Healthy Cities Programme Research Articles

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.

2015-2018 Regional Prevention Plan of Lombardy (Northern Italy) and sedentary prevention: a cross-sectional strategy to develop evidence-based programmes.

Cross-sector, life-course, and setting approaches are identified in the 2015-2018 Regional Prevention Plan (PRP) of Lombardy Region (Northern Italy) as valuable strategies to ensure the efficacy and sustainable prevention of the non-communicable disease (NCDs). The involvement of non-health sectors in health promotion activities represents a suitable strategy to affect on social, economic, and political determinants and to change environmental factors that could cause NCDs. A dialogue among communities, urban planning, and prevention know-how is a prerequisite to develop a system of policies suitable to promote healthy lifestyle in general and, specifically, active lifestyles. The 2015-2018 Lombardy PRP pursues its aims of health promotion and behavioural risk factors for NCDs prevention through programmes that implement their own setting networks (Health Promoting Schools - SPS; Workplace Health Promotion - WHP) and develop new networks. Sedentary lifestyle prevention and active lifestyle promotion are performed through the approach promoted by the Healthy Cities Programme (WHO), encouraging two main processes: 1. creating integrated capacity-building among health and social prevention services, academic research, and local stakeholders on different urban planning and design issues; 2. promoting community empowerment through active citizens participation. Through this process, Lombardy Region aims to orient its services developing evidence-based programmes and enhancing advocacy and mediating capacity skills in order to create a profitable partnership with non-health sectors. This paper reports the main impact data: 26,000 children that reach school by foot thanks to walking buses, 57% of 145 companies joining WHP are involved in promoting physical activity, 18,891 citizens who attend local walking groups.

News Briefs

Morgan Stanley selects Cleveland for Healthy Cities program. State Street launches new workforce training initiative. Home Depot pledges $1.6 million for veterans' housing. MassMutual awards $2.5 million for special needs education center. HSBC launches new $150 million Community Fund. MetLife awards $1.8 million to expand financial services in rural China. GE Foundation awards $14 million for health care initiative. Boeing commits $15 million for STEM program at Museum of Flight. Charity Navigator taps ex‐Microsoft exec for CEO.

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.

Urban planning for healthy cities. A review of the progress of the European Healthy Cities Programme.

The purpose of this paper is to evaluate the progress made by European cities in relation to Healthy Urban Planning (HUP) during Phase IV of the World Health Organization's Healthy Cities programme (2003-2008). The introduction sets out the general principle of HUP, identifying three levels or phases of health and planning integration. This leads on to a more specific analysis of the processes and substance of HUP, which provide criteria for assessment of progress. The assessment itself relies on two sources of data provided by the municipalities: the Annual Review Templates (ARTs) 2008 and the response to the Phase IV General Evaluation Questionnaire. The findings indicate that the evidence from different sources and questions in different sections are encouragingly consistent. The number of cities achieving a good level of understanding and activity in HUP has risen very substantially over the period. In particular, those achieving effective strategic integration of health and planning have increased. A key challenge for the future will be to develop planning frameworks which advance public health concerns in a spatial policy context driven often by market forces. A health in all policies approach could be valuable.

Governance and implementation of sports safety practices by municipal offices in Swedish communities

The objective of this study was to explore whether all-purpose health or safety promotion programmes and sports safety policies affect sports safety practices in local communities. Case study research methods were used to compare sports safety activities among offices in 73 Swedish municipalities; 28 with ongoing health or safety promotion programmes and 45 controls. The offices in municipalities with the WHO Healthy Cities (HC) or Safe Communities programmes were more likely to perform frequent inspections of sports facilities, and offices in the WHO HC programme were more likely to involve sports clubs in inspections. More than every second, property management office and environmental protection office conducted sports safety inspections compared with less than one in four planning offices and social welfare offices. It is concluded that all-purpose health and safety promotion programmes can reach out to have an effect on sports safety practices in local communities. These safety practices also reflect administrative work routines and managerial traditions.

Advancing coalition theory: the effect of coalition factors on community capacity mediated by member engagement

Community coalitions have the potential to enhance a community's capacity to engage in effective problem solving for a range of community concerns. Although numerous studies have documented correlations between member engagement and coalition processes and structural characteristics, fewer have examined associations between coalition factors and community capacity outcomes. The current study uses data from an evaluation of the California Healthy Cities and Communities program to examine pathways between coalition factors (i.e. membership, processes), member engagement (i.e. participation, satisfaction) and community capacity as hypothesized by the Community Coalition Action Theory (CCAT). Surveys were completed by 231 members of 19 healthy cities and communities coalitions. Multilevel mediation analyses were used to examine possible mediating effects of member engagement on three community capacity indicators: new skills, sense of community and social capital. Results generally supported CCAT. Member engagement mediated the effects of leadership and staffing on community capacity outcomes. Results also showed that member engagement mediated several relationships between process variables (i.e. task focus, cohesion) and community capacity, but several unmediated direct effects were also observed. This suggests that although member engagement does explain some relationships, it alone is not sufficient to explain how coalition processes influence indicators of community capacity.

Evaluating the implementation of the WHO Healthy Cities Programme across Germany (1999-2002)

The WHO Healthy Cities Project (1988) is a well-known example of the setting-based approach to health promotion. Developed as a framework for translating the key principles of the Ottawa Charter for Health Promotion (1986) into practice, it is best characterized as a process for successfully encouraging healthy public policy. In 2001, the German Healthy Cities Network (HCN) commissioned a survey of the 52 local Healthy Cities programme Coordinators (HCC) to monitor progress and identify strengths and weaknesses associated with its implementation. Most (90%; 47/52) HCC participated in the survey. Several positive aspects of the Health Cities Programmes (HCP) in Germany were identified: during the first 5 years, it expanded rapidly; project coordinators felt highly engaged, despite limited resources; a combination of traditional and innovative approaches was adopted and applauded; and almost 75% of HCC felt that their efforts had been beneficial. Nonetheless, the following shortcomings were identified: increased resources required; greater clarification of concepts and strategies at the local level; stronger commitment to the Nine-Point Programme of Action; greater integration within the national HCN and the local political administrative system (PAS); better programme documentation and evaluation. In conclusion, the HCN in Germany has expanded and developed since its inception 20 years ago. German HCP will only improve if professionalism and quality of local work are improved, particularly in terms of strengthening their influence on the local PAS and on public policies.

Mixing Urban Health Research Methods for Best Fit

Mixing Urban Health Research Methods for Best Fit

Evaluation findings on community participation in the California Healthy Cities and Communities program

As part of an evaluation of the California Healthy Cities and Communities (CHCC) program, we evaluated resident involvement, broad representation and civic engagement beyond the local CHCC initiative. The evaluation design was a case study of 20 participating communities with cross-case analysis. Data collection methods included: coalition member surveys at two points in time, semi-structured interviews with key informants, focus groups with coalition members and document review. Participating communities were diverse in terms of population density, geography and socio-demographic characteristics. Over a 3-year period, grantees developed a broad-based coalition of residents and community sectors, produced a shared vision, conducted an asset-based community assessment, identified a priority community improvement focus, developed an action plan, implemented the plan and evaluated their efforts. Local residents were engaged through coalition membership, assessment activities and implementation activities. Ten of the 20 coalitions had memberships comprised of mainly local residents in the planning phase, with 5 maintaining a high level of resident involvement in governance during the implementation phase. Ninety percent of the coalitions had six or more community sectors represented (e.g. education, faith). The majority of coalitions described at least one example of increased input into local government decision-making and at least one instance in which a resident became more actively involved in the life of their community. Findings suggest that the Healthy Cities and Communities model can be successful in facilitating community participation.

Health in the Urban Environment: A Qualitative Review of the Brighton and Hove WHO Healthy City Program

Phase IV of the WHO European Region's Healthy Cities Program ended in December 2008. This article presents the findings from a recently completed review of Brighton and Hove's Healthy City Program which aimed to scope whether added value had accrued from the city's role as a WHO Healthy City during phase IV. In contrast to most other evaluations of healthy cities, this review adopted a qualitative approach representing an appraisal of the Brighton and Hove Healthy City Program from the internal viewpoint of its local stakeholders. In addition to documentary analysis and a facilitated workshop, a series of in-depth interviews (N = 27) were conducted with stakeholders from the Brighton and Hove Healthy City Partnership representing each of the sectors reflected in the Local Strategic Partnership (public, statutory, elected, community and voluntary, neighborhood and communities, business). The key findings of the review are presented in a way which reflects the three key areas of the review including (1) the healthy cities approach, (2) participation in phase IV of the WHO Healthy Cities Program, and (3) the Brighton and Hove Healthy City Partnership. These findings are discussed, and recommendations for action at local, national, and European levels are proposed. In particular, we argue that there is an urgent need to develop a suitable monitoring and evaluation system for the WHO Healthy Cities Program with appropriate indicators that are meaningful and relevant to local stakeholders. Moreover, it would be important for any such system to capitalize on the benefits that qualitative methodologies can offer alongside more traditional quantitative indicators.

“A good spot”: Health promotion discourse, healthy cities and heterogeneity in contemporary Denmark

Health promotion at a community level has gained popularity in recent decades within and outside academic environments. The health promotion discourse is part of a wider political discourse, aimed at empowering individuals to take control of their own lives and enabling them to be engaged, responsible and active citizens in their own communities. Key values of the discourse, deriving from a democratic and individualistic culture, are evident in how local authorities develop and implement policies aimed at promoting population health and wellbeing. In this article, we draw on data from a relatively poor multicultural Danish community incorporated in the WHO Healthy Cities Programme. We explore how key terms of the health promoting discourse are constructed, operationalized and resisted by different subgroups. The contradictions that emerge challenge how we comprehend communities in relation to safety and harmony, and how people within defined communities are involved in common community life.

Partnership for Healthy Neighbourhoods: City Networking in Multilevel Context

Social polarization in the urban landscape means that there are a lot of neighbourhoods with a concentration of residents suffering from high crime rates, a loss of feeling of safety, ethnic conflicts and general decay. Local and national governments respond to these challenges by adopting urban development programmes with a pronounced area-based orientation. Inspired by the global Healthy Cities Programme, some of these initiatives have an explicit public health-related focus. This article analyses the possibilities and obstacles for an initiative of this kind undertaken by four Swedish cities under the label Partnership for Sustainable Welfare Development. Sustainable development, healthy cities, neighbourhood and partnership are concepts rhetorically underpinning the policy intervention under study. After a brief, critical survey of these concepts the article presents the empirical study undertaken on the basis of interviews, official documents and participatory observation. Finally the results of this study are summarized and related to some of the literature in this field. It is found that the role of the partnership as a node for mutual learning and coordination is held in high esteem by the partnership participants. Other qualities given high priority by them are the need for comprehensive, long-term planning and residents' participation and influence. However, from a more distanced point of view it is also obvious that the approach has its limitations due to the fact that even successful interventions cannot affect the fundamental causes of urban social polarization as these causes relate to general socio-economic cleavages in society.

Strengthening Community Leadership: Evaluation Findings From the California Healthy Cities and Communities Program

Collaborative approaches to community health improvement such as healthy cities and communities have the potential to strengthen community capacity through leadership development. The healthy cities and communities process orients existing local leadership to new community problem-solving strategies and draws out leadership abilities among residents not previously engaged in civic life. In an evaluation of the California Healthy Cities and Communities (CHCC) Program, leadership development was one of several outcomes assessed at the civic-participation level of the social ecology. Data collection methods included focus groups and surveys, semistructured interviews with coordinators and community leaders, and review of program documents. Findings suggest that the CHCC program enhanced capacity by expanding new leadership opportunities through coalition participation, program implementation, and civic leadership roles related to spin-off organizations and broader collaborative structures. Communities in rural regions were particularly successful in achieving significant leadership outcomes.

Achieving organizational change: findings from case studies of 20 California healthy cities and communities coalitions

As part of an evaluation of the California Healthy Cities and Communities (CHCC) Program, we assessed the extent to which coalitions implementing the healthy cities and communities model demonstrated capacity to leverage financial resources, expand programs and influence organizational policies. The evaluation design was a multiple case study of 20 participating communities with cross-case analysis. Participating communities spanned the state's diverse geographic regions and ranged from remote areas within rural counties to neighborhoods within large cities. Data included: semi-structured interviews with coordinators and community leaders, focus groups with coalition members and document review. Many CHCC coalitions were able to leverage significant financial resources across a diverse array of funding sources, including federal, state, county and city governments. In addition, all CHCC coalitions developed at least one new program, most commonly focused on youth development, civic capacity-building or lifelong learning. Changes in policies, reported by 19 of the 20 coalitions, were consistent with healthy cities and communities principles and were implemented in community-based organizations, county and city governments, and school districts. Typical changes included an increased willingness to collaborate, increased emphasis on engaging diverse parts of the community, greater responsiveness to community needs and more opportunities for resident input into decision-making. Our findings suggest the healthy cities and communities model has the potential to strengthen the organizational infrastructure of communities to promote health.

Skill improvement among coalition members in the California Healthy Cities and Communities Program

Community-driven, collaborative approaches to health promotion have the potential to enhance skills among community members and, in turn, increase community capacity. This study uses data from an evaluation of the California Healthy Cities and Communities (CHCC) Program to examine whether, and how, community problem-solving and collaboration skills are improved among coalition members and local coordinators in 20 participating communities. Methods include semi-structured interviews with coordinators and mailed surveys with coalition members (n=330 in planning phase and n=243 in implementation phase). The largest number of coordinators reported skill improvement in defining health broadly and assessing needs and assets. Similarly, coalition members reported greatest skill improvement for defining health broadly, assessing needs and assets and setting priorities and developing action plans. Modest correlations were observed between number of roles played in the local healthy cities and communities project and each skill area assessed. Time committed to the local CHCC coalition and its activities was not meaningfully correlated with any of the skills. Types of skill-building opportunities may be more important than number of hours devoted to meetings and activities in strengthening community problem-solving and collaboration skills among coalition members.

Tourism as a Mechanism for Farm Survival

This case study explores the linkages between tourism, community and development forces in the peri-urban zones of Sydney, Australia. The Hawkesbury Harvest Farm Gate Trail (HHFGT) emerged as a response to market, development, settlement and consumer pressures threatening the survival of farming in the region, together with connections to community health initiatives in food access, safety, security and quality that were spawned by the Healthy Cities programme and Agenda 21. The interaction created between farmers and tourists involved new challenges for farmers in production, marketing and service provision. Although challenging, community-based initiatives like the Farm Gate Trail are shown to hold great potential for sustainable development and sustainable tourism despite the attendant risks associated with small-scale, intensive agriculture, tourism management issues and the land use conflicts that are created when town and country meet in the urban fringe areas of major metropolises.

Healthy Cities and the Built Environment

Here, the effective founding father of the Healthy Cities Programme provides an overview of its twenty-year history. As he explains too often health has been equated with the absence of illness, and hence with medicine and medical care. But today, health is being redefined as quality of life and general well-being. In this approach, health is a multi-disciplinary phenomenon: we must begin to look at everything that impinges on the human being. The total physical and social environment affects human development, as does a particular culture, and even the weather - and the constant interactions between all the parts.

The Healthy Cities approach-- reflections on a framework for improving global health.

The roots of the Healthy Cities concept may be traced back to 1844, when the Health of Towns Association was formed in the United Kingdom to deliberate on Edwin Chadwick's reports about poor living conditions in towns and cities. The revival of those concerns in the "new public health" era dates from the Healthy Toronto 2000 convention in 1984 and, subsequently, the enthusiasm of the World Health Organization (WHO) Regional Office for Europe to translate its principles into a tangible global programme of action to promote health. WHO defines a Healthy City as "one that is continually developing those public policies and creating those physical and social environments which enable its people to mutually support each other in carrying out all functions of life and achieving their full potential". This philosophy seeks to enhance the holistic well-being of people who live and work in cities, based on four criteria: (a) explicit political commitment at the highest levels to the principles and strategies of a Healthy Cities project; (b) establishment of new organizational structures to manage change; (c) commitment to developing a shared vision for the city, with a healthy plan and work on specific themes; and (d) investment in formal and informal networking and cooperation. The concept is founded on the moral and political beliefs that inequalities in social conditions (and therefore health) are unjustified and that their reduction should be an overriding public health objective. While the entry point of the Healthy Cities approach is health, its underlying rationale has always been based on a model of good urban governance, which includes broad political commitment, intersectoral planning, citywide partnerships, community participation, and monitoring and evaluation. The Healthy Cities principles draw on various work on the social determinants of health, notably studies initiated by Thomas McKeown. However, its proponents rightly diverged from McKeown's overemphasis on the "invisible hand" of improved nutrition at the expense of various types of important social interventions, such as improvements in living and working conditions, public education, medical science, democratic governance, public health practices, and human rights. The International Healthy Cities Foundation partners are drawn from leaders in these sectors. The strategy also takes account of the increasing recognition of the complex effects of urbanization on health. Rapidly growing cities in Africa, Asia, and the Americas constitute the majority of the 300 cities with over one million inhabitants. While poor people in urban cities operate under the most life-threatening living and working conditions, their high concentration nevertheless provides opportunities for improving health: economies of proximity greatly reduce unit costs for provision of piped water, sewers, rubbish collection, immunization services, schools and public transport. Recent United Nations statistics estimate that, by 2007, more than half of the world's population will live in urban areas. Thus, Healthy Cities may be viewed as a set of public health strategies of potential benefit to more than half the people in the world. Now in its second decade, a number of important achievements have been attributed to this approach. For example, California's Healthy Cities and Communities programme, which began in 1987, has contributed significantly to improving the state's health profile through a multitiered strategy that includes technical assistance, funding, promotion, coordination and collaboration, systems reform, programme evaluation, and recognition. However, the effectiveness of Healthy Cities has largely been confined to industrialized countries, for a number of reasons. First, although its proponents acknowledge that conventional public health projects for the prevention or treatment of diseases did not adequately take account of health risks such as poverty, urban violence and terrorism, the predominantly functionalist health promotion framework within which the Healthy Cities approach operates makes it less likely to focus effectively on these underpinnings of "unhealthy" cities. …

Healthy cities programme in the Western Pacific Region.

This rapid expansion of Healthy Cities initiatives need to be adequately documented and their experiences should be shared. We must know what has succeeded and what has failed so that new Healthy Cities projects can replicate successes and avoid pitfalls. WHO has therefore commissioned special studies published case-study reports and developed technical guidelines on Healthy Cities based on the experiences of the early Healthy Cities projects. WHO has also convened regional meetings supported study tours and training courses and developed and maintained a regional database on Healthy Cities projects to facilitate the exchange of experiences. (excerpt)