The global diffusion of the healthy cities/communities movement

The Healthy Cities/Communities (HC/C) Movement began in the mid-1980s as an idea at an International Conference on Health Promotion in Toronto Canada.  It was quickly translated into action by the World Health Organization’s European office which created 34 healthy cities initiatives over the next few years.  It then was adopted in the US, Australia, Latin America and Africa. The HC/C  is a community based effort to develop and improve health and the quality of life by mobilizing local leaders, residents, and organizations to collaborate for positive change in prevention, health equity, and the environment.  The movement has been supported and institutionalized through a series of local and national private foundations and government agencies.  HC/C is a reformative social movement that advocates for limited social change across an entire community.  It involves a series of interventions that bring a community together to create multi-sector partnerships that set priorities, establish new public health policy and implement programs to improve the health of the population.  The World Heath Organization and others have created a set of tools to build coalitions, develop plans, gain municipal approval and secure funding for local HC/C programs.  They recommend that the effort should be citizen driven and feature collaborative problem solving.  HC/C projects should utilize community-based Participatory Action Research for both process and outcome evaluations.  WHO recommends the MARI Framework (Monitoring, Accountability, Reporting, and Impact assessment) while US projects tend to employ the Logic Model to guide the evaluation effort.  Most published evaluations have been case studies, but the California Healthy Cities Project conducted a multi site comparative evaluation of 20 communities.  This evaluation sheds light on difference and similarities among projects that vary in community size and sponsoring organization.