Healthy Cities in Europe: Editorial

Abstract

This special supplement evaluates work undertaken in phase IV (2003–2008) of the European Healthy Cities Network (WHO-EHCN) supported by the World Health Organization regional office for Europe with contextual references to development in the current phase V (2009–2013) of the EHCN and its goals and priorities in phase VI (2014–2018). The network has grown through five phases, spanning 25 years since its inception in 1987 and, as our first article indicates, has had a significant influence on the development of Health 2020: the new European policy for health and well-being.1 Approved by central government representatives of member states of the European Region in 2012, Health 2020 nevertheless emphasizes the leadership and unique position of local governments in addressing the wider determinants of health. Twelve articles convey the scope and substance of policy development and implementation in the 77 member cities of the WHO-EHCN located by the map overleaf, and the 13th article summarizes activities of national networks of healthy cities, with over 1,500 members. All 13 convey both continuity and innovation. As in our evaluation of phase III of the WHO-EHCN summarized in a special supplement of Health Promotion International (issue 24, 2009), there is continuity, first, in membership of the network and, second, in enduring values such as equity and sustainability, political preconditions such as intersectoral partnerships, democratic governance, and strong municipal leadership for health and work on themes such as healthy urban planning and healthy aging. The methodology for evaluating complex cities with concurrent interventions and multiple outcomes was developed by Evelyne de Leeuw for phase III and is further developed both in this special supplement and in a complementary article in the Journal of Urban Health.2 In practice, much of the evidence for our evaluation is derived from the 59 valid city responses to a General Evaluation Questionnaire and a similar number completing an annual reporting template. We are hopeful that the methodology of realist evaluation and synthesis will challenge or at least complement more traditional public health research paradigms. Innovation has developed sequentially within the rapidly evolving socioeconomic landscape of Europe and compelling new evidence on the wider determinants of health inequalities. Innovative City Health Plans of phase II evolved into City Health Development Plans in phase III, with more precision about investing for health in phase IV. The innovative tool of health impact assessment disseminated in phase III was fully operational by phase IV. The imperative of active living evolved from phase III, influencing the innovative theme of healthy aging in phase IV, now high on the agenda of European policy makers in phase V (2009–2013). The framework next phase of the WHO-EHCN (phase VI, 2014–2018) is shaped around the goals and objectives of the new European policy and strategy for health and well-being. Health 2020 reinforces the values and principles on which healthy cities is based and offers the potential to strengthen the policy standing and to broaden both the strategic and operational scope of the work of healthy cities. The adoption of Health 2020 by all 53 member states of the European Region provides a supportive and encouraging environment for implementing Healthy 2020 locally. Most importantly, Health 2020 recognizes the important role of local governments in developing health and especially focused on whole-of-government and whole-of-society approaches to health. The 8th Global Conference on Health Promotion in Finland in June 2013 reiterated the importance of health in all policies in addressing the consequences of public policies on health determinants, aiming to improve the accountability of policy makers for health impacts at all levels of policy making and emphasized the need for strengthening governance for health. Phase VI is an adaptable and practical framework for delivering Health 2020 at the local level. It provides a unique platform for joint learning and sharing of expertise and experience between cities, the sub-national level, and countries. It recognizes that every city is unique and will pursue the overarching goals and core themes of phase VI according to the city’s situation. In delivering Health 2020, phase VI will support and encourage cities to strengthen their efforts to bring key stakeholders together to work for health and well-being, harnessing their potential for innovation and change and resolving local public health challenges. The future prosperity of urban populations depends on the willingness and ability to seize new opportunities to enhance the health and well-being of present and future generations. Map