Creating a healthy city

A healthy city is not a finished product created at one point in time; it is a dynamic place where citizens and government have established relationships and processes that allow them to collaborate in tackling any problems that arise. The healthy city approach calls for collective action, in which all the sectors—local government as well as community, religious and other groups and individual citizens—work together for a common purpose. A healthy city is also sensitive to gender, working to eliminate the discrimination that women face in access to housing, services and jobs.

The role of local government is too often overlooked. Yet in analysing health improvements in the city of Oxford (UK) in the past 200 years, public health physician Jessie Parfitt wrote: “Many would be surprised to learn that the greatest contribution to the health of the nation over the past 150 years was made not by doctors or hospitals but by local government.”

Municipal governments are involved in making decisions about urban planning, public works, housing, fire and police protection, education, public health, transportation and a whole host of other issues that have, cumulatively, far more impact on the well-being of their citizens than do health care services. Ensuring that local officials take health into account in making decisions is an important part of the process of creating healthier cities and communities.

People tend to view needs as endless and resources as few. But resources are greater than anyone at first imagines, and discovering that fact makes people realize how much power they have to address their most pressing problems. Every community has individuals who are ready and willing to contribute their untapped, if not professional, skills—entrepreneurial, political and managerial.

While no city can claim to have achieved the ideal, Horsens (Denmark), one of the first cities in the WHO Europe project, comes close. With initial leadership from local government staff and politicians, this community of 70,000 people has made the healthy city approach integral to its way of working and to municipal decision-making. Representatives from all municipal departments make up a Healthy City Group chaired by a full-time coordinator. At a Healthy City Shop, people come together to work on myriad problems ranging from environmental clean-ups to closer integration of immigrants into the life of the city. So successful is the approach that a joint public/private sector partnership has established a consulting group to advise others on how to create healthier cities.

The Healthy Communities banner is guiding similar efforts in many other cities. In 1990, the City Council and the residents of Parksville (Canada) developed a process to involve all parts of the community in defining a set of shared values and writing a plan based on them. The values statement developed by the citizens of Parksville, a rapidly growing community of 10,000 people in British Columbia, emphasizes environmental quality, maintenance of a small-town atmosphere, economic vitality, equal access to a range of human services and amenities, affordable public transportation and an ongoing forum for citizens to express opinions on local issues. These values have been integrated into a decision-making checklist that is applied to new construction.

The Healthy Community process has now also been used as the framework for developing a strategic plan for Parksville. This effort resulted in the creation of a ‘Healthy Community Advisory Commission’ and a new organizational design for local government. Five committees, staffed by over 100 volunteers, are working in areas such as economic development, environment, housing, transportation and access for people with disabilities.