Cities on the road to health by Flemming Holm

ublic awareness of the administration for decades. Although it start-up period had not been a visible need for health develop­ has now recovered financial autonomy and solid success. ment has increased there are families receiving socioeco­ In 1990 a WHO study found that greatly in Horsens, nomic aid for four generations! This Horsens was performing better than , since the city means that the young people from the 29 other participating cities in becameP part of a European project these families get their money from the respect of seven health-related criteria: entitled "Healthy Cities-by the year social security office. They have given political support, visibility, structure and 2000". up from the beginning, because that is process with leadership and direction, Although situated in a rich part of what they saw their parents do. And action for health, intersectoral action, the world, Horsens certainly has its they did it, because that was the community participation, and problems. Alcohol and drug abuse is a solution their grand-parents showed resources. For an eighth criterion, daily reality for the 5 full-time and 35 them. voluntary staff who keep the Healthy The situation began changing in The Healthy Cities project City project of Horsens running. 1987, when Horsens, which has The project embraces a network of Failures in industry and businesses, 55 000 inhabitants, joined the European cities that experiment with unemployment, and resulting loss of European Healthy Cities project. Since new ways of promoting health and ;improving the environment. The goal is income for a large part of the popu­ then, great progress has been made in to turn a vision of hea lthy cities into lation have put the municipality in disease prevention and health pro­ reality through political commitment the constant need of funds. Financial motion. The municipality's 5000 shaping of ideas and exp·eriences. inno­ hardship goes back to the Wall Street employees are now much more aware vative action and institutional change. As has been said by Dr Jo E. Asvall. crash in 1929, since when the munici­ than formerly of the health impli­ Director of the WHO Regional Office for pality has never been able to make cations of their actions and decisions. Europe, we already know what the ends meet. As a result, the city has This applies to town planners, social problems are and much about how to been under central government workers, teachers, refuse collectors and solve them. A political w ill for action has to be created: the challenge is to deploy many others. WHO recommendations the managerial skill and innovation The small town of Horsens in Denmark will be implemented throughout the required to pull together the vast human forms part of Europe's Healthy Cities municipality over the next few years. and other resources that cities possess project_ This would not have happened if the and to bring them to bear on this work.

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14 W ORLD HEALT H, November - December 1991 A bar serving alcohol-free drinks is a Another important development has Qualities of a healthy city popular rendezvous for youngsters in been the bringing together of different - A clean. safe physical environment Gwynedd, North Wales; a healthy life services in the interest of health, in (including housing) doesn't mean you have to be miserable! what is known as intersectoral collabor­ - A stable. sustainable ecosystem ation. Both the education department - A strong. mutually supportive. non- exploitative community equity, Horsens was adjudged to be and environmental department coop­ A high degree of participation and inferior; this, of course, is a matter of erated in such a way that schoolchil­ control by the public over decisions taking initiatives that can close the gap dren became involved in the disposal affecting their lives between the deprived and the affluent. of domestic waste materials, such as - The meeting of basic needs (food. water. shelter. income. safety. work) The people are being shown that chemicals, paints and solvents. This for all inhabitants change depends on themselves and has helped to demonstrate to young Access to a wide variety of experi­ on their community participation in people the practical significance of ences and resources. with opportuni­ ties for diverse contacts. interactions recovery from social and ecological ecology teaching. Furthermore, the and communication breakdown. People are rediscovering children tend to influence their parents A diverse. vital and innovative purpose and dignity as they begin in favour of healthy housekeeping. economy taking care of their neighbourhood, in The environmental department - Encouragement of connections with the past. with th~ cultural and bio­ small but valuable daily actions. thereby saves energy and resources, logical heritage. and with other and pollution is reduced. Easy? Yes, in groups and individuals Some project cities a way, but someone has to bring the A form compatible with and enhanc­ Austria Israe l two departments together. In Horsens ing the preceding cha racteristics - An optimum level of appropriate Vienna Jerusalem it was the Healthy City project. Belgium Italy public health' and sickl)ess care Liege Milan At present there are some 60 colla­ services accessible to all Bulgaria Padua borative schemes in the city, including High health status Sofia Lithuania instances of cooperation between the Denmark Kaunas Netherlands public and private sectors. In fact the all who visit the shop. Self-help groups Horsens Eindhoven private sector is now happy to invest have been formed and some 70 other Rotterdam money in health promotion. Recently, health-promoting activities have been Spain a private consultancy, the Horsens· undertaken. France Barcelona Montpellier Seville Health and Environment Group, was Thank you, WHO, for the inspiration! Nancy set up by the municipality with a view And please take these ideas to all the Rennes to exporting advice and know-how. other cities in the world where people Germany The city is also using what it calls are suffering urban deprivation. • Bremen United Kingdom Dusseldorf Belfast action-oriented health communication, Frankfurt Bloomsbury a way of reaching out to people Munich Camden without adding unnecessarily to their Mr Flemming Holm IS a Greece Glasgow Patras Liverpool already excessive burden of informa­ journalist in Denmark. His Hungary USSR tion. A Healthy City Shop has been address is Healthy Cities Pro­ Pecs St Petersburg established with exhibitions, ject. Radhustorvet 23. 8700 Ireland Yugoslavia workshops, telephones, fax and other Zagreb Horsens. Denmark. Dublin facilities. The aim is to provide help for

W ORLD H EALTH, November- December 1991 15