Picture this. A woman is dragging on the remnants of her cigarette, a pushchair perched on the kerb as she tries to cross the road between the heaving traffic. Her child, his face smeared with sticky orange, is sucking on his lolly and inhaling the dark gases from the bus exhaust in front of his nose. A familiar scene to most city dwellers, it nevertheless fills health care professionals and environmentalists alike with a sense of impotence and frustration.

Most doctors entered their profession because, filled with youthful idealism, they believed that they could help to improve the health of their communities. But reorganisations of health services and power struggles now loom so large that many are disillusioned and feel that they are failing in a culture of competition and rationing.

Health and the urban environment were brought sharply into focus at a symposium in Manchester last month that ran alongside Global Forum '94, the official follow up to the earth summit in Rio de Janeiro in 1992. The symposium was organised by a partnership between the British Council, the UK Health …