Healthy Cities Phase V evaluation: further synthesizing realism.

In this article we reflect on the quality of a realist synthesis paradigm applied to the evaluation of Phase V of the WHO European Healthy Cities Network. The programmatic application of this approach has led to very high response rates and a wealth of important data. All articles in this Supplement report that cities in the network move from small-scale, time-limited projects predominantly focused on health lifestyles to the significant inclusion of policies and programmes on systems and values for good health governance. The evaluation team felt that, due to time and resource limitations, it was unable to fully exploit the potential of realist synthesis. In particular, the synthetic integration of different strategic foci of Phase V designation areas did not come to full fruition. We recommend better and more sustained integration of realist synthesis in the practice of Healthy Cities in future Phases.

Tackling the social determinants of inequalities in health during Phase V of the Healthy Cities Project in Europe.

The WHO European Healthy Cities Network has from its inception aimed at tackling inequalities in health. In carrying out an evaluation of Phase V of the project (2009-13), an attempt was made to examine how far the concept of equity in health is understood and accepted; whether cities had moved further from a disease/medical model to looking at the social determinants of inequalities in health; how far the HC project contributed to cities determining the extent and causes of inequalities in health; what efforts were made to tackle such inequalities and how far inequalities in health may have increased or decreased during Phase V. A broader range of resources was utilized for this evaluation than in previous phases of the project. These indicated that most cities were definitely looking at the broader determinants. Equality in health was better understood and had been included as a value in a range of city policies. This was facilitated by stronger involvement of the HC project in city planning processes. Although almost half the cities participating had prepared a City Health Profile, only few cities had the necessary local level data to monitor changes in inequalities in health.

Equity and the social determinants of health in European cities.

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. Results show that although cities continue to focus considerable support on vulnerable groups, rather than the full social gradient, most are now making the necessary shift towards more upstream policies to tackle determinants of health such as poverty, unemployment, education, housing, and the environment, without neglecting access to care. Although local level data reflecting inequalities in health is improving, there is still a long way to go in some cities. The Healthy Cities Project is becoming an integral part of structures for long-term planning and intersectoral action for health in cities, and Health Impact Assessment is gradually being developed. Participation in the WHO-EHCN appears to allow new members to leap-frog ahead established cities. 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.

Equity and social determinants of health at a city level.

Equity in health has been the underlying value of the WHO Health for All policy for 30 years, distinguished from equality and difference in a commissioned series of theoretical reports in the early 1990s. This article examines how cities translated this principle into action. Using information designed to help evaluate Phase III (1998-2002) of the WHO European Healthy Cities Network, plus documentation from city programmes and websites, an attempt is made to assess how far stakeholders in cities understood the concept of equity in health, had the political will to tackle the issue and the types of action undertaken. Results show that cities focused mainly on support for vulnerable groups, and a wide range of actions were being implemented, including lifestyle-oriented methods or those to improve access to care. Few cities made the necessary shift towards more upstream policies to tackle determinants of health such as poverty, unemployment and housing. There was little experience of evaluating the impact of interventions to reduce the gaps. This is partly explained by a frequent lack of local level data reflecting inequalities in health. The article concludes that although half the cities in the Network needed stronger action to make equity in health an integral part of long-term planning, innovative experience was available to be shared by its members in Phase IV (2003-2008) of the Network.

Gaining health: analysis of policy development in European countries for tackling noncommunicable diseases

There is no greater threat to the health of people in the WHO European Region than that of noncommunicable diseases,yet this is an area where the greatest health gains are available at relatively modest cost. This book gives a detailed insightinto the policy development in eight European countries over several decades to address the challenge of noncommunicable diseases, and draws out the main themes to assist policy-makers in formulating their own response. While originallydeveloped to support countries in the implementation of the WHO European Strategy for the Prevention and Control ofNoncommunicable Diseases, the insights are likely to be of benefit to a much wider audience.

Demystifying the myths of ageing

This pamphlet indicates how certain problems associated with old age can be largely attributed to myths surrounding the ageing process. It shows how many of these problems could be effectively tackled through changing lifestyles, providing appropriate care and adjusting the social, working and physical environments. It aims to broaden the debate on the changes necessary to ensure that people of all ages take advantage of a longer and healthier life.

Exploring health policy development in Europe

Countries in Europe have long recognized that good health care, though essential, is not in itself sufficient to improve health or to reduce the increasing gaps in health status between the rich and the poor. In 1984, together with WHO, they adopted what has become known as the health for all policy. By the late 1990s, over half the European Member States had developed national health policies in line with health for all. This called for a radical shift from health services planning to an approach based on setting objectives and targets for health, requiring partnerships with industry, agriculture and commerce, and settings such as workplaces and schools. It also required changes in action to ensure a fairer distribution of the determinants of health, such as income, education, employment opportunities, and adequate food and housing. This book provides a comprehensive review of health for all policy development in all 51 Member States. It draws together the main policy lessons from over 20 years of experience in Europe. It also identifies some of the future challenges for policy-makers throughout the Region, such as increasing inequities in health, social exclusion, demographic changes, rising expectations and the rapidly expanding developments in information and technology. It will be of use to those in health administrations interested in health policy development, to their colleagues in other sectors and departments whose work may have an effect on health, and to decision-makers at national, regional and local levels who must take action for health and development.