Healthy Cities projects

This is a review article on "Healthy Cities". The Healthy Cities programme has been developed by the World Health Organization (WHO) to tackle urban health and environmental issues in a broad way. It is a kind of comprehensive policy package to carry out individual projects and activities effectively and efficiently. Its key aspects include healthy public policy, vision sharing, high political commitment, establishment of structural organization, strategic health planning, intersectoral collaboration, community participation, setting approach, development of supportive environment for health, formation of city health profile, national and international networking, participatory research, periodic monitoring and evaluation, and mechanisms for sustainability of projects. The present paper covered the Healthy Cities concept and approaches, rapid urbanization in the world, developments of WHO Healthy Cities, Healthy Cities developments in the Western Pacific Region, the health promotion viewpoint, and roles of research.     

Introduction of health impact assessment and healthy cities as a tool for tackling health inequality]

In order to reduce the health inequalities within a society changes need to be made in broad health determinants and their distribution in the population. It has been expected that the Health impact assessment(HIA) and Healthy Cities can provide opportunities and useful means for changing social policy and environment related with the broad health determinants in developed countries. HIA is any combination of procedures or methods by which a proposed 4P(policy, plan, program, project) may be judged as to the effects it may have on the health of a population. Healthy city is one that is continually creating and improving those physical and social environments and expanding those community resources which enable people to mutually support each other in performing all the functions of life and in developing to their maximum potential. In Korea, social and academic interest regarding the HIA and Healthy Cities has been growing recently but the need of HIA and Healthy Cities in the perspective of reducing health inequality was not introduced adequately. So we reviewed the basic concepts and methods of the HIA and Healthy Cities, and its possible contribution to reducing health inequalities. We concluded that though the concepts and methods of the HIA and Healthy Cities are relatively new and still in need of improvement, they will be useful in approaching the issue of health inequality in Korea.     

Healthy Cities, local environmental action and climate change

This paper reports results of a study that explored the relationship between the local environmental actions of Healthy Cities programs and the adverse health impacts of climate change. The analysis is primarily based on a limited literature review of climate change and health, with particular attention to the relationships between Healthy Cities and climate change, and on documentary analysis of information from organization reports and website content associated with Healthy Cities programs in Europe and Australia. Four semi-structured interviews with key people in two Healthy Cities programs in Europe and Australia were conducted to provide information to supplement and complement the published information and to verify theme identification. The main findings of this study are that, although there is no explicit connection between the local activities of Healthy Cities programs and the potential (or actual) adverse health impacts of climate change, Healthy Cities programs are involved in many local environmental actions and some of these actions, for example, those relating to improving air quality and reducing pollution, are linked implicitly to the health impacts of climate change. Through their local relationships and their participation in regional networks, Healthy Cities are able to make connections between local environmental actions and the health impacts of climate change. Furthermore, expanding Healthy Cities to include eco-social sustainability as a central aim not only has the potential to strengthen the links between local environmental actions and climate change, but also presents a relevant health development setting for exploring the social and environmental sustainability of cities.     

Healthy Cities and change: social movement or bureaucratic tool?

Healthy Cities is seen as a vision, project and movement. Itswide appeal leaves it open to losing touch with the core valuesenvisaged by the origtnators of Healthy Cities. This paper considersthe outcomes Healthy Cities should aim for in Australia andthe processes by which they can be achieved It identifies thepolitical ideology underlying the Ottawa Charter as social democraticand collectivist. Economic rationalism, individualism and misplacedprofessionalism are discussed as blocks to achieving HealthyCities. It is suggested that professional workers seeking topromote health should operate within a 'health promotion winners'triangle' as many do currently. The paper concludes by arguingthat Healthy Cities should ensure complacency does not permita taken-for-granted economism, individualism and professionalismto dominate agendas for change and suggests ways in which collaborationswith forces inside and outside bureaucracies may assist theprocesses of achieving healthier cities.     

The health of cities and their citizens (urban development and municipal public health). 2008 SESPAS Report

The policy of continued improvement in citizens' health, further to the definitions provided in the latest World Health Organization reports, entails a huge undertaking on the part of local administrations in issues that not only affect health management but also involve a change in other health-related policies, such as urban development and planning. Until now, urban development has been reluctant to incorporate the criteria defined by health strategies into its field of knowledge. However, there is a lack of research in public health, which could specify the clear effects of the environmental on citizens' health and enable criteria applicable to spatial planning to be defined. The present article reflects on certain experiences acquired in our environment of processes that bring together these two views of health, ranging from urban and environmental policies in indicator-based reports to a series of good practice. The integrated municipal action of San Fernando de Henares in the Healthy Cities project has also been significant.     

Healthy community indicators: the perils of the search and the paucity of the find

The Canadian Healthy Communities Project (CHCP) is an ambitiousattempt to implement principles of health promotion and healthypublic policy at the municipal level. The aim of CHCP is tofoster local community organization and action around issueswhich threaten or may enhance residents' well-being. To participatein the project, communities must be prepared to monitor andevaluate their progress using indicators that are relevant,sensitive and easy to collect, and that will facilitate comparisonswith other communities. The perils of the search for indicatorswhich meet the criteria above coalesce around five main issuesincluding lack of guidance about how to proceed; lack of expertise;gathering the data itself; lack of resources and finally theconcern about how the results will be used. The paucity of thefind is not isolated to the Canadian Healthy Communities Project,but experienced by WHO Healthy Cities Europe project participantsas well. Finding one-size-fits-all indicators is doubtful giventhat the contextual dependence of relations are unique to eachlocal community. This paper addresses practical and theoreticalquestions about the role of indicators in the CHCP.     

Empowerment for Healthy Cities and Communities in Korea

The Healthy Cities project started in 1998 in Korea. Around the world, public health and healthy cities are becoming bigger and bigger priorities. Capacity mapping is an important tool for improving a country’s health status. This study aims to review the initiation of the Korean “Healthy City” project. Korea follows a bottom-up approach for the development of Healthy City policies and has implemented plans accordingly. Korea has created a unique program through Healthy Cities; it has developed a Healthy City act, indicators for evaluating the program, a health impact assessment program, an award system, and a domestic networking system.     

Emergence Model of social and human capital and its application to the Healthy Municipalities project in Northeast Brazil

We developed the Emergence Model and introduced the concept of social and human capital into designing and evaluating the Healthy Cities/Municipalities project to ensure health promotion infrastructure. This model hypothesizes that through the interaction and utilization of the other forms of capital, namely financial, physical and natural, the emergence of collective action takes place in the community or municipal setting. Subsequently, collective action may influence health and quality of life determinants. Once health and quality of life improvements are achieved, the enhancement of the social, human and other capital may be brought about through positive feedback, and successive collective action is thereby facilitated. According to the model, practitioners and policy makers of the Healthy Cities/Municipalities project should primarily strengthen social and human capital. The model is currently applied to designing the Healthy Municipalities project implemented in rural areas of Northeast Brazil, where infrastructure and a supportive environment to facilitate collective action for control over health and health determinant have been considerably frail due to geographical, historical, social and cultural reasons. Various interventions have been conducted in the scope of the project to enhance social and human capital on three levels, namely the state, municipality and community. Through the capacity development of health promoters, obliging volunteers and so on, the project attempts to create the social mechanism that enables people to build healthy public policies through inter- and trans-sectoral collaboration as well as to address and resolve day-to-day issues using their potentialities.     

健康城市建设及其发展趋势

全球城市化快速发展的同时给城市人口的健康带来了威胁。健康城市建设已成为世界各国减少城市化进程中健康危害的新策略。本文详细介绍了我国及日本、加拿大、英国三个发达国家健康城市建设的进展现状及其开展健康城市创建的主要做法。同时, 对国内外健康城市建设模式进行比较, 为国内健康城市建设提供借鉴。最后, 提出我国目前健康城市创建中存在的主要问题及其思考。     

Healthy Cities: the new public health and supportive research

This paper views Healthy Cities as a local expression of thenew public health. It then discusses the potential contributionsof and issues involved in research supportive of policies forhealth at local and national levels. Finally, it suggest the roles Healthy Cities can play in sustainingthe new view of health-making through its functions as politicalreality and policy laboratory.     

From projects to policy: 'healthy cities' as a mechanism for policy change for health?

One of the aims of the European Healthy Cities project was to contribute to the development of healthy public policy. This paper examines the evidence from ten cities in the Netherlands and the United Kingdom which are either part of the World Health Organization (WHO) Healthy City Project or part of their respective National Networks. Five key issues are identified based on current thinking in political and administrative science concerning change and policy-making. These provide a framework for the analysis of key informant interviews undertaken in the ten case studies. It was concluded that, at the time of the research, a substantive policy change had not taken place and in most cases the Health city initiatives were still projects rather than policies and, where plans or strategies had been developed, they were still insufficient in their impact in raising health as opposed to health care up the policy agenda.     

Utility-driven evidence for healthy cities: problems with evidence generation and application

The question whether the WHO Healthy Cities project 'works' has been asked ever since a number of novel ideas and actions related to community health, health promotion and healthy public policy in the mid 1980s came together in the Healthy Cities Movement initiated by the World Health Organization. The question, however, has become more urgent since we have entered an era in which the drive for 'evidence' seems all-pervasive. The article explores the nature of evidence, review available evidence on Healthy Cities accomplishments, and discusses whether enough evidence has been accumulated on different performances within the realm of Healthy Cities. A main point of reference is the European Healthy Cities Project (E-HCP). Building on the information gathered through documentary research on the topic, it is concluded that there is fair evidence that Healthy Cities works. However, the future holds great challenges for further development and evidence-oriented evaluations of Healthy Cities. There are problems with (1) the communication of evidence, (2) the tension between the original intention of the Healthy Cities Movement and its current operations, and (3) the complex nature of Healthy Cities and the methodological tools currently available.     

Health promotion evaluation: focus on "healthy cities"

Since the Healthy City movement is a health promotion strategy, an update study was carried out to put into context the health promotion evaluation debate stressing the principles to be considered in an evaluation initiative and in the problematic of Health Cities projects. A literature review of "Healthy Cities" was conducted. A typology based on of Healthy Cities papers found in MEDLINE, LILACS and published in the "Health Promotion International" between 1985 and 2000 was proposed taking into consideration the main focus of each paper. Articles on evaluation were analyzed in more details according to stressing methods, research tools, indicators, study results, and critical appraisal of their models. Finally, it is highlighted initiatives that would come close to the principles of "Health Promotion" and adopt evaluation as a tool for building up capabilities and the empowerment of community groups involved with Healthy Cities initiatives.     

Developing healthy local communities at local government level: lessons from the past decade

Abstract: There have been many approaches by the health sector to developing healthy communities based on local government areas in Australia in the past decade. Each has struggled with the need to establish realistic goals and to find ways of working more effectively with local government. This paper outlines four of these approaches–Healthy Cities, the Healthy Localities project, municipal health plans, and programs to address specific health problems or issues. Although the picture is one of huge diversity in the ways in which the issue is defined and action taken, a number of dimensions to a healthy community are emerging. However, if we are to be able to monitor change within and between the health of communities over time, indicators need to be developed and goals set. This will require a shift away from defining goals and targets in terms of populations (people), towards goals based on changes in organisations and systems. Engaging local government in this process will be vital and will require the health sector to develop a better understanding of the ways in which local government defines its role in creating healthy communities. It will also involve learning from local government the strategies that they have found most effective in dealing with complex problems that require action at many levels.     

Sustainable funding of health initiatives in Wonju, Republic of Korea via a tobacco consumption tax

Wonju is the first municipality in the Republic of Korea to fund the Healthy City project through municipal revenues from the local tobacco consumption tax. We investigated the process of the local tobacco consumption tax being approved as the main source of financing for the local Healthy City project. We also examined the sustainability and sufficiency of the funding by looking at the pricing policies instituted for cigarettes, smoking prevalence, cigarette consumption and revenues from local tobacco consumption as well as the budgetary allocations among programs in the city. The strong initiative of the mayor of Wonju was one of the factors that enabled the earmarking of the local tobacco consumption tax for the Healthy City Wonju project. He consulted academic counselors and persuaded the municipal government and the City Council to approve the bill. Despite the increasing price of cigarettes in Korea, adequate funding can be sustained to cover the short-term and mid-term programs in Wonju for at least 5 years of the mayor's term, because the smoking rate is persistently high. Analyzing the effects of strong leadership on the part of local authorities and the balance between revenues from the tobacco tax and the prevalence of smoking in the face of anti-smoking policies would be helpful for other countries and communities interested in developing sustainable Healthy Cities projects.     

WHO Healthy Cities and the US family support movements: a marriage made in heaven or estranged bed fellows?

The family support movement in the US emerged at about the sametime that the WHO Healthy Cities project was gaining momentumin Europe, and the underlying principles and ecologic frameworksof the two have much in common. However, while many ‘HealthyCities’ in Europe have included activities that benefitfamilies, this has not been made a major focus. There seemsto be little awareness of experience gained in the US in termsof establishing programs with limited or no government funding,using volunteers, and developing social marketing and advocacystrategies to sustain long term viability. Similarly, citiesand states in the US are struggling to develop networks of familysupport programs and they appear to be doing this without thebenefit of experience gained in Healthy Cities projects on howto engage political leadership, develop public policies, establishintersectoral councils, fund a coordinator position, mobilizeneighborhoods, and evaluate community wide health promotionprograms. The purpose of this paper is to examine how thesetwo movements might join forces and learn from each other.     

The Valencian Community Healthy Cities Network: assessment of the implementation process

In 1986 WHO-Euro began to develop the Healthy Cities projectwhich was later extended to Spain, in this paper the factorsrelated to the initial development of the Healthy Cities Projectin the member towns and cities of the Valencian Community HealthyCities Network, and the level of their development will be described. The project began in 1987 and the Network, at the time of thisstudy (March 1991), was made up of 48 towns and cities. Theinstrument used to assess the process of the project developmentwas a questionnaire administered by personal interview withthe three people responsible for the project in each city: theMayor, Health Councillor and Health Officer. A score was establishedto measure the level of development of the project in each citywhich included performance of the health diagnosis and plan,the existence of intersectoral committees and the creation ofchannels of community participation. A large proportion of the cities (72%) have carried out theHealth Diagnosis; 26% of the cities have intersectoral committeesand community participation is as yet in the initial stages.Political parties' support of their city's membership in theNetwork, has been almost unanimous with only three exceptions.Resources allocated to the project are not yet constant, althoughthere is important support from different levels, and on thepart of local and autonomous institutions. Differences can beobserved in the level of development of the cities which makeup the Network, related partly to length of time of membership,to the size of the city and to other factors difficult to assess.     

Addressing perinatal health inequities in Dutch municipalities: Protocol for the Healthy Pregnancy 4 All-3 programme

BackgroundHealth inequities are already present at birth and affect individuals’ health and socioeconomic outcomes across the life course. Addressing these inequities requires a cross-sectoral approach, covering the first 1,000 days of life. We believe that - in the Dutch context - municipal governments can be the main responsible actor to drive such an approach, since they are primarily responsible for organising adequate public health. Therefore, we aim to identify and develop transformative change towards the implementation of perinatal health into municipal approaches and policies concerning health inequities.MethodsA transition analysis will be combined with action research in six Dutch municipalities. Interviews and interactive group sessions with professionals and organisations that are relevant for the institutional embedding of perinatal health into approaches and policies regarding health inequities, will be organised in each municipality. As a follow-up, a questionnaire will be administered among all participants one year after completion of the group sessions.DiscussionWe expect to gain insights into the role of municipalities in addressing perinatal health inequities, learn more about the interaction between different key stakeholders, and identify barriers and facilitators for a cross-sectoral approach to perinatal health. This knowledge will serve to inform the development of approaches to perinatal health inequities in areas with relatively poor perinatal health outcomes, both in the Netherlands and abroad.     

Monitoring Millennium Development Goals in Brazilian municipalities: challenges to be met in facing up to iniquities

The Healthy Cities and Agenda 21 programs improve living and health conditions and affect social and economic determinants of health. The Millennium Development Goals (MDG) indicators can be used to assess the impact of social agendas. A data search was carried out for the period 1997 to 2006 to obtain 48 indicators proposed by the United Nations and a further 74 proposed by the technical group for the MDGin Brazil. There is a scarcity of studies concerned with assessing the MDG at the municipal level. Data from Brazilian health information systems are not always consistent or accurate for municipalities. The lack of availability and reliable data led to the substitution of some indicators. The information systems did not always provide annual data; national household surveys could not be disaggregated at the municipal level and there were also modifications on conceptual definitions over time. As a result, the project created an alternative list with 29 indicators. MDG monitoring at the local community can be important to measure the performance of actions toward improvements in quality of life and social iniquities.     

Comparative study on objective-setting public health policy--historical background and path dependence

The historical background and the path dependence of objective-setting public health policy are described in this review. The New Public Health movement appeared in the 1980s and was inspired by the Ottawa Charter on Health Promotion. This movement is based on the idea that public health is mostly promoted by creating a supportive environment for health as well as by individual efforts toward a healthy life style. The first objective-setting public health policy called Healthy People was proposed in USA, 1979, under the influence of The Lalonde Report published in Canada, 1974. Goals and targets were set in order to reduce the mortality of American people. This project led to Healthy People 2000 and Healthy People 2010. In the 1990s, objective-setting public health policies prevailed in Western countries, such as United Kingdom, Australia, New Zealand, and also in Japan. The objective-setting public health policy is the application of the management by objectives in the health policy domain. This policy is especially accepted in Anglo-Saxon countries where public sector reform was conducted on the basis of the New Public Management theory in the 1980s, which is when the WHO Regional Office for Europe started the Healthy Cities project that emphasized a network of project cities. The Health 21 in 1999 is another model of object-setting public health policy. A comparative study of four different objective-setting public health policies (USA, United Kingdom, WHO Regional Office for Europe, and Japan) was conducted regarding the goals and domains of the targets, methods of targeting, and evaluation of the project. The goals were almost identical in the four public health policies, while the domains of the targets were different. These differences were explained by the past experience of public health policy development in each country.