Healthy Cities

Dr Tara Kessaram, Medical Officer for Noncommunicable Diseases

August 10 2017

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 Summary

• Journey, rather than a destination, but starts with a vision

• Systematic approach and framework, rather than single health

project(s) conducted in a city setting

• Healthy cities well established approach globally

• Discourse shifted towards urban health

• Implementation differs across cities and regions

• Common success factors and common actions to implement

• Opportunity for Bangladesh to lead in the region

• Aligns well with the Sustainable Development Goals (SDGs)

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 Background

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 A healthy city

…constantly creates and improves those physical and

social environments and

….expands those community resources which enable

people to mutually support each other in performing all the
functions of life and developing their maximum potential

http://www.who.int/healthy_settings/types/cities/en/

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 Being a health city

…..does not depend on current health infrastructure,

rather upon,

a commitment to improve a city's environs and a

willingness to forge the necessary connections in
political, economic, and social arenas

http://www.who.int/healthy_settings/types/cities/en/

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 Origins and Development

1986 Europe, Australia, Canada, USA

1990’s Developing countries
1996 World Health Day: Healthy Cities for a Better Life
2010 World Health Day: 1000 cities, 1000 lives
2016 9th Global Conference on Health Promotion

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 Shanghai Mayors Consensus on Healthy Cities 2016

Recognition of urbanization’s impact on health and opportunity to improve it.

SDGs cannot be achieved without mayors and cities

Shanghai Consensus:

Healthy Cities have been platforms for implementing good governance for
health as well as for promoting health.

Commit to prioritise the political choice for health in all domains

of city governance and to measure the health impact of all our
policies and activities.

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 5 governance principles which will reflect the
transformative agenda of the SDGs.

Integrate health as a core

Address social, economic and
consideration in all policies
environmental determinants of health

Promote strong
community Reorient health and
engagement social services
towards equity

Assess and monitor wellbeing,

disease burden and health
determinants

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 Regional Implementation Models

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 WHO European Healthy Cities Network

A healthy city is defined by a process, not an outcome.

A healthy city is not one that has achieved a particular

health status.

It is conscious of health and striving to improve it.

Thus any city can be a healthy city, regardless of its

current health status.

http://www.euro.who.int/en/health-topics/environment-and-health/urban-health/activities/healthy-cities/who-european-healthy-cities-network/what-is-a-healthy-city

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 A healthy city aims to provide….

• Safe, clean environment

• Sustainable ecosystem

• Strong community, participation

• Meet basic needs for all

• Vital economy

• Provide access to experiences, resources, contact and interaction

• Connect with culture and heritage

• Optimal level of appropriate, accessible health and social services

• High health status

http://www.euro.who.int/en/health-topics/environment-and-health/urban-health/activities/healthy-cities/who-european-healthy-cities-network/what-is-a-healthy-city/healthy-city-checklist

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 WHO European Healthy Cities Network
[Structured Designation and Networking]
5 year phases with

• priority themes

• political declaration

• set of strategic goals

Goals of Phase VI 2014-2018 Health 2020.

• improving health for all and reducing health inequalities; and

• improving leadership and participatory governance for health

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 Application Process

o Letter of commitment from city mayor and council resolution

o Full time coordinator

o Steering group

o City health profile

o City health development plan

– vision, values, multi sectoral

o Participate in wider network

o Capacity building

o Monitoring and evaluation mechanism

http://www.euro.who.int/en/health-topics/environment-and-health/urban-health/publications/2014/phase-vi-2014-2018-of-the-who-european-healthy-cities-network-goals-and-requirements

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 Getting started in WHO European Healthy
Cities Network
1. City Health Profile:
Health of city’s population and its determinants, inequalities
• Socioeconomic conditions

• Housing

• Environment conditions

• Access to services

• Disease prevalence

• Risk factors

Dahlgren-Whitehead from http://www.esrc.ac.uk/about-us/50-years-of-esrc/50-achievements/the-dahlgren-whitehead-rainbow/

2. City Health Development Plan – integrated planning for health

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 Designation Process

World Health Organization 2009. Phase V (2009-2013) of the WHO European Healthy Cities Network: goals and requirements.

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 Western Pacific Region
[Networking, Recognition]
Alliance for Healthy Cities since 2004

Membership application process

Secretariat (University/WHO Collaborating Centre)

Steering committee comprised of different cities and rotational chair

Every 2 years, global conference

• Mayors, governors, city officers,

• Public health and urban planning professionals,

• NGOs, academic institutions

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 WPRO Recognition Awards
Categories for awards included

- Supporting built environments for physical activity

- Early essential newborn care standards for health facilities

- Responding to gender based violence

- Reducing food waste

- Responding to gender based violence

- Salt reduction

- Suicide prevention

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 Suggested criteria for national healthy cities
accreditation systems
• Political commitment (signed statement)

• Integrated into health planning

• Mechanisms to ensure financial support

• Equity

• City development planning, health impact assessment

• City profiles - regular monitoring of health and determinants

• Community and citizen participation

• Networking mechanisms

• Capacity building mechanisms

• Outcomes – social, economic, health behavior, health status

REFERENCE CRITERIA FOR NATIONAL HEALTHY CITIES ACCREDITATION SYSTEMS: WHO
• National government support REGIONAL OFFICE FOR THE WESTERN PACIFIC’S RECOMMENDATIONS

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 South-East Asia Region
Introduced to the region in 1994

Bangladesh: Chittagong, Cox’s Bazaar, Sylhet and Rajshahi

Key challenges in the Region:

• Capacity building in municipalities

• Training of manpower to initiate healthy cities

• Sustainability

• Commitment from local government

• Poverty and illiteracy dominate concerns

Strengthening Healthy City Projects in the South East Asia Region. An Opinion Survey
http://apps.searo.who.int/PDS_DOCS/B4439.pdf

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 Summary and Adaptation

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 Ingredients for Success

Commitment of local municipal officials

- Good guidance and good governance
- Strong leadership

Participation of local community members

Clear vision

Ownership of policies

Wide array of stakeholders

Institutionalizing the approach

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 Challenges

Securing long-term commitment

Stability of local coordinators

Capacity for good guidance to lead the project –

development of health profiles, evaluation

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 Opportunity:
Sustainable Development Goals

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 Bring together different divisions in
health and different Ministries
Healthy Cities involves:

• Noncommunicable disease

• Maternal and child health

• Infectious diseases

• Environmental health

• Disaster preparedness and response

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 Bangladesh

Identify the most appropriate approach for Bangladesh

Consultation with different health sectors in DGHS and Ministries

National coordinator

+/- National Steering Committee

*Start small - identify potential participating cities

Meet with mayor and local government department – advocacy, SDGs

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 Bangladesh

Bring city stakeholders together

Identify the city’s vision for itself

*Establish a city focal point/group for the initiative

*Set up a coordinating structure and secretariat within the city

Develop a city profile

Develop a city action plan

- Integrate current ongoing initiatives

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 Summary of Principle Elements
Leader of the city makes a public commitment

The vision is outlined and consensus obtained

Intersectoral committee/taskforce for planning established

City health profile development

Identify priority issues

Develop action plan

Implement action plan

Monitor action plan

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