Health Promotion within WHO Healthy Cities in the Baltic Sea Region
Johanna Reiman is M.Sc. (Agriculture), M.Sc. (Economics), and has 28 years working experience in health and wellbeing. She has organized tons of international conferences and seminars, promoted multi-stakeholder programmes and projects and promoted ideas to innovations.
There are challenges in taking health as a core of the planning process in the cities. Lack of clear responsibilities in part of the municipalities, weak leadership for health, and missing procedures are only a few examples. This results in insufficient budget allocations. Economic challenges continuously overweigh health in decision–making, even if choosing correct actions could bring considerable savings. It is essential that the municipality or region knows the health situation in the respected area and has the resources and skills to analyse impacts of major policies from the health perspective. Political will and legal backing are also important in bringing cross- sectoral health promotion into practice.
Health promotion work needs innovations on the local level. Healthy Cities is a programme which encourages cities and municipalities for cross-sectoral work. Health and wellbeing should be put high on the agenda of the cities. Structures are needed to ensure the sustainability of the work. This means that all city functions must take health promotion into account. Education, transport, urban planning, culture and youth services should take residents’ health to their plans. It is advisable to build a cross-sectoral health and wellbeing board which follows the plans and activities. Healthy Cities is about involving all sectors.
Healthy Cities work in phases and the themes vary. Phase VI (2014-2018) themes are linked to European Health 2020 strategy. Thus, the topics are 1) improving health for all and reducing health inequities; and 2) improving leadership and participatory governance for health.
All in all, the health promotion work is connected to urban health. Urbanization is a trend all over the world. People move to cities as there are most of the jobs. Cities also have a wide variety of culture and possibilities for various types of housing. City life may – despite its benefits – bring aspects which are harmful to life. Loneliness, sedative lifestyle, pollution and lack of social belonging are serious problems which affect people’s lives. Cities should find innovative solutions to the challenges their people face over the life course.
European Health Challenges
Europe is facing big changes which affect the health of the population. Societies are ageing rapidly. Unemployment is a problem of young people and affects also persons in middle age and older. Migration changes the services needed. Urbanization means that planning becomes more challenging for cities. Ensuring the wellbeing of the population requires an open mind and readiness for cooperation. Municipalities have to start to combat the challenged together with companies and non-governmental organisations. World Health Organization is willing to help cities plan their work for the health of the residents. In Healthy Cities programme open local innovations are shared among the network members.
Western lifestyle is a threat to the society. The health data show that non-communicable diseases (NCDs) cause the biggest disease burden in all European countries. Illnesses such as diabetes, cancer, and cardiovascular diseases account for an ever larger share of fatal illnesses. This challenge is being faced by other parts of the world also.
In the Baltic Sea Region countries, non-communicable diseases cause about 80 % of deaths. These diseases are preventable and can be avoided by the modification of unhealthy lifestyles, e.g. healthy habits. Diets containing more vegetables, adequate physical activity and the avoidance of smoking should all be adopted. The national governments recognize this necessity in their health programmes and strategies. How they are implemented depends on the capacity of the municipalities, their politicians, public health administrators and methods of working. Healthy Cities programme states that unifying the efforts of different sectors and making health promotion not only effective otherwise but also cost-effective.
WHO Healthy Cities– How Did It Start?
For decades, United Nations organisations have traditionally worked with ministries and nations. Healthy Cities began as a World Health Organization project in 1987. It has over the years become a movement with very committed cities. The network has an annual business and technical conference and also runs several sub-networks. The WHO Healthy Cities programme has promoted cross-sectoral well-being effort as well as comprehensive and systematic policies and planning for health. The Healthy Cities movement is present in more than 30 European countries and over 1400 cities and regions.
Baltic Region Healthy Cities Association has served as a World Health Organization Collaboration Centre for Healthy Cities and Urban Health in the Baltic Region since 2002. The Association assists cities in implementing Healthy Cities’ goals and to build capacity for health and well-being. Furthermore, the Association is involved in health promotion projects, many of which concentrate on promoting cross-sectoral planning for health. The members of Baltic Region Healthy Cities Association include the City of Turku, University of Turku, Åbo Akademi University and the Social Insurance Institute of Finland. Baltic Region Healthy Cities Association – based in Turku, Finland – aims at increasing the awareness of local governments in adopting health as a central part of the decision-making process in municipalities.
Health inequities mean that differences in societies grow. In Europe, many people are doing well and live healthy and long lives. However, there are people whose health conditions are bad and they may be outside the society with no education. Despite several years of efforts to combat the inequities, the divide is only growing.
Coordinated Action Is Needed
Social and welfare costs remain to account for a very large share of both national and local budgets in all countries surrounding the Baltic Sea. Promotion of health and well-being requires coordinated action from all sectors of the society at national, regional and local level. It has been confirmed that investment in health promotion is cost-effective and that the best results are obtained if all sectors work together, taking into account the effects of policies on well-being. This means that, for example, education, economic and cultural sectors can strongly promote health. Also, traffic and environmental departments should enhance human well-being.
There are challenges in taking health as a core of the planning process in the cities. Lack of clear responsibilities in part of the municipalities, weak leadership for health, and missing procedures are only a few examples. This results in insufficient budget allocations. Economic challenges continuously overweigh health in decision–making, even if choosing correct actions could bring considerable savings. It is essential that the municipality or region knows the health situation in the respected area and has the resources and skills to analyse impacts of major policies from the health perspective. Political will and legal backing are also important in bringing cross- sectoral health promotion into practice.
Baltic Region Healthy Cities Association has accomplished numerous local health promotion projects. Recent themes in the projects include promoting volunteering of elderly people and thus making them participate in the society and find meaningful daily activities (www.letusbeactive.eu). Promoting children’s healthy habits is a theme of a project where the other partners are University of Turku, University of Tallinn Rakvere College and City of Jurmala in Latvia. One theme where the Association has been active is health literacy. It has been found that many Europeans lack understanding of health information. Health and welfare experts should pay special attention to understandable health information and ensure that guidance given is understood.
The World Health Organization definition of health says that “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The challenge remains around the Baltic Sea and the rest of Europe to ensure health for all.
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