Healthy Settings

Types of Healthy Settings

Healthy Cities

A healthy city is one that is continually creating and improving those physical and social environments and expanding those community resources which enable people to mutually support each other in performing all the functions of life and developing to their maximum potential.

City by night
The World Bank/Curt Carnemark

Healthy Cities are arguably the best-known and largest of the settings approaches. The programme is a long-term international development initiative that aims to place health high on the agendas of decision makers and to promote comprehensive local strategies for health protection and sustainable development. Basic features include community participation and empowerment, intersectoral partnerships, and participant equity.

A Healthy City aims to:

  • to create a health-supportive environment,
  • to achieve a good quality of life,
  • to provide basic sanitation & hygiene needs,
  • to supply access to health care.

Being a Healthy City depends not on current health infrastructure, rather upon, a commitment to improve a city's environs and a willingness to forge the necessary connections in political, economic, and social arenas.

Examples of implementation

Starting in 1986, the first Healthy Cities programmes were launched in developed countries (i.e. Canada, USA, Australia, many European nations). Around 1994, developing countries used the resources and implementation strategies of initial successes to begin their own programmes. Implementation strategies are quite individual by city, though they follow the basic idea of involving many community members, various stakeholders, and commitments of municipal officials to achieve widespread mobilization and efficiency. Today, thousands of cities worldwide are part of the Healthy Cities network and exist in all WHO regions in more than 1,000 cities worldwide.


Evaluations of Healthy Cities programmes have proven them successful in increasing understanding of health and environment linkages and in the creation of intersectoral partnerships to ensure a sustainable, widespread programme. The most successful Healthy Cities programmes maintain momentum from:

  • the commitment of local community members;
  • a clear vision;
  • the ownership of policies;
  • a wide array of stakeholders;
  • a process for institutionalizing the programme.

Lack of programme permanence and other outcomes-related issues have developed with little commitment from public officials or stability of local coordinators. Additionally, many studies have identified that cities, particularly in developing countries, lack the resources to develop good guidance to lead the project, via the development of health profiles and sufficient evaluation time prior to starting. While several regional and national networks exist to facilitate strategy sharing, little information has been published on country profiles and actual implementation plans outside of the WHO European Region.

Selected publications
  • Boonekamp GMM, Colomer C, Tomás A, Nuñez A (1999) Healthy Cities Evaluation: the co-ordinators perspective. Health Promotion International. 14(2): 103-110.
  • Harpham et al. (2001). Healthy city projects in developing countries: The first evaluation. Health Promotion International. 16(2): 111-125.
  • Khosh-Chashm, K. (1995) Healthy Cities and Healthy Villages. Eastern Mediterranean Health Journal. 1(2): 103-111.
  • Kenzer M. (2000) Healthy Cities: A guide to the literature. Public Health Reports. 115: 279–289.
  • Tsouros, A. (1995) The WHO Healthy Cities Project: state of the art and future plans. Health Promotion International. 10(2): 133-141.