Structure

1. Public Health WalesStaff Conference15 October 2009The WHO Healthy Cities ApproachEryl PowellPrincipal Health Promotion SpecialistCardiff Local Public Health Team

2. Structure • Introduction to WHO Healthy Cities – origin, approach and key elements • Phase V (2009-2013) and its core themes • Applying the approach • Progress in Cardiff • Questions

3. WHO Healthy Cities • “The original idea was that between four and six cities would develop local action plans for health promotion based on Health for All principles. Within a short time, the project had all but been eclipsed by a world-wide movement of city-based public health initiatives” • “In one sense the Healthy Cities Project was a new initiative, in another it was the Health of Towns Association of Exeter 1844 reborn…the challenge to us is to pick up where Chadwick’s thinking left off 100 years ago” (John Ashton 1992)

4. Healthy Cities Projects • Launched in Lisbon in 1986 by 21 European cities – 87 ‘designated’ cities in Phase IV (2003 – 2008) • As well as ‘designated ‘ cities, over 1,200 cities & towns from more than 30 countries in WHO European region involved

6. How WHO defines a healthy city • A healthy city is defined by a process, not an outcome. • A healthy city is not one which 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. • What is required is a commitment to health and a process and structure to achieve it.

7. The Healthy Cities Approach:vision, principles & methods • Post modern ‘movement’ – is ecological & environmental & focus on positive subjective health • Requires adoption of WHO ‘Health for All’ principles • Seeks to put health high on the political & social agenda of cities & to build a strong movement for public health at the local level • Strong emphasis is given to equity, partnerships, action to address the determinants of health & adapting to new challenges

8. Four elements for action • Explicit political commitment at the highest level to the principles & strategies of the Healthy Cities project • Establishment of new organisational structures/infrastructure to manage change (or a focus for existing structures) • Commitment to developing a shared vision for the city, with a health development plan & work on specific themes (products & outcomes) • Investment in formal & informal networking & co-operation

9. Phases and themes • Phase I (1988-1992) – setting the agenda • Phase II (1993-1997) – city health plans, health impact assessment • Phase III (1998-2002) – city health development plan, healthy urban planning, active living • Phase IV (2003-2008) – city health development plan, healthy urban planning, health impact assessment, active living and healthy ageing

10. Phase V (2009 – 2013) Overarching theme • Health and health equity in all local policies Core themes • Caring and supportive environments – better outcomes for children, age friendly cities, migrants and social inclusion, active citizenship, health and social services and health literacy) • Healthy Living – preventing non-communicable diseases, local health systems, tobacco-free cities, alcohol and drugs, active living, healthy food and diet, violence and injuries, healthy settings and well-being and happiness) • Healthy urban environment and design – healthy urban planning, housing and regeneration, healthy transport, climate change and public health emergencies, safety and security, exposure to noise and pollution, healthy urban design and creativity and liveability)

11. Some tangibles of Healthy Cities • Cities are becoming more assertive in the domain of public health – Council leaders are leading by example • A range of action has been planned & implemented in participating cities across Europe • Almost one-third of Healthy Cities had a high level of activity on Healthy Urban Planning in 2006 – 07 • Over 50% of Healthy Cities had undertaken Health Impact Assessments in 2006 - 07

12. Applying the approach Political commitment at the highest level • Influence Leader/Mayor of local authority • Incorporate public health issues into Community Strategy New organisational structures • Re-frame existing partnerships to focus on health inequalities and public health issues Products & outcomes • Influence and incorporate approach and principles into Health, Social Care and Well-Being Strategies, Children and Young Peoples Plans, Local Development Plans • Lead /facilitate multi-agency action plans and team work programmes that include the core themes Formal & informal networking • Share experiences and learning across organisations and professional groups • Engage in WHO led networks

13. Progress and next steps for Cardiff • Application form submitted to join the WHO European Network of Healthy Cities in June 2009 • Executive strategic level group established – reports to the Vision Forum and Cardiff Health Alliance • Progress to date • Commitment to achieving WHO Healthy City status and implementing a programme included in Proud Capital (the Community Strategy), the HSC&WB Strategy, the Local Development Plan and the C&YPP • Implementation plans supporting the strategies incorporate the core themes (caring and supportive environments, healthy living and healthy urban environment and design) • Agreement to focus action on obesity and overweight – the ‘Healthy Weight Healthy City Strategy’ is being developed incorporating healthy urban planning, physical activity, food, work place health and weight management) • Regular engagement with WHO and the UK and Ireland Healthy Cities Network