Healthy Cities Project Research Articles

An analysis of health levels and various indicators of urban environments for Healthy Cities projects

STUDY OBJECTIVES(1) To identify and to categorise the various city indicators that are related to health levels; (2) to demonstrate the extent of the influence on health of these categorised...

Assessing community change at multiple levels: the genesis of an evaluation framework for the California Healthy Cities Project.

More than 40 cities have participated in the California Healthy Cities Project since its inception in 1988. Because Healthy Cities efforts are community driven, these cities address diverse health and social issues using a wide variety of strategies. This complexity, in addition to the usual difficulties associated with evaluating community interventions, creates many challenges for evaluation. Given the community building and process orientation of Healthy Cities, it may be most appropriate to measure intermediate community changes that have been linked to health outcomes in previous research or, at a minimum, theoretically. The California Healthy Cities evaluation framework conceptualizes change at five levels: individual, civic participation, organizational, interorganizational, and community. The framework, developed collaboratively with Healthy Cities participants, attempts to synthesize current thinking and practice on evaluation of community projects by applying concepts from community capacity/competence, social ecology, and urban planning.

Achieving wider participation in strategic health planning: experience from the consultation phase of Liverpool's City Health Plan'

Background: As a member of the World Health Organization's Healthy Cities Project, Liverpool (UK) has developed an integrated plan to improve health, the City Health Plan (CHP). Based around the key areas of the former national health strategy for England, ‘The Health of the Nation’, a draft CHP was developed by five task groups. Although multi-sectoral, these groups were not able to achieve the desired level of participation from the community, or from those working in health, local government or voluntary sectors. One of the main goals of the consultation was to redress this situation and achieve wider participation. Objective: To assess how adequately the consultation process carried out in Liverpool contributed to broad-based participation in the development of the city health plan. Subjects and methods: (i) Semi-structured interviews with 20 key informants and 17 facilitators who held consultation meetings in a variety of settings, and seven minority group contacts; (ii) Self-administered questionnaires to participants who had attended consultation meetings. So far as was possible, the design encouraged participation in defining the goals and content of the evaluation. Main question areas: Views on the importance of participation in planning; evaluation of the consultation against respondents’ criteria for successful participation in the CHP; views on the purpose of the consultation, and on the methods used to publicise the CHP, inform participants about its purpose and content, and obtain their opinions about the plan. Questionnaires to those attending consultation meetings examined how adequately this process permitted participation in contributing to the final version of the plan. Findings: This was the most ambitious public policy consultation ever undertaken in Liverpool. There was wide agreement that participation was vital. Expectations varied considerably, but for many commitment and optimism co-existed with cynicism about real involvement and achieving change. The consultation was widely appreciated, but some aspects which might improve effectiveness were identified. Most important was having more opportunity for participants to understand and think through the implications of the CHP, and keeping people in contact with the process of revising the plan. Conclusions: There is a growing expectation for public policy to be multi-sectoral and participative: this study reports experiences of putting this into practice on a large scale. Despite people expressing mixed feelings, there was a lot of support for the methods used. Clear aims about the level of participation sought, adequate resources, time and facilitation, and good two-way communication can be expected to provide for wider and more effective participation. However, given the investment of time and personnel deployed, this experience raises important questions about the feasibility of achieving wide participation in the development of urban (health) policy on a more routine basis.

Housing and health — a joint approach: The Manchester experience

The Manchester Healthy City project has carried out a major consultation with communities over the action plan for the Healthy City initiative. The four clear themes were housing and homelessness, the environment, crime and disorder, and mental health. These have formed the basis for key areas of work in which housing takes a lead role. This article will identify some of the joint initiatives which are going on in the various areas of strategic planning, commissioning and service delivery.

Development of a Russian Satisfaction With Prenatal Care Scale

Patient satisfaction with health services is used as a measure of the quality of patient care received. The emphasis on accountability and patient as consumer has contributed to the growing interest in studying patient satisfaction. Patient satisfaction with prenatal care services has not been extensively studied including instrumentation to develop a satisfaction scale. The purpose of this study was to develop a reliable and valid scale to measure satisfaction with prenatal care services in St. Petersburg, Russia, using the 6 satisfaction dimensions in Aday and Andersen's Theoretical Framework (1974). It was conducted under the auspices of the World Health Organization, Healthy Cities Project. Although the study was conducted internationally, it provides a basis for further testing of reliability and validity in the United States. A convenience sample of 397 women with uncomplicated pregnancies and normal deliveries was studied (86% response rate). Content, construct, and predictive validity, and reliability testing using Cronbach's alpha was conducted. The scale was found to be an adequate and theoretically sound measure of satisfaction with prenatal care services in Russia. However, rather than the 6 hypothesized satisfaction dimensions, Russian women identified 2 satisfaction subscales or measures for quality of prenatal care received. One was, as hypothesized, convenience, and the other was the doctor's behavior.

Use of a Western theoretical model to investigate the relationships among characteristics of pregnant women, utilization, and satisfaction with prenatal care services in St. Petersburg, Russia.

Few studies of utilization and satisfaction with prenatal care services have been conducted internationally. In this study, utilization and satisfaction with prenatal care services in St. Petersburg, Russia were examined using Aday and Andersen's (1974) A Framework for the Study of Access to Medical Care. This study was conducted under the auspices of the European Region, World Health Organization (WHO) Healthy Cities Project, which promotes a community-based intersectoral approach to meeting health needs. The convenience sample included 397 women with uncomplicated pregnancies and normal deliveries, representing an 86% response rate. Multiple regression and path analysis found significant predictors of prenatal care utilization and satisfaction. They were different, however, from those posited in the theoretical model. This indicates that Aday and Andersen's health care services model is specific to the U. S. health care system, where it originated. The Russian health care system has been and remains different from that of the United States. If the reformed Russian health care system takes on aspects of the U. S. health care system, the utility of Aday and Andersen's theoretical model may change.

Literature review. Healthy cities: a guide to literature

The author reviews the literature on attempts by city governments, international agencies, and nongovernmental and community organizations to improve city life around the world through Healthy Cities projects.

Healthy cities: overview of a WHO international program.

Health is the outcome of all the factors and activities impinging upon the lives of individuals and communities. The last decade has seen an emerging understanding within development circles that living conditions are greatly affected by local action, by the work of local government, and by community groups and organizations. In addressing health and environmental issues and making interventions, an integrated approach, based on 'settings', exemplified in the Healthy Cities approach, has proved most effective. A Healthy City project can involve people and organizations in the programs and activities that are needed for better health, and enables a city or neighborhood to mobilize the human and financial resources required to address many health and quality of life issues. The WHO program involves implementating city projects and networks in all regions of the world and serves as a vehicle for many health programs, including major disease control initiatives. Healthy City projects allow Ministries of Health to develop stronger partnerships with local government organizations (such as the Union of Local Authorities and its members, "Local Agenda 21" initiatives, and others). One focus for the program is the development of 'multi-'multi-city action plans' for major global priority issues, including AIDS, sanitation, women's health, and violence, to ensure that major public health programs are strengthened by wider community participation. It is recognized that city networking--at national, regional, and international levels--now must be better exploited by individual cities and municipalities to solve local health problems.

Practical lessons in using indicators of determinants of health across 47 European cities

A survey was conducted of 47 European cities applying to join the third phase of the World Health Organization Healthy Cities Project. The survey tested the feasibility of recording baseline information on health-promoting processes and activities in the cities. A broad multi-sectoral focus for health in the questionnaire presented formidable challenges to respondents. Despite goodwill and local networks, the quality of certain responses was variable. Socio-economic statistics are not universally available at city level; however, descriptive responses about services and health promotion yielded uniquely useful local information over the national level. Survey responses were not comparable across cities and such interpretation would be counter-productive. Recommendations for future surveys are made. Key words: city health; determinants of health; indicators; measures

Utilization and satisfaction with prenatal care services.

This study was conducted in St. Petersburg, Russia, under the auspices of the World Health Organization, Healthy Cities Project, and the St. Petersburg Healthy City Project. The purpose of this study was to investigate the predict use of prenatal care services (utilization) and satisfaction with the services. A high maternal mortality rate and low attendance at prenatal clinics brought this health care issue to the forefront of the St. Petersburg Healthy City Project agenda. Aday and Andersen's conceptual model was used to investigate use of and satisfaction with prenatal care services. Several characteristics of pregnant women were found to influence early use of prenatal care services and women's level of satisfaction. Need had no influence in explaining when women started prenatal care or satisfaction with the services. Lastly, there was no relationship between early use of prenatal care services and women's level of satisfaction with the services.

From healthy city projects to healthy cities

This paper discusses experience to date with the formulation and implementation of Healthy City projects in the South. After describing the origin of the Healthy Cities movement and what constitutes a Healthy City project, it reviews the experience of Healthy City initiatives in Fayoum (Egypt), Quetta (Pakistan) and Campinas (Brazil). It then discusses the roles of three critical stakeholders: international agencies (and how their support should facilitate local action rather than dictate it); local government staff and politicians (and the difficulties in getting their sustained support); and citizens and grassroots organizations. It ends by discussing how the real success of any Healthy City project is when it ceases to be a project, because the system it set up to ensure that health issues are given priority, to involve all stakeholders and to ensure that all sectors recognize that their role in healthy cities becomes part of the structure of local governance.

Evaluation of healthy city projects:stakeholder analysis of two projects in Bangladesh

This paper describes the Healthy City projects that are underway in Chittagong and Cox’s Bazar and presents the findings of a stakeholder analysis in each city. These analyses were used to demonstrate to project staff the value of evaluations and to show how such evaluations can involve the stakeholders in identifying evaluation needs and tools. The paper discusses the potential of this kind of analysis within evaluations of on-going projects, especially to primary stakeholders. It also discusses why few evaluations of Healthy City projects have been undertaken and how and why those involved in what they perceive to be “successful” projects often feel that evaluations are unnecessary.

Healthy cities: a guide to the literature

This paper reviews the literature on “healthy cities” and, more specifically, the attempts by city governments, international agencies, NGOs and community organizations to improve health in cities within Healthy Cities programmes or projects. Such programmes are generally initiated by city authorities, but with a recognition that to be effective, first they must mobilize integrated action from citizen groups, NGOs and private enterprises and, secondly, they must involve coordinated action between many sectors. As such, this review reflects on the achievements of Healthy Cities programmes around the world and the future challenges they face. It also seeks to give some idea of the number of Healthy Cities initiatives underway, especially in Africa, Asia and Latin America, even though there is still relatively little published literature on them.

Healthy cities: a guide to the literature

This paper reviews the literature on “healthy cities” and, more specifically, the attempts by city governments, international agencies, NGOs and community organizations to improve health in cities within Healthy Cities programmes or projects. Such programmes are generally initiated by city authorities, but with a recognition that to be effective, first they must mobilize integrated action from citizen groups, NGOs and private enterprises and, secondly, they must involve coordinated action between many sectors. As such, this review reflects on the achievements of Healthy Cities programmes around the world and the future challenges they face. It also seeks to give some idea of the number of Healthy Cities initiatives underway, especially in Africa, Asia and Latin America, even though there is still relatively little published literature on them.

Evaluation of healthy city projects: stakeholder analysis of two projects in Bangladesh

Evaluation of healthy city projects: stakeholder analysis of two projects in Bangladesh

From healthy city projects to healthy cities

From healthy city projects to healthy cities

Smoke‐Free California: Democracy Meets Public Health

AbstractAn initiative of the California Healthy Cities Project (a statewide program to help cities and their local partners promote healthier communities), California Smoke‐Free Cities is an example of an effort that is grounded in such healthy‐cities principles as inclusiveness, cooperation, and building on current assets.

Community representatives: Representing the “community”?

This paper takes as its starting point the apparent disjunction between the assumptions of the self-evidence of the meaning of community in major international declarations and strategies which promote community participation and the observation that meanings of “community” are a subject of extensive debate in literatures of social analysis and to some extent health. Given that the word's meaning is not agreed, those working to promote “community participation” in health are forced to adjudicate on competing meanings in order to operationalise the notion. This raises questions about how this is done and what are the implications of particular choices for what may be achieved by the participating “community”. This paper presents the findings of an empirical study which examined the manner in which ideas of “community” are operationalised by people engaged in encouraging community participation in health promotion in the context of the selection of members for health for all steering groups in healthy cities projects in the United Kingdom. It argues that the demands of the role of the “community representative” are such that particular interpretations of “community” achieve ascendance. The paper explores the consequences of the interpretation of “community” as part of the “voluntary sector” and argues that this may compromise one of the stated desired outcomes of community participation i.e. extending democracy in health decision-making.

Conditions for health: the Toronto Healthy City Model.

"Governance initially developed at the city level, and as a horizontal coordination between multiple social agents, at its best is democratic, participatory and accountable to the stakeholders. The Healthy City approach is a model in bringing together different stakeholders and increasing participation in decision making. And only those cities that have understood this to be at the essence of the healthy city project have truly succeeded."1

The Canada-Who-St Petersburg Maternal Child Health Programme: The Healthy Cities Project

In 1994, an educational programme in perinatal care was initiated in St Petersburg, Russian Federation, in collaboration with the Health Committee of St Petersburg, the WHO-Euro Healthy Cities Project and the Centre for International Health, McMaster University. Funded by the Canadian International Development Agency (CIDA) for three years, the programme was designed to strengthen the Maternal and Child Health services of St Petersburg through the provision of training programmes for obstetricians, neonatologists, midwives, nurses and family practitioners.The development of this project, its objectives, activities undertaken and progress to date are described.