Healthy city programme

 

A healthy city is an urban area which maintains and improves the social and natural environment and enables people to support each other through developing their potential to promote health.

In the Eastern Mediterranean Region, the healthy cities programme addresses specific issues, such as strengthening health services, the water supply, sanitation, pollution and housing and focuses on healthy lifestyles, particularly the prevention of noncommunicable diseases. At present, a population of nearly 13 million in Bahrain, Islamic Republic of Iran, Iraq, Pakistan, Saudi Arabia, Oman, Somalia, Sudan and Tunisia are implementing the healthy city programme.

Over the last few decades most countries, particularly urban areas, have witnessed extensive growth as a result of rural-to-urban migration and increases in population.

Rapid expansion of urban areas has over-stretched existing services and utilities, including health services. The situation is worse in poor slum areas where there is:

• low access to safe drinking-water, sanitation and other formal social sectors;

• low access to health care services;

• lack of access to schools; overcrowded environment/ poor housing;

• high prevalence of sexual abuse, HIV/AIDS, SARS, tuberculosis, etc.; and

• problems in addictions, drugs and social defiance.

In the rapidly expanding cities, population growths have resulted in unplanned expansion and the mushrooming of urban slums and low-income settlements, particularly in low-income countries.

The lack of resources and economic opportunities has restricted good urban planning and the orderly expansion of cities has lead to chaotic building with little consideration of the aesthetic in architecture. High-rise buildings with limited parking facilities and insufficient open spaces, coupled with the overuse of private vehicles and poor public transport systems, have added to public health problems. As a result of uncontrolled urban development, green areas have been eroded leaving behind inhospitable environments.

Swelling urban populations have also created problems, such as congestion, air pollution, water contamination, inadequate sewage disposal and the unmanageable disposal of solid waste, lack of human services, deficient energy resources and insufficient means of communication.

In the face of these conditions, municipal authorities and services lacking managerial capacity, institutional strength and resources have failed to deal with emerging urban issues. On the other hand, citizens have grown to expect that municipal authorities will improve conditions and have developed a non-participatory attitude towards the maintenance and welfare of their neighbourhoods and surroundings.

 

The healthy city programme: a sustainable response to urban needs 

In order to address urban issues in a comprehensive manner, the international healthy cities movement was first conceived in Canada in 1984 as an outcome of a symposium on “Healthy Toronto 2000: Beyond Health Care”. Subsequently, the WHO Regional Office for Europe launched the healthy cities programme in 1986 with the participation of 11 European cities. The programme was intended to provide a vehicle to test the application of the strategy of health for all in urban areas. This programme became a global movement and introduced the intersectoral approach for achieving health gains. The programme has been expanded to cover several regions, and now, subsequently involves more than 3000 municipalities throughout the world. 

The development of the programme has so far taken different paths in different regions with regional and local adaptation of the guidelines and implementation framework. Initially, the focus was only on large cities but the approach has changed to include smaller cities and towns. 

The healthy cities concept is based on community participation and partnership between municipal authorities, civil society, individuals and all other stakeholders to take action to improve health, the environment and the quality of life in cities. Therefore, the programme is concerned with the physical, social, economic and spiritual determinants of health and the essential elements necessary to improve health and the environment. It addresses issues such as improving health services, the water supply, sanitation, pollution and housing. It also focuses on the promotion of healthy lifestyles and supports projects and activities which generate income, improve education, address women’s issues and children’s needs and enlist the support of volunteer groups. The approach works on the principle that health and quality of life can be improved by modification of living conditions in the home, school, workplace, city—the places or settings where people live and work.

Health status is often determined more by the conditions in these settings than merely the lack of or provision of health care services. Looking at the health determinants in urban settings, the programme goes beyond the health sector and looks at related aspects, including economic status, employment and social needs. Moreover, it creates an awareness of factors related to the pace of urbanization and population growth rates, as well as the impact of national development plans on cities and poverty in urban slums and squatter settlements. 

The creation of a healthy city is a process, not an outcome. Similarly, a healthy city does not represent a particular state of health but rather an awareness of health and an ongoing goal of improving the physical conditions in which people live, with the ultimate goal of achieving health for all. A healthy city can be summarized as a clean urban setting with good health and environmental services. It is a physically safe area where people can live with their own beliefs, customs, lifestyles and social bonds. As countries of the Region are unique, it is important to take into consideration societal and cultural norms and community requirements to ensure the creation of a social and physical environment where people do indeed feel comfortable and safe.

As the ultimate goal of the programme is to improve health and the environment in cities, it gives priority to upgrading environmental health services and improving the quality of people’s life. Health development in urban areas involves health services, the environment, the economy, population growth, social factors, education and awareness, etc. To achieve improved health, the healthy cities concept provides a good opportunity to address all the determinants of health in an integrated and holistic manner.

It has its foundation in community participation and aims to put health at the centre of the city’s social and political agenda. The concept also provides public health and environmental leadership, stimulates innovation and relies heavily on community involvement and the mobilization of skills, resources and ideas. A healthy city has a significant level of commitment, facilitated by reliable structures and supported by processes to address all the determinants of health in achieving improved health and healthy neighbourhoods. There must be manifest efforts by the city and local government, nongovernmental organizations and community groups to work together to address all of the priority issues. Political commitment augmented by intersectoral support and collaboration by stakeholders is an essential factor in the healthy cities model.

Criteria for selection of a healthy city

A city must have the:

• presence of an effective, influential and enthusiastic core support group capable of assisting in programme introduction, implementation and monitoring;

• commitment of the highest authority to join the healthy cities network;

• willingness to appoint a coordinator and required staff, facilities and resources;

• interest of the city authorities in establishing a healthy city council with representatives from related sectors and agencies, nongovernmental organizations, international organizations, concerned citizens and community leaders;

• eagerness of city officials and leaders to form a steering committee to implement the programme using a participatory approach and setting feasible strategies;

• willingness to share information about its situation analysis, activities and progress with partners and other cities of the healthy city network in the Region.

Framework for implementation of the programme 

 

Challenges for the programme in the Region

1. Rural migration, rapid growth of urban slums and growth of urban population in mega cities;

2. Insufficient political commitment;

3. Not adopting the healthy city programme approach and coordination mechanism based on local needs;

4. Not fully utilizing local potential: nongovernmnetal organizations, donors, UN agencies, academic, research institutions and partners in city planning;

5. Not institutionalizing the healthy city programme concept and methodology as an integral part of development sectors;

6. Existence of industries in urban areas;

7. Insufficient infrastructure to accommodate rapid growth of urban areas: roads, primary health care, schools, housing, public transport, sanitation, etc.;

8. Lack of proper regulatory mechanisms for quality control: transport and roads, food safety, health and medicine, education, water and sanitation, etc.