|Healthy Cities (WHO)|
|Part 2: Action in cities examples of integrated approaches to action|
The Copenhagen Healthy City Plan 1994-1997 which was endorsed by the Copenhagen City Council in June 1994, presents a wider commitment to prevention of diseases and health promotion in Copenhagen.
Setting out with WHO's ambitious "Health for All by the year 2000" strategy, the plan consitutes the framework for a number of preventive and health promoting initiatives in the city during the period 1994-1997 with perspectives towards the year 2000. The plan consists of targets as well as specific activites for health promotion in various areas and includes initiatives from all sectors in the city.
The Copenhagen Healthy City Plan 1994-1997 was endorsed unanimously by the Copenhagen City Council in June 1994. Thus a much wider commitment to prevention of diseases and health promotion in Copenhagen is planned.
Taking the WHO's ambitious "Health for All by the year 2000" strategy as a starting point, the plan constitutes the framework for a number of preventive and health promoting initiatives in the city during the period 1994-1997 with perspectives towards the year 2000. The plan consists of targets as well as specific activities for health promotion in various areas.
The Copenhagen Healthy City Plan has been translated into English, and a popular version, Healthy City Plan - in a nutshell, has also been published. Moreover, by request of WHO, a shortened version of the plan has been translated into Russian.
Why a Healthy City Plan?
A plan must always be made to meet specific purposes according to local conditions and traditions. Therefore, different models of planning will be relevant in different cities.
The specific purposes of the Copenhagen Healthy City Plan, which seem also to be relevant to other cities, were that the plan should be instrumental in giving Copenhagen:
· common guidelines and priorities for political approval
· a clear foundation for intersectoral cooperation
· a possibility to switch from short term to longer range planning.
As a consequence, a municipal steering group with representatives from all sectors prepared a proposal for a Healthy City Plan for political decision. The Healthy City Project, based within Copenhagen Health Services, chaired the steering group and also had the secretarial function.
The level of ambition: improving health
The plan's general ambition is that it should make a difference. It should be beneficial to the health of Copenhageners. However, not everything should be included in the plan which could be relevant to the subject. For instance, work in Copenhagen on AIDS was already well on the way, so a plan could not do much to improve this. The same goes for the ambition of reducing unemployment, where the City of Copenhagen is working hard to combat unemployment, especially among the youngsters.
To have a level of ambition to make a difference within a planning period of 4 years meant that we should take up the themes where initiatives could also be beneficial to the health of citizens in the short run.
It was also an ambition to show the scope of health promotion for the city. Therefore, it was found necessary to show a broad range of initiatives in the field.
It was crucial to the relevance of the plan to make an accurate description of the health problems of the city. Therefore, much effort was put into this, including official data on health problems that put limitations on everyday activities and data on health problems which create illness, handicaps and death. To meet this end, a health profile was also made for each of the 14 districts of the city, based on a questionnaire distributed to 25 000 citizens.
The description of the health problems of Copenhagen compared to other cities in Denmark emphasizes the city's alcohol problems and other problems of substance abuse, the relatively weak social networks and the many deaths caused by among other things cancer.
In deciding upon the contents of the plan, five criteria were set up.
The most important criterion is the concern for important health problems in Copenhagen as mentioned above.
The second criterion was that it should be possible to do something about the health problem in question. Usually this means that the health problem should have known causes and that the cause and causality should be well documented. It is equally important to learn whether the preventive work has an effect. Therefore, systematic monitoring of national as well as international experience will be of great importance.
A third criterion is the priority given to activities consistent with health promotion work in progress. This will give greater coherence to the combined efforts and increase their impact.
A fourth and very important criterion is the attitude and interest among the citizens concerning health promotion. A positive attitude in the population is often a prior condition for health promotion. To meet this criterion, and also the principle of community participation, which is inherent in health promotion in Copenhagen, meetings were arranged in all 14 districts of Copenhagen and people were asked to come up with proposals for the Healthy City Plan.
The citizens' proposals were given as an input to the steering group before the steering group made up their minds on priorities and the citizens' proposals have made a significant impact on the Healthy City Plan.
Finally it is a criterion that the expenses of health promotion should have a reasonable relation to the size of the health problem and the expected effect of the health promoting work.
The frame of the Healthy City Plan of Copenhagen
On the basis of criteria of priority it was decided to give high priority to the following themes in the plan:
A number of lifestyle issues
The main emphasis is on the prevention of health damage resulting from alcohol and tobacco smoking. In addition to this there are a number of initiatives on nutrition, exercise, accidents and unwanted pregnancy.
This is a question of preventing loneliness and improving the basis for contact among the citizens of Copenhagen.
Road traffic and the external environment of the city
This is a question of limiting air-pollution and noise, reducing the number of road accidents, creating a greener city and experimenting in urban ecology etc.
These themes highlight the technical challenge in health promotion. Equally important is the emphasis on how to put these health promotion themes into practical action by organizational means. In general this is at least as big a challenge for health promotion to work with organizational issues as with the technical side.
Therefore, the plan focuses on four key settings for health promotion to concentrate the city's efforts. These key settings are the local community, schools, workplaces and the health services.
It is an integral part of the plan that all initiatives should be evaluated.
The creation of networks is a central theme in the plan, but it is also a central concept for the development of supportive environments for other health issues. This makes social networks a cardinal point of the plan and the special developmental aspect of the plan.
See Fig. 1 for the frame of the plan.
The benefits from making a Healthy City Plan
The benefits from the Healthy City Plan have so far been very encouraging.
Health promotion by means of the plan has now got the approval of the city and is now a real part of city politics. The importance and value of this cannot be overestimated.
Secondly, the interest of the different sectors of the city has much improved. The interest goes beyond mere cooperation and also includes financial aspects and personal resources from the various sectors. This means that the phrase 'intersectoral cooperation in health promotion' is beginning to have a real meaning. Moreover, the back-up from the health services, where the Healthy City Project is based, is steadily increasing.
Fig. 1 Frame of Copenhagen Healthy City Plan
Furthermore, making a plan for the Healthy City Project means that we have a strategy for health promotion in Copenhagen. Being a four-year strategy, it also gives a far better chance to do a good professional job than previously.
Finally, it should be mentioned that the resources allocated to the project have been significantly improved, which gives a much better basis to put political priorities into action.
40 DK-2200 Copenhagen N