Photo courtesy of Yeh Tsungli What a big tree! The Tainan City government is promoting the Healthy City concept especially among children.

By Ma Kang-yao
Taiwan News,Supplement Reporter
Photos Courtesy of DOH

Evergreen Neighborhood did not exist until 2002 when Tainan City government re-demarcated its administration districts. Residents of Evergreen now face the issue of rebuilding their shabby village, which was built to house soldiers moving here from Mainland China.

Tsao Sun, (曹森), the head of Evergreen Neighborhood had no idea where to start since the neighborhood belonged to the military. He had neither the power nor the budget to rebuild his neighborhood. But he learned of the National Model Community competition and thought that if he won it, maybe the community would have enough resources for the rebuilding project. He and his wife formed the Environmental Protection Volunteers and started building a simple recycling yard. They won the competition that year and kept winning subsequently.

"People are the key element towards success," Tsao said, "For a neighborhood like ours where everything is dilapidated, what we needed was cohesion. When we formed ourselves into a solid community, it was easy to mobilize and work efficiently." Afterwards, they formed a Community Patrol Squad and designed new dwellings, including a community hall for public gatherings.

An idea changes the world

"Government commitment and community participation are two of the spirits of the Healthy Cities Program," said Dr. Susan C. Hu, (胡淑貞) the Director of Healthy Cities Research Center. "What matters are not the subjects, but the means and the strategies."

"The idea of Healthy Cities has to be deeply integrated with in municipal works, so that every issue could be integrated with this idea. For example, when a government decides to build a road, the government can choose the location and start digging. However, with the concept of a healthy city, they should gather the neighboring communities and experts to discuss the construction of the road, and include such amenities as a pedestrian sidewalk, a bike trail, etc."

Healthy Cities Program is all about decision-making and cooperation. The people have a right to be a part of the decision-making process that affects their lives and should also participate in the execution of government policies.

The idea of Healthy City started from the research done by the World Health Organization. Research showed that the number of cities with populations of more than 1 million in developed countries has increased from 49 in 1950 to 112 in 1995, the figure for developing countries leapt from 34 to 213. In 2000, there were 24 cities with populations more that 10 million. It is estimated that by 2010, there will be 25 cities with populations more than 20 million and by 2025, 61% of human beings will live in urban areas. The highly developed urban areas will face more severe challenges in terms of safety, sanitation and environment. These factors can potentially become threats to human health.

WHO said that the city should not only focus on economic development, but should have other factors that encourage people to stay. These factors are complicated and to manage them is beyond the capabilities of the departments of health.

Coordination among government, non-governmental organizations, enterprises and communities are extremely crucial. The idea was endorsed by the Declaration of Alma Ata (Health for All) in 1978 and the WHO Ottawa Chapter for Health Promotion in 1986. Those two events emphasized equity in health, community participation, health promotion, inter-department cooperation, personal health care and international cooperation. WHO further stated that a healthy city should be a clean, safe, high-quality living environment with a sustainable ecological system and friendly communities and where the residents actively participate in the city's activities. Such a city will make its residents cherish and preserve their historical legacy and maintain a vision for future development.

The WHO Healthy Cities Program engages local governments in health development through the processes of political commitment, institutional change, capacity building, partnership-based planning and innovative projects. It promotes comprehensive and systematic policies, as well as planning with a special emphasis on alleviating health inequalities, urban poverty, the needs of vulnerable groups, participatory governance and the social, economic and environmental determinants of health. It also strives to include health considerations in economic regeneration and urban development efforts.

"The leader of the county or city government has to make a commitment that they are going to apply this idea to their municipal works by building a livable place for the people," said Dr. Hu, "it is necessary to have the mayor or the head of the county be the director of the board and preside over the meetings rather than merely give remarks." She stressed that once the head of the government is in, other resources such as funds or personnel would follow. The second strategy is inter-department cooperation.

"Take safety as an example. The issues of safety cover a wide range of things such as traffic safety, nosocomial safety or exercise safety," she said, "It takes the participation of many departments to accomplish the task and this is one reason why we stress the participation of different departments."

"Community participation is a good way of preventing inequitable policies," said Dr. Hu. "Through community participation, the government has to prioritize their policies to meet people's demands rather than wasting money on holding too many festivals that give no substantial help in people's lives."

Healthy Cities is a global movement. Since 1986, over 1,200 cities and towns in more than 30 countries in the WHO European Region have become healthy cities. These are linked through national, regional, metropolitan and thematic Healthy Cities networks, as well as the WHO Healthy Cities network for more advanced cities.

Never too late

The WHO Healthy Cities Program is now in its fourth phase (2003-2007). Cities currently involved in this phase are working on three core themes: healthy aging, healthy urban planning and health impact assessment. Although Taiwan has a slow head start on the program, experience from other cities gives Taiwan an advantage.

The first phase of Healthy Cities Program is to promote the idea of all people's health. The second phase is government participation in the implementation of policies and in strengthening ties among government departments. The third phase brings an equal development of society. Finally, the assessment will help stakeholders understand their problems and provide solutions.

In 2003, the Bureau of Health Promotion (an agency within the Department of Health) designated Tainan, the Palace City, as the model of Taiwan's Healthy City. Since then, the Tainan government has integrated public service departments, community organizations, scholars and non-governmental organizations to promote the healthy city program. On July 26th, 2005, Tainan City took the lead and became a member of the international healthy cities community.

"The key to being a healthy city lies in cooperation among the public service sector, scholars and non-governmental organizations," said Chao Khung- yu (趙坤郁), the deputy director of the Bureau of Health Promotion. Besides, Tainan's size and resources give it an edge. Many of Tainan's communities have received few community building awards. "Tainan's population of 750,000 plus its characteristics, culture and heritage" and in cooperation with Cheng Kung University gave Tainan a tremendous advantage.