Healthy Cities Network Research Articles

Explaining Mechanisms That Influence Smoke-Free Implementation at the Local Level: A Realist Review of Smoking Bans

While studies have been undertaken to understand the adoption of outdoor and indoor smoking bans, not much is known about why implementation of smoke-free (SF) environments differs at local levels. As most European countries remain at the level of indoor bans, we aim to translate existing evidence into practical recommendations on how to improve SF (outdoor) implementation within European municipalities. We applied six methodological steps of a realist review consistent with the RAMESES publication standards for realist syntheses. Literature search was conducted in PubMed/MEDLINE and Web of Science. In total, 3829 references were screened, of which 43 were synthesized. Studies dating from 2004 to 2015 with rigor evidence of SF implementation at the local level were selected. Implementation outcomes were SF enforcement, monitoring, nonsmoking compliance, and public support in cities. The explanatory realist framework links four innovation stages with three context-mechanism-outcome (CMO)configurations. We identified "triggering trust," "increasing priorities," and "limiting opposing interests" as underlying mechanisms, when (1) establishing, (2) developing, (3) contesting, and (4) implementing local smoking bans. The CMO propositions (CMOs) support practical recommendations, such as (1) providing authorities with local data when establishing and developing bans, (2) developing long-term strategies and implementing state-funded SF programs to prioritize sustained enforcement, and (3) limiting opposing interests through the use of the child protection frame. This is the first realist review on the implementation of SF enviroments at the local level. The process-oriented theory explains how and why CMOs determine SF development in cities and municipalities from planning until implementation. In 2015, only 16% of the world's population lived under the jurisdiction of comprehensive SF laws. The findings of this realist review are useful to implement WHO goals of the Framework Convention on Tobacco Control (FCTC) and specifically SF environments at more local levels and to adjust them to specific contextual circumstances. This paper unpacks three mechanisms that could be triggered by SF strategies developed at local levels and that can result in improved policy implementation. Such evidence is needed to enhance SF strategies at the level of cities and municipalities and to achieve WHO "Healthy Cities Network" objectives.

The World Health Organization European Healthy Cities Network 30 years on

The World Health Organization European Healthy Cities Network 30 years on

Emotional Maps: Participatory Crowdsourcing of Citizens´ Perceptions of Their Urban Environment

Public participation and civic engagement in the urban planning process are societal trends that stretch across countries, cultures, and classes. After decades of communist regimes in the Eastern Bloc, where there was basically no civic participation, civic society in the Czech Republic began to engage in discussions with the authorities, and citizens became more active in local planning. In 1994 eleven municipalities started the Network of Healthy Cities of the Czech Republic as a platform for sharing good practices in sustainable development and local participation. In the last three years, members of the Network have used emotional mapping activities to facilitate and improve the process of participatory planning. This paper describes the timeline of development and the deployment of an emotional mapping methodology in various workshops in the Healthy Cities network. A total of forty-six emotional mapping workshops were organised in thirty-five municipalities of the Czech Republic. The paper presents the change from crayon-based maps to digital web-mapping platforms; and presents a case study of the Prague 12 district, where emotional mapping workshops were used to explore the perception of safety, among other issues.

Health in all policies and urban green spaces: the baseline study of the GREENH-City project

Health in all policies (HiAP) is a key strategy for tackling social inequalities in health (SIH) and contributes to act on health determinants, among which environmental determinants play a major role. In France, cities have levers to act on environmental determinants such as green spaces. This communication aims to present the baseline study of the GREENH-City interventional participatory project (INCa n°2017-003). The general goal of the project is to identify the most promising interventions to operationalize HiAP at the city level and act on the social inequalities in health through green space policy in urban area. The baseline study will contribute to analyze the HiAP approach among the cities of the French Healthy Cities Network. The objective of this presentation is to provide profiles of the cities regarding the degree of maturity of the HiAP approaches. Methods Drawing on the HiAP analytical framework, a qualitative analysis will be conducted among 80 cities of the French Healthy Cities Network by using an online survey addressed to elected official and technicians from public health departments in the cities. Items will rely on the degree of maturity of HiAP approaches regarding the modes of collaborations between sectors, the consideration of health, social inequalities in health and green spaces accessibility equity. Results The survey will identify profiles of cities regarding their style of HiAP. These results, crossed with SIH indicators and green space indicators will define 6 cases. Conclusions The six cases should enable us to profile the cities in terms of their HiAP approaches and how they address social inequalities in health as part of their policies and interventions on green spaces.

Evaluation of Development of Cooperation in South Bohemian Municipalities in the Years 2007–2014

AbstractThe article presents results of the research of cooperation of municipalities in the South Bohemian Region, focused on the analysis of forms and means of cooperation between 2007 and 2014. The published results are part of an internal research that lasted for many years, the goal of which was both to analyse the development of cooperation of municipalities in the studied region and to identify the prerequisites and barriers of all cooperative relations. The research was done on a sample of 623 South Bohemian municipalities in the period of 2007-2010 and 2013- 2016, the obtained data was processed using descriptive statistics and multidimensional statistical methods, and the results show an almost 20% increase in the means of municipal cooperation across the entire South Bohemian Region. Based on the respective means of cooperation, National Healthy Cities Network of the Czech Republic saw the biggest growth, amounting to +3.275% between 2007 and 2014. Participation in local action groups, where the total of 580 municipalities are already engaged, increased by 32.12%. Although less dynamic, this growth is much more important, as it significantly contributes to the development of rural areas and their absorption abilities, mainly as regards financial resources from the national and European sources. However, fragmented means of municipal cooperation is a current problem of cooperation of municipalities, leading to the disintegrated power of the respective municipalities.

Some Reflections on Designing Effective Social Telerehabilitation Services for Older Adults

The share of the population aged 65 years and over is increasing in every EU Member State, candidate country, and EFTA Member State. WHO/Europe has established a Subnetwork on Healthy Ageing within the European Healthy Cities Network and provides guidance to Member States in developing profiles of healthy ageing, since, given the increasing number of older adults, maintaining their health status is a crucial issue. This article, which is part of the Latvian national scientific program VPP INOSOCTEREHI, focuses on the issues related to the design, implementation, and assessment of user interfaces that can maximize usability in social telerehabilitation systems for older adult users. This is a very real challenge, since older adults don’t form a homogeneous class. Investigating older adults’ skills and their attitudes towards the perceived usefulness of computer applications could be helpful in identifying some sub-sets of older adult users and their typical behaviours.

City Diplomacy: Towards More Strategic Networking? Learning with WHO Healthy Cities

AbstractCities are increasingly capturing the attention of major international actors and now regularly feature in multilateral processes. Yet while there are many studies on networking among cities, there have been few studies of ‘city networks’ as formal and institutionalized governance structures facilitating city‐to‐city and city‐to‐other actors cooperation, or ‘city diplomacy’. Institutionalized networks of cities, while not new, are becoming a growing presence on the international scene, almost omnipresent and perhaps even too common. Might it be time for a ‘Darwinian’ selection between city networking options? Diving deeper into this networked challenge, this essay focuses on the effects this networked diplomacy and overlap it might have on cities. Drawing on a research collaboration between the UCL City Leadership Laboratory at University College London and the World Health Organization's Healthy Cities Network and both a global dataset of city networks as well as qualitative focus group data, we consider the growth of these governance structures, their strengths, but also the weaknesses associated with their rapid growth, and how cities can engage with this networked landscape more strategically. In short, we argue that the potential of city networks must go hand‐in‐hand with more integrative and strategic thinking at both local and international levels.

The development and achievement of a healthy cities network in Taiwan: sharing leadership and partnership building.

The World Health Organization (WHO) Healthy Cities (HC) projects are the best known of the settings-based approaches to health promotion. They engage local governments in health development through a process of political commitment, institutional change, capacity-building, partnership-based planning and innovative projects. Many cities have promoted HC projects in Taiwan since 2002. In 2008, the Taiwan Alliance for Healthy Cities (TAHC) was launched to assist local governments in effectively establishing, operating and promoting HC projects. In this article, we share our experiences of establishing a platform and network to promote the HC program in Taiwan. Based on individual city profiles and governance in Taiwan, the TAHC developed a well-organized framework and model to encourage strong leadership in local governments and to promote participation and engagement in their communities. In the last 6 years, leaders from Taiwan's local governments in HC networks have integrated the HC concepts into their governance models, actively engaging and combining various resources with practical expertise and private sectors. The network of health in Taiwan allows each city to develop its unique perspective on the HC projects. Using this method, not only local government meets its needs, but also increases governance efficiency and effectiveness, resulting in the promotion of its citizens' overall sustainable urban health development. This HC network in Taiwan has partnerships with government and non-governmental organizations (NGOs), with academic support and citizen involvement, a dynamic data collection system and demonstrated leadership in the sharing of information in the Asian region.

WHO’s city networks: From healthy to age-friendly

The Age Friendly City-network of WHO is a continuation and further specification of the Healthy Cities-network and especially a challenge to architecture and urbanism, a call for a new approach. How can we learn from different approaches of cities? And can design play a significant role?

European Healthy City Network Phase V: patterns emerging for healthy urban planning.

There is a tradition of planning cities and their infrastructure to successfully tackle communicable disease arising from urban development. Non-communicable disease follows a different course. Development brings in its wake a basket of adverse health and health equity outcomes that are proving difficult to tackle. In response, within Phase V of the European Healthy Cities Network, municipalities have implemented a range of policy and physical interventions using a settings approach. Owing to the time lag between physical interventions and health outcomes, this research interrogates city activity itself to develop better understanding. Self-reported city case studies and questionnaire data were analysed to reveal patterns using an inductive approach. Findings indicate that some categories of intervention, such as whole city planning and transport, have a systemic impact across the wider determinants of health. Addressing transferability and stakeholder understanding helped cities create conditions for successful outcomes. Cities had varying urban development approaches for tackling climate change. Improvements to current practice are discussed, including; a distinction between supply side and demand side in healthy urban planning; valuing co-benefits and developing integrative approaches to the evidence-base. This evaluative article is important for cities wanting to learn how to maximize benefits to public health through urban development and for researchers exploring, with a systemic approach, the experiences of European cities acting at the interface of urban development and public health. This article also provides recommendations for future phases of the WHO European Healthy Cities programme, posing questions to better address governance and equity in spatial planning.

Is a healthy city also an age-friendly city?

Healthy Ageing is an important focus of the European Healthy Cities Network and has been supported by WHO since 2003 as a key strategic topic, since 2010 in cooperation with the Global Network of Age-friendly Cities and Communities. Based on the methodology of realist evaluation, this article synthesizes qualitative evidence from 33 structured case studies (CS) from 32 WHO European Healthy Cities, 72 annual reports from Network cities and 71 quantitative responses to a General Evaluation Questionnaire. City cases are assigned to three clusters containing the eight domains of an age-friendly city proposed by WHO's Global Age-friendly City Guide published in 2007. The analysis of city's practice and efforts in this article takes stock of how cities have developed the institutional prerequisites and processes necessary for implementing age-friendly strategies, programmes and projects. A content analysis of the CS maps activities across age-friendly domains and illustrates how cities contribute to improving the social and physical environments of older people and enhance the health and social services provided by municipalities and their partners.

Healthy Cities Phase V evaluation: further synthesizing realism.

In this article we reflect on the quality of a realist synthesis paradigm applied to the evaluation of Phase V of the WHO European Healthy Cities Network. The programmatic application of this approach has led to very high response rates and a wealth of important data. All articles in this Supplement report that cities in the network move from small-scale, time-limited projects predominantly focused on health lifestyles to the significant inclusion of policies and programmes on systems and values for good health governance. The evaluation team felt that, due to time and resource limitations, it was unable to fully exploit the potential of realist synthesis. In particular, the synthetic integration of different strategic foci of Phase V designation areas did not come to full fruition. We recommend better and more sustained integration of realist synthesis in the practice of Healthy Cities in future Phases.

Twenty-seven years of the WHO European Healthy Cities movement: a sustainable movement for change and innovation at the local level.

Healthy Cities in Europe was launched with the ambitious aim to put health high onthe social and political agenda of cities. This ambition resonates well with the understanding today of the significance of the social, economic, environmental, cultural and commercial determinants of health and the fact that health is ultimately a political choice. What was remarkable from the start was that city leaders from across Europe enthusiastically embraced the concept of a healthy city as a whole-of-local-government responsibility. Paradoxically, 27 years on, such an understanding remains an elusive challenge for national governments, even though the evidence of the effects of these determinants of health is immensely stronger today than it was then. The evolution of healthy cities in Europe can be seen as the history of modern public health through a local lens, covering 27 years of major political developments in Europe and globally, major changes in how health and sustainable development are understood and dealt with as well as majorchanges in the social and public health landscape of the WHO European Region. The WHO European Healthy Cities Network was for

European Healthy Cities evaluation: conceptual framework and methodology.

This paper presents the methodology, programme logic and conceptual framework that drove the evaluation of the Fifth Phase of the WHO European Healthy Cities Network. Towards the end of the phase, 99 cities were designated progressively through the life of the phase (2009-14). The paper establishes the values, systems and aspirations that these cities sign up for, as foundations for the selection of methodology. We assert that a realist synthesis methodology, driven by a wide range of qualitative and quantitative methods, is the most appropriate perspective to address the wide geopolitical, demographic, population and health diversities of these cities. The paper outlines the rationale for a structured multiple case study approach, the deployment of a comprehensive questionnaire, data mining through existing databases including Eurostat and analysis of management information generation tools used throughout the period. Response rates were considered extremely high for this type of research. Non-response analyses are described, which show that data are representative for cities across the spectrum of diversity. This paper provides a foundation for further analysis on specific areas of interest presented in this supplement.

Tackling the social determinants of inequalities in health during Phase V of the Healthy Cities Project in Europe.

The WHO European Healthy Cities Network has from its inception aimed at tackling inequalities in health. In carrying out an evaluation of Phase V of the project (2009-13), an attempt was made to examine how far the concept of equity in health is understood and accepted; whether cities had moved further from a disease/medical model to looking at the social determinants of inequalities in health; how far the HC project contributed to cities determining the extent and causes of inequalities in health; what efforts were made to tackle such inequalities and how far inequalities in health may have increased or decreased during Phase V. A broader range of resources was utilized for this evaluation than in previous phases of the project. These indicated that most cities were definitely looking at the broader determinants. Equality in health was better understood and had been included as a value in a range of city policies. This was facilitated by stronger involvement of the HC project in city planning processes. Although almost half the cities participating had prepared a City Health Profile, only few cities had the necessary local level data to monitor changes in inequalities in health.

Policymaking in European healthy cities.

This paper assesses policy development in, with and for Healthy Cities in the European Region of the World Health Organization. Materials for the assessment were sourced through case studies, a questionnaire and statistical databases. They were compiled in a realist synthesis methodology, applying theory-based evaluation principles. Non-response analyses were applied to ascertain the degree of representatives of the high response rates for the entire network of Healthy Cities in Europe. Further measures of reliability and validity were applied, and it was found that our material was indicative of the entire network. European Healthy Cities are successful in developing local health policy across many sectors within and outside government. They were also successful in addressing 'wicked' problems around equity, governance and participation in themes such as Healthy Urban Planning. It appears that strong local leadership for policy change is driven by international collaboration and the stewardship of the World Health Organization. The processes enacted by WHO, structuring membership of the Healthy City Network (designation) and the guidance on particular themes, are identified as being important for the success of local policy development.

Healthy cities as catalysts for caring and supportive environments.

'Caring and Supportive Environments' are fundamental to a social model of health and were a core theme of Phase V (2009-13) of the WHO European Healthy Cities Network. Deploying the methodology of realist evaluation, this article synthesizes qualitative evidence from 112 highly structured case studies from 68 Network cities and 71 responses to a General Evaluation Questionnaire, which asked cities to analyze city attributes and trends. A schematic model was developed to describe the interaction between action targeted toward children, migrants, older people and action on social and health services, health literacy and active citizenship-the six subtopics clustered within the theme Caring and Supportive Environments. Four hypotheses were tested: (i) there are prerequisites and processes of local governance that increase city capacity for creating supportive environments; (ii) investing in health and social services, active citizenship and health literacy enhance the social inclusion of vulnerable population groups; (iii) there are synergies between social investment and healthy urban planning; and (iv) these investments promote greater equity in health. The evaluation revealed many innovative practices. Providers of health and social services have developed partnerships with agencies influencing wider determinants of health. Health literacy campaigns address the wider context of people's lives. In a period of economic austerity, cities have utilized the social assets of their citizens. Realist evaluation can help illuminate the pathways from case study interventions to health outcomes, and the prerequisites and processes required to initiate and sustain such investments.

WHO European Healthy Cities network – supporting local governments to improve health

Background The World Health Organization has supported a global network of Healthy Cities over 25 years. The WHO European Network consists of 99 municipalities committed to improving health and sustainable development via socioeconomic and environmental policies. Designated cities reflect enduring values of equity and cooperation, and focus on specific themes and goals for each five-year phase. This research project considers Phase V (2009–2013) impact and evaluation. Methods A ‘realist synthesis’ …

On the Internet of Things, smart cities and the WHO Healthy Cities

This article gives a brief overview of the Internet of Things (IoT) for cities, offering examples of IoT-powered 21st century smart cities, including the experience of the Spanish city of Barcelona in implementing its own IoT-driven services to improve the quality of life of its people through measures that promote an eco-friendly, sustainable environment. The potential benefits as well as the challenges associated with IoT for cities are discussed. Much of the 'big data' that are continuously generated by IoT sensors, devices, systems and services are geo-tagged or geo-located. The importance of having robust, intelligent geospatial analytics systems in place to process and make sense of such data in real time cannot therefore be overestimated. The authors argue that IoT-powered smart cities stand better chances of becoming healthier cities. The World Health Organization (WHO) Healthy Cities Network and associated national networks have hundreds of member cities around the world that could benefit from, and harness the power of, IoT to improve the health and well-being of their local populations.

Architecture as a Generator of Health and Well-being.

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