Abstract
BackgroundInter-urban area (UA) health inequalities can be as dramatic as those between high and low-income countries. Policies need to focus on the determinants of health specific to UAs to effect change. This study therefore aimed to determine the degree to which policymakers from different countries could make autonomous health and wellbeing policy decisions for their urban jurisdiction area.MethodsWe conducted a cross-sectional, qualitative interview study with policymakers recruited from eight European countries (N = 37).ResultsThe reported autonomy among policymakers varied considerably between countries, from little or no autonomy and strict adherence to national directives (e.g. Slovak Republic) to a high degree of autonomy and ability to interpret national guidelines to local context (e.g. Norway). The main perceived barriers to implementation of local policies were political, and the importance of regular and effective communication with stakeholders, especially politicians, was emphasized. Having qualified health professionals in positions of influence within the UA was cited as a strong driver of the public health (PH) agenda at the UA level.ConclusionLocal-level policy development and implementation depends strongly on the degree of autonomy and independence of policymakers, which in turn depends on the organization, structure and financial budget allocation of PH services. While high levels of centralization in small, relatively homogenous countries may enhance efficient use of resources, larger, more diverse countries may benefit from devolution to smaller geographical regions.
Highlights
Around 54% of the world’s population live in cities.[1]
Local-level policy development and implementation depends strongly on the degree of autonomy and independence of policymakers, which in turn depends on the organisation, structure and financial budget allocation of public health services
Results from EURO-URHIS 1 suggested that even when sub-national data is available it is often unused for local policymaking, with decisions still being made at national level.[21]
Summary
Around 54% of the world’s population live in cities.[1]. Urban populations have become the poorest subset of the global population.[2]. UAs often differ in health outcomes from the national level,[7 8] and inter-UA health inequalities can be as dramatic as those between high and low-income countries.[9]. Inter-urban area (UA) health inequalities can be as dramatic as those between high and low-income countries. Aim: We aimed to determine the degree to which policymakers from different countries could make autonomous health and wellbeing policy decisions for their urban jurisdiction area. Conclusion: Local-level policy development and implementation depends strongly on the degree of autonomy and independence of policymakers, which in turn depends on the organisation, structure and financial budget allocation of public health services. While high levels of centralisation in small, relatively homogenous countries may enhance efficient use of resources, larger, more diverse countries may benefit from devolution to smaller geographical regions
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
