Journal of urban health : bulletin of the New York Academy of Medicine
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This article synthesizes diverse official reports, statistics, and scientific papers that present demographic, economic, environmental, and social trends impacting on the health and quality of life of citizens living in European cities. A literature review led to the identification of some key challenges including an aging society, migration flows, inequalities in health, global change, and risk behaviors that should be addressed in order to promote urban health. ⋯ Cities that have participated in one or more of the phases of the WHO European Healthy Cities Network have implemented a number of policies, programs, and measures to deal with the challenges discussed in this article. Some contributions are presented to illustrate how health and quality of life in urban areas can be promoted by local authorities.
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Equity in health has been the underlying value of the World Health Organization's (WHO) Health for All policy for 30 years. This article examines how cities have translated this principle into action. Using information designed to help evaluate phase IV (2003-2008) of the WHO European Healthy Cities Network (WHO-EHCN) plus documentation from city programs and websites, an attempt is made to assess how far the concept of equity in health is understood, the political will to tackle the issue, and types of action taken. ⋯ However, this evaluation also exposes barriers to effective local policies and processes to reduce health inequalities. Armed with locally generated evidence of critical success factors, the WHO-EHCN has embarked on a more rigorous and determined effort to achieve the prerequisites for equity in health. More attention will be given to evaluating the effectiveness of action taken and to dealing not only with the most vulnerable but a greater part of the gradient in socioeconomic health inequalities.
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An intersectoral partnership for health improvement is a requirement of the WHO European Healthy Cities Network of municipalities. A review was undertaken in 59 cities based on responses to a structured questionnaire covering phase IV of the network (2003-2008). Cities usually combined formal and informal working partnerships in a pattern seen in previous phases. ⋯ This applied to long-established phase III cities as well as newcomers to phase IV. The network, and in particular the WHO brand, is well regarded and encourages political and organizational engagement and is a source of support and technical expertise. A key challenge is to apply a more rigorous analytical framework and theory-informed approach to reviewing partnership and collaboration parameters.
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Physical activity is associated with reduced risk of a number of health outcomes, yet fewer than half of adults in the United States report recommended levels of physical activity. Analyses of structural characteristics of the built environment as correlates of physical activity have yielded mixed results. We examine associations between multiple aspects of urban neighborhood environments and physical activity in order to understand their independent and joint effects, with a focus on the extent to which the condition of the built environment and indicators of the social environment modify associations between structural characteristics and physical activity. ⋯ We found modest support for the hypothesis that associations between structural characteristics and physical activity are modified by aspects of the social environment. Results presented here point to the value of and need for understanding and addressing the complexity of factors that contribute to the relationships between the built and social environments and physical activity, and in turn, obesity and co-morbidities. Bringing together urban planners, public health practitioners and policy makers to understand and address aspects of urban environment associated with health outcomes is critical to promoting health and health equity.