Building Healthy Cities

It has become evident that Learning Cities and Healthy Cities share a good deal in common, and that community learning strategies can contribute much to Healthy City objectives. This convergence of interests owes much to the strong interest among Healthy City initiatives in the social determinants of health following the work of the World Health Organisation’s (WHO) Commission on Social Determinants of Health. The Commission’s report has been followed up by a number of national studies which have identified ways of addressing inequities in access to health services and achieving a healthy lifestyle and well being, including the important role of local government.

Much could be gained by facilitating a convergence of the Learning City and Healthy City concepts, so that the residents of cities will benefit from a more holistic and integrated approach to community building and well being in cities. The benefits to be gained could also be enhanced through recognition of the links between the Healthy City and Green City ideas.

Background

The concept of a Healthy City emerged from the work of the World Health Organisation, and has been progressed by a number of international and regional conferences and studies. An Alliance of Healthy Cities now exists in the Asian region directed at protecting and enhancing the health and health care of city dwellers,  A number of Australian cities are members of the Alliance along with a large number of Asian cities.

WHO has defined a Healthy City in the following terms:

A Healthy City is one that is continuously creating and improving those physical and social environments and expanding those community resources which enable people to mutually support each other in performing all the functions of life and in developing their maximum potential. (WHO 2011)

The links with Learning City aspirations are evident in this statement. These include the significance of the social environment, the role of partnership, and the central objective of supporting people in developing their maximum potential. Learning to be is an aspiration of both Learning Cities and Healthy Cities.

The Social Determinants of Health

The common social interests that Learning Cities and Healthy Cities share were articulated in the Final Report of the WHO Commission on Social Determinants of Health. (WHO 2008).

The social determinants of health have been defined in the following terms.

The socio-economic conditions that influence the health of individuals, communities and jurisdictions as a whole. These determinants also establish the extent to which a person possesses the physical, social, and personal resources to identify and achieve personal aspirations, satisfy needs and cope well with the environment. (Raphael 2004)

The social justice perspective of the WHO Commission brought a strong focus on inequities in health conditioned by social and economic policies. The Commission urged WHO and all governments to lead global action on the social determinants of health with the aim of achieving health equity. It also noted that governments alone could not achieve health equity, but that partnership was essential involving civil society and local communities, business, and international agencies. This view was summed up in the statement that health is the business of all sectors. This orientation raises the question of what Learning City initiatives can contribute.

The overarching recommendations of the Commission involved:

• Improve daily living conditions.
• Tackle the inequitable distribution of power, money, and resources.
• Measure and understand the problem and assess the impact of action.

The latter recommendation called on national governments and international organisations to set up national and global health equity enquiries and surveillance systems. A number of these have been undertaken with the UK enquiry discussed below particularly interesting in emphasising the role of local government in addressing the social determinants of health inequities.

Social Determinants of Health and the Role of Local Government

The role of local government in addressing the social determinants of health was addressed in a report from the UK Improvement and Development Agency.

This report built on an earlier report set up by the UK Government to propose the most effective strategies for reducing health inequities in England from 2010.

This report identified the following key policy areas where action was likely to be the most effective in reducing health inequities. These were:

• early childhood development and education;
• employment arrangements and working conditions;
• social protection
• the built environment;
• sustainable development;
• economic analysis;
• delivery systems and mechanisms;
• priority public health conditions;
• social inclusion and social mobility.

A number of these policy areas are typically addressed in Learning City initiatives. A further connection exists in the emphasis given in the IDeA report to the importance of place in addressing health inequities:

• Using the concept of place to understand and reduce health inequities (pp16-25)
• Embedding health in a vision of Total Place (pp41-43)

There are grounds for believing that the concept of place-making has become more significant in strategies for successful learning communities.

Health, Learning, and Well-being

The convergence of key aspects of Learning City and Healthy City development may be observed in the principles and values identified for Healthy Cities, and in the shared interest in well-being and happiness. Learning for what purpose is a necessary question for Learning Cities.

The Healthy City movement has led to a number of regional and national networks. These include the European Healthy Cities Network which in 2009 adopted a Zagrab Declaration for Healthy Cities. This Declaration contains a set of Healthy City Principles and Values set out below. It is evident that much of this statement will apply equally to Learning City initiatives with a commitment to social justice principles.

Healthy Cities Principles and Values

• Equity:  addressing inequality in health, and paying attention to the needs of those who are vulnerable and socially disadvantaged, inequity is inequality in health that is unfair and unjust and avoidable causes of ill health. The right to health applies to all regardless of sex, race, religious belief, sexual orientation, age, disability or socioeconomic circumstance.
• Participation and empowerment: ensuring the individual and collective right of people to participate in decision making that affects their health, health care and well-being. Providing access to opportunities and skills development together with positive thinking to empower citizens to become self-sufficient.
• Working in partnership: building effective multisectoral strategic partnerships to implement integrated approaches and achieve sustainable improvement in health
• Solidarity and friendship: working in the spirit of peace, friendship and solidarity through networking and respect and appreciation of the social and cultural diversity of the cities of the Healthy Cities movement.
• Sustainable development: the necessity of working to ensure that economic development – and all the supportive infrastructure needs…

is environmentally and socially sustainable……

The relevance of well-being and happiness to policies for lifelong learning and building learning communities was raised by John Field in a Thematic Paper prepared for the NIACE Inquiry into the Future of Lifelong Learning. This paper included the following definition of well-being taken from a 2008 statement by the UK Government Office for Science.

A dynamic state, in which the individual is able to develop their potential, work productively and creatively, build strong and positive relationships with others, and contribute to their community. It is enhanced when an individual is able to fulfil their personal and social goals and achieve a sense of purpose in society. (Field 2009,p9)

This paper also made the following observations relevant to well-being

• The evidence that learning promotes well-being is overwhelming.
• Learning providers must make more of their contribution to well-being
• Adults who are not currently working are likely to lose out as a result of public funding priorities.
• Making the most of learning’s contribution to well-being requires inter-departmental and inter-organisational co-operation.
• We need to development well-founded approaches to measurement,

(Field, 2009, pp5-6)

The relevance of well-being and happiness to both Learning City and Healthy City objectives points to the need for broader approaches that progress both aspirations simultaneously.

Durban Declaration on Climate and Health

The connections between climate change and health were brought out in the Durban Declaration on Climate and Health made by a conference of health organisations and associations. The Declaration cited the WHO position on climate change in the following terms.

The World Health Organisation predicts that unmitigated climate change will lead to significant increases in illnesses and death brought on by environmental change.  (Durban Declaration 2011)

The Declaration called on health organisations and other partners to take action in combating climate change and to follow up on the 2009 Principles for a Healthy Planet endorsed by 130 health organisations in Copenhagen in 2009.

The Way Forward

This discussion of a number of common interests shared by Learning Cities and Healthy Cities points to the need for holistic/integrated strategies at a city level which promote learning, health, and well-being as key objectives in successful cities. The links between environmental aspects and health aspects can further be brought out as, for example, in action taken by committed Green Cities such as Copenhagen, Stockholm, and Hamburg which have health outcomes and benefits.

There is a need, in this context, to share ideas and practical examples of ways in which cities are responding to these imperatives. Much will be gained if cioties participating in the PIE exchanges posted accounts of their experience in fostering health objectives in their city development, including health promotion through vehicles such as Learning Festivals.[1]

The inclusion of the Healthy City theme in the PIE dialogue provides a significant broadening of these discussions, and represents a step towards reconceptualising the features of sustainable 21^st century Learning Cities that are responsive to the challenges they face while also providing welcoming people-friendly environments.

For Discussion

1. Can you give further examples of ways in which community learning strategies have been applied in progressing Healthy City objectives?
2. What do you see as the biggest contribution a Learning City initiative can make to a Healthy City?
3. Should more attention be given to well-being and happiness as objectives of Learning Cities?  In what ways?
4. In what ways can a Green City initiative contribute to both Healthy City and Learning City objectives?

References

Campbell F (ed) 2010, The Social Determinants of Health and the Role of Local Government, I&DeA, London

Durban Declaration on Climate and Health, www.dublincity.ie/Pages/EurocitiesDeclarationClimateChange.aspx

Field J 2009, Well-being and Happiness, IFLL Thematic Paper 4, NIACE, Leicester

Raphael D 2004, Social Determinants of Health : Canadian Perspectives, Toronto,CSPI

World Health Organisation 2011, Healthy Cities : Health Promotion Glossary http://www.who.int/entity/healthy_settings/publications/en

World Health Organisation 2008, Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health, WHO, Geneva

World Health Organisation, Europe 2009, Zagreb Declaration on Healthy Cities, WHO Europe

[1]  Cork is notable for a wide ranging learning festival while Bad Tolz in Germany conducts a Learning Festival and Health Festival in alternate years