European Healthy CitiesNearly 30 years of intersectoral innovation

Agis D. TsourosDirector, Division of Policy and Governance for Health and Well-being

Background• Launched in 1988 as a policy project with ambitious aim to put health high on the

social and political agenda of cities • Based on recognition that local action, urban setting and the key role of local

governments in health development• Approach consisted of 4 elements: political commitment, supportive mechanisms

for intersectoral collaboration, strategic city health development planning, and formal and informal networking across sectors and society

• Evolved over 5-year phases – always anticipating and integrating cutting edge-public health concepts and developments

• Provided the legitimacy to experiment with new ideas but always with a view to converting temporary project arrangements to sustainable permanent ones

Emphasis on the how and on preconditions for success

• Political commitment was based on strong Mayor and City Council support (executive and cross-party) and partnership statements by key stakeholders – this ensured broad support and continuity.

• Management of change included project office (dedicated capacity with staff and resources) working directly with the mayor’s office (supervised by mayor or other assigned senior politician) and intersectoral committee at senior level.

• Strategic thinking and city health development plan drawing on the contribution of different sectors.

• Regular fora and platforms engaging a wide spectrum of civil society and public stakeholders to promote dialogue and involvement on issues relating to health and development.

Intersectoral work happened at three levels: action, policy and governance

Healthy Cities have experimented successfully with intersectoral work

Health as a whole-of-local government responsibilityHealth and Equity in all local policies

Good intersectorality across the health spectrum

• Addressing inequalities with upstream (social determinants) action

• Health and sustainable development – quality of the physical and built environment

• Health impact assessment• Healthy urban planning and design• Caring and Supportive Environments• Vulnerable and disadvantaged groups

• Age-friendly Cities• Community action and healthy choices• Noncommunicable disease risk factors• Smoke-free cities• Cities fighting obesity• Active Cities – Physical activity• Health literacy• Community resilience in the face of austerity• City health diplomacy

Determinants of city intersectorality• Local (city) and global (WHO) commitment and leadership• Unity in diversity (one vision for many cities in many Member States)• Rigour in flexibility (thematic and strategic priorities and entry points but

not in strict “cookbook” compliance, not one fit for all)• Firm connection to newest evidence base (for example, on governance;

social determinants; literacy – solid facts, etc.)• It takes time but sustained effort pays off• Formal and informal networking at every level• Respect, participation, engagement

Healthy Cities are intersectorally effective• The number of intersectoral partnerships has increased in every Phase

since measurement started.• Intersectoral partnerships now extend beyond project action to sustainable

policies and governance.• Good intersectoral governance boosts systems-based upstream health

action.• Because of good experiences, WHO guidance and city-to-city networking,

there is a strong belief that health equity is attainable.• This is the time to strengthen urban health across Europe.

Progress on all aspects of HealthyCities workare regularly monitoredand evaluated

Intersectoral policy engagement

Healthy Cities is now a strategic vehicle forimplementing Health 2020 at the local level

The public health challenges of the 21st century to be addressed effectivelyrequire the full engagement of local governments

Whole-of-government, whole-of-society and health in all policies approachesrequire the involvement of all levels of government