Palgrave Macmillan Journals

The Evolution, Impact and Significance of the Health Cities/Healthy Communities Movement
Author(s): Trevor Hancock
Source: Journal of Public Health Policy, Vol. 14, No. 1 (Spring, 1993), pp. 5-18
Published by: Palgrave Macmillan Journals
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The Evolution, Impact and Significanceof the
Healthy Cities/HealthyCommunities
Movement
TREVOR HANCOCK

N January I986, a small group of health promoters

_ gathered at the WHO Regional Office for Europe in
Copenhagen to plan a WHO Europe healthy cities
project. The group was convened by Dr. Ilona Kick-
busch, at that time Regional Officer for Health Pro-
Kscsea motion; her interest in the concept of healthy cities
had been sparked by a one-day workshop-Healthy Toronto zooo
organized in conjunction with a I984 conference on healthy public
policy (i). She saw in the healthy city concept the potential to take
the concepts of health promotion then under development at WHO
Europe (z) off the shelf and onto the streets of the cities of Europe, to
take the global concepts and apply them locally and concretely. The
planning group anticipated that here was a project that might attract
the interest of some six to eight cities (3).
In June i992 the 7th Annual Healthy City Symposium was held in
Copenhagen, hosted jointly by WHO Europe, the City of Copen-
hagen and the Danish Ministry of Health, and was attended by 465
delegates from 9z cities in 30 countries. The symposium marked the
end of the first five-year phase of the WHO Europe Healthy Cities
Project, a project now encompassing 35 project cities in Europe, I8
national networks in Europe and elsewhere, some 400 cities and
towns in Europe, several hundred more cities, towns and villages in
North America and Australia, and a growing interest from cities and
towns in the developing nations. As a I990 WHO report (4) put it, if
this had been a private company it would have been one of the suc-
cess storiesof the I980s.
This article is a brief summary of the healthy city concept, the evo-
lution of the project, its impact and potential future significance.
Fuller accounts are available elsewhere (4,5,6).

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6 JOURNAL OF PUBLIC HEALTH POLICY * SPRING 1993

THE HEALTHY CITY CONCEPT

The conceptof a healthycity is hardlya new one. The igth century

publichealthmovementwas rootedin the citiesand towns and owes
much of its strengthto the Health of Towns Association,led by
EdwinChadwick,whichwas formedin Exeter,Englandin I 844 as a
resultof the work of the Healthof TownsCommissionestablishedby
the Britishgovernmentin I843 (7). In I875, Sir BenjaminWard
Richardson,a self-professeddiscipleof Chadwickand editor of the
Sanitarian,gavea speechto the SocialScienceAssociationmeetingin
Brighton,Englandto markthe passageof the "Great"PublicHealth
Act passedthat year.His topic was "Hygeia:A City of Health"(8),
and his descriptionof an ideallyhealthycity is one that is still rele-
vant today.In its time, it must have inspiredEbenezerHowardand
the gardencity movementof the i 89os.
Here in Canada,the FederalCommissionon Conservation,estab-
lishedin I909 and modelledon PresidentTheodoreRoosevelt'scom-
missionin the U.S.A.,includedamongits committeesa publichealth
advisory committee.This reflectedthe Commission'sconcern not
only with the conservationof naturalresourcesbut with the conser-
vation of what Dr. CharlesHodgetts,Ontario'sChief MedicalOffi-
cer of Health and the Commission'sadviseron publichealth,called
"vitalresources"-health and the prolongationof life (9). Concerned
with the healthof the population,and drawingon the lessonslearned
in Britain,the publichealthadvisorycommitteewas instrumentalin
bringingto CanadaThomasAdams,formerlysecretaryof the First
Garden City Company at Letchworthand a leading member of
the town planningmovementin Britain.Between 1914 and i9z0,
ThomasAdamsplayeda vital role in establishingtown planningand
preparingprovincial and municipal town planning legislation in
Canada,servingas the firstPresidentof the Town PlanningInstitute
of Canadain 1917 (io). And at a time when the "city beautiful"
movementwas at its peakfollowingthe Chicagoexposition,Charles
Hodgettswas movedto remarkthat "it is not so muchthe city beau-
tiful as the city healthythat we want for Canada"(i i).
As JessieParfitt,authorof a historyof healthin Oxfordfrom I 770
to I974, has wiselyremarked:
Manywould be surprisedto learnthat the greatestcontribution
to the healthof the nationoverthe past I 50 yearswas made,not

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HANCOCK * HEALTHY CITIES/HEALTHY COMMUNITIES 7
by doctorsor hospitals,but by local government.Ourlack of ap-
preciationof the role of our cities in establishingthe healthof the
nation is largely due to the fact that so little has been written
about it.. .. (iz2)
Thus the healthycity conceptis firmlyrooted in an understandingof
the historical importanceof local governmentsin establishingthe
conditions for health, and a firm belief that they can-and must-
again play a leadingrole in health promotion.
A second importantroot for the healthycity conceptis healthpro-
motion. The HealthyCity concepthas evolvedin parallelwith and as
an applicationof health promotion;indeed, the initial background
paper (I 3) was subtitled"PromotingHealth in the UrbanContext."
Thus, right from its inceptionthe project was seen as a vehicle for
health promotion. This is evident in the fact that the five annual
themesin the five-yearplan (I4) are basedon the five strategiesof the
Ottawa Charterfor Health Promotion(I 5). Moreover,the definition
of a healthycity proposedby Hancock and Duhl (I 3) reflectshealth
promotionconcepts:
A healthycity is one that is continuallycreatingand improving
those physicaland social environmentsand strengtheningthose
communityresourceswhich enable people to mutuallysupport
each other in performingall the functionsof life and achieving
their maximumpotential.
Two points are worth makingabout this definition.The firstis that,
as with the Ottawa Charterstrategies,there is an implicithierarchy
heremovingfrom publicpoliciesthat createenvironmentsfor health
throughthe strengtheningof the communityto personalaction. The
second is the emphasison process;it is a process definition.Thus a
healthycity is not necessarilyone that has high health status,though
that is important;rather,it is one that is consciousof health, striving
continuallyto be more healthyand to take health into account in all
decisions-in other words, healthypublicpolicy at the local level.
This emphasisupon the role of local governmentis centralto the
healthy city/communityconcept; it is what distinguishesit from
other,equallylaudablecommunity-levelhealthpromotionprograms.
There are many programsthat seek to establishcoalitions and part-
nershipsat the communitylevel, often around specifichealth issues

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8 JOURNAL OF PUBLIC HEALTH POLICY * SPRING 1993

such as hearthealth,tobacco, accidentpreventionand the like. But

the healthycity conceptspecificallyrequireslocal governmentcom-
mitmentandinvolvementandseeslocalgovernmentas playinga cen-
tral role, though not necessarilyrunningthe project.This political
commitmentis soughtand securedby requiringcities,towns and vil-
lages that wish to join nationalnetworksto evidencetheircommit-
mentthrougha resolutionof City Councilin supportof the project.
Moreover,the WHO projecthas twice broughttogetherthe Mayors
or senior politicians of the project cities (in Milan in I990 and
Copenhagenin I992) to securepoliticalcommitmentand issue sup-
portivedeclarations.
Moreover,the focus of the healthpromotionactivitiesis not con-
finedto one or even severalspecifichealthproblemsbut is intended
to build health into the decision-makingprocessesof local govern-
ments,communityorganizationsand businesses,to developa broad
range of strategiesto addressthe broad social, environmentaland
economicdeterminantsof health,and ultimatelyto changethe cor-
porateand communitycultureby incorporatinghealth.The implica-
tions of this for the role, structureand functionof local governments
are describedlater.
The rangeof topicsto be addressedin a healthycity projectis vast.
Tablei lists the componentsof a healthycity identifiedby Hancock
and Duhl (I3). As can be seen, the subjectincludessocial, political,
environmental,economicand culturalfactors, urbanplanning,hu-
man services,heritage,communityempowermentand participation.
In the interveningsix years,cities and towns have been attempting,
with differingdegreesof success,to addressthis broadagenda.
PROJECT DEVELOPMENT AND ACTIVITIES

The WIHOHealthyCitiesProjectbeganwith a HealthyCities Sym-

posiumin Lisbonin April I986 attendedby 56 participantsfromz I
cities and I 7 countries;thus within threemonthsof the initiationof
the project,it was clear that the initialexpectationsfor six to eight
city projectswere far too modest.Elevencities were selectedfor the
WHO projectin I986, but the popularityof the projectmeantthat a
furtherI4 citieswere selectedin I988, growingto 35 cities by I99I.
I988 also saw the first national network meeting in Helsinki, at-
tended by ten nationalnetworks,includingtwo-Canada and Aus-
tralia-from outsideEurope.The projectalso got a boost in I988 be-

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HANCOCK * HEALTHY CITIES/HEALTHY COMMUNITIES 9
TABLE I

ElevenParametersof a Healthy City

i. A clean, safe, high quality physical environment(includinghousing
quality).
z. An ecosystemwhich is stablenow and sustainablein the long term.
3. A strong,mutually-supportive and non-exploitativecommunity.
4. A high degreeof public participationin and control over the decisions
affectingone's life, healthand well-being.
5. The meetingof basic needs (food, water,shelter,income, safety,work)
for all the city'speople.
6. Accessto a wide varietyof experiencesand resourceswith the possibility
of multiplecontacts,interactionand communication.
7. diverse,vital and innovativecity economy.
A
8. Encouragementof connectednesswith the past, with the culturaland
biologicalheritageand with othergroupsand individuals.
9. city form that is compatiblewith and enhancesthe above parameters
A
and behaviours.
IO. An optimumlevel of appropriatepublichealthand sick careservicesac-
cessibleto all.
ii. High health status (both high positive health status and low disease
status).
SOURCE: Hancock & Duhl (I3)

cause a number of case studies on local-level healthy public policy

were presented at the second International Conference on Health
Promotion (Adelaide, South Australia) and subsequently published
(5). The project received a further boost when it was one of four sub-
themes at the i99i World Health Assembly Technical Discussions
(i 6). This provided an important opportunity to discuss the potential
of the concept with delegates from the developing nations of Latin
America, Asia and Africa, as did the third International Health Pro-
motion Conference in Sundsvall, Sweden the following month. As a
result, there is growing interest in the health cities project in these
areas, although the project is often referred to as healthy communi-
ties in these situations.
In terms of the WHO project cities, the range of activities is too
great to be easily summarized, and readers are referred to more de-
tailed reviews (4,6). The I990 mid-term review (4) noted that of the
z9 cities in the project, only one (Horsens in Denmark) was smaller

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IO JOURNAL OF PUBLIC HEALTH POLICY * SPRING 1993

thanIOO,000 in population,I3 hada populationbetweenIOO,OOO

and 500,000, seven had populations between 5oo,ooo and i,ooo,ooo
and eight had populationsin excess of 1,OOO,OOO people. Thus the
European project cities are very large cities. City size was an impor-
tant factor influencing the development of the project in a number of
ways; it proved more difficultto achieve citizen participationand
projectvisibilityin largecities,and althoughlargecities could apply
moreresources,they also had often foundit necessaryto concentrate
on one or moredistrictswithinthe city or one or moregroupsof con-
cern. Moreover,intersectoralaction for healthypublicpolicy is eas-
ier in smallercities with their smaller,more intimatebureaucracies.
Otherfactorsinfluencingthe developmentof the projectincludeeco-
nomicdifferences,"somecities,suchas those in the Nordiccountries
and the Netherlands,having strongerand more stable economic
bases,"while a numberof other cities (e.g., Liverpool,Bremen,Za-
greb and Liege) "havesufferedprolongedperiodsof economic de-
pressionand industrialdecline,which has affectedthe healthstatus
of theirpopulations"(4, p. 4 5). Anotherimportantfactorinfluencing
developmenthas been the social and political culture of the city:
"Citiesin SouthernEurope(suchas Barcelona,MilanandPadua)say
that they have less of a traditionof long termplanningin the public
sector and that this producesresistanceto planningfor health"(4,
p. 46). In additionto these social and politicaldifferences,thereare
differencesin jurisdictionand organization;while the healthycities
projectassumesthat citieshavea responsibilityfor health,this is not
the case in a numberof cities in the projectwhere nationalgovern-
ments may be responsiblefor health servicesand city governments
may not easily see their role in promotinghealth (in spite of their
membershipin the project!).
The mid-termreview(4) noted i i qualitiesor characteristicsthat
are presentto varyingdegreesin the projectsthat have achievedsig-
nificantsuccess so far. These are strong political support,effective
leadership,broadcommunitycontrol,high visibility,strategicorien-
tation, adequateand appropriateresources,sound projectadminis-
tration, effective committees, strong community participation, coop-
erationbetweensectors,and politicaland managerialaccountability.
The WHO projectcities have undertakena wide rangeof actions
in the pursuitof health. These include actions intendedto reduce

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HANCOCK * HEALTHY CITIES/HEALTHY COMMUNITIES II

healthinequalitiessuch as communityhealthdevelopmentprojectsin
low income communities,environmentalchangesto improvethe liv-
ing conditions of disadvantagedgroups, and the encouragementof
communityactivism.The environmenthas been a majorconcernfor
manycities, therebeingclose parallelsbetweenthe concernsof those
who wish to promote health and those who seek to promote envi-
ronmentalsustainability(17). This has includedmeasuresto reduce
trafficand other forms of air pollution, to "green"the city by estab-
lishing new parks and greenspaces,to addresswater pollution and
solid waste disposal,to encourage"clean"city projectsto removelit-
ter, to promote healthy workplaces, and to incorporateecological
and health concernsin urban planningand design. Cities have also
takenmeasuresto strengthencommunityaction, includingdecentral-
ization of decision making and servicesin several cities, the estab-
lishmentof mechanismsto ensure not just communityinvolvement
but communitymanagementof local health city projects,and a par-
ticulareffort to involve children-tomorrow'scitizens-in determin-
ing what sort of future they want for their city and then involving
them in activities intendedto achieve such a future. In those cities
where local governmentis responsiblefor health services,therehave
also been steps taken to reorienthealth servicestowards health pro-
motion, disease preventionand community-basedcare, particularly
for young childrenand for elderlypeople. Finally,"severalcitieshave
acted to place health on the wider urbanpolitical agenda,including
Montpellier,Rennes, Seville, Vienna, Zagreb, Belfast, Camdenand
Copenhagen"(4, p. 72). This has involved establishingmechanisms
for intersectoraldecision-makingand policy development,establish-
ing health-consciouspolicy principles, determiningurban renewal
policies throughneighbourhoodoffices, organizingcommunitycon-
ferencesand so on. In short, there is a great deal of active experi-
mentationunderway.
A recentWAHO publication(I8) reviewsthe experiencegained by
the projectcities in getting started,and providesa handbook of 20
stepsfor developinga healthycitiesproject,dividedinto threephases:
-getting started(buildinga supportgroup,understandingthe healthy
city concept, getting to know the city, finding finances, deciding
the organizationalstructure,preparinga proposal and getting ap-
proval);

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12 JOURNAL OF PUBLIC HEALTH POLICY * SPRING 1993

-getting organized(appointinga committee,doingan environmental

scan, definingprojectwork, settingup an office,planningstrategy,
buildingcapacityand establishingaccountability);
-taking action (increasingpublic awarenessof health, advocating
strategicplanningby the city, mobilizingintersectoralaction, en-
couraging community participation,promoting innovation for
health,and securinghealthypublicpolicy).
A full reviewof the experienceof the firstfive yearsof the WVO
EuropeHealthyCitiesProjectis currentlybeingpreparedand will be
availabletowardsthe end of i99z or in early I993. This reviewwill
look at progressin termsof input(whathas beendone),output(what
has been produced),and impact (what has been the effect) at the
local, subnational,nationaland internationallevels.However,as the
outline for the review cautions (I9), it is importantto realizethat
changetakestime:perhapstwo to fouryearsto changestructuresand
processes,threeto six yearsto develophealthypublicpolicies, four
to eight yearsto createhealthiersettings,and five to ten yearsto see
this reflectedin healthgains.Thisis becauseit takestimeto overcome
politicalconcern,bureaucratictradition,communityscepticism,pro-
fessionalresistanceand the scarcityof resources.It is thuspremature
to expect concreteresultsfrom the healthycities projectin Europe,
sincemanyof the cities involvedhave only been involvedfor two to
four yearsand are only just beginningto come to gripswith the real
issues.
One interestingrecentdevelopmentin the WHO projecthas been
the emergenceof "multi-city action projects" or MCAPs.Theselink
togethercities workingon commonthemessuch as tobacco, traffic,
socialequity,housing,AIDScare,andthe health-promoting hospital.
Theseprojectslink activitiesin interestedcitieswith the resourcesof
national and internationalagenciesand organizationswith specific
andrelevantareasof interestandexpertise.Theirstrengthis thatthey
allow specificinterestgroupswithincities to play a definedrole in a
healthycity projectand allow cities to developor sharetheirexper-
tise in a given area;their weaknessis that they narrowthe focus of
the project, losing its emphasis upon the broad determinantsof
healthand the broadsocial and politicalmeasuresneededto attain
health.Timewill tell whetherand to what extent such projectscon-
tributeto or weakenthe healthycity approach.
At the Copenhagenconference,the WIHOHealthy Cities Project

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HANCOCK * HEALTHY CITIES/HEALTHY COMMUNITIES 13
officer,Dr. Agis Tsouros,outlinedthe scope of the WHO projectfor
the five-yearperiod 1993-1997. A new WHO healthycities network
of 45 participatingcities will be established,comprisingboth new
membersand membersof the previousnetwork.Particularemphasis
will be placed upon the provisionof supportto cities in EasternEu-
rope who will comprisea significantproportionof the 4 5 participat-
ing cities. In addition,it is anticipatedthat a Europeanhealthycities
associationwill be established,as will supportcentres for technical
and professionaldevelopment.Cities wishing to be among the 45
designatedfor the projectwill need to meet more stringentrequire-
mentsincludingthe establishmentof an intersectoralpolicy commit-
tee at the city level, a full time office with staff and budget, and the
appointmentof a politicallyresponsiblepersonfor the project.They
will have to committhemselvesto developinga "healthfor all" pol-
icy and a city plan basedon the EuropeanHealth For All targets,in-
cludingthose relatingto equity,environmental,social and health is-
sues, and to acting upon WHO's strategicprioritiessuch as tobacco
and alcohol. They will be expectedto establishmechanismsto sup-
port accountabilityfor healththroughoutthe city administration,in-
cludingregularreportson agreedsets of healthand environmentalin-
dicatorsand periodiccity health reportsto city council.
National networks have developed in a number of countries,
chieflyin Europebut also in Canada,Australiaand the UnitedStates.
Recently,nationalnetworkshave begunto emergein Iran,SaudiAra-
bia, Egypt, Yemen,Tunisia and Morocco, while regional networks
are developingin FrancophoneAfrica,SoutheastAsia, and the West-
ern Pacific(zo). For a reviewof the nationalnetworks,readersare re-
ferredto the midtermreview (4) and to a national networksupdate
distributedat the Copenhagenconferenceand availablefrom WHO
Europe,Healthy City Office.
In Canada,a national projectwas establishedwith fundingfrom
Health and WelfareCanada in I988; the project was based at the
CanadianInstituteof Planners(a deliberatestrategyto move the proj-
ect beyond the health sector) and co-sponsoredby the Federationof
CanadianMunicipalitiesand the CanadianPublic Health Associa-
tion. The projectis known as HealthyCommunitiesin Canada.It be-
came healthy communitiesratherthan healthy cities for three main
reasons:the firstwas that the Federationof CanadianMunicipalities
felt that the term "cities" was too exclusionary,since many of its

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14 JOURNAL OF PUBLIC HEALTH POLICY * SPRING 1993

memberswere small municipalitiesand Canadadoes not have a lot

of placesthat considerthemselvescities. Secondly,therewas a con-
cern with the need to developprojectsin the largercitiesthat could
also occur in smallersections of the city ratherthan the city as a
whole. Thirdly,Canadianhealth promotioneffortshave includeda
strong focus on communitymobilization.These reasonsled to the
change of name, and this in turn has led to a somewhatdifferent
focus for the Canadianproject,involvingas it does manymoresmall
communitiesthan is the case in Europe.It remainsthe case, however,
that the commonfactor is that there be a level of local government
(evenvillagesof a few thousandpeoplehavelocal councils,afterall),
and that therebe at least a commitmentto workingto involvelocal
governmentin the project,even if they are not initiallyresponsive.
Thismeansthat communityorganizationscan be supportedfromthe
outset,while they are still workingto put the projecton the local po-
liticalagenda.
Although major federal funding was not renewed in I99I, the
Canadianprojectwas successfulin stimulatinga numberof provin-
cial projects,notablyin Quebec,BritishColumbia,and most recently
Ontario,as a directresultof whichover zoo cities,town and villages
are involvedin the Canadianhealthycommunitiesnetwork,which
continuesto flourish.The Quebecproject(Villeset Villagesen Sante)
has had an effectivecentralofficewhichhas providedadvice,consul-
tation,traininganddevelopmentsupportto interestedmunicipalities.
It has also placedconsiderableemphasisupon monitoringand evalu-
ation of the project,and a numberof publications(mostlyin French)
are available(zi). The BritishColumbiaprojecthas takena different
tack, with provinciallyfundedgrantsavailableto interestedmunici-
palities on a competitivebasis to help them initiate and develop a
healthycommunitiesproject.They too have a numberof excellent
available(z2,z3,24).
publications
In the UnitedStates,the firststate-widehealthycities projectwas
establishedin Indianaby the Universityof IndianaSchoolof Nursing
with fundingfrom the KelloggFoundation,while the state of Cali-
fornia has supporteda state-wideproject and other projects are
emergingin Texasand New Mexico. The U.S. Officeof HealthPro-
motion and DiseasePreventionhas providedsupportfor a national
healthycities networkbased at the National Civic League(see Ap-
pendix for contactaddresses).The conceptis only just beginningto

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HANCOCK * HEALTHY CITIES/HEALTHY COMMUNITIES I5

develop in the United States,and this will doubtlessbe helped by an

internationalconferenceon healthycities to be held in San Francisco
in December1993.
REFLECTIONS ON THE HEALTHY CITIES PROJECT

The healthycities projectis just gettingunderwayand it is premature

to arriveat any final conclusionsas to its effectiveness.On the posi-
tive side, it has put health on the social and political agendaof hun-
dreds of cities, towns and villages all over the world-no small
achievementin itself. It has also sparkedexperimentation,enthusi-
asm, political commitment,communityinvolvement,and, perhaps,
some real and positive improvementsin health. But as a projectit is
merely at its beginning.We should not lose sight of the fact that it
took decadesfor the health of towns/publichealth movementof the
i9th century to achieve its gains, and we should not expect to do
much better.
On the negativeside, healthycities-like health promotionitself-
is subjectto the criticismthat it does not have a firmtheoreticalfoun-
dation, that it has not paid adequateattention to the lessons to be
found in social and political theory and the experience of social
movements,that it is itself not a social movement becauseit is too
much within the governmentand the bureaucracy,and that it does
not have a clear and well defined researchagenda (25). All these
thingsare true;they arevalidcriticismsthat will have to be addressed
as the project evolves. There is in particulara need to agree upon
some importantmeansof assessinghealthimpact,at least at the city
level, and of developing community-based,participatoryresearch
that both supports and explicates change. As to whether healthy
cities-and for that matter health promotion-can truly become a
health movement,only time will tell.
Lookingbeyondthose immediateneeds, one can at least speculate
about the intriguingimplicationsthat this and similar approaches
have for the ways in which city governmentswill operatein the 2ist
century.For the most part we have city governmentswith depart-
ments whose roots are in the igth century (public health, public
works, housing, urbanplanning,parks,etc.) tryingto come to grips
with a set of zist centuryissues such as health,sustainability,equity,
safetyand so on. These zist centuryconcernscut acrossthe igth cen-
tury departments;addressingthem will need a new style of manage-

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i6 JOURNAL OF PUBLIC HEALTH POLICY * SPRING 1993

ment in which power is wielded by influenceratherthan authority

and is sharedwith peopleratherthan held overthem;involvesnego-
tiationratherthan direction,requirescollegialratherthan hierarchi-
cal relations,enhancescollaborationratherthan competition,and
takesa holisticratherthansectoralapproach(4). Willthis meana re-
structuringof local government?Ultimately,doesn'tthe healthycity
projectcall for a new way of organizingand managingour cities,just
as the health of towns movementcontributedto changein the way
the cities were managedand governedin the igth century?It could
be an interestingdecade!

CONTACTS

WHO HealthyCitiesOffice
WHO Europe
8, Scherfigsvej
Copenhagen,DK zioo
Denmark
CanadianHealthyCommunitiesNetwork
c/o CanadianInstituteof Planners
iz6 YorkStreet
Ottawa,Ontario KIN 5T5
Villeset Villagesen Sante'
1050 cheminSte-Foy
Quebec,Quebec GIS 4L8
B.C. HealthyCommunitiesNetwork
300-30 East6th Avenue
Vancouver,B.C. V5T 4P4

HealthyCitiesIndiana
IndianaUniversitySchoolof Nursing
I Ii i MiddleDrive,NU 23 6
Indianapolis, IN 46zoz
CaliforniaHealthyCitiesProject
HealthPromotionSection
P.O. Box 94z73z
Sacramento, CA 94z34-73zo

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HANCOCK * HEALTHY CITIES/HEALTHY COMMUNITIES 17

Healthy Cities Project

National Civic League
1445 MarketSt.
Denver,Colorado 80202-1728
InternationalHealthy Cities Conference
2 1 5 I BerkeleyWay,Annex i i
3rd Floor
Berkeley,CA 94704

REFERENCES

I. "BeyondHealthCare:Proceedingsof a WorkingConferenceon Healthy

Public Policy," Can. J. Public Health, 76 (I985): i-io8.
z. WHO Europe.A DiscussionDocumenton the Conceptsand Principles
of Health Promotion.Copenhagen:WHO Europe,I984.
3. Ashton, John, Grey,P., and Barnard,K. Healthy Cities:WHO's New
PublicHealth Initiative.HealthPromotion,i (I986): 3I9-24.
4. WHO Europe.The WHO Healthy CitiesProject:A ProjectBecomesa
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ABSTRACT

The HealthyCitiesmovement,or HealthyCommunitiesas it is known in

some partsof the world, has grownrapidlysince it was launchedin I986.
In additionto the 35 citiesformallyassociatedwith the WHO Europeproj-
ect, thereare now I8 nationalnetworksand hundredsof towns and cities
activelyinvolvedin Europe,North America,and, increasingly,the develop-
ing world.
This articlereviewsthe concept,its evolutionand currentpractice,con-
siderssome of the problemsin applyingthe concept,and speculateson its
potentialfuturedevelopment.

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All use subject to JSTOR Terms and Conditions