The role of cities in improving population health: international insights
The King’s Fund has released a report that explores the role cities are playing in improving population health and the conditions needed for success. The report draws on case studies to explore the conditions required for successful health governance in cities and the roles that city governments can play in improving population health.
Characteristics and enabling conditions
1. Bold political leadership and a willingness to invest personal political capital in championing health-promoting policies. Case study: The Mayor of Paris has been vocal about her ambition to reduce air pollution and improve the urban environment by ‘reconquering the public space’ from vehicles. This included changes aimed at cutting the amount of traffic in the city.
2. Clear governance and decision-making processes, including effective partnership working between city-wide government and more local tiers of government. Case study: Copenhagen’s perceived success as a city was a willingness to collaborate across political parties, levels of government and sectors of society (including innovative public – private partnerships).
3. Understanding and making full use of regulatory and other powers available at city and local level. Case study: New York’s ‘Board of Health’ has extensive powers to introduce new regulations without going through normal legislative processes. The city’s high-profile public health interventions were introduced using these powers including the ban on trans-fats in restaurant food and mandatory calorie labeling.
4. The distribution of public health expertise needs to match the wider governance arrangements in a city. Case study: In Barcelona, all public health officers are concentrated in a single organisation, which has staff of around 300 people covering a population of 1.7 million. This reflects the balance of power in the city.
5. Being connected both internally and with other cities to tackle shared challenges. Case study: In Vienna the Mayor travels with a team of around 30 people for a week twice a year to another city to learn in detail about what they are doing well and what they are struggling with.
Roles for city governments in population health
1. Coordinating system-wide action. Case study: In Amsterdam co-ordinating activities across organisations has been a crucial component of work on childhood obesity and HIV. The city’s success in reducing childhood obesity rates has been attributed to the co-ordinated, whole-system approach it has taken since 2013, supported by a dedicated programme management team…Read on