Presentation delivered by Agis D. Tsouros, Director, Division of Policy and Governance for Health and Well-being, on 15 September 2015, at the 65th session of the WHO Regional Committee for Europe (Vilnius, Lithuania, 14–17 September 2015)

1. European Healthy Cities
Nearly 30 years of intersectoral innovation
Agis D. Tsouros
Director, Division of Policy and Governance for Health and Well-being

2. Background
• Launched in 1988 as a policy project with ambitious aim to put health high on the social and
political agenda of cities
• Based on recognition that local action, urban setting and the key role of local governments in
health development
• Approach consisted of 4 elements: political commitment, supportive mechanisms for
intersectoral collaboration, strategic city health development planning, and formal and informal
networking across sectors and society
• Evolved over 5-year phases – always anticipating and integrating cutting edge-public health
concepts and developments
• Provided the legitimacy to experiment with new ideas but always with a view to converting
temporary project arrangements to sustainable permanent ones

3. Emphasis on the how and on
preconditions for success
• Political commitment was based on strong Mayor and City Council support (executive and cross-
party) and partnership statements by key stakeholders – this ensured broad support and
continuity.
• Management of change included project office (dedicated capacity with staff and resources)
working directly with the mayor’s office (supervised by mayor or other assigned senior politician)
and intersectoral committee at senior level.
• Strategic thinking and city health development plan drawing on the contribution of different
sectors.
• Regular fora and platforms engaging a wide spectrum of civil society and public stakeholders to
promote dialogue and involvement on issues relating to health and development.

4. Intersectoral work happened at
three levels: action, policy and
governance
Healthy Cities
have
experimented
successfully
with
intersectoral
work
Health as a whole-of-local government responsibility
Health and Equity in all local policies

5. Good intersectorality across the health spectrum
• Addressing inequalities with upstream (social
determinants) action
• Health and sustainable development – quality
of the physical and built environment
• Health impact assessment
• Healthy urban planning and design
• Caring and Supportive Environments
• Vulnerable and disadvantaged groups
• Age-friendly Cities
• Community action and healthy choices
• Noncommunicable disease risk factors
• Smoke-free cities
• Cities fighting obesity
• Active Cities – Physical activity
• Health literacy
• Community resilience in the face of austerity
• City health diplomacy

6. Determinants of city intersectorality
• Local (city) and global (WHO) commitment and leadership
• Unity in diversity (one vision for many cities in many Member States)
• Rigour in flexibility (thematic and strategic priorities and entry points but not in
strict “cookbook” compliance, not one fit for all)
• Firm connection to newest evidence base (for example, on governance; social
determinants; literacy – solid facts, etc.)
• It takes time but sustained effort pays off
• Formal and informal networking at every level
• Respect, participation, engagement

7. Healthy Cities are intersectorally effective
• The number of intersectoral partnerships has increased in every Phase since
measurement started.
• Intersectoral partnerships now extend beyond project action to sustainable
policies and governance.
• Good intersectoral governance boosts systems-based upstream health action.
• Because of good experiences, WHO guidance and city-to-city networking, there is
a strong belief that health equity is attainable.
• This is the time to strengthen urban health across Europe.

8. Progress on all
aspects of
Healthy
Cities work
are regularly
monitored
and evaluated
Intersectoral policy engagement

9. Healthy Cities is now a strategic vehicle for
implementing Health 2020 at the local level
The public health challenges of the 21st century to be addressed effectively
require the full engagement of local governments
Whole-of-government, whole-of-society and health in all policies approaches
require the involvement of all levels of government