To sanitize cities following rapid urbanization causing shortage of infrastructure and deterioration of public health conditions and environmental hygiene

Developed on the logic of improvement of environmental hygiene and public health conditions to reduce the disease burden

Aimed at introducing innovative environmental strategies and to build a local lobby to improve public health conditions

Focused on preventive healthcare, especially for the poor

Of the 102 major diseases, disease groupings and injuries, environmental risk factors contributed to disease burden in 85 categories.

As estimated 24% of the disease burden (healthy life years lost) and an estimated 23% of all deaths (premature mortality) was attributable to environmental factors. Among children 0-14 years of age, the proportion of deaths attributed to the environment was as high as 36%.

An estimated 94% of the diarrhoeal burden of disease is attributable to environment.

Household solid fuel use, second-hand tobacco smoke and outdoor pollution cause 42% of lower respiratory infection in developing countries.

Introduced as a New Public Health Initiative by WHO at Copenhagen in 1986

Adopted the Alma Ata Declaration on Primary Healthcare

Is a rebirth of the Health of Towns Association of Exeter of 1844 in UK

Not a stand alone phenomenon but a collection of innovative strategies developed over the years at the local level

A gradual change from therapeutic to preventive healthcare

Introduction of health as a component of city planning

An effort to upgrade utility infrastructure with increasing population and expanding city-size to reduce environmental deterioration

A Healthy Setting is one where its citizens recognize the physical, mental, social and spiritual nature of health and work together to create conditions that promote healthy livings.

WHAT IS HEALTHY SETTINGS

Health should be an integral part of settlement management and development.

Health can be improved by modifying the physical, social and economic environment.

Conditions in settings such as home, school, workplace and city profoundly influence health status.

Inter-sectoral coordination for health is necessary at local level.

KEY PRINCIPLES OF HEALTHY CITY

Reduce inequalities in health status and in the determinants of health.

Develop healthy public policies at local level to create physical and social environments that support health.

Strengthen community action for health.

Help people develop new skills for health compatible with these approaches.

Reorient health services in accordance with policy.

HEALTH CHALLENGES FOR CITIES

To reduce the disease burden

Help the weaker sections of the society

Introduce community participation and promote self-help

Bring awareness on cleanliness and environmental hygiene

Link preventive healthcare and city planning

Promote ecological balance and sustainable development

Integrate sectoral planning and management at the local area level

Reorient medical services and health systems away from hospital care towards primary healthcare

Promote physical, mental and environmental well-being of the urban dwellers

A collective effort to include innovative strategies in environmental planning

A movement to build a lobby at the local level to improve environmental hygiene

Synergize multi-sectoral and multi-level planning efforts - intra-city, inter-city - towards a clean environment and healthy living for better economic productivity

Strengthen horizontal and vertical linkages

Reduce wastage of resources from duplication and repetition

A clean and safe physical environment

A stable ecosystem that is sustainable

A strong mutually supportive and non-exploitative community

A high degree of participation and control by the public

A diverse, vital and innovative city economy

Retention of ethnicity and heritage

High health Status

Develop Task Forces at city and local levels

Build public support and raise awareness

Identify key priority issues

Obtain approval of the municipal government

Set up an HCP office and appoint HCP

coordinators

Prepare and implement the Healthy City Plan

Assess and evaluate the Healthy City Plan

Who will coordinate with the different levels of administration?

Under what kind of leadership?

Who will fund the local office?

What kind of linkages should be established?

How to introduce health promoting strategies?

How to create supporting environments?

How to strengthen community action?

What kind of training is to be given?

How to reorient health services towards health promotion activities?

How to identify the important health problems in the city?

The nature of community participation to be developed?

How to solicit support from business, industry and labour for the project?

What kind of information to be collected for project development?

What actions?

Who will carry out?

By when?

What resources to be used?

Communications?

Disseminations?

Building networks to

coordinate and implement

Establish Structures

Form working groups

Community groups

Coordination committees

Partnership involvement

Healthy Cities Project (HCP) was initiated in 1994, in 3 cities/areas of India, namely; Trans-Yamuna Area, New Delhi, Mirzapur of UP and Kottayam of Kerala.

Evaluation of HCP in India was conducted in 2001.

The results of the evaluation show some improvement in intersectoral collaboration among healthy schools, markets, food handlers, traffic, police and NGO.

Lack of sense of ownership and still dependence on financial support from outside.

HEALTHY CITIES EVALUATION IN INDIA

Political will mobilized – even though more at the initiation stage The idea/concept of Healthy Settings as potential for intersectoral

action is catching on – evidenced by the increased numbers of such settings and WHO and ESCAP resolutions

There is increasing inquiry by levels of policy and academia Managerial capacity of coordinators and settings managers have

improved Committed mayors (ownership) have made intersectoral

collaboration possible NGO involvement in capacity building and service delivery seen Incorporation of HC as a operational mechanism for urban

development into national plan in one country including budget (Thailand 9th National Development Plan 02-06)

EVALUATION OF HEALTHY CITIES IN THE REGION FINDINGS – STRENGTHS/OPPORTUNITIES

Involvement of the poor and women were limited. Predominantly male leadership in HCPs Decentralization remained poor in larger programs (city and

even municipality level) Very limited change in written policies and processes of the

local government because of HC Deeper roots of healthy cities where cooperatively written

plans and separate HC management structure exists. Political leadership takes too much of the ownership leaving

others players reactive. Networking among cities minimal Too much banking on image, power and charisma of the

leader Although new resources are being mobilized, scanty

evidence of re-programmed local resources

FINDINGS – WEAKNESSES

Participation was greater when the community was well aware of the program

Degree of involvement of stakeholder was influenced by the economic status of individual and by type of activity.

Output was better in smaller settings (school, ward, township, island, building, etc) than in city wide action

Well prepared plans and management processes are needed for success – inclusive community involvement for sustainability

LESSONS

DELHI HEALTHY CITY PROJECT

S.No.

District Subdivision

1 Central Delhi

Dary Ganj Pahar Ganj Karol Bagh

2 North Delhi Sadar Bazaar Kotwali Civil Lines

3 South Delhi Kalkaji Defence Colony Hauz Khas

4 East Delhi Gandhi Nagar Preet Vihar Vivek Vihar

5 North East Delhi

Seelampur Shahdara Seema Puri

6 South West Delhi

Vasant Vihar Najafgarh Delhi Cantt

7 New Delhi Connaught Place Parliament Street Chanakya Puri

8 North West Delhi

Saraswati Vihar Narela Model Town

9 West Delhi Patel Nagar Punjabi Bagh Dwarka

Sulabh proposes to initiate the pilot project in all the 9 districts of Delhi covering 80,000 population for developing the localities into ‘Healthy Settings’ in the overall perspective of promoting Delhi as a ‘Healthy City’.

Step 1: A orientation workshop will be conducted to the officials of Delhi Administration, Elected Representatives, Government Officials, etc to provide a over view of the ‘Healthy Cities’, its importance and significance, benefits of being a Healthy City, approach towards achieving the result, role and responsibilities of the stakeholders, fiscal and physical policies, etc

 

Step 2: In each of the district, two localities are identified covering 5,000 population from each locality:

1. Locality covering middle and high income group population, industrial areas, commercial centres, etc;

2. Locality covering weaker section and low income group population, slums and shanty colonies, etc.

Step 3: Identification of the key stakeholders in the locality including NGOs, CBOs, etc.

 

Step 4: In each of the locality, a sample of 100 households are drawn by stratified random sampling method and household survey will be conducted using a structured questionnaire designed for this purpose.

Step 5: Compilation, validation and analysis of the data drawn from the interviews and prioritization of the developing needs of each locality.

Step 6: District-wise analysis and prioritization of the developing needs of the District.

Step 7: Conduct of one workshop for each district to discuss and formulate the Health Setting Action Plan (HSAP) for each Locality.

Step 8: Formulation of Draft HSAP for each District.

Step 9: Conduct of workshop for all stakeholders involved in the Project to finalize district-wise draft HSAP recommendations.

Step 10:Consolidation of finalized district level Action Plans.

Step 11:Preparation of ‘Healthy City Action Plan’ (HCAP) for Delhi.

Step 12:Submission of Report.

Thank You