1. The Healthy City Approach
The Role of Local Governments
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2. Evolution of Public Health The Health City movement
1970s
Recognition that the shift from communicable to chronic disease needed new approach.
Health for all and Alma Ata
addressing social targets for
health
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3. Canadian Philosophical Shift
Lalonde Report .1974
Health Fields
Environment
Human Biology
Lifestyle
Health Services
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4. Public Health In 1980s Toronto’s Blueprint for change
Addressed Chronic disease
Reorganized The Health Department
Attracted Public health Leaders
Strong Political commitment
Recognition that municipalities have
strong role in addressing
the health of the population
Beyond health Care Conference
Healthy Public policy
Healthy City conceived
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5. Rethinking Policy Development and Health
Key Assumptions
The health of the population has less to do with health care spending than other factors
Policy development in all sectors can have major health impacts
See speech notes
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6. Ottawa Charter for Health Promotion 1986 Cornerstone for change.
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7. Health Promotion Process of enabling people Increase control
Determinants of health
Improved health
In ther 1980s The First WHO Charter on HP was developed. This was the Ottawa Charter. Most development of HP has evolved from this thinking. Global input and conceptualisation.
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8. Ottawa Charter Conditions or Determinants for health
Peace
Shelter
Education
Access to food and clean water
Income
A stable ecosystem
Sustainable resources
Social justice
Equity
The Ottawa Charter clearly outline the conditions in ones life that were necessary to live healthy lives. These are sometimes called the Determinants of HEALTH.
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9. Approaches to Health Treatment Behavioural Socio-environmental
Page 10 model 1.
Socio-environmental
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10. Socio-environmental approach to health
Health Status
Physiological risk factors
Behavioural risk conditions
Psychosocial risk conditions
Psychosocial risk factors
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11. Socio-environmental approach
Risk Factors
Isolation
Lack social support/networks
Self esteem
Self blame
Perceived power
Risk Conditions
Poverty
Education/occupation
Dangerous stressful work
Discrimination
Power
Gaps in income
Unaffordable housing
Access to nutrition
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12. POLICY FRAMEWORK APPROACHES GOALS STRATEGIES Treatment
Quality hospitals and people
Build hospitals
High Tech.
Behavior
Change behavior
Knowledge and skills
Education
Lifestyle
Socio
Environmental
Access to
healthy conditions
Healthy public policy.
3 slides. General; Diabetes or cvd and road traffic accidents.
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13. Policy Framework example Heart disease
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14. Road Traffic Accidents
Approach
Goals
Strategies
Treatment
Increase paramedic response and treatment
Development of Regional Trauma Unit
Behavioural
Increase use of seat belts
Decrease driving speeds
Decrease drunk driving
Education campaigns in seat belt use/drunk driving
Police spot checks
Socio/
environmental
All roads and cars have safety standards and construction
Alternate modes of safe transportation ensured
Gmt Policy and incentives for safe design,maintenance
Comprehensive funded transportation policy and program.
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15. Healthy Cities Development WHO Euro. Leadership
Formal project 1985
WHO partnered with local government
Health for All at municipal level
Intersectoral and multisectoral
Health profiles and plans
People involved in process
Political commitment
funding
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16. WHO. Parameters of Healthy City
Safe high quality Clean environment
Stable sustainable ecosystem
Strong supportive non-exploitive community
High degree of public participation
Provision of basic needs.
Access to wide variety of experiences,resources, interaction
Diverse vital economy
Connections to cultural and biological heritage
City form compatible with and enhances parameters and behaviours
Optimum level of appropriate health services
High health status
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17. Strong Board of Health and Political Leadership
1989-Toronto
Strong Board of Health and Political Leadership
Strong leadership in Public Health Department
Clearly laid out priorities
Formally instituted Healthy Cities Office outside Health Department.
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18. Toronto Healthy City Approach
New decision making process
Work on issues that affect health and cross municipal departments
Work in partnership with other levels of government and community and private sector
Strategically placed within the organization
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19. Decision making frameworks/
Equity/Community
Environment
Economy
Original speeches.
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20. Changes in Decision Making
Rigid
Bureaucratic
Hierarchical
Chimney Pipe
Top down
Innovative
Flexible
Inter sectoral
Decentralized decision making
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21. Settings Approach to Health
Healthy cities
Healthy communities
Healthy schools
Healthy workplaces
Healthy islands
Healthy marketplaces
etc
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22. Big Smog 1989 Toronto suffered major smog problem
Assigned to Health City Toronto-first task from city council
Chaired Interdepartmental working committee on smog reduction
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23. Major progress Clean Air strategy Task Force on Automobile
Air shares
Building retrofit
Toronto Atmospheric fund
Task Force on Automobile
Green Tourism Strategy
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26. Healthy City Toronto Model Political commitment Part of city structure
Funding
Staffing
Intersectoral steering committee
Developed to address the key determinants
Innovation valued
Integrated Partnerships approach
Also Focus on community/
neighbourhoods.
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27. Healthy City Strategies. Moving the Vision
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28. State of The City reporting
Organizing facts for citizen and political use
Economy
Environment
Community Health
Education
Housing
Transportation
Safety
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29. Partnerships Coalition and partnership development
Citizens committees and Mayors task forces
Community capacity building
Strengthening community input
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30. Innovation
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31. Equity
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32. Healthy Public Policy
Policy implemented or changed in any sector that would work towards improving the health of the population.
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33. Applying the model to the built environment.
Issues
Link between built environment and human and social behaviour
Address Urban sprawl
Low density development
Heavy car use
Poor building design
Lack of green space
High levels of noise
Poor air quality
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34. New approach to community planning
Create a balance between developing built environment and conserving natural ones.
Require all official plans to include human service planning and integrated healthy community concepts
Ideal community. Transportation. recreational space etc.
Establish a role for Public Health Units in fostering Healthy Communities
Coordinate planning across jurisdictions and develop mechanisms to integrate decision making at local level.
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35. Points for success Establish a formal Intersectoral approach
Visionary and visible
Leadership
Cross sectoral, Partnership and cooperation
Community participation
Political commitment
Strategies developed by people
Adequate Resources mobilizes together
People own the action and outcome
Healthy public policy
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36. Eating an elephant.
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