"Healthy cities"--requirements and performance. Questionnaire results and a suggestion on quality monitoring (healthy-cities-barometer)

Abstract

The overall goal of the WHO Healthy Cities Project was to translate some key points of the Ottawa Charter for Health Promotion (1986) into reality such as public health policies, creating health-promoting environments, strengthening community action through active public participation (empowerment of communities) and equity in health at the local level. These should be anchored within the local political administrative system (PAS), which means health should be on the agenda of policymakers in all sectors. To figure out how far this has been attained after almost 15 years of "healthy cities" policy in Germany was the focal point of the first questioning of local project coordinators. A written questionnaire containing 128 items has been developed in collaboration with the Healthy Cities Network-Coordinator. The questionnaire consists of 78 standardised questions and some (23) open-ended questions for more specific qualitative information. Also included are 27 ten-point rating scales to evaluate the coordinators' view of some aspects of their healthy cities work and to assess its progress. Based on 30 questions of the questionnaire we generated six quality indices, summarised to a quality index for a monitoring model. 47 (90 %) project-coordinators from a list of 52 took part in the first German Healthy Cities survey in the spring 2002. Selected results of the network questioning concerning the local "healthy cities" offices, work priorities and methods demonstrate differences between East and West Germany and general weakpoints of the "healthy cities" projects. Data analysis based on six quality dimensions of the "Healthy Cities" work, Programme Equipment and Commitment (Structure), Concept Quality and Integration within the Network (Process), Self-reported Success and Integration within the City/Municipality (Outcome), revealed some weak points of the " Healthy Cities" work as follows: Basing on the six quality dimensions we present a monitoring model (Healthy-Cities Barometer) which can also be used for strategic controlling (benchmarking) within the German Healthy Cities Network. Based on the data we identified 13 Cities at an A-level (excellent), 22 Cities at a B-level (satisfactory) and 12 Cities at a C-level (INADEQUATE). The "Healthy-Cities Barometer" provides a surveillance instrument which - if constantly used over several years - could offer data for a longitudinal analysis of the Healthy Cities' development. With its help the Healthy Cities Network-Coordinator could gain more information for a better performance and a continuous quality improvement process of the local Healthy Cities projects.