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.     

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.     

Evaluation of Partnership Working in Cities in Phase IV of the WHO <Emphasis Type="Italic">Healthy Cities</Emphasis> Network

An intersectoral partnership for health improvement is a requirement of the WHO European Healthy Cities Network of municipalities. A review was undertaken in 59 cities based on responses to a structured questionnaire covering phase IV of the network (2003–2008). Cities usually combined formal and informal working partnerships in a pattern seen in previous phases. However, these encompassed more sectors than previously and achieved greater degrees of collaborative planning and implementation. Additional WHO technical support and networking in phase IV significantly enhanced collaboration with the urban planning sector. Critical success factors were high-level political commitment and a well-organized Healthy City office. Partnerships remain a successful component of Healthy City working. The core principles, purpose and intellectual rationale for intersectoral partnerships remain valid and fit for purpose. This applied to long-established phase III cities as well as newcomers to phase IV. The network, and in particular the WHO brand, is well regarded and encourages political and organizational engagement and is a source of support and technical expertise. A key challenge is to apply a more rigorous analytical framework and theory-informed approach to reviewing partnership and collaboration parameters.     

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.     

Healthy Cities Evaluation: the co-ordinators perspective

The Healthy Cities Project is based on the development of healthypublic policies by local governments. The study aim of someproject teams in different countries has been to find out whatprocesses are involved in the development of these policies,how decisions are made, and who and what they are influencedby. The Valencian Community Healthy Cities Network conductedan evaluation process, part of which is presented in this paper.The aim was to find out the concepts and opinions of the projectco-ordinators concerning the opportunities and problems forhealthy municipal policies, and to analyse the municipal organizationwith a view to detecting structural opportunities for interdepartmentalwork. Interviews were conducted with the people responsiblefor the project in 13 cities and the relevant documents analysed.When discussing their health concept and actions for health,few of the co-ordinators mentioned the ideas contained in theOttawa Charter. The established health programmes were ratherbased on personal/ individual changes and topic approach thansetting-based strategies. The structural and strategic opportunitiesfor interdepartmental work, as well as the active participationof the community in the healthy policies decision-making processneed to be strengthened, as they are perceived to be insufficient.Personal relationships and political differences between thedifferent actors appear to play an important role in the opportunitiesfor the implementation of intersectoral policies.     

Assessing community change at multiple levels: the genesis of an evaluation framework for the California Healthy Cities Project.

More than 40 cities have participated in the California Healthy Cities Project since its inception in 1988. Because Healthy Cities efforts are community driven, these cities address diverse health and social issues using a wide variety of strategies. This complexity, in addition to the usual difficulties associated with evaluating community interventions, creates many challenges for evaluation. Given the community building and process orientation of Healthy Cities, it may be most appropriate to measure intermediate community changes that have been linked to health outcomes in previous research or, at a minimum, theoretically. The California Healthy Cities evaluation framework conceptualizes change at five levels: individual, civic participation, organizational, interorganizational, and community. The framework, developed collaboratively with Healthy Cities participants, attempts to synthesize current thinking and practice on evaluation of community projects by applying concepts from community capacity/competence, social ecology, and urban planning.     

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.     

Health in the Urban Environment: A Qualitative Review of the Brighton and Hove WHO Healthy City Program

Phase IV of the WHO European Region’s Healthy Cities Program ended in December 2008. This article presents the findings from a recently completed review of Brighton and Hove’s Healthy City Program which aimed to scope whether added value had accrued from the city’s role as a WHO Healthy City during phase IV. In contrast to most other evaluations of healthy cities, this review adopted a qualitative approach representing an appraisal of the Brighton and Hove Healthy City Program from the internal viewpoint of its local stakeholders. In addition to documentary analysis and a facilitated workshop, a series of in-depth interviews (N = 27) were conducted with stakeholders from the Brighton and Hove Healthy City Partnership representing each of the sectors reflected in the Local Strategic Partnership (public, statutory, elected, community and voluntary, neighborhood and communities, business). The key findings of the review are presented in a way which reflects the three key areas of the review including (1) the healthy cities approach, (2) participation in phase IV of the WHO Healthy Cities Program, and (3) the Brighton and Hove Healthy City Partnership. These findings are discussed, and recommendations for action at local, national, and European levels are proposed. In particular, we argue that there is an urgent need to develop a suitable monitoring and evaluation system for the WHO Healthy Cities Program with appropriate indicators that are meaningful and relevant to local stakeholders. Moreover, it would be important for any such system to capitalize on the benefits that qualitative methodologies can offer alongside more traditional quantitative indicators.     

Healthy cities -- WHO's New Public Health initiative

The World Health Organization's European Office has initiateda major new project known as "Healthy Cities". As a laboratoryfor the lifestyle targets agreed for Europe, the time seemsright to support integrated approaches to health promotion atthe city level. The city is often the lowest administrativelevel which can marshal the resources and has the politicalmandate and authority to develop and implement intersectoralapproaches to health; because it is a place with which its citizensidentify, there are good prospects for participation harnessedto neighbourhood or civic pride. Throughout the European Regionat present there is evidence of a general renaissance of publichealth activity at this level and it seems appropriate for WHOto support and facilitate processes which are already underway. The project will initially bring together ten or twelve Europeancities to collaborate in the implementation of intersectoralcity health plans. In turn, these cities will take responsibilityfor supporting the development of further networks of citieswhich wish to participate in the project. WHO will provide technicalexpertise and generate a range of resource materials of valueto the cities involved. In addition there will be a major collaborativeEuropean television series on the healthy city. By concentrating on concrete examples of health promotion whichinclude a commitment to community participation and intersectoralcollaboration, it is expected that the Healthy Cities projectwill mark the point at which WHO philosophies and frameworksare taken off the shelves and into the streets of European cities     

What about healthy networks? An analysis of the national networks of healthy cities in Europe

The World Health Organization (WHO)/Euro Healthy Cities Projecthas received much attention since the first project cities wereselected in 1987 in fact many more cities than can participateshowed (and still show) their interest. Thus initiatives havebeen taken to establish activities similar to the Healthy CitiesProject, not only in Europe but all over the worl4 ‘nationalnetworks of Healthy Cities’ have developed The nationalnetworks in Europe call themselves ‘EURONET’, aEuropean network of national Healthy Cities networks. EURONETis not a formal association; how this initiative will developin the near future is under discussion. A national network is an example of a social network but becauseof its complexity and different leveLs of ‘networking’,is difficult to analyse. However analysis, and evaluation, isneeded to review the functioning and impact of the healthy citiesidea. To study and analyse the networks in Europe, which areas a whole rather large, a selection has been made to reducethe number of participants (n=14), number of resources (n=4)and (categories of) activities (n=9) which were examined Theanalysis provided information about the development of the network;among other things it looked at why they started who took theinitiative, what changes occurred during the period of development,who were the participants at a national level, what activitieswere undertaken, and the relationship between activities andparticipants. As expected the findings did not provide a uniformpicture of ‘what a national Healthy Cities network shouldlook like’ nor did they give the recipe of ‘howto become a Healthy Cities network’. However, the strengthof national networks is that they have the potential to continuethe Healthy Cities project aims and objectives, even if theWHO project ever ceases.     

Intersectoral Planning for City Health Development

The article reviews the evolution and process of City Health Development Planning (CHDP) in municipalities participating in the European Network of Healthy Cities organized by the European Region of the World Health Organization. The concept of CHDP combines elements from three theoretical domains: (a) health development, (b) city governance, and (c) urban planning. The setting was the 77 cities which participated in Phase IV (2003–2008) of the network. Evidence was gathered principally from a General Evaluation Questionnaire sent to all Network Cities. CHDPs are strategic documents giving direction to municipalities and partner agencies. Analysis revealed a trend away from “classic” CHDPs with a primary focus on health development towards ensuring a health dimension to other sector plans, and into the overarching strategies of city governments. Linked to the Phase IV priority themes of Healthy Aging and Healthy Urban Planning, cities further developed the concept and application of human-centered sustainability. More work is required to utilize cost–benefit analysis and health impact assessment to unmask the synergies between health and economic prosperity.     

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.     

Impact of the China Healthy Cities Initiative on Urban Environment

The China Healthy Cities initiative, a nationwide public health campaign, has been implemented for 25 years. As “Healthy China 2030” becomes the key national strategy for improving population health, this initiative is an important component. However, the effects of the initiative have not been well studied. This paper aims to explore its impact on urban environment using a multiple time series design. We adopted a stratified and systematic sampling method to choose 15 China healthy cities across the country. For the selected healthy cities, 1:1 matched non-healthy cities were selected as the comparison group. We collected longitudinal data from 5 years before cities achieved the healthy city title up to 2012. We used hierarchical models to calculate difference-in-differences estimates for examining the impact of the initiative. We found that the China Healthy Cities initiative was associated with increases in the proportion of urban domestic sewage treated (32 percentage points), the proportion of urban domestic garbage treated (30 percentage points), and the proportion of qualified farmers’ markets (40 percentage points), all of which are statistically significant (P?<?0.05). No significant change was found for increases in green coverage of urban built-up area (5 percentage points), green space per capita (2 square meter), and days with Air Quality Index/Air Pollution Index?≤?100 (25 days). In conclusion, the China Healthy Cities initiative was associated with significant improved urban environment in terms of infrastructure construction, yet had little impact on green space and air quality.     

A seat at the table? A study of community participation in two Healthy Cities Projects

Achieving community participation has become a statutory obligation for many national and local governments, building on the optimism about the possible benefits to partnerships. However, there have been substantial critiques of the limited gains made in increasing the levels and outcomes of community participation. This paper explores the role of meetings in shaping the contribution of communities to two Healthy Cities programmes. Meetings are the key site at which partnership work visibly happens, and how they are managed shapes the outcomes of partnership programmes. We argue that by offering ‘a seat at the table’ to community partners, but controlling the form and content of meetings, statutory authorities elide the structural imbalance between contributing participants, but make possible the incremental shifts that do offer some possibility of change, at least at the margins.     

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.     

Healthy Cities Australia: the evaluation of the pilot project in Noarlunga, South Australia

This paper reports on the evaluation of the Healthy Cities (Noarlunga)Project which was one of the three original pilot cities inthe Australian Healthy Cities Project. The evaluation nethodologyused is outlined the project's organization and activities,and the data (from a variety of sources) used to assess itsachievements are discussed. These data were collected from arange of local informants including comnuinity members and froman analysis of the local print media. The implications of theevaluation findings for the development of the Healthy Citiesmovement are discussed.     

Healthy Cities: Facilitating the Active Participation and Empowerment of Local People

Community participation and empowerment are key values underpinning the European WHO Healthy Cities initiative, now in its fifth phase. This paper provides a brief overview of the history, policy context, and theory relating to community participation and empowerment. Drawing on Phase IV evaluation data, it presents the findings in relation to the four quadrants of Davidson’s Wheel of Participation—information, consultation, participation in decision making, and empowerment. The large majority of European Healthy Cities have mechanisms in place to provide information for and to consult with local people. Most also demonstrate a commitment to enabling community participation in decision-making and to empowering citizens. Within this context, the evaluation highlighted a diversity of approaches and revealed varied perspectives on how participation and empowerment can be integrated within city leadership and governance processes. The paper concludes by suggesting that there is a need to strengthen future evaluative research to better understand how and why the Healthy Cities approach makes a difference.     

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.     

Do Healthy Cities Work? A Logic of Method for Assessing Impact and Outcome of Healthy Cities

In this article, we discuss an appropriate methodology for assessing complex urban programs such as the WHO European Healthy Cities Network. The basic tenets and parameters for this project are reviewed, and situated in the broader urban health tradition. This leads to a delineation of the types of questions researchers can address when looking at a complex urban health program. Such questions reach appropriately beyond traditional public health concepts involving proximal and distal determinants of health (and associated upstream, midstream, and downstream rhetoric). Espousing a multi-level, reciprocal pathways perspective on Healthy Cities research, we also adopt a distinction between impacts and outcomes of Healthy Cities. The former are value-driven, the latter intervention-driven. These approaches lead to the acknowledgment of a logic of method that includes situational and contextual appreciation of unique Healthy City experiences in a Realist Evaluation paradigm. The article concludes with a reflection of evaluation and assessment procedures applied to Phase IV (2003-2008) of the WHO European Healthy Cities Network and an interpretation of response rates to the range of methods that have been adopted.     

Equity and the Social Determinants of Health in European Cities

Equity in health has been the underlying value of the World Health Organization’s (WHO) Health for All policy for 30 years. This article examines how cities have translated this principle into action. Using information designed to help evaluate phase IV (2003–2008) of the WHO European Healthy Cities Network (WHO-EHCN) plus documentation from city programs and websites, an attempt is made to assess how far the concept of equity in health is understood, the political will to tackle the issue, and types of action taken. Results show that although cities continue to focus considerable support on vulnerable groups, rather than the full social gradient, most are now making the necessary shift towards more upstream policies to tackle determinants of health such as poverty, unemployment, education, housing, and the environment, without neglecting access to care. Although local level data reflecting inequalities in health is improving, there is still a long way to go in some cities. The Healthy Cities Project is becoming an integral part of structures for long-term planning and intersectoral action for health in cities, and Health Impact Assessment is gradually being developed. Participation in the WHO-EHCN appears to allow new members to leap-frog ahead established cities. However, this evaluation also exposes barriers to effective local policies and processes to reduce health inequalities. Armed with locally generated evidence of critical success factors, the WHO-EHCN has embarked on a more rigorous and determined effort to achieve the prerequisites for equity in health. More attention will be given to evaluating the effectiveness of action taken and to dealing not only with the most vulnerable but a greater part of the gradient in socioeconomic health inequalities.