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Healthy Cities around the worldAn overview of the Healthy Cities

movement in the sixWHO regions

Published on the occasion of the 2003 International Healthy Cities Conference,Belfast, Northern Ireland, United Kingdom, 19–22 October 2003

2 . HEALTHY CITIES AROUND THE WORLD

African RegionAn introduction to Healthy Cities in theRegion

The strong tradition of com-munity-based health pro-grammes in Africa, com-bined with the excess burdenof disease associated withhuman environmental fac-tors, makes Africa especiallysuitable for Healthy Citiesprogrammes. World HealthDay 1996, with its theme“Healthy cities for better liv-ing” raised awareness of ur-ban environment and health

concerns and spurred some countries, such as Ethiopia,Mali and Zimbabwe, to initiate some form of HealthyCities activities.

Rufisque in Senegal developed a Healthy Cities pro-gramme with the support of its twin city, Nantes, inFrance. Other cities developed substantial Healthy Cit-ies programmes with support from the United Nationsand bilateral funding agencies (e.g. Dar es Salaam) orusing local resources (e.g. Cape Town, Johannesburg).

In 1999–2000, the Regional Office organized fourworkshops to promote the concept of Healthy Cities inthe Region. These workshops strongly endorsed theHealthy Cities approach as being relevant to Africa, andwere major milestones towards the effective introduc-tion/implementation of Healthy Cities projects inMember States of the Region.

Many countries (e.g. Cameroon, Gabon, Mozam-bique, United Republic of Tanzania) are piloting thesettings approach. Other countries are focusing on spe-cific environment and/or health issues. Zimbabwe, forexample, focuses on housing, waste management andwater supply. In other countries both strategies are em-

ployed, and in Johannesburg there are activities focus-ing on environmental improvement and citywideawareness campaigns and the settings approach. InUganda, Healthy Cities is not a structured programmein the traditional sense but an initiative that plays acatalytic role in making health an integral componentof activities taking place in urban areas.

The urban health context and keychallengesInadequate development policies have led to high rateof migration from rural to urban areas. This, coupledwith low levels of economic growth, causes overcrowd-ing, overloading of services and mushrooming of un-planned and un-serviced urban settlements in most Af-rican cities and urban centres. Other problems include:• severe cuts in municipal budgets owing to structural

adjustment policies;• inappropriate domestic and industrial waste manage-

ment and pollution control;• inadequate access to health care;• social problems (street children, child abuse);• inadequate institutional capacity to prevent and/or

address environmental health challenges and fosterhealth within urban development; and

• a lack of well structured developmental committeewhich hinders effective community participation.

State of the artWHO is playing a key role in advocating for theHealthy Cities concept by organizing awareness-raisingworkshops and providing documentation and training.WHO also provides support to countries to developmunicipal or city health plans and community-basedinitiatives. It supports the initiation of pilot projectsthat will yield good results and attract others to adoptthe approach.

The Regional Office has designated the University ofCape Town, Medical Research Council (MRC) as a WHOcollaborating centre, in order to support the develop-ment of Healthy Cities programmes in the Region.

At regional level, an officer is responsible for theHealthy Cities settings approach. At national level, a fo-cal point for environmental health activities at WHOcountry offices oversees Healthy Cities activities.

Different countries have established different struc-tures and mechanisms for supporting the developmentof Healthy Cities. For example, some have establishedintersectoral working groups (Congo, Mozambique)while others have coordination units (Central AfricanRepublic). Yet others have steering committees chairedby mayors task forces, project offices or part-time coor-dinators.

Preliminary discussions have taken place at regionallevel to explore the possibility of forging partnershipswith UN-HABITAT Water for African Cities (MAWAC)

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programme and an ILO waste management initiativethat aims to create employment through privatizedwaste collection programmes.

At country level, the Healthy Markets project inCongo has forged partnerships with UNICEF and othernongovernmental organizations. The Mutare HealthyCities Project in Zimbabwe is twinned with that inHaarlem in the Netherlands.

There are still many challenges.• Strong advocacy is still required to explain and gain

acceptance for the Healthy Cities approach.• It is still difficult to give effective priority to poverty

reduction initiatives in the Healthy Cities projects.• Many local authorities tend to associate interna-

tional initiatives with potential external financial re-sources, and are therefore unwilling or unable tomobilize local resources.

• Resources need to be securing that meet and respondto the needs of countries and communities.

• Other initiatives, such as Safer Cities and SustainableCities, that have similar principles and strategies, un-dermine the case for the Healthy Cities approach.

• Healthy Cities is recognized as an important publichealth programme.

• Widespread poverty leads to concern for economicand housing issues to predominate over that for en-vironment and health issues.

• A serious change of attitude at both national and lo-cal level will be required if genuine intersectoral col-laboration is to occur.

Overview of achievementsProgress has been made in preparing city health plans,at least for the capital cities, in all 46 countries. Almostall countries have in place elements of a Healthy Citiesprogramme but, in the absence of formal networks, theHealthy Cities model has often been only partially im-plemented rather than forming a central component ofgovernment or city health planning.

Achievement at regionallevel includes the productionof implementation and evalu-ation manuals, and documen-tation of Healthy Cities expe-riences.

At country level, theBangui Healthy Cities pro-gramme was included in the2001–2002 municipal budget.Healthy Cities activities/envi-ronmental health activitieswere included in annual mu-nicipal plans in Ethiopia. The only Healthy Citiesproject that has been externally evaluated is that in Dares Salaam, United Republic of Tanzania, in a WHOdocument entitled Healthy cities in action. WHO/UNDP-

LIFE Healthy City projects in five countries: an evaluation(document WHO/SDE/PHE/00.02).

The Buguruni Healthy Market project, which is a keycomponent of the Dar es Salaam Healthy Cities pro-gramme, was exhibited at the Hanover 2000 World Fairas an example of a successful community-based healthand development project.

Future prospectsThe main goal of the Region will be on developingmechanisms and strategies that will effectively main-stream poverty reduction efforts and initiatives, basedon the findings of recent literature, into the HealthyCities projects. At the core of this are efforts to inten-sify awareness-raising and capacity-building, so as tostrengthen and expand the adoption of the HealthyCities concept.

Further informationFirst Healthy Cities Workshop for the Anglophone andLusophone Countries of WHO African Region. Brazzaville,AFRO.Healthy Cities in Africa. Urban Health and DevelopmentBulletin, 2001, 4(3/4) (available from the Regional Of-fice).

For more information on Healthy Cities activities inthe WHO African Region please consult the web site ofthe Regional Office at http://www.afro.who.int.

Contact informationDr Emilienne Anikpo N’TameDirector, Division of Healthy Environments and Sus-tainable DevelopmentWHO Regional Office for AfricaB.P. 6 Brazzaville, CongoTel: +242 8 39210 or +47 241 39210 (office)Tel: +242 8 39427 or +47 241 39456 (private)Mobile: +242 63 67 57 Hawa SenkoroResponsible Officer for Healthy Settings and ChildrenDivision of Healthy Environments and Sustainable De-velopmentWHO Regional Office for AfricaB.P. 6 Brazzaville, CongoE-mail: [email protected]

AFRICAN REGION


EasternMediterraneanRegionAn introduction to Healthy Cities in theRegionFollowing preparatory conferences in 1989, the HealthyCities programme in the Eastern Mediterranean Regionwas formally launched in November 1990 in Cairo,Egypt, when the objectives, strategies and approaches ofthe Healthy Cities programme for the Region wereadopted by the Member States. Since 1990, the HealthyCities concept has been expanded in a number of coun-tries in the Region, where it is at various levels andstages of implementation.

The Healthy Cities programme in the Region doesnot replace or otherwise affect ongoing health and en-vironmental activities undertaken by various govern-mental and municipal agencies. On the contrary, it at-tempts to generate local and community support tosuch ongoing activities, and to facilitate contact anddialogue between related activities so as to improveintersectoral coordination and collaboration.

The urban health context and keychallengesThe Eastern Mediterranean Region has one of the fastestrates of population growth in the world. The limitedavailability of safe water and adequate disposal of wastewater are major issues. Solid waste management is themost pressing environmental concern in many second-ary and some major cities in the Region. These prob-lems are coupled with increasing levels of air pollutionand a housing shortage.

The Healthy Cities programme faces a number ofhindrances and difficulties, including:• limitation of resources (financial, human and mate-

rial);• deficient technical capacities and supportive infra-

structures;• lack of good governance and absence of community

development plans;• insufficient political commitment and ownership;• inappropriate community participation and local

empowerment;• lack of coordination between intersectoral (and even

international) agencies;• lack of realization that health is central to develop-

ment;• high levels of poverty and scarcity of economic

means; and

• changing lifestyles and cultures, bringing new socialand health problems.

In addition to the primary objective of improving thehealth and quality of life of urban dwellers in the East-ern Mediterranean Region, the following secondary ob-jectives have been determined:• increased awareness of health and environmental is-

sues in urban development efforts;• political mobilization and community participation

in preparing and implementing municipal (citywideor local) health and environment activities andprojects, ideally and whenever feasible through thedevelopment of a systematic city health and envi-ronment plan; and

• increased capacity of municipal authorities to man-age urban problems using participatory approaches.

State of the artThe Healthy Cities concept has been adopted across theRegion, bridging different political and demographicsystems and different kinds of socioeconomic andhealth problem. The WHO Regional Office for the East-ern Mediterranean works through Healthy Cities coor-dinators and ministries of health and provides the fol-lowing support:• development of promotional materials and technical

guidelines;• provision of limited support for country- and city-

level meetings;• provision of consultancy support and for the devel-

opment of technical projects and programmes;• development of project proposals and support for se-

curing external assistance;• holding of intercountry meetings and conferences;• establishment of regional networks and contacts

with other regions; and• dissemination of information, technical manuals,

papers, publications, etc.

The organization of the Healthy Cities programme isconsistent with the social and governmental infrastruc-tures of the Member States. Uniformity in Healthy Citiesactivities is ensured through the establishment of focalpoints, support groups and coordinating committees.

Partners have included the Arab Gulf Programme forUnited Nations Development Organizations (AGFUND)and the Islamic Educational, Scientific and Cultural Or-ganization (ISESCO).

Overview of achievementsHealthy Cities interventions have transformed societies,and a qualitative change is visible in the programme ar-eas. Environmental health and quality of life have beenmade integral components of the national and local de-velopment strategies for promoting health. A dynamic

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platform has been provided for facilitating collaborativelinks between communities and other sectors of thecivil society. As a result, communities have gained tech-nical and leadership skills through improved access topublic services and credit schemes. Vulnerable groupshave been empowered and better served, with a focuson their real problems and needs. Women have attainedhigher prestige and leadership in dealing with commu-nity affairs and social causes.

Future prospectsThe future strategy for the Healthy Cities concept inthe Region will be:• to generate and disseminate information on the im-

pact of Healthy Cities interventions on the health,socioeconomic and environmental determinants ofquality of life;

• to continue supporting the Member States in consoli-dating and expanding Healthy Cities programmesthrough the establishment of national, subregionaland regional networks of interested cities;

• to help in empowering communities and vulnerablegroups, particularly women, to play a leading role inimproving health in cities;

• to build and expand partnerships within and outside

the Region in support of Healthy Cities projects forresource mobilization and joint advocacy and ac-tions; and

• to assist Member States in incorporating communitydevelopment approaches, such as Healthy Citiesprojects, into national strategic agendas and policies.

Further informationHealthy Cities programme and initiatives in the EasternMediterranean Region. Alexandria, EMRO, 1995 (English,Arabic).Guidelines for the development of Healthy Cities projects andactivities. Alexandria, EMRO, 1997 (English, Arabic).Healthy Villages initiatives in the Eastern MediterraneanRegion. Alexandria, EMRO, 1997 (English, Arabic).The Basic Development Needs Initiative: integrated commu-nity development in action. Alexandria, EMRO, 1998(English, Arabic).Guidelines and tools for the management of basic develop-ment needs. Cairo, EMRO, 2002 (English, Arabic).Urbanization and the Healthy Cities programme. Cairo,EMRO, 2003.Guidelines for developing women’s health and developmentcountry profiles. Cairo, EMRO, 2003.Framework for planning, mobilization and implementationof Healthy Hospitals. Cairo, EMRO, 2003.Framework for planning, mobilization and implementationof Healthy Schools. Cairo, EMRO, 2003.Community based initiatives. Cairo, EMRO, 2003.Community empowerment for health and development.Cairo, EMRO, 2003.Community based initiatives: eight steps for establishingmodel areas. Cairo, EMRO, 2003.Community based initiatives: frequently asked questions.Cairo, EMRO, 2003.Manual for environmental health promoters. Cairo, EMRO,2003.Advocacy package for decision makers on community basedinitiatives. Cairo, EMRO, 2003.

For more information on Healthy Cities activities inthe WHO Eastern Mediterranean Region please consultthe web site of the Regional Office at http://www.emro.who.int.

Contact informationDr Mubashar SheikhRegional Adviser, Community and Sustainable Devel-opmentWHO Regional Office for the Eastern MediterraneanAbdul Razzak Al Sanhouri Street, Nasr CityCairo 11371, Egypt

Tel: +20 2 2765307/6702535/2765000Fax: +20 2 6702492/6702494E-mail: [email protected] or [email protected]

The Healthy Cities Programme in theIslamic Republic of Iran: a role modelA national workshop was organized in Tehran inDecember 1991 to introduce the Healthy Citiesconcept. The Tehran Healthy Cities project waslaunched in March 1992 and became thecornerstone of the Healthy Cities concept in Iran aswell as the Eastern Mediterranean Region of WHO.The project initiated a number of innovativethemes and activities, which had a major impact onhealth and social sector. Following theestablishment of the project, 55 cities in 22provinces have initiated similar projects.

In 1996, a National Coordination Council forHealthy Cities and Healthy Villages was established,with representatives from key ministries.Simultaneously, the Province Health Councils andDistrict Health Councils follow the implementationand monitoring of decisions taken by the NationalCouncil, as well as providing support for HealthyCities and Healthy Villages programmes.

National Healthy Cities projects have had veryimpressive results, and have led to the creation ofsome 60 000 women health volunteers, 5000community schools and employment opportunitiesfor unemployed young people.

Healthy Cities projects in Iran have made greatstrides, and provide a model to be followed byother countries in the Region.

EASTERN MEDITERRANEAN REGION


European RegionAn introduction to Healthy Cities in theRegionThe Healthy Cities concept was based on the recogni-tion of the importance of the local and urban dimen-sion in health development, and of the key role of localgovernment in health policy and partnership buildingfor health and sustainable development. Healthy Citieshas a 15-year history in Europe, which coincides withhistoric changes in the political and social scene ineastern and western Europe and at the global level.Healthy Cities has evolved over three 5-year phases(1988–1992, 1993–1997 and 1998–2002). Althougheach phase placed special emphasis on a number ofcore themes and sought to expand the strategic scopeof the project, the goals, methods and vision ofHealthy Cities in Europe have remained true to fourconstants:• addressing the determinants of health and the prin-

ciples of health for all and sustainable development;• integrating and promoting European and global pub-

lic health priorities;• placing health on the social and political agendas of

cities; and• promoting good governance and partnership-based

planning for health.

In each phase a WHO net-work of designated andfully committed citiesfrom across Europe pro-vided the testing groundfor new ways of workingand new approaches todealing with health mat-ters. There were 35 citiesin the network in 1988–1992, and this grew to 39

in 1993–1997 and 55 in 1998–2002. The idea provedvery popular with cities from the start resulting in aspontaneous and rapid development of nationalHealthy Cities networks, offering interested cities thepossibility of becoming part of this new initiative. Na-tional networks amplified the potential for disseminat-ing Healthy Cities ideas and experiences to hundreds ofcities, and became a tremendous resource of expertise,innovation and solidarity as well as a platform for pub-lic health advocacy and an effective mechanism for in-ter-city cooperation.

State of the artTo date, Healthy Cities networks have been establishedin 29 countries in the WHO European Region, bringing

together more than 1300 cities, counties and townsacross the Region. Today, the interest of European citiesin the Healthy Cities movement is stronger than ever.Healthy Cities is a dynamic concept that has adapted tonew country needs, international strategies, new scien-tific evidence, lessons learnt from past experience, andchanges in policy and organization. In addition toworking closely with the WHO global network, the Re-gional Office supports national networks in developingtheir capacity and raising their quality standardsthrough a system of accreditation.

The work of WHO citiesand national networks hasbeen the source of preciousknow-how and the basisfor developing a successfulseries of practical tools andresource materials. Severalof these tools have beenpublished in many lan-guages – some in morethan 20. A wealth ofknowledge and innovativeideas has been accumu-lated on different ap-proaches to partnership-building, health developmentplanning and participative governance, as well as on awide range of public health topics. These reflect therich diversity of Healthy Cities in Europe, one of whosemajor strengths is the continued strong and active in-volvement of politicians.

Developing strategic partnerships with other agen-cies and networks that are concerned with urban devel-opment and local government has been a long-stand-ing priority for WHO. As a founder and active memberof the European Union-supported European SustainableCities and Towns Campaign, the WHO EuropeanHealthy Cities programme works closely with the prin-cipal local government networks in Europe. The pro-gramme has the following six-point strategy:• to promote policies and action for health and sus-

tainable development at the local level;• to increase accessibility of the WHO Healthy Cities

network to all 52 Member States of the European Re-gion;

• to promote solidarity, cooperation and working linksbetween European cities and networks and withother WHO regions;

• to strengthen the national standing of Healthy Cit-ies;

• to invest in strategic partnerships with other agen-cies and networks concerned with urban issues; and

• to give more emphasis to the evaluation and dis-semination of knowledge and examples of goodpractice.

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Case study – healthy urban planningIn 1997, the WHO European Centre for Urban Healthlaunched a healthy urban planning initiative as part ofa move to integrate health more firmly into the sus-tainable development agenda of cities. The initiativehas involved collaboration between urban planningpractitioners in healthy cities and experts fromacademia. In 2000, the book Healthy urban planning: aWHO guide to planning for people was published follow-ing a series of seminars and wide consultation. Thebook advocates health and well-being as a key goal oftown planning, setting out 12 key health objectives forplanners and robust policy guidelines for developmentprojects. Furthermore, the City Action Group forHealthy Urban Planning was established to test and fur-ther develop the ideas put forward in the book. TheGroup includes urban planners from Vienna (Austria),Zagreb (Croatia), Horsens (Denmark), Turku (Finland),Pécs (Hungary), Milan (Italy), Sandnes (Norway), Seixal(Portugal), Gothenburg (Sweden), Geneva (Switzerland)and Belfast and Sheffield (United Kingdom). TheGroup’s meetings provided a forum for exchangingideas and knowledge on what healthy urban planningimplies in practice and how it affects planning proc-esses and outcomes. Case studies of the experience ofthis group were published in 2003. Healthy urban plan-ning has been identified as a core theme for phase IV ofthe WHO Healthy Cities programme in Europe.

Future prospectsUrban health is an increasingly relevant field for the Eu-ropean Region. National and local governments arecalled on to address a wide range of challenging issues,such as social exclusion and migration, the needs of Eu-rope’s ageing population, urban transport and regenera-tion, physical inactivity and obesity, community safetyand violence, local environmental health, and access toservices and quality of life in cities. A host of new Euro-pean and global strategies and initiatives recognize andstress the importance of the urban context and the keyrole of local government. Healthy Cities is well posi-tioned owing to its long experience in partnership-basedwork and its well established networks. There are greatnew opportunities to further expand the Healthy Cities

policy and strategic agenda and to strengthen its stand-ing nationally, regionally and internationally. In July2003, phase IV (2003–2007) of the WHO Healthy Citiesprogramme was launched, with healthy urban planningand health impact assessment as its core themes andhealthy ageing as a complementary theme. In addition,the cities in the WHO European network will continueto focus on developing and implementing health devel-opment plans, with a particular emphasis on equity.Last but not least, WHO will give priority to promotingand supporting the development of national networksand projects in the newly independent states and theBalkan region, and to strengthening links with HealthyCities programmes and networks in other WHO regions.

Further informationTsouros AD, ed. World Health Organization Healthy CitiesProject: a project becomes a movement. Review of progress1987 to 1990. Milan, Sogess, 1991.Twenty steps for developing a healthy cities project. Copen-hagen, EURO, 1997 (document EUR/ICP/HSC 644(2)).Community participation in local health and sustainabledevelopment: approaches and techniques. Copenhagen,EURO, 2002 (European Sustainable Development andHealth Series, No. 4).City health profiles: a review of progress. Copenhagen,EURO, 1998 (document EUR/ICP/CHDV 03 01 01/1).Barton H, Tsourou C. Healthy urban planning: a WHOguide to planning for people. London, Spon Press, 2000.Barton H et al. Healthy urban planning in practice: experi-ence of European cities. Copenhagen, EURO, 2003.

For more information on Healthy Cities activities inthe WHO European Region please consult the web siteof the Regional Office at http://www.euro.who.int/healthy-cities.

Contact informationCentre for Urban HealthWHO Regional Office for EuropeScherfigsvej 82100 Copenhagen Ø, DenmarkTel: +45 39 17 14 79Fax: +45 39 17 18 60E-mail: [email protected]

EUROPEAN REGION


Region of theAmericasAn introduction to Healthy Cities in theRegionLatin America and the Caribbean (LAC)

An increase in demo-cratic processes andwidespread decentraliza-tion of state functions inthe late 1980s gave sup-port to the subsequentadoption and rapid ex-pansion throughout theLAC countries of theconcept of Healthy Mu-nicipalities and Commu-nities (HMC). Countrieshad already been in-

volved in various projects that focused on local solu-tions to health problems, equity in health services andcommunity priority-setting. Many projects address twocommon areas of concern for communities: the envi-ronment and basic sanitation.

CanadaSince the Healthy Cities movement began in Canada in1984, two strong provincial networks of Healthy Citieshave developed in Ontario and Quebec, representing atotal of 200 communities. Provincial networks are alsobeing formed in New Brunswick and Saskatchewan. Ar-eas that are currently being addressed include youthprogrammes, community safety, local economic devel-opment, recreation and urban planning.

United StatesThere are more than 200 self-declared Healthy Citiesand Communities at both the state and city level in theUnited States. A few common themes have emerged,such as conservation of resources and environmentalhealth, domestic and youth violence, adolescent serv-ices, and job and life skills training. The Coalition forHealthier Cities and Communities and the NationalCivic League in Denver, Colorado support and promotethe HMC concept.

The urban health context and keychallengesHMC is an effective strategy for influencing localhealth and development policies and is an opportunityfor the health sector to promote local health policiesand achieve equity in access to health services.

There is a need in the Americas to disseminate andadvocate for the implementation of the HMC strategyand to build and strengthen intersectoral alliances.There is also a need to conduct ongoing monitoring andevaluation. Nevertheless, the best sustainable resource ofcommunities is proving to be the members themselves.

State of the artThe primary function of the Pan American Health Or-ganization (PAHO) is to provide a clearing house for in-formation and to serve as a technical resource for thedevelopment and evaluation of HMC projects. The roleof technical cooperation in the area of HMC projectshas been to promote the use of methodological instru-ments, technical information and exchanges amongcountries so that they develop their own models. To fa-cilitate the exchange of HMC experiences within the Re-gion and internationally, PAHO has included on its website information on each Member State’s involvement,including contact information and in some cases linksto a country’s own HMC web site

Partners include the International Union of LocalAuthorities, the International Union of Health Promo-tion and Education, the Society for Public Health Edu-cation, the Centers for Disease Control and Prevention(CDC), the Inter-American Consortium of Universitiesand Training Centers in Health Education, the LatinAmerica and Caribbean Healthy Municipalities Net-work and the Healthy Schools Network.

Overview of achievements• A number of projects have been assessed and for-

mally documented.• The national Mexican Network of Municipalities for

Health has over 1000 municipalities participating.• Ten countries have developed national networks.• The regional HMC network was recently revived and

now has over 16 countries participating.• Many countries in the Region have established local

and national intersectoral committees and have de-veloped local HMC plans.

• Most countries are using the PAHO-developed advo-cacy and orientation materials.

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Salamá, Honduras: creating synergies toimprove healthThe HMC process in Salamá, launched in 1994,demonstrated a positive impact on material andphysical conditions throughout the municipalityand its surrounding communities. It establishedinter-municipal alliances as a new norm forfurthering sustainable community development inthe face of seemingly overwhelming obstacles. Theimplementation of various health promotionactivities created an empowering environment.

Standardized surveys can not only guide thedevelopment of the HMC initiative but canfacilitate resource mobilization from municipalauthorities in support of the HMC process. They canconstitute an important means of measuring andevaluating progress.

Where there is a strong sense of communityownership of the HMC initiative, the lack ofpolitical commitment from municipal authoritiesinhibits – but does not preclude – determined actionto improve health and living conditions within themunicipality.

Regional alliances are at times necessary in orderto effectively address the underlying determinantsof poor health at the community level.

Future prospectsThe future strategy for the Region will be:• to strengthen HMC in the Region, supported by an

active network and up-to-date website;• to facilitate cooperation and collaboration among

PAHO/WHO collaborating centers and MemberStates;

• to strengthen and contribute to the database of HMCeffectiveness; and

• to advocate for and build capacity in developing, im-plementing, monitoring and evaluating the effec-tiveness of HMC projects in the Region.

Further informationMayors’ guide for promoting quality of life. Washington,DC, PAHO, 2002 (English, French, Portuguese, Spanish).Healthy municipalities and communities (a promotionalbrochure). Washington, DC, PAHO, 2003. (English,Spanish). Hard copies and electronic format availablefrom [email protected]).Municipios saludables. Washington, DC, PAHO, 1997(Comunicación para la Salud No. 11) (Spanish).Participatory evaluation resource kit. Washington, DC,PAHO, in press (English, French, Portuguese, Spanish).The Healthy Municipalities movement: a settings approachand strategy for health promotion in Latin America and theCaribbean (draft, available electronically [email protected]).Health promotion anthology. Washington, DC, PAHO,1996 (Scientific Publication No. 557) (English, Spanish).Economic evaluation guide and principles of health promo-tion. Washington, DC, PAHO, in press (English, Span-ish).Rapid evaluation of health promotion initiatives. Washing-ton, DC, PAHO, in press (English, Spanish).Proyecto desarrollo espacios saludables (Loja, Ecuador).PAHO, Ecuador, 2003 (Spanish). Planificación LocalParticipativa – metodologías para la promoción de la saluden América Latina y el Caribe. Washington, DC, PAHO,1999 (Spanish).Health promotion evaluation: recommendations forpolicymakers in the Americas. Washington, DC, PAHO,2003, in press (English, Portuguese, Spanish).Health promotion in the Americas. Washington, DC,PAHO, 2003, in press (English, Spanish).Municipios saludables – una opción de política pública.Avances de un proceso en Argentina. PAHO, Argentina,2002 (Spanish).

For more information on Healthy Cities activities inthe WHO Region for the Americas please consult thePAHO web site at http://www.paho.org.

Contact informationMarilyn RiceRegional Adviser for Healthy Municipalities and Com-munitiesPan American Health Organization/WHO Regional Of-fice for the Americas525 23rd Street, NWWashington, DC 20035, USATel: 1-202-974-3969Fax: 1-202-974-3640E-mail: [email protected]

REGION OF THE AMERICAS


South-East AsiaRegionAn introduction to Healthy Cities in theRegionThe Interregional Healthy Cities Programme launchedin the South-East Asia Region in 1994 comprised six cit-ies. Progress in Healthy Cities development has beenslow owing to a lack of clear concepts among local au-thorities and a lack of coordinated urban infrastructureto support the process. To address these issues, severallocal and regional meetings and workshops were held.A comprehensive review of the programme in selectedMember States was conducted in 1998, and a HealthyCities Framework for Action was developed for the Re-gion in 1999.

The urban health context and keychallengesMost governments and civic authorities have notplanned for the projected population explosion in cit-ies. At only 42 %, the South-East Asia Region has thelowest sanitation coverage of all WHO regions, and thesituation is far worse in urban slums. Other challengesare the poor urban infrastructure and governance andlow capacity for intersectoral collaboration.

The prevailing mass illiteracy and poverty in manycountries of the Region makes it difficult for large seg-ments of the population (the potential recipients of thebenefit) to understand the Healthy Cities concept andparticipate in it. Nevertheless, the increasing trend to-wards political decentralization seen in the Region is anemerging opportunity for promoting healthy settings atlocal levels.

There is a need:• to generate political mobilization and community

participation in preparing and implementing a mu-nicipal health plan;

• to increase awareness of health issues in urban devel-opment efforts by municipal and national authori-ties, including non-health ministries and agencies;and

• to create a network of cities that promotes informa-tion exchange and technology transfer.

• To facilitate intersectoral action for health;• to strengthen capacity-building for sustaining

Healthy Cities projects;• to improve the role of city planning and the quality

of living conditions in the city (promoting decen-tralized decision-making and management of health-related action);

• to improve urban governance; and

• to establish mechanisms for resource mobilization tosustain Healthy Cities projects.

State of the artThe common threads that run through the process ofmaking a conceptual difference between a Healthy Cit-ies project and other community development effortscomprise three elements: a defined action plan, amanagerial mechanism and a built-in approach to com-munity involvement. Several actions undertaken so farto facilitate the national process include training for co-ordinators and others, a review of Healthy Citiesprojects in selected countries, development of theHealthy Cities Framework for Action, and a HealthyDistrict concept formulated in 2001.

The role of WHO in Healthy Cities projects has beento advocate and raise awareness, facilitate operations,provide technical guidance, build capacity, provide fi-nancial support for initiating projects, establish re-gional networking, promote information exchange andassist in donor coordination and evaluation.

Besides technical support, WHO provides seedmoney to almost all Healthy Cities projects for initiat-ing advocacy and planning meetings among projectleaders and their stakeholders. Most Healthy CitiesProject began with one or two selected “settings”.

Overview of achievementsDespite a slow beginning, there are at present about 40Healthy Cities in the Region, involving all MemberStates. In 2002, the Regional Office commissioned anevaluation of Healthy Cities projects in 12 cities in In-dia, Nepal, Sri Lanka and Thailand. Some of the impor-tant observations/conclusions of this study indicatethat the following factors contribute to successful im-plementation:• exposure and commitment of decision-makers, par-

ticularly local politicians;• clarity of vision and mission, with a strong planning

and management team;• sense of ownership of policies;• high degree of stakeholder involvement; and• institutionalization of Healthy Cities programme

policies.

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The example of ThailandHealthy Cities, as a formal process, was launchedin Thailand on World Health Day 1996. In that year,WHO and the Thai Government together carriedout Healthy Cities demonstration projects in fivecities. Healthy Cities appeared in the 8th NationalEconomic and Social Development Plan (1997–2001), with a regular annual budget from theDepartment of Health for direct support to the“settings” approach.

The Healthy Cities concept is now wellestablished, even though there have been manychanges in decision-makers, both at central andlocal authority level. In the 9th National Economicand Social Development Plan (2002–2006), HealthyCities is the main approach for urban developmentand will covers all municipalities and TombonAdministration Organization, thus signalling amove from concept to integration into thedevelopment process.

The Healthy Cities movement has established aNational Steering Committee with subcommitteesat both national and local level, with policies ofadvocacy and cooperation among organizations,the private sector and civil society. In addition,technical advice and in-service supervision andtraining courses help to strengthen the capacity ofstaff at all levels in implementing policy. Besidesthe normal governmental lines of administration orcooperation, the National Municipality Leagues ofThailand participated actively in stimulating themunicipalities to apply the Healthy Cities approach.

Future prospectsThe Healthy Cities process augurs well as a support toolfor local-level intersectoral collaboration. We hope toalso see increasing evidence of this healthy settingsconcept being incorporated into national planningprocesses, as a means both of looking at health and de-velopment issues more comprehensively and of imple-menting national development through intersectoral.The Regional Office will continue to provide guidance,facilitation and networking support to Member Statesas the process moves forward.

Further informationHealthy Cities: report of a regional consultation, New Delhi,20–22 April 1999. New Delhi, SEARO, 1999 (documentSEA/EH/527).Healthy Cities: framework for action. New Delhi, SEARO,1999 (document SEA/EH/529).Strengthening Healthy Cities projects in the South-East AsiaRegion: an opinion survey. New Delhi, SEARO, 2000(document SEA/EH/530).

Healthy settings. New Delhi, SEARO, 2000 (documentSEA/EH/532).Evaluation of Healthy Cities in South-East Asia. NewDelhi, SEARO, in press.Healthy Districts: a concept. New Delhi, SEARO, 2001.

For more information on Healthy Cities activities inthe WHO South-East Asia Region please consult theweb site of the Regional Office at http://www.whosea.org.

Contact informationDr Abdul Sattar YoosufDirector, Department of Sustainable Development andHealthy EnvironmentE-mail: [email protected]

Mr Terrence ThompsonRegional Adviser, Water Sanitation and HygieneE-mail: [email protected]

Dr Sawat RamabootCoordinator, Health PromotionE-mail: [email protected]

Office Address:WHO Regional Office for South-East AsiaNew Delhi 11002, IndiaTel: 91-11-2337 0804Fax: 91-11-23370197

SOUTH-EAST ASIA REGION


Western PacificRegionAn introduction to Healthy Cities in theRegionSince the late 1980s, when Australia, Japan and NewZealand embarked on their Healthy Cities projects, sev-eral more countries in the Western Pacific Region havejoined the Healthy Cities movement. These includeCambodia, China, the Lao People’s Democratic Repub-lic, Malaysia, Mongolia, the Philippines, the Republicof Korea, and Viet Nam. Countries such as Fiji andPapua New Guinea are considering joining the move-ment.

Currently over 100 Healthy Cities projects are beingimplemented in the Region. These projects share somecommon features, such as intersectoral collaborationand community participation. Nevertheless, they alsoaddress a diversity of priority health issues, reflectingthe different states of economic development, physicalenvironments, political/administrative systems, and so-cial and cultural norms of the cities involved.

The urban health context and keychallengesIn the last several years, other regional entities andagencies have also become interested in collaboratingwith WHO on Healthy Cities. ASEAN held its firstHealthy Cities conference in June 2002, at which theUrban Governance Initiative of UNDP also participated;CityNet wishes to have a Healthy Cities activity amongits member cities; and the United Nations University’sInstitute of Advanced Studies wishes to undertake urbanecosystem assessment studies in some Healthy Cities.

A number of human and institutional resources (e.g.national coordinators, external consultants, short train-ing courses, etc.) have been developed to provide tech-nical input to Healthy Cities initiatives in the Region.Many cities implementing Healthy Cities activities,even in developing countries, have local resources toimplement various activities, in some cases with budg-ets specific to Healthy Cities (e.g. Ulaanbaatar). Theywish to learn from the experience of others and ex-change information with other cities. They have alsoexpressed a strong desire to be recognized more for-mally, particularly about those aspects of the initiativesthat they implement well.

To cope with the growing interest in Healthy Cities,facilitate mutual support among Healthy Cities initia-tives and utilize the human and institutional resourcesavailable in the Region in an effective and coordinatedmanner, WHO is currently supporting the establish-

ment of a new regional network known as the Alliancefor Healthy Cities. The Alliance would encourageHealthy Cities initiatives to develop innovative ap-proaches and learn from each other, and also provideformal recognition to individual Healthy Cities initia-tives and to work carried out well. The setting up of theAlliance has just been discussed at a WHO regionalconsultation held on 15–17 October 2003.

State of the artSince 1994, WHO has:• convened technical review workshops on Healthy

Cities (Johor Bahru, 1995; Beijing, 1996; Malacca,1999; Johor Bahru, 2001; Manila, October 2003);

• documented experiences in developing Healthy Cit-ies projects;

• worked with training/educational institutions in of-fer training courses on Healthy Cities (4-week courseby the National Institute of Public Administration inMalaysia, with financial support from the Japan In-ternational Cooperation Agency; 1-week course bythe Flinders University in South Australia; and 1-week and 2-week courses by the Tokyo Medical andDental University in Japan);

• in June 2000, published regional guidelines for de-veloping a Healthy Cities project;

• developed and maintained a regional database onHealthy Cities projects and made it available on theWHO web site;

• formulated with Member States a regional actionplan for 2000–2003 at the regional workshop in Ma-lacca in October 1999; and

• developed case studies on evaluation methodologiesfor Healthy Cities projects and discussed them at theJohor Bahru workshop in 2001.

The approach described in the guidelines documentwill be adopted by the Alliance. The Alliance will issuecriteria for accepting members to the network, and forrecognizing outstanding practices.

At the regional level, the Alliance will be establishedwith cities as members, and with all interested indi-viduals and non-city entities as associate members. Inaddition, there are national networks with coordinatorsin China, the Lao People’s Democratic Republic, Malay-sia, Mongolia, the Philippines and Viet Nam. WHO willparticipate in the Alliance as a member (not as a secre-tariat). ASEAN, CityNet, TUGI and UNU/IAS are also ex-pected to form partnerships with the Alliance.

The Healthy Cities programme at both local and na-tional levels in Malaysia has played a pioneering andleadership role in the Western Pacific Region. Started in1994 in two cities (Kuching and Johor Bahru), the pro-gramme has grown, not only in the number of partici-pating cities, but also in terms of helping cities in othercountries to learn from the Malaysian experience.

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Future prospectsThe establishment of the Alliance for Healthy Cities isthe most urgent matter in the immediate future. It isenvisaged that local governments across the Region willparticipate in the Alliance as a mechanism for improv-ing their capacity to respond to health and quality oflife needs in relation to good governance. It is also en-visaged that members of the Alliance will be champi-ons for responsive city health care systems within theirnational sphere of influence and “centres of excel-lence” for learning about Healthy Cities approaches.

Further informationPublications and information relevant to Healthy Citiesin the Western Pacific Region can be found at: http://www.wpro.who.int/themes_focuses/theme2/focus1/healthy_cities.asp.

Contact informationDr Susan Mercado or Hisashi OgawaHealthy Settings and Environment FocusWHO Regional Office for the Western PacificP.O. Box 2932 (United Nations Avenue)1000 Manila, PhilippinesTel: (632) 528-8001Fax: (632)521-1036E-mail: mercados@wpro/who/int [email protected]

WESTERN PACIFIC REGION

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