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The Healthy Cities Perspective in the Manifestos for the September 2013 Local Elections

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The Healthy Cities Perspective in the Manifestos for the September 2013 Local Elections Public ScienceS & PolicieS | ciênciaS e PolíticaS PúblicaS | Vol. V, n.º 2, 2019, 13-31 The healthy cities perspective in the manifestos for the September 2013 local elections A perspetiva das cidades saudáveis nos programas eleitorais das eleições autárquicas de setembro de 2013 (PT: 33-54) Bruno Noronha Gomes * Instituto Superior de Ciências Sociais e Políticas, Universidade de Lisboa, Portugal DOI: 10.33167/2184-0644.CPP2019.VVN2/pp.13-31 Abstract This study sets out to conduct a qualitative analysis of 49 manifestos for the September 2013 local elections, using the conceptual framework of the World Health Organization’s Healthy Cities initiative as the benchmark for this assessment. The methodology consisted of extensive gathering of manifestos for local authority elections, obtaining a total of 203 out of a potential number of 1047. Of these 203, a qualitative analysis was conducted of 49, applying an analytical table that we developed for this purpose. The results show that, in terms of policy proposals in line with the healthy cities philosophy, the political parties present an alignment between their proposals and the feasibility afforded by the law. In terms of policy priorities, the focus was on economic issues (employment, poverty), quality of municipal infrastructure and youth policies. Keywords: healthy cities, elections, local authorities, social determinants of health * E-mail: [email protected] 13 Public ScienceS & PolicieS | ciênciaS e PolíticaS PúblicaS The healthy cities perspective in the manifestos for the September 2013 local elections B. N. Gomes 1. Introduction The object of our study are local authority policies based on the modelling of the social determinants of health as a way of improving the quality of life in the mu- nicipality, in particular the level of importance assigned to them in manifestos for local elections. We accordingly set out to analyze the manifestos for the local authority elec- tions in September 2013 in Portugal. In order to analyze the selected manifestos, we developed our own matrix which was based conceptually on the guidelines in Phase V of the Healthy Cities project of the World Health Organization – Euro- pean Region. Our overall goal was therefore to understand how far the manifestos drawn up for the 2013 local elections incorporated measures aligned with what the WHO calls healthy cities. The healthy cities philosophy addresses a set of social determinants of health, the incorporation of which in the design and implementation of local authority policies is believed to contribute to the well-being and quality of life of the in- dividuals living in those geographical areas. For example, in their study Smart cities, healthy kids: The association between neighborhood design and children’s physical activity and time spent sedentary, Esliger, Sherar e Muhajarine (2012) demonstrated the existence of a relationship between urban planning and physi- cal activity and sedentary lifestyle in children. In another study, Healthy bodegas: Increasing and promoting healthy foods at corner stores in New York city, Dannefer et al. (2012) assessed the effectiveness of an initiative that consisted of increasing stocks and promoting health foods at 55 corner stores in socio-economically de- prived urban developments, demonstrating how low cost initiatives, supported by local authorities, can offer a high level of returns in terms of the health of local people. d In keeping with our overall aims, we also set a number of specific objectives: d To assess whether the winning candidates in the elections are those presenting the highest percentage of policy proposals consistent with a healthy city. d To analyze whether, in cities already classed as healthy cities (and therefore members of the National Network of Healthy Cities), the main political grouping remained in power, or whether there was change. d To understand which parties present manifestos with the largest per- centage of content consistent with a healthy city. 14 Public ScienceS & PolicieS | ciênciaS e PolíticaS PúblicaS The healthy cities perspective in the manifestos for the September 2013 local elections B. N. Gomes d To infer whether it is possible to define a model manifesto for a healthy city, in abstract terms, which could be used as the working basis for drafting future local authority policy programs. Our methodological approach was largely qualitative, insofar as it centered on analysis of the content of the selected local elections manifestos, in the light of the categories and sub-categories in the matrix that we developed. 2. Theoretical framework 2.1 Healthy cities and social determinants of health For an understanding of the theoretical framework for the WHO - Europe Healthy Cities Project, it is essential to review the “Health for All in the Twenty-first Cen- tury” (1998), as part of the Health21 European policy framework, that advocates a concern for health, in its abstract conception, in all public policies. The aim of Health21 was to achieve full health capacity for all persons in the European region through two main levers: 1. Promoting and protecting people’s lifelong health; 2. Reducing the incidence of the main illnesses and injuries, and also alleviating the suffering they cause. This was the framework within which WHO-Europe launched the Healthy Cities project, establishing from the outset that the main aim would be to support the development of a process geared to achieving cities that promote quality of life, rather than setting measurable targets that each city should attain. Accord- ingly, a healthy city is seen as an entity whose actors are aware of the standard of health that it provides and who endeavor to improve that standard. In order to achieve this, two requirements must be met: 1. There must be a clear commitment to Health; 2. A process and a structure must be implemented to achieve this. WHO-Europe has since then recommended a basic model for a healthy city. With a view to constructing a strong movement around public health locally, it lays emphasis on fairness, participative governance, solidarity and inter-sectoral collaboration as principles to be adopted in the approach to the social determi- nants of health. As well as involving the local population in the decision-making process, this way of working and thinking also requires political commitment and consequent organizational and community development that recognizes that the process is as important as the results. 15 Public ScienceS & PolicieS | ciênciaS e PolíticaS PúblicaS The healthy cities perspective in the manifestos for the September 2013 local elections B. N. Gomes In 2005, WHO-Europe, meeting in Bursa, adopted a position that advocates that good urban planning can shape people’s health through design of their envi- ronment, insofar as this acts on the social determinants of health, which include, for their part, the economic and social environment, the physical environment and the individual characteristics and behaviors of citizens. Analysis of these factors allows us to say that they are expressed in each of the following dimensions (WHO, 2014): d Transport network; d Agriculture; d Housing conditions; d Waste processing; d Energy types, management and consumption; d Industrial activities; d Urban planning; d Water; d Radiation levels; d Individual nutrition. In addition to the social determinants of health, the WHO (2011) has also listed a number of aspects of social dynamics that influence the health levels of popu- lations and whose nature makes them eligible for attention from public policies: d The social gradient – poor economic and social conditions affect life- long health. People on the lower rungs of the social ladder run twice the risk of contracting serious illnesses and of premature death com- pared to those at the top. d Stress – social and psychological circumstances can cause long term stress. Continuous anxiety, insecurity, low self-esteem, social isola- tion and lack of control at work or in family life can have powerful effects on health. d The quality of the early years of life – observational and interven- tional studies have shown that the foundations of adult health are laid in early childhood and before birth. d Social exclusion – poverty, relative economic deprivation and so- cial exclusion have a major impact on health and premature death, and the chances of living in poverty are fairly high in certain social groups. 16 Public ScienceS & PolicieS | ciênciaS e PolíticaS PúblicaS The healthy cities perspective in the manifestos for the September 2013 local elections B. N. Gomes d Work – in general, having a job is better for health is better than not having a job. However, the social organization of labor, management style and social relations in the workplace have a significant influence of levels of health. d Unemployment – evidence obtained from several countries has shown that the unemployed and their families suffer a substantial increase in the risk of premature health, as well as the strong link between the effects of unemployment and mental health. d Social support networks – social support and good social relations are an important contribution to health, insofar as they provide peo- ple with the emotional and material resources they need. d Addictions – alcohol addition, use of unlawful drugs and smoking are associated with markers of social and economic disadvantage. Both the social determinants of health and the social dynamics listed here were valuable contributions to the matrix we developed for qualitative analysis of the political manifestos in our sample, insofar as they helped to determine the analytical categories and sub-categories for the purpose of content analysis. 2.2 Methodologies for assessing quality of life in cities In developing the matrix, consideration was also given to other examples of meth- odologies for assessing quality of life in cities, insofar as the respective processes of construction and development, and also the conclusions they reached, provided pointers to potential pitfalls and options to be considered.
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