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Networking for action on sustainability and health

Agis D. Tsouros, M.D., Ph.D.

Healthy Cities Project Coordinator

World Health Organization

Regional Office for Europe

Keeping up with the recent international conventions and plans in the environmental, social and health field can be an overwhelming and sometimes confusing experience for those who work at the local level. On the eve of the 21st century an abruptly awakened international community is rushing to lay the foundations for a world with new aspirations. These represent the legitimizing umbrellas for action in areas that have been neglected for too long and areas that have crucial significance for human development, wellbeing and the survival of the planet. The implications for change are breathtaking, including above all changing and reviewing the values and the principles (explicit and implicit) on which we build our institutions and against which we measure our achievements and progress.

No matter how distant (and far away) all these developments may seem from a community or town perspective (which is often the case) it is important to remember that they are grounded in a response to the accumulation of a set of concerns, pressures and expectations which have a high relevance to the urban context. They are city agendas as much as they are the national governments' agendas and the agendas of the international community.

During the social summit week in Copenhagen in March this year, moods and assessments constantly changed from disappointment and disillusionment to approval and optimism. The natural impatience and expectations for firm (legally binding) commitments to social development by developed and developing countries at times overshadowed the political significance of the summit and its implications for the future. Again the point that was repeatedly made is that these issues should be everybody's business. As the chairman of the summit said: ask what you can do, not what they can do for you. The issues addressed at the summit draw a lot on the experiences of urban communities and have enormous implications for local governments, as was the case at the Rio Summit on Environment and Development in 1992.

Values do not change from one day to the other, nor do decision-makers turn their institutions and policies upside down every time an international declaration calls for change. It took many governments more than 15 years to recognize officially the link between poverty and health and begin to develop policies to reduce health and environmental inequalities. Many countries, regions and cities could today boast examples of innovative programmes and initiatives that are based on or reflect the principles of the strategies for health for all, Agenda 21 and social development. Often these are isolated islands of good practice that have limited impact on the pursuit of large scale integrative actions.

The emphasis on integrative strategies and long term social, economic and environmental sustainability provide the link between the Healthy Cities project and the OECD's project on the Ecological City. The concept of the Healthy City, like that of the Ecological City, does not describe a city that has reached a particular environmental state or condition, but rather a city that is committed to putting the environment (and health) high on its political agenda and creating a structure and process to achieve it.

Health is not a party political issue. Sustaining our environment is not a party political issue either. The challenge for cities is not one of scientific or technical know-how but it is one of the social and political application of answers already known to us. City administrations are faced with major decisions in a highly complex and changing internal and external environment: ecological, public health and social demands, decentralization trends, economic development challenges and opportunities, metropolisation, consumerist and community pressures, technological developments, new democratic processes and reforms (in several countries), as well as the challenge to being open and living up to new ideals.

In the context of these challenges to our environmental, social and economic sustainability and the search for new integrative and cross-sectoral strategies, three points have great importance in the Healthy Cities work. The first point is that cities that wish to be in the forefront of development today and to have the ability to adapt continuously must possess the space, the time, the skills and expertise and the energy to explore and take advantage of new opportunities and ideas. In other words they need to pre-invest in enabling and empowering structures and processes that will help create the capacity for and a climate conducive to innovation, experimentation and alliance building. All modern social movements call for intersectoral action, community participation and empowerment. Governments should also adopt an enabling framework of policies and strategies targeted at supporting community initiatives and actions.

Researchers today are now paying much more attention to the process by which new ideas are adopted and successfully implemented in organizations. As Colin Hastings (6) said:

"There is a fund of ideas and actions available if only we're prepared to find the means to unlock them. The resourcefulness of people in their ideas and actions is directly related to the environment in which they operate. Creating the right climate is the biggest step needed to achieve innovation. Harvesting, analyzing and disseminating information about innovative actions from different countries and settings is an essential tool for catalyzing change".

The Healthy Cities network is a group of cities and towns around the world that have been investing in innovation for some years now. They represent a body of knowledge and experience that is of real value not just for themselves but for cities around the world.

This leads to the second point. The need to invest in creating cooperative networks that cut across traditional territorial boundaries. Networks are organizational forms that provide for collective learning processes and can thus reduce uncertainty in the implementation of innovation. By sharing the experience of innovators, networks can help cities avoid repeating mistakes or having to reinvent the wheel. Thus networks can increase the efficiency of cities and can also provide the basis for competence building, creating complementarity, socializing risks and influencing (and controlling) the evolution/innovation process. Collaboration permits networks to mobilize, coordinate and reconfigure the developmental processes, thus creating permanent innovation capabilities. There is a growing body of research in the field of innovation networks and notably the work of Roberto Camagni and the GREMI group. (5, 7)

Networks can mobilize the unique innovative capabilities of different partners within cities, while simultaneously connecting these diverse contributions into an interdependent global network of cities. Times of rapid social, economic and technological change highlight the need to use innovation networks as strategic instruments. These networks represent strategic alliances (within a closed set of selected and explicit linkages with preferential partners) which in essence allow control and influence over the development process.

The WHO project cities networks bring together partner cities that are committed to a comprehensive approach to the Healthy Cities idea. The network is guided and given purpose and direction by a strong set of organizational principles. It is characterized by diversity, cooperative strategies and a strong branding of the product. The project structures and processes help change the way cities understand and deal with health and the environment and produce both the strategic glue for inter-sectoral health plans as well as alliances for environmental and health development. A very wide range of mechanisms for communication and sharing of information have been put into place that serve to exchange learning, provide support and to hold the overall project together while simultaneously enabling a wide range of diverse activities (2, 3, 4, 1).

The project gives cities methodologies and structures that can be transferred from the health field into other fields where the 'integrated' approach is called for. In other words Healthy Cities project processes are now placed ideally in cities to play a key role in the development of strategies for sustainability, social integration and social development. Such processes can give cities a valuable competitive advantage, for example when bidding for European Commission programmes in the fields of the environment and telematics.

Undoubtedly the major strength of the WHO network is the political legitimacy it has provided to a wide range of innovative policy changes and practices. Large and smaller cities today through the internationalization process become the gateways of international relationships. The internationalization of linkages makes it also necessary to overcome the antagonism between local and national institutions and to elaborate integrated programmes with the collaboration of the public and private sectors. The WHO Healthy Cities project has established collaboration with the EU sustainable cities campaign and all project cities have endorsed the plan to develop Agenda 21 plans.

The final point follows from this second point. The Healthy Cities network - and other networks such as sustainable cities - represent a global resource. Already there are many examples of East-West and North-South exchanges in the WHO Europe network. The East-West linkages have received most attention, but there is also the example of Glasgow's work with Chittagong in Bangladesh, the work of the Francophone group (joined by the Quebec network) in West Africa, the links between the Spanish network and the Latin American cities and Toronto's work with Sao Paulo in Brazil.

The power of the Healthy Cities approach and its global importance is now being recognized by WHO at a global level. More than 900 cities and towns world wide are involved in the Healthy Cities Healthy Communities movement. Not only is there the symbolic importance of designating Healthy Cities as the theme for World Health Day in 1996 - the tenth anniversary of the establishment of the European project - but WHO Headquarters is now embarking on making Healthy Cities a major interregional programme. This means that there will soon be formal Healthy City networks in all of WHO's regions.

But while networks within regions are very important, there is also a need to expand linkages and exchange of experience and information between North and South and recognize that this is very much a two-way exchange - as noted in a recent pamphlet from the Local Government Management Board in the United Kingdom, discussing "North-South linking for sustainable development":

"North-South links provide a vehicle, both for extending mutual understanding of global problems and for joint action on sustainable development initiatives. Direct contact with other cultures and communities can vividly highlight issues of over-consumption, excessive use of resources and other problems in our own communities".

If the health, wellbeing, quality of life and human development of people in cities throughout the world is to be improved, not only must the cities of the North assist the cities of the South, they must learn from them how to reduce their adverse global impacts on health and sustainability. And within this global approach it is clear that the problems of distressed urban areas should get priority - both within the cities of the North and the cities of the South. Indeed, recent developments in the USA serve to underscore this perspective and the relevance of South-North exchange. In the inner cities, the experience gained in the Third World by the US Agency for International Development is now being applied to address the health, social, environmental and economic needs of inner city residents.

As we approach the dawn of the urban millennium, when for the first time the majority of the human species will live in towns and cities, we have a desperate global need for the innovation and the networking that is characteristic of the Healthy Cities network. It is clear that environmental, social and economic development go hand in hand; that there can be no health without socially and environmentally sustainable economic development and that human development is intimately linked to improved human health and wellbeing. Strategies that integrate health in development must be at the core of action to promote social cohesion and sustainable development. And while global thinking and global summits are valuable for the ethical framework they establish and while national governments are valuable for the statutory framework they establish, it is at the local level - in the cities, towns and villages - that the fate of the world will be decided.



1. TSOUROS, A., ED. WHO Healthy Cities Project: a project becomes a movement. Copenhagen/Milan, FADL/Sogess, 1990.

2. The WHO Healthy Cities Five Year Review. Copenhagen, WHO Regional Office for Europe, 1992.

3. Twenty steps for developing a Healthy Cities Project. Copenhagen, WHO Regional Office for Europe, 1992.

4. National Healthy Cities networks in Europe. Copenhagen, WHO Regional Office for Europe, 1994 (second edition).

5. CAMAGNI, R., ED. Innovation networks: spatial perspectives. London, Belhaven Press, 1991.

6. HASTINGS, C. The new organisation - growing the culture of organisational networking. London, The IBM McGraw-Hill Series, 1993.

7. CAMAGNI, R. From innovative circles to global networks. In: La Ville, Centre National de la Recherch‚ Scientifique, No. 81, Summer 1994, pp. 36-37.