Healthy Cities In World

 Healthy city: global systematic scoping review of city initiatives to improve health with policy recommendations

Background

Global health will increasingly be determined by cities. Currently over half of the world’s population, over 4 billion people, live in cities. This systematic scoping review has been conducted to understand what cities are doing to improve health and healthcare for their populations.

Methods

We conducted a systematic search to identify literature on city-wide initiatives to improve health. The study was conducted in accordance with PRISMA and the protocol was registered with PROSPERO (CRD42020166210).

Results

The search identified 42,137 original citations, yielding 1,614 papers across 227 cities meeting the inclusion criteria. The results show that the majority of initiatives were targeted at non-communicable diseases. City health departments are making an increasing contribution; however the role of mayors appears to be limited.

Conclusion

The collective body of evidence identified in this review, built up over the last 130 years, has hitherto been poorly documented and characterised. Cities are a meta-system with population health dictated by multiple interactions and multidirectional feedback loops. Improving health in cities requires multiple actions, by multiple actors, at every level. The authors use the term ‘The Vital 5’. They are the five most important health risk factors; tobacco use; harmful alcohol use; physical-inactivity, unhealthy diet and planetary health. These ‘Vital 5’ are most concentrated in deprived areas and show the greatest increase in low and middle income countries. Every city should develop a comprehensive strategy and action plan to address these ‘Vital 5’.

A healthy city is defined by a process, not an outcome.

• A healthy city is not one that 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.
• The requirements are: a commitment to health and a process and structure to achieve it.
• A healthy city is one that continually creates and improves its physical and social environments and expands the community resources that enable people to mutually support each other in performing all the functions of life and developing to their maximum potential.
• WHO/Europe recommends a basic model for a healthy city.

Healthy cities are places that deliver for people and the planet. They engage the whole of society, encouraging the participation of all communities in the pursuit of peace and prosperity. Healthy cities lead by example in order to achieve change for the better, tackling inequalities and promoting good governance and leadership for health and well-being. Innovation, knowledge sharing and health diplomacy are valued and nurtured in healthy cities.

Healthy Cities : Revisiting the Role of Cities in Promoting Health (English)

The Healthy Cities Report, accordingly, aims to provide policymakers and development practitioners with an action-oriented framework for achieving healthy cities. Informed by an extensive literature review, it draws on the wealth of World Bank experience in urban development, citing examples and case studies of healthy city successes and challenges globally. It also recognizes the significant existing global efforts made by other stakeholders and partners on the healthy cities agenda, incorporating these lessons and practices. The report seeks to reposition the role that cities play in improving human and ecosystem health. It functions as a high-level guide for practitioners in urban development, offering overarching recommendations for working towards healthier cities. It needs to be read with the understanding that every city faces specific challenges and will likewise require unique actions tailored to the local context. The report is structured around a framework with three broad areas for supporting healthy cities – targeted support, integrated action, and preparation for the future – known as the TIP framework, outlined below.