Implementation of the Healthy Cities' principles and strategies: an evaluation of the Israel Healthy Cities Network

Abstract

The Israel network of Healthy Cities has been operating since 1990, and the first evaluation of its performance was carried out in 2004. The objectives were to evaluate the level of implementation of the 'Healthy Cities' principles and strategies in each network city and to assess the contribution of the network to its member cities. Coordinators of 18 active healthy cities participated in the study by completing a questionnaire with the aid of key informants in the municipality. The survey covered six dimensions of Healthy Cities' principles and strategies, and each was analyzed as a sum of scores of separate components and measures, converted to a 0-10 scale. Cities were found to differ in their performances. The dimension of intersectoral collaboration received the highest mean score (8.0 +/- 1.6), while the environmental protection dimension received the lowest one (4.5 +/- 2.2). Time investment by the coordinator of > 20 h a week is significantly associated with a higher score on the management dimension (7.8 versus 4.4 where the coordinator invests 20 h a week or less, P < 0.001). Previous work experience in either public health or community work was associated with higher scores of the community participation and intersectoral partnership dimensions (6.9 versus 5.2 and 8.5 versus 6.8, respectively, P < 0.05). Political support was associated with the city equity policy dimension (8.1 versus 4.8 in cities with high versus low political support, P < 0.01). Coordinator's participation in the network's activities is associated with better scores on all the dimensions except for environmental protection. It appears that political commitment and support is a significant enabling condition, which, together with the capacity building of the coordinator, may lead to better implementation of Healthy Cities' policy. Environmental issues should be incorporated into training sessions to enhance the environmental protection dimension.

The Application of Salutogenesis in Cities and Towns

“…Whereas cities in low-income countries could still struggle with providing basic infrastructure like adequate waste disposal and access to clean water, cities in richer countries were able to focus on building networks and establishing inter-sector collaborations (Harpham, Burton, & Blue, 2001). Overall, evaluations reveal that success is highly dependent on political and material support for the ideas and principles of the Healthy City (Donchin, Shemesh, Horowitz, & Daoud, 2006). Aronson, Norton, and Kegler (2007) found that conflicting views regarding the importance of intervention on social and living conditions, versus intervention on individuals' lifestyle, were reduced through implementing a healthy cities approach.…”

“…The role of individual project ambassadors and coordinators and their capacity to facilitate engagement was examined in several evaluations (e.g., Donchin et al, 2006;Harpham et al, 2001). One of the major challenges identified was a lack of resources following the Project, as well as the need to develop overarching evaluation systems and theories to integrate knowledge and develop interventions based on evidence (Rychetnik et al 2012;Pluemer, Kennedy, & Trojan, 2010).…”

European National Healthy City Networks: the Impact of an Elite Epistemic Community

“…The Israeli network published their evaluation of 18 active healthy cities members. 18 The cities were assessed on six criteria (see Figure 4). Political support, together with the coordinators' building capacity, was found to be significant facilitators for sustaining successful healthy cities policies.…”

Implementation, Effectiveness and Political Context of Comprehensive Primary Health Care: Preliminary Findings of a Global Literature Review

“…Community participation proved important in ensuring that comprehensive PHC programs attended to issues of equity (access, outcome) in Australian cases, and in Middle East Healthy Cities projects (Donchin, Shemesh, Horowitz, & Daoud, 2006). This suggests that countries with broadly social democratic politics and openness to citizen engagement (including advocacy) are more likely to support a comprehensive PHC approach.…”