Healthy Cities Project Research Articles

세계보건기구 서태평양지역 건강도시 지침의 비교와 의의

Although Korean Healthy Cities have shown rapid growth in number, there is still no official Healthy Cities guideline developed in Korea. Before the Healthy Cites article of Korean Health Promotion Act comes into effect in 2023 December, it is important to review the two official Healthy Cities guidelines published by World Health Organization Western Pacific Regional Office(WPRO). The first official guideline which reflects actions during the early pilot Healthy Cities projects is written by pioneers from academia and by staff at the WHO. The guideline still has implications today regarding the common steps according to the three phases of developing a healthy city. The second official guideline added many useful tools for partner mobilization and situation analysis in addition to strategic objectives and other resources. By reviewing these official Healthy Cities guidelines, the Korean Healthy Cities Partnership and the Academy of Urban Health would be able to add value to the development of Korean Healthy Cities.

The Importance of Midwifery Services in Achieving Healthy Cities: A Review Article

Introduction: WHO has developed the Healthy Cities Project, based on how a city can be a healthy city. Effective delivery of midwifery services is very important in delivering healthy services to all segments of the society. In this study, we aimed to draw attention to the importance of effective provision of midwifery services in the way of being a healthy city. Methods: Data were collected using the literature review method. The keywords "healthy city", "women-friendly city", "child-friendly city", "midwifery", "sustainable development" and "urban health" were used for the search. Turkish and English articles obtained through PubMed, GoogleAcademic were analyzed and compiled in line with the scope. The review of the subject was carried out between June and July 2022. Results: Healthy societies and cities can be achieved by protecting children from all kinds of harm from prenatal period to adulthood, providing quality birth and postpartum services to mothers and making these services accessible. In order to reach a healthy society, midwifery care provided by midwives is very important to protect and improve the health of women, families and children, and especially to reduce health inequalities in the society. In order to be a healthy city, midwifery care services must be well organized. Conclusion: The Healthy Cities Project makes significant contributions to the formulation, implementation and evaluation of health policies in the city. Each of the Sustainable Development Goals and the concept of a healthy city are interrelated. It is important for cities to organize and expand midwifery services well in order to achieve their sustainable development goals.

Driving HIA implementation in Ireland: The role of academia and public health institutions

Abstract Over the past decades public health research has presented compelling evidence that health is socially determined. To address structural inequalities and inequities in health, public policies require intersectoral development and implementation. Health Impact Assessment (HIA) is an established tool for analysing potentially detrimental health outcomes of policies, programmes and projects. In Ireland, we are presented with a unique opportunity to examine HIA implementation by capitalising on the synergy of recent policy commitments driving HIA implementation. Specifically, the national public health framework Healthy Ireland 2013-2025, and the newly developed all-island Institute of Public Health HIA guidance (2021), have coalesced in steering the strategic direction of HIA. This presentation outlines the current synergistic policy context on the island of Ireland, including the publication of new HIA guidance, which opens opportunities and new possibilities for implementing HIA. Reflections will be made on the potential and reality of current HIA training programmes in Ireland. Learning from the lessons of a dearth of HIA implementation at varying time periods since 2000, this presentation discusses the mechanisms in place, such as the successful World Health organization-led healthy cities projects in Ireland, such as Cork Healthy Cities, and those key drivers that are required to capture policy synergy for meaningful HIA implementation.

Evaluating healthy cities: A scoping review protocol.

BackgroundThe Healthy Cities project supports municipal policymakers in the struggle to safeguard the health of urban citizens around the world (and in other limited geographies such as islands). Although Healthy Cities has been implemented in thousands of settings, no synthesis of implementation experiences have been conducted. In this article, we develop a scoping review protocol that can be applied to collect evidence on process evaluations of Healthy Cities.MethodsTo develop a scoping review protocol that could identify experiences evaluating the Healthy Cities project, we followed the PRISMA guidelines for Scoping Reviews (PRISMA-ScR). We applied these guidelines in consultation with a research librarian to design a search of the peer-reviewed literature, specifically Ovid Medline, Ovid Embase, Web of Science Core Collection, and Scopus databases, and a grey literature search.DiscussionIn addition to the aim of collecting evidence on Healthy Cities process evaluation experiences, the broader goal is to spark discussions and inform future evaluations of Healthy Cities. This work can also inform other evaluations of initiatives seeking to raise socio-political change, such as those focused on enhancing intersectoral and multisectoral action.

Co-Benefits of Transdisciplinary Planning for Healthy Cities

Synergies between urban planning and public health were synthesized a decade ago by the Lancet Commission’s article “Shaping Cities for Health: Complexity and the Planning of Urban Environments in the 21st Century.” Since then, innovative research projects, urban planning projects, and accumulated experience from the World Health Organization Healthy Cities project confirm that transdisciplinary contributions enable the achievement of core principles of healthy cities. This article clarifies important differences between the content, scope, and outcomes of interdisciplinary and transdisciplinary projects about public health and urban planning. It explains why transdisciplinary contributions are more likely to bridge the applicability gap between knowledge and practice in response to persistent urban health challenges; notably, they transgress the boundaries of public health and medical science; they prioritize political action in both the formal and informal construction sectors; and they include citizens, community associations, and private enterprises as partners in consortia for concerted action. This article proposes a radical shift from incremental, reactive, and corrective approaches in planning for urban health to proactive and anticipative contributions using backcasting and alternative scenarios that prioritize health. The article uses the case of public green spaces in planning for urban health. It identifies the shortcomings of many empirical studies that are meant to promote and sustain health before describing and illustrating an alternative way forward.

Participatory Systems Mapping for Municipal Prioritization and Planning

Rapidly growing cities face new and compounding health challenges, leading governments and donors to seek innovative ways to support healthier, more resilient urban growth. One such approach is the systems mapping process developed by Engaging Inquiry (EI) for the USAID-funded Building Healthy Cities project (BHC) in four cities in Asia. This paper provides details on the theory and methods of the process. While systems mapping is not new, the approach detailed in this paper has been uniquely adapted to the purpose of municipal planning. Strategic stakeholder engagement, including participatory workshops with a diverse group of stakeholders, is at the core of this approach and led to deeper insights, greater buy-in, and shared understanding of the city’s unique opportunities and challenges. This innovative mapping process is a powerful tool for defining municipal priorities within growing cities across the globe, where the situation is rapidly evolving. It can be used to provide evidence-based information on where to invest to gain the biggest impact on specific goals. This paper is part of a collection in this issue providing a detailed accounting of BHC’s systems mapping approach across four project cities.

Designing for a Healthier Makassar, Indonesia: Participatory Systems Mapping

In Makassar, Indonesia, the USAID-funded Building Healthy Cities (BHC) project engaged 240 multi-sector stakeholders to gather qualitative data across three workshops and two citizen town halls from 2019 to 2021. These data were synthesized with results from BHC’s nine other Makassar activities to build maps of the current system and identify high-impact areas for engagement. Contextual findings showed that Makassar leadership has actively innovated and used new technology to improve the city, resulting in improved connectivity and responsiveness. However, this drive toward innovation has strained existing infrastructure and workforce capacity. When this strain fails to meet promised results, citizens are less likely to engage and support the innovations. This is central to the systems map that BHC developed, and is expanded upon through additional patterns that fall within four main areas: (1) leadership, governance, and financing; (2) infrastructure and workforce; (3) collaboration and data; and (4) community cohesion and awareness. Stakeholders found three key leverage points within this context that, if included in every action, could help overcome barriers. These leverage opportunities are: (1) increasing data-driven decision-making; (2) ensuring equitable policy and leadership; and (3) increasing community participation. By combining key patterns discovered in the Context Map with the leverage opportunities, BHC was able to co-create with stakeholders six “coherent actions” that can move Makassar to a healthier, “Sombere (kind-hearted and hospitable) and Smart City.” BHC has been working with the city planning office to incorporate the map findings into its bottom-up planning processes and the 5-year mid-term plan for Makassar.

Data-driven assessment framework of health cities for elderly individuals in China

The “Healthy Cities Project” is a well-recognized response to the health challenges associated with rapid urbanization. While previous studies have adopted qualitative or quantitative methods to guide the development of healthy cities for elderly individuals, they do not offer an assessment framework based on stakeholders' expectations or the interdependent relationships among aspects of the assessment. To address these challenges, this study proposes a hybrid method that integrates quantitative normalization, exploratory factor analysis and reliability tests, Google Trends data transformation, and the fuzzy synthetic method with the decision-making trial and evaluation laboratory method to develop a data-driven assessment framework. The results reveal that (1) current developments exhibit imbalances in regional performance and among socioeconomic, health, and societal factors; (2) the development of healthy cities should take public expectations into account, which may help to address the issues stemming from the abovementioned imbalances; (3) healthy cities for elderly individuals in China have their own characteristics for development (concentrating on socioeconomic aspects), and these characteristics differ from the characteristics of similar cities worldwide (focusing on the environment). The results demonstrate the importance of health and stakeholder interests, which may have universal relevance for correcting imbalance issues worldwide.

Healthy City Project: An application of data envelopment analysis.

PurposeThe importance of Korea’s Healthy City Project has recently increased due to the growth of the elderly population and chronic diseases. Consequently, local governments are expanding the project to manage health at the local level; however, because local government resources are limited, efficient business operation is required. Thus, the purpose of this study is to present a plan for effective project management by developing a strategy for a Healthy City Project that is suitable for the scale of local governments.MethodsFor efficiency analysis, data were collected from the homepages of 90 local governments that are implementing the Healthy City Project in Korea, and data envelopment analysis (DEA) was conducted using both the CCR model and the BCC model. The input variables for the DEA included budget, manpower, organization, planned projects, and research education. In addition, we selected program, network, and project performance as output variables.ResultsAnalysis results indicated that the CCR model identified 22 (out of 90) municipalities in which Healthy City Projects are implemented efficiently, while 68 are inefficient. The BCC model identified many more efficient regions than the CCR model; however, the difference was insignificant. Thus, the budget, manpower, planned projects, and network must be increased to improve efficiency.ConclusionFirst, to improve the efficiency of the Healthy City Project, a sufficient budget must be secured during its implementation. Second, long- and short-term plans are needed to expand the Healthy City Program. Third, networks must be created for local governments to benchmark Healthy City Projects.

Cidade saudável: o diagnóstico do território urbano por meio dos determinantes sociais de saúde: o caso Maracanaú

Compreender o território urbano por meio da análise dos Determinantes Sociais de Saúde (DSSs) como pressupostos para a estruturação de uma Agenda de Cidade Saudável. Esta pesquisa se caracterizou como um levantamento documental por meio das leis, plano diretor e relatórios de gestão da cidade de Maracanaú e nos cadernos de informação em saúde do governo. A análise se deu pela leitura e identificação do que versava sobre os DSSs, utilizando-se a análise de conteúdo. Os resultados trouxeram duas categorias de análise que estruturaram um diagnóstico do território, mapeando as fragilidades encontradas no que diz respeito aos DSSs analisados como crescimento demográfico, taxa de mortalidade, violência urbana, dentre outros. Acredita-se que o diagnóstico do território realizado por meio dos DSSs possibilitou identificar os pontos interventivos que possam ser utilizados para a preparação de uma agenda de cidade saudável.

Noncommunicable disease risk profile of urban women in Indore city, India

Background: Lifestyle changes are affecting the health risk profile of women in developing countries. This study assesses risk factors for noncommunicable diseases (NCDs) and access to NCD screening services among women in Indore city, India. Materials and Methods: A NCD risk factor survey was undertaken in Indore city through the United States Agency for International Development-funded Building Healthy Cities project. The survey used the World Health Organization STEPwise methodology and tools. A total of 1987 women and 1083 men aged 18–69 years were randomly selected from 90 settlements across 30 wards of the city. Weighted analysis based on sampling strategy and response rate was conducted. Results: A total of 22% of women (95% confidence interval [CI]: 21, 24) had raised blood pressure and 13% (95% CI: 11, 14) had raised fasting blood sugar or had already been diagnosed with hypertension or diabetes. While only 6% of women were current tobacco users and <1% consumed alcohol in the last 30 days, 60% of women were overweight or obese. Central obesity was observed in 70% of women; 89% of women were not consuming adequate fruits and vegetables, and 20% were physically inactive. Only 41% and 20% of women had their blood pressure and blood sugar measured, respectively, in the last 12 months; <1% were screened for oral and cervical cancers. Conclusion: Women living in Indore have higher levels of metabolic risk factors, and current NCD screening programs have poor uptake. Gender-sensitive solutions targeting awareness, access, and community environment need further exploration.

Prioritní a prioritní nebezpečné látky v říčních sedimentech v blízkosti Prahy

The report presents a part of the Clean Water – Healthy City project, which deals with the assessment of the river sediments quality with view of the load of priority and priority hazardous substances (PPH substances) which may endanger the aquatic ecosystems and human health during the flood.

Opportunity for HiAP through a Healthy Cities initiative in Taiwan: a multiple streams analysis.

Health in All Policies (HiAP) is an effective approach to promote population health through addressing comprehensive social determinants of health. In 1997, the World Health Organization designed a 20-step protocol for developing a Healthy Cities (HC) project to build healthy public policies. Taiwan adopted the concept of HC in 2002 and established the first demonstration project in Tainan City in 2003. This study explores the impact of the HC initiative on the development of HiAP, as well as how a window of opportunities for HiAP was opened through the HC movement, using Tainan City as an example. Tainan was selected as the case for this study because of its relative maturity in the development of an HC initiative. A theory-driven thematic analysis was conducted in the study with archived documents between 2003 and 2010. We first adopted a Multiple Streams Approach to examine how the city government opened a window for HiAP through the HC initiative and then drew on the Maturity Model to evaluate the stage of HiAP in the Tainan HC project. After analyzing all related documents, we concluded that HiAP in the Tainan HC project had reached Stage V Institutionalization after 7 years. Key contexts, factors, challenges and strategies were identified. This study suggests that the HC initiative can indeed contribute to the development of HiAP and that the window was opened for HiAP through a concurrence of the three streams of problem, policy and politics along with the HC movement process.

Healthy City Project in Cienfuegos, Cuba

Objectives: The World Health Organization’s Healthy City Project was established to increase the health commitment of citizens in urban settings and to improve deteriorating health conditions. Cuba’s Cienfuegos city introduced the “Healthy City Project”, adapting the concept with projects based in primary healthcare. The study aimed to review the implementation of this project in Cienfuegos City, Cuba. Methods: Cuba’s Healthy City Project was reviewed by analyzing the experiences of Cienfuegos city. Relevant literature related to the implementation of the Healthy City Project was also reviewed and web-based gray literature was assessed, searched, and selected. Additionally, reports from Google Scholar and the Scientific Electronic Library Online were used to gather complementary information. Results: Initiated in 1989, the city of Cienfuegos used the Healthy City Project as a strategy for health promotion, lifestyle modification, and disease prevention. It undertook this initiative as the local government’s plan to help reduce non-communicable diseases and the associated initiatives to transform the city into a healthier one has proven to be successful, especially by involving the community and engendering the government’s political commitment. The Project has involved schools and hospitals to improve personal and community health. Conclusion: The Project has been proven effective by involving the community, yet there are some considerations, such as upgrading the evaluation system, that would improve the overall outcome of the Project.

Healthy Cities Projects in Taiwan

AffiliationsBoth authors are with Healthy City Research Center, Research and Services Headquarters, National Cheng Kung University, Tainan City, Taiwan. Susan C. Hu is also with the Department of Public Health, College of Medicine, National Cheng Kung University.

Developing an Indicator System for a Healthy City: Taking an Urban Area as a Pilot.

PurposeThe Healthy Cities Project is an important strategy for global health. This study aimed to develop a scientific and appropriate indicator system for the evaluation of a Healthy City in Chongqing, China.MethodsData were collected via a review of government documents, focus group discussions, and in-depth interviews. A total of 34 government documents were reviewed to build the indicator database based on our previous studies. The first round of focus group discussions, which involved eight health-related experts, was conducted to form the indicator system framework. In-depth interviews with 15 experts from government departments were conducted to design the improved indicator system. The second round of focus group discussions, which featured four experts, was conducted to obtain the final recommended list of indicators. A thematic framework was used to analyze the detailed interview notes.ResultsThe indicator system for the Healthy City consisted of 5 first-level indicators, 21 second-level indicators (e.g., health literacy), 73 third-level indicators (e.g., incidence of myopia), and three characteristic indicators. This indicator system spanned the scope of the environment, society, health services, healthy people, and health behaviors.ConclusionThis indicator system was based on the current status of the construction of the Healthy City in the pilot district. The indicator system could be dynamically adjusted according to the development of the Healthy City in the pilot district. Government departments play an important decision-making role in the development process of this indicator system.

Engaging Citizens Via Journey Maps to Address Urban Health Issues.

Effectively addressing urban health challenges requires engagement of citizens. However, citizens often face barriers providing feedback, and city officials likewise face difficulties incorporating feedback in a meaningful and systematic way. This paper shares one innovative approach to capturing citizens’ stories about urban health concerns, developed by the Building Healthy Cities (BHC) project in 2 Asian cities (Indore, India, and Makassar, Indonesia).Using ethnographic methods, BHC developed “journey maps” as a monitoring tool to follow key service issues over time. Several urban health-related issues were identified in each city. For this paper, we focus on wastewater management, which was a serious health issue in both cities. Qualitative data were collected from citizens in one neighborhood and city officials quarterly starting in early 2018; these data were supplemented by city spending data, usage statistics, photos and news articles. In both cities, the journey maps captured notable changes during the first 2 years of the project. At the start of the journeys (2018), informal settlement citizens in Indore reported poor drainage which was compounded by trash, narrow roads blocking vehicular removal of waste, and unsafe infrastructure leading to waterborne diseases and injuries (including several child deaths). Likewise in Makassar, dirty water overflowed from open drains due to frequent flooding and garbage. Citizens reported exposure to diarrhea, dengue and skin symptoms due to the drains, which was confirmed by the local health post. By the end of Year 2 (2019), these journeys captured increasing dialogue between citizens and the city, which resulted in several improvements. In Indore, changes included garbage vans built for narrow streets and construction of a safer bridge. In Makassar, while they still suffer from seasonal flooding, the city has increased garbage pickup, included drainage activities in the village-level budgeting process, and a slum improvement project has pledged funding to improve drainage and street issues in 41 neighborhoods. Journey maps work on the premise that capturing a community’s experience and relaying it to government officials can bring about positive change. They also provide crucial grassroots level evidence to support more traditional research findings, which can lead to effective urban health solutions. As this work continues, BHC is training citizens to collect and share their own journeys.

Čistá voda – zdravé město: Využitelnost stávajícího systému sběru informací pro naplnění cílů projektu

The contribution is part of the Clean Water – a Healthy City project, which deals with the prediction of the possible occurrence of hazardous chemicals during the accidental pollution and floods. Lists the databases that are currently on the subject and with their practical applicability.

A review of assessment indicators used by Healthy Municipalities and Communities Program in Latin America and the Caribbean region.

The Healthy Municipalities and Communities Strategy (HMCS) was developed by the Pan American Health Organization in 1990. Evaluation and monitoring are fundamental components of health promotion policies. The aim of this study is to explore the indicators used in Latin America and the Caribbean (LAC) countries to assess the performance of HMCS. We searched MEDLINE, EMBASE, LILACS, BVSDE and Google Advanced Search for documents published between January 2000 and April 2016. We included only documents with assessment indicators of the strategy. All articles were independently assessed for eligibility by pairs of reviewers. We classified the indicators with a supporting framework proposed by O'Neill and Simard (Choosing indicators to evaluate Healthy Cities projects: a political task? Health Promot Int 2006, 21, 145-152.). Local level indicators figured far more prominently among countries and were distributed both in projects and specific activities. Regarding the evolution of the HMCS, indicators were reported in the five levels of analysis (local projects and activities, provincial, national and international networks). Empowerment was represented through the presence of active community organizations and different methods of community participation (forums, open hearing and participation maps). Public policies (such as for tobacco cessation) and bylaws adherence and changes in school's curricula regarding healthy eating were frequently mentioned. However, this review demonstrated that impact indicators related to lifestyle changes or built environment are not clearly defined and there is a lack of indicators to measure progress in achieving change in long-term outcomes in LAC. We highlight the importance of designing validated indicators for measuring the impact of health promotion policies in partnership with each country involved.

Sustainable Urban Mobility Policies as a Path to Healthy Cities—The Case Study of LMA, Portugal

Sustainable development has become the basis of several worldwide policies over the last few decades, and its role will continue to shape policies for decades to come, especially those that are focused on urban mobility. At the same time, urban mobility is included in the framework of the Healthy Cities movement. In this context, using the Lisbon Metropolitan Area (LMA), Portugal, as the study area, this article intends to answer the following research question: are sustainable urban mobility policies contributing to healthy cities? Urban mobility planning and public health instruments were compared with the discourses and practices of those responsible for the implementation of urban mobility policies and Healthy Cities projects. The results reveal that a large number of responses proposed in the mobility planning instruments are, to some extent, related to the principles of healthy cities. Also, while municipal agents tend not to consider the inclusion of those principles, they instead incorporate the concepts of sustainable development. Nevertheless, we found that both approaches overlap the policy directions of healthy cities. On the other hand, public health policies and Healthy Cities projects presented a scarce number of references to its interventions in the urban mobility domain and mainly focused on the promotion of soft modes. It is concluded that, in the case of the observed municipalities of the LMA, the healthy cities framework is greatly benefited by the inclusion of sustainable development principles in all policies, especially those for urban mobility.