Sri Lanka’s northern City of Jaffna has faced the brunt of a 30-year internal conflict which saw the decline of most of its facilities. The conflict which affected the development of this historic city ended in 2009, with the ensuing decade seeing rapid urbanization.
As the revival of Jaffna with an estimated population of nearly 625,000 began, this urbanization was causing a massive strain making the city to burst at the seams with congestion and unclean environments.
The all-encompassing strain was being experienced in the water supply system, sanitation, food safety, housing and working conditions and the fast and complicated lifestyle of Jaffna’s citizens.
These are the outcomes of many interwoven and complex factors and smoothening them out are beyond the responsibility and capacity of the health sector alone. It needs efforts from various sectors, working in tandem to build on the resources and strengths to promote the health of the people in this resilient city.
It was in this backdrop that the World Health Organization (WHO) Sri Lanka Office advocated our ‘settings approach’ to the authorities in charge of Jaffna and also individuals and groups interested in injecting new life to this city.
The novel ‘settings approach’ links the environment and health promotion and protection programmes with the everyday lives of people.
‘Settings’ are places that have defined physical parameters; social contexts; and represent common patterns of behaviour among the people within that specific setting.
The WHO actively promotes the ‘settings approach’ and its ‘healthy settings initiatives’ have been implemented in hundreds of locations including cities, schools, hospitals and workplaces across the world. The impetus for this health promotion strategy by the WHO may be traced back to the Ottawa Charter for Health Promotion, the outcome of the first International Conference on Health Promotion held in Canada in 1986.
So, what is a ‘Healthy City’?
A Healthy City continually creates and improves its physical and social environments and expands its community resources to enable people to support each other in performing all life functions while developing themselves to their maximum potential.
The WHO recommends ‘domains of action’ with the active participation of city governance. The focus is on improving the health and well-being of the citizens by promoting a health-in-all policies approach, creating physical environments more conducive for health, empowering communities to create environments that support their own health and making the city better prepared to respond to public health emergencies.
In 2019, this is what the then Mayor of Jaffna, Mr. E. Arnold heading a multi-stakeholder group, embraced with WHO’s technical guidance. This was followed through by current Mayor Mr. V. Manivannan.
The wide-ranging ‘Jaffna Healthy City Programme’ promotes the health of its citizens by using the settings approach to modify health determinants. Activities to create an environment conducive to health are ongoing in three sub-settings of the city – schools, workplaces and public spaces.
Schools
For schools, the basic domains of action recommended by WHO include promoting formal and informal policies focusing on health and wellbeing; reducing inequities among students and teachers; creating physical and social environments supportive to health and healthy choices; and empowering students and teachers to promote their own health and well-being.
The prioritized areas of work in 10 schools with 8,074 students and 466 teachers are the promotion of WASH (water, sanitation and hygiene) facilities with a focus on maintaining menstrual hygiene to promote school attendance and well-being of schoolgirls; a sustainable sold waste management project with a ‘zero plastic’ policy; and a programme to overcome barriers to create opportunities for schoolchildren to engage in physical activities. The healthy city initiative is also instrumental in supporting these schools to plan and conduct government directed COVID-19 preventive measures.
Workplaces
For government offices, the domains of action are improving governance to promote health and well-being of workers; promoting health in all policies, reducing health inequalities; creating physical and built environments to be supportive to health choices of workers; and empowering the Public Service to promote their own health.
Public spaces
The domains of action prioritized for public spaces are the implementation of a sustainable solid waste management programme; capacity building of city dwellers on ‘new normal’ ways of day-to-day operations to effectively respond to the COVID-19 epidemic and any public health emergencies; and promoting physical activity at all ages.