history of “magic bullets” for sick cities, such as public housing, employment subsidies, “zero tolerance” or ambitious urban or touristic “revival” initiatives shows a discouraging rate of failure, unintended consequences and conflict between different groups of interest pressing to speed up for a new, and equally specific solution. Policies get mixed up with politics and vice versa, creating regulatory mazes that become a quagmire for reformers.
And then, people get sick of the city and leaves.
Property values drop, unwanted settlers like squatters and criminals get in and business and investment gets out at ever more alarming rates.
By then, the sick city has become also a “third rail” that every new administration tries to avoid, postponing solutions for cosmetic quick fixes.
It is usually a big event –such as Olympic Games, or land getting cheap enough to attract real estate speculation or a major social upheaval- that brings the sick city back to the spotlight.
By then, everybody is painfully aware that partial solutions and quick fixes will not do.
They have to find a doctor for the city that can unravel the maze of conflicting partial solutions and unlock the forces for change, aligning them towards a shared vision of the future all stakeholders want not for them, but for their children and grandchildren. This is the way every great city started in the first place.
In discussing the case of Colon City, Panama, and the approach we propose as a team of “city doctors”, we will show how a systemic, multi disciplinary and strategic plan can be developed and applied by a private-public consortium, the tools required and the lessons learned from what happened to Colon and the experience in other cities’ turnarounds.
Read how our City Doctors team used the Mega planning and PI approach to transform Colon City in this article:
Bernardez, Kaufman, Arias & Krivatsy (2009) City Doctors: a plan for the transformation of Colon City, Panama. Performance Improvement Review
 According to a 1981 study, approximately one-third of patients’ illnesses in a university hospital were caused by treatment. (Steel, German, Crescenzi, & Anderson, 1981)
With approximately 225,000 deaths per year, treatment-caused, iatrogenic factors are the third leading cause of death in the United States – following heart disease and cancer. (Starfield, 2000)
 (Bernardez, Surviving "performance solutions": aligning performance improvement interventions, 2009)
 (Katz, 2008) (Kline, 2009)
 (Center for Urban Research and Policy Studies, University of Chicago, 1999)
 (Barr, 2000) (Lee, 2000)
 (Sowell, Basic economics: a common sense guide to the economy, 2007) (Sowell, The housing boom and bust, 2009)