Eastern Mediterranean Health Journal | All issues | Volume 31 2025 | Volume 31, issue 5 | Building a sustainable future in Bahrain: Evolving from healthy cities to healthy settings

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Building a sustainable future in Bahrain: Evolving from healthy cities to healthy settings

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Commentary

Tasnim Atatrah1, Deena Alkhamis1, Shanine Mohebat1, Asmaa Khalil1, Yusuf Jalili1 and Samar Elfeky2

1WHO Country Office, Bahrain (Correspondence to Tasnim Atatrah: This e-mail address is being protected from spambots. You need JavaScript enabled to view it ). 2WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt.

Keywords: healthy cities, healthy settings, sustainable future, noncommunicable disease, urbanization, Bahrain

Citation: Atatrah T, Alkhamis D, Mohebat S, Khalil A, Jalili Y, Elfeky S. Building a sustainable future in Bahrain: Evolving from healthy cities to healthy settings. East Mediterr Health J. 2025;31(5):306–308. https://doi.org/10.26719/2025.31.5.306. Received: 25/07/2024; Accepted: 14/01/2025

Copyright © Authors 2025; Licensee: World Health Organization. EMHJ is an open access journal. All papers published in EMHJ are available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

Almost 40 years ago, WHO launched the Healthy Cities programme, which represents a global shift towards prioritizing health in urban planning and governance (1). The programme seeks to enhance the physical, mental and social wellbeing of people living and working in urban areas, because by 2050, around 70% of the world’s people would be living in cities (2). In the WHO Eastern Mediterranean Region (EMR), enrolling in the Healthy Cities programme involves signing a letter of collaboration to commit to the programme, joining the regional healthy cities network, conducting a self-assessment on the 80 indicators targeting the social determinants of health (SDH) and sustainable development goals (SDGs), requesting an assessment by the joint regional and country evaluation team to qualify as one of the global healthy cities, and receiving a certificate from the WHO Regional Office for the Eastern Mediterranean (3).

After signing the letter of collaboration, implementation began using a tailored approach that involved 3 key stages (3). The first stage—getting started—was a collaboration between stakeholders to develop a city health profile (4) and secure political support. There is multisectoral collaboration between the governorates, Ministry of Interior, Ministry of Health, and WHO in Bahrain. The second stage—getting organized—involved establishing governance structures and administrative mechanisms, with the Health Promotion Directorate of the Ministry of Health overseeing the initiative at the national level and the office of the coordinator of Healthy Cities at the local level. The third stage—taking action—involved implementing plans, increasing health awareness, encouraging intersectoral collaboration, and promoting community participation.

As of 2024, Bahrain had 4 recognised healthy cities and 5 health promoting universities (5–8). In 2021, Manama, in Bahrain, was the first capital city in the EMR designated as a healthy city, joining Umm-Al- Hassam, which was recognised in 2018. Two other cities, A’ali (2022) and Busaiteen/Al-Sayah (2022), were later added (5,7–8). Bahrain adopted the WHO Healthy Cities programme as a response to rapid urbanization and increased prevalence of noncommunicable diseases (NCDs), which account for 75% of deaths in the country (9,10). Implementation of the programme in Bahrain has helped in addressing the challenges relating to urbanization and increased risk of NCDs, which are further compounded by extreme temperatures. (11). Research has shown that NCDs are more prevalent in urban than rural areas (12). Heat stress exacerbates underlying illnesses such as cardiovascular disease, diabetes, mental illness, and asthma and can eventually lead to death (11). NCDs cost Bahrain US$ 1.4 billion yearly, which equalled 3.8% of its Gross Domestic Product (GDP) in 2019 (9,10).

Urbanization is one of the key public health challenges in the 21st Century (12). Healthy Cities aim to address people’s wellbeing and the risks of NCDs (tobacco use, unhealthy diets, physical inactivity) by investing beyond the health sector with an ultimate aim of contributing to better health and wellbeing (3). Bahrain’s adoption of the Healthy Cities programme aligns with the broader global health promotion strategies, including the Ottawa Charter (1986), the Shanghai Declaration (2016), the Geneva Charter (2021), the United Nations 2030 Agenda for Sustainable Development, and WHO’s 13th (2019–2023) and 14th (2025–2028) General Programme of Work. High-level political commitment and participatory governance are a major driving force for the programme.

In 1990, EMR adopted the Healthy Cities programme to address the urban and diverse health challenges in the region. There are currently 118 registered cities and 40 recognised healthy cities in the EMR (13). EMR countries face diverse public health challenges due to the differences in their socioeconomic and demographic characteristics.

The governorates in Bahrain play a significant role in NCD response at the local level (10), and 3 of the 4 governorates in Bahrain have pledged to expand the initiative beyond individual cities to the entire governorate (15). The core concepts behind Healthy Cities are the multisectoral action and the whole-of-government and whole-of-society approach.

Bahrain has implemented the healthy settings approach in various settings, including malls, schools and workplaces, to promote safe and healthy environments across the life course of individuals. For instance, the Ministry of Health and Ministry of Education launched Health Promoting Schools in 2002, targeting adolescents and children, in line with population health models and the social determinants of health (16). Similarly, the Ministry of Health and the Higher Education Council initiated the Health Promoting Universities programme in 2022 to foster wellbeing among young adults in academic settings (6–8).

In 2015, Bahrain launched a national programme known as Health Promoting Malls, a prime example of the country’s high-level political commitment to promoting health and wellbeing (14,17). Led by the Ministry of Health, the programme considers shopping malls as indoor settings for promoting a healthy lifestyle. The activities include opening the malls before official hours to facilitate physical activity, implementing an indoor smoking ban, promoting health-related messages, offering healthier food options, conducting health promotion campaigns to improve community awareness, providing first aid training to personnel at the malls, designating breastfeeding areas, as well as providing services for the elderly, pregnant women and persons with disabilities (18). Neighbouring countries with similar contexts have expressed interest in implementing a similar initiative to the Health Promoting Malls.

Healthy Cities is a crucial programme that will help promote better health and wellbeing in EMR countries. As urbanization continues to accelerate across the region, the success of health promoting initiatives and their adaptability to local context are vital for improving public health outcomes and quality-of-life at country level.

Bahrain has become a champion for the Healthy Cities programme by adapting it to local context in line with national, regional and global priorities. Through the Regional Healthy Cities Network, the programme has provided a platform for exchanging experiences, lessons and best practices among countries in the EMR and other regions facing the impact of urbanization on health (13,19). The political commitment and multisectoral approach, as seen in the case of Bahrain, are vital for sustainability of the Healthy Cities programme (20).

Funding: None.

Competing interest: None declared.

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