The World Health Organization Healthy Cities Project

Healthy Cities Action
Targets of action starting with a motto of “Health for All” are as follows:
- To create an environment for all citizens to live happily in, sharing their experiences on creating a healthy, clean and safe place,
- To develop common projects in areas, such as health, transportation, environment, etc. to provide an equal and high class habitat based on equality without religion, language, race, culture, class and notion discrimination

Healthy Cities Network
WHO, which undertakes the pioneer role in health reform field throughout its past of 66 years has adopted a social based approach towards health rather than a disease based one from the beginning; and considered health as a complete wellness state in terms of physical, spiritual and social aspects. Following invitation of international societies for struggle with regards to health for everyone in the World Health Assembly held in 1977 in Geneva, the organization started to re-review the formation of health policies in Europe; and these works resulted with the initiation of implementation of regional “Health for All strategy”, with 38 targets, in 1984.

The Healthy Cities Project implemented in Europe Region presents the importance of an integral approach in order to provide a sustainable development environment for issues such as resolving problems such as poverty, violence, social exclusion, contamination, substandard accommodation conditions, uncovered needs of middle aged and young people, homeless people and Immigrants, unhealthy settlement planning, inequity and also increasing the insufficient society participation works.

The participant cities make a cross-sectoral collaboration with regards to requirements of non-protected groups; develop and implement a broad program and a product range which include city health profiles and city health plans & strategies based on social development initiatives and programs.

WHO Healthy Cities Project is a long-term international development initiative which aims to place health to positions having priority in agendas of decision makers and to develop comprehensive local strategies for a healthy and sustainable improvement in line with principles and goals of health for everyone strategy across Europe. The main goal of Healthy Cities Project is to increase physical, mental, social and environmental prosperities of people living and working in cities.

Fourth phase of the project, which advances in five-year periods, completed in 2008 and the fifth phase (2009-2013) has begun. At each phase, cities aiming to be a “healthy city” become member to the international network; and perform result-oriented works within the scope of determined main themes. Membership to WHO Healthy Cities Network is completed by following up a public application process. At the end of each phase divided into five-year periods the former network is dissolved and the next phase is continued with a new network formed.

Issues and terms specified up until today are as follows:
At Phase 1 (1987-1992); It took part in 35 city projects, extended borders of general strategy project, developed and introduced new methods on health targets of cities.
At Phase 2 (1993-1997); It took part in 39 city projects and focused on improving city health plans and public health policies at this phase.
At Phase 3 (1998-2002); It took part in 50 city projects and the main target was to develop policies based on Health 21 and Agenda 21 and to create city health development plans.
At Phase 4 (2003-2008); It took part in 75 city projects, four main themes, specifically healthy city planning, healthy aging, health affect evaluation identified at this phase and practices were performed on these themes. Bursa, İstanbul, Kadıköy, Bartın, Yalova, Eskişehir/Tepebaşı, Çankaya, Kırıkkale, Avanos, Gölcük, Aydın and Trabzon from Turkey attended this phase.
Phase 5 (2009-2013); The Zagreb Healthy Cities Declaration outlines the principles, goals and themes of Phase V of the WHO European Healthy Cities Network. The overarching theme for Phase V is health and health equity in all local policies. The core themes are; Caring and supportive environments, Healthy living, Healthy urban environment and design.

Core theme 1
Caring and supportive environments. A healthy city should be above all a city for all its citizens, inclusive, supportive, sensitive and responsive to their diverse needs and expectations.

Important issues;
• Better outcomes for all children. Providing early childhood services and support to all young citizens and aiming to systematically improve the lives of children. Investing in early childhood development is one of the best ways to reduce inequality in health.
• Age-friendly cities. Introducing policies and holistic action plans addressing the health needs of older people that emphasize participation, empowerment, independent living, supportive and secure physical and social environments and accessible services and support.
• Migrants and social inclusion. Systematically addressing the health and social needs of migrants, promoting integration, tolerance and cultural understanding.
• Active citizenship. Providing an effective infrastructure for community participation and empowerment, utilizing community development techniques as the catalyst for action and promoting social networking opportunities.
• Health and social services. Advocating and supporting the development of health and social services that are responsive, high quality and accessible to all, based on systematic needs assessment of the population and particularly for vulnerable groups.
• Health literacy. Developing and implementing programmes aiming to strengthen the health literacy skills of the population. Health literacy means the degree to which individuals have the capacity to obtain, process and understand basic health information and services provided by complex health systems needed to make appropriate decisions to maintain and promote their health.

Core theme 2
Healthy living. A healthy city provides conditions and opportunities that support healthy lifestyles.

Important issues;
• Preventing noncommunicable diseases. Scaling up efforts and strengthening local partnerships to tackle the epidemic of noncommunicable and chronic diseases through population-based integrated approaches addressing the risk factors and social determinants of these diseases.
• Local health systems. Strengthening the capacity of local health systems, including public health services and primary health care services, to prevent, control and manage cardiovascular disease, cancer, respiratory disease and alcohol-related disease.
• Tobacco-free cities. Implementing and enforcing city-wide smoke-free policies in public and working spaces.
• Alcohol and drugs. Developing intersectoral plans of action to prevent alcohol and drug abuse.
• Active living. Making active living, physical activity and pedestrian mobility a core part of city development policies and plans.
• Healthy food and diet. Increasing equitable access to healthy food and broadening the understanding of healthy eating habits.
• Violence and injuries. Introducing policies and plans to deal with all aspects of violence and injuries in cities, including violence involving women, children and older people, road crashes and home accidents.
• Healthy settings. Supporting programmes on healthy living and mental wellbeing that would be implemented through the settings of people’s everyday lives, such as neighbourhoods, schools and workplaces.
• Well-being and happiness. Broadening the understanding of and exploring and promoting the factors and conditions that support well-being and happiness, reduce stress and enhance the resilience of communities.

Core theme 3
Healthy urban environment and design. A healthy city offers a physical and built environment that supports health, recreation and well-being, safety, social interaction, easy mobility, a sense of pride and cultural identity and that is accessible to the needs of all its citizens.

Important issues;
• Healthy urban planning. Integrating health considerations into urban planning processes, programmes and projects and establishing the necessary capacity and political and institutional commitment to achieve this goal. Especially emphasizing master planning, transport accessibility and neighbourhood planning.
• Housing and regeneration. Increasing access through planning and design to integrated transport systems, better housing for all, health-enhancing regeneration schemes and to green and open spaces for recreation and physical activity.
• Healthy transport. Promoting accessibility, by facilitating the ability for everyone, including very young people and people with limited mobility, to reach their required destination without having to use a car.
• Climate change and public health emergencies. Tackling the health implications of climate change in cities and being vigilant about global changes such as the impact of globalized economies, the free movement of people and preparedness for and response to public health emergencies.
• Safety and security. Ensuring that the planning and design of cities and neighbourhoods allows social interaction, increases a sense of safety and security and supports easy mobility for everyone, especially young and older people.
• Exposure to noise and pollution. Promoting and adopting practices that protect people, especially children, from toxic and health-damaging exposure, including indoor and outdoor air pollution, tobacco smoke in workplaces and public places and noise.
• Healthy urban design. Creating socially supportive environments and an environment that encourages walking and cycling. Enhancing cities’ distinctive and multifaceted cultural assets in urban design and promoting urban designs that meet all citizens’ expectations for safety, accessibility, comfort and active living.
• Creativity and liveability. Promoting policies and cultural activities that encourage creativity and contribute to thriving communities by developing human and social capital, improving social cohesion and activating social change.

Zagreb Declaration was signed on the last day of the conference, held at Zagreb, Crotia between October 15–18, 2008 by Healthy Cities Network of World Health Organization to lead practices on enhancing healthy cities and life standard in forthcoming 5 years.

Conditions, stipulated by WHO to be a member of International Healthy Cities Network are as follows:

- Political Commitment
- Founding Health City Project Office
- Presenting City Health Profile
- Specifying Healthy City Indicators
- Preparing City Health Development Plan

Healthy Cities Project
- It is a long-term development project aiming to enhance physical, psychological and environmental welfare of the people living and working in the city.
- The Healthy Cities Project starts with the fact that how the city is and how a healthy city should be.
- According to the approach, a “City” might be likened to a living, breathing, growing and complex organism, having an ever-changing internal dynamic.
- Healthy city is a city that can enhance its environment and extend its resources.
- Healthy city concept is not only a conclusion, but also a method.
- Healthy city is not a city that reached a certain health level; it is a city having a health conscious and endeavoring to enhance it. Hence, any city can be a healthy city without regarding its current health status; it is necessary to a structure and mechanism to bring necessary determination and success.

Targets of Healthy Cities Project
- To encourage healthy public policies,
- To create supporting social environment,
- To enable sources to be used properly,
- To incent and enhance public attendance,
- To prepare integrated city health programs and plans,
- To make national and international partnerships.