A healthy city is defined by a process, not an outcome.

• A healthy city is not one that has achieved a particular health status.
• It is conscious of health and striving to improve it. Thus any city can be a healthy city, regardless of its current health status.
• The requirements are: a commitment to health and a process and structure to achieve it.
• A healthy city is one that continually creates and improves its physical and social environments and expands the community resources that enable people to mutually support each other in performing all the functions of life and developing to their maximum potential.
• WHO/Europe recommends a basic model for a healthy city.

Healthy cities are places that deliver for people and the planet. They engage the whole of society, encouraging the participation of all communities in the pursuit of peace and prosperity. Healthy cities lead by example in order to achieve change for the better, tackling inequalities and promoting good governance and leadership for health and well-being. Innovation, knowledge sharing and health diplomacy are valued and nurtured in healthy cities.

People

A healthy city takes a human approach to development, prioritizing investment in people and ensuring access for all to common  goods and services. This includes:

• investment in human and social capital as a strategic approach for urban development
• promoting inclusion, integration and non-discrimination
• building trust, resilience and a focus on ethics and values.

Participation

A healthy city leads by example ensuring community participation in decisions that affect where and how people live, their  common goods and services. This includes:

• improved city spaces and services, based on the needs and assets in communities
• stronger accountability and governance for health and well-being
• empowered and resilient populations
• increased ownership over individual health and well-being.

Prosperity

A healthy city strives for enhanced community prosperity and strengthened assets through values-based governance of common  goods and services. This includes:

• progressive measures of social progress
• investment in the circular economy
• universal minimum social protection.

Planet

A healthy city ensures that the health and well-being of both the people and the planet are at the heart of all the city’s  internal and external policies. This includes:

• a whole-of-city approach to health and well-being
• coherence across levels of governance in the approach to health and well-being
• strengthened city health diplomacy.

Place

A healthy city creates an accessible social, physical and cultural environment that facilitates the pursuit of health and  well-being. This includes:

• shifting from a needs-based to an assets-based approach
• human-centred urban development and planning
• integrating health equity and sustainability into urban development and planning
• enhanced inclusiveness in the use and governance of common spaces.

Peace

A healthy city leads by example by promoting and keeping peace in all its actions, policies and systems. This includes:

• institutions, governance systems and architecture that prioritize social justice and inclusive participation;
• the promotion of cultural norms of inclusion and equity, a non-exploitative egalitarian approach;
• formal governance and societal norms that tackle corruption, discrimination and all forms of violence.

City health profiles

One of the first steps that cities take in the WHO Healthy Cities project is to develop a comprehensive city health profile, a public health report that describes the health of the city’s population, bringing together key pieces of information on health and its determinants in the city and interpreting and analysing the information.

This profile usually uses health indicators to define the population’s health and presents information on the lifestyles and environmental and social factors in the city that affect health. Of the 45 city health profiles submitted to the WHO European Healthy Cities Network in 2005, 35 used all 500 indicators of inequality. Areas covered by the indicators included measures of health or well-being, disease prevalence, socioeconomic conditions, lifestyle, environmental conditions, service utilization (admission or attendance rates) and other factors influencing health, such as traffic and crime.

The profiles are essential tools for change and are an integral part of local decision-making and strategic planning processes. Tools and guidance have been developed on profiles and indicators, which helps a city to portray its health and its determinants.

City health profiles are not an end in themselves but an important element in the process of improving health and thus moving closer to the reality of a healthy city.