healthy urban planning in practice: experience of … urban planning in practice: experience of...

Healthy urban planning in practice:experience of European cities

Report ofthe WHO City Action Group on Healthy Urban Planning

Edited by:

Hugh Barton, Claire Mitcham and Catherine Tsourou

2 . HEALTHY URBAN PLANNING IN PRACTICE

AbstractHealthy urban planning means planning for people. Healthy urban planning – a WHO guide to planning for people (SponPress, 2000) introduced the concept and principles of healthy urban planning. This book describes the efforts of agroup of cities in the WHO European Healthy Cities Network to introduce health in their urban planning practices.Six city case studies covering a wide range of approaches are presented and analysed. Some are at an early stage inlinking planning and health, whereas others have many years of experience on which to draw. Some focus on specificpolicy areas or projects, whereas others focus on the process of making plans. The analysis draws not only on thewritten material from each city but also on in-depth interviews with key protagonists and seminar discussions withinthe wider group of cities that participated in this work. The book summarizes the conclusions and lessons learned andmakes recommendations for taking healthy urban planning practices forward on a larger scale.

KeywordsURBAN HEALTHCITY PLANNINGHEALTH PROMOTIONHEALTH POLICYEUROPE

ISBN 92 890 1088 6

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Contents

Foreword 5

Acknowledgements 6

1. Introduction and context 7

2. Getting started: the experience of Seixal, Portugal 11

3. A progressive, learning approach: the experience of Milan, Italy 15

4. Decentralized integration: the experience of Gothenburg, Sweden 25

5. Health-integrated spatial planning: the experience of Sandnes, Norway 30

6. Prizing open the barriers: the experience of Belfast, United Kingdom 39

7. Health as the goal of planning: the experience of Horsens, Denmark 45

8. Analysis and evaluation 50

9. Emerging principles and prospects 54


EditorsHugh Barton

Executive Director, WHO Collaborating Centre for Healthy

Cities and Urban Governance, University of the West of

England, Faculty of the Built Environment, Bristol, United

Kingdom

Claire Mitcham

Urban planner, postgraduate student, University of the

West of England, Bristol, United Kingdom; focal point for

urban planning at the WHO Centre for Urban Health

(until 2002)

Catherine Tsourou

Architect and urban planner, Padua, Italy

Cover design: Antonella Bruzzese, Milan, Italy

Layout and typesetting:

Christensen Grafisk ApS, Copenhagen, Denmark

ForewordThis publication is based on the experiences andwork of a group of member cities of the WHO Eu-ropean Healthy Cities Network, which has madeefforts to introduce healthy urban planning intopractice. This is an exciting and challenging areaof work requiring the active engagement of urbanplanners and architects. After Healthy urban plan-ning – a WHO guide to planning for people was pub-lished in 2000, WHO set up the WHO City ActionGroup on Healthy Urban Planning. Planners from12 diverse members of the WHO EuropeanHealthy Cities Network agreed to work togetherfor 3 years. The City of Milan supported the workof the Group. Participants were convinced of theimportance and the potential benefits of integrat-ing health into planning processes and practicesand therefore attempted to explain, promote andapply these ideas in their cities. The Group be-came thus a forum for sharing and learning.

Technical documents must be based on evi-dence. The knowledge acquired from testing newideas in practice can be an invaluable source oflearning and inspiration. Integrating health andquality of life considerations into planning prac-tices implies a cultural shift in how people under-

stand and deal with space and human needs. TheGroup’s work demonstrated that healthy urbanplanning is worth developing and exploring fur-ther. The case studies are concrete examples ofhow health concerns can influence planning deci-sions. These are glimpses into the richness of thepractical implications of healthy urban planning.

WHO is giving high priority to healthy urbanplanning. Healthy urban planning and health im-pact assessment are core developmental themesfor the fourth phase (2003–2007) of the WHO Eu-ropean Healthy Cities Network. Thus, many citieswill achieve the political legitimacy and the tech-nical support to work systematically and to inno-vate in urban planning and health. The lessonslearned by the Group will be useful for the new-comers. Healthy urban planning should be in-creasingly recognized as a key domain for publichealth policy.

Agis D. TsourosHead, Centre for Urban HealthHealthy Cities and Urban Governance programmeWHO Regional Office for Europe

FOREWORD . 5


AcknowledgementsThis work would not have been possible withoutthe generous support by the City of Milan and thecommitment of the member cities of the WHOCity Action Group on Healthy Urban Planning:Belfast (United Kingdom), Geneva (Switzerland),Gothenburg (Sweden), Horsens (Denmark), Milan(Italy), Pécs (Hungary), Sandnes (Norway), Seixal(Portugal), Sheffield (United Kingdom), Turku(Finland), Vienna (Austria) and Zagreb (Croatia).

Thanks are due to Emilio Cazzani (Head of theUrban Planning Department of the City of Milan),Alessandro Balducci (Dean of the Politecnico deMilano Technical University) Eleuterio Rea (Head

of the Social Services Sector for adults of the Cityof Milan) and Laura Donisetti (Coordinator of theHealthy City Project in Milan) for their extraordi-nary commitment to this work and most valuablecontributions to the work of the Group.

A special word of thanks to Connie Petersen,who provided most efficient administrative sup-port to the Group, and Gill Weadon and JulieTriggle for excellent word-processing, often withvery tight deadlines. Finally, many thanks toDavid Breuer, who considerably improved the lan-guage and style of the book.

1.Introduction and context

Hugh Barton1

Purpose and scopeThe WHO Regional Office for Europe launchedthe healthy urban planning initiative in 1997 aspart of a move to integrate the agenda for healthwith that of sustainable development. Thehealthy cities movement had recognized from thestart that the quality, equity and efficiency of theurban environment profoundly influences health.But the new initiative went further than that, see-ing human health and well-being as the centralpurpose of sustainable development. Health, itwas believed, should be a prime goal of urbanplanning, helping to provide a coherent and evi-dence-based foundation for policy-making.

The WHO healthy urban planning initiativehas involved collaboration between practitionersin the healthy cities movement and academic ad-visers from England and Italy. The first phase ofthis collaboration resulted in Healthy urban plan-ning – a WHO guide to planning for people in 2002 .2

The second phase involved the formation ofthe WHO City Action Group on Healthy UrbanPlanning. The members of the City Action Grouphave pushed forward with practical programmes,implementing the principles advocated in thebook. This new publication attests to their effortsand their achievements.

The book reviews the practical experience of arange of cities as they move towards health-inte-grated planning. The cities are self-selected mem-bers of the action group, but they do represent agood range of approaches. Some are at an early

stage in linking planning and health, whereas oth-ers have many years experience to draw on; someare concerned with specific policy areas or projects,whereas others focus on the process of plan-mak-ing. The people directly involved in each city wrotethe six case studies. They are structured on a com-mon pattern, telling the story of the developmentof their healthy planning initiative and highlight-ing specific projects and programmes. Taken to-gether, the case studies offer a rich and diversesource of inspiration for others to follow.

Chapter 1 sets the scene for the city studies, sum-marizing the principles of healthy urban planningand outlining the development of the WHO initia-tive on healthy urban planning. Chapter 8 analysesthe case studies. This draws not only on the writtenmaterial from each city but also on in-depth inter-views with key protagonists and seminar discus-sions within the wider City Action Group. Thisleads on to Chapter 9, the conclusions, recommen-dations and the next steps. The work reported hereis blazing a trail that all member cities will take upin the fourth phase of the WHO European HealthyCities Network: healthy urban planning will be akey aspiration and obligation.

The WHO initiative on healthy urbanplanningThe WHO initiative on healthy urban planningwas based on a conviction that urban spatial andtransport planning significantly influence the de-

1 Executive Director, WHO Collaborating Centre for Healthy Cities and Urban Governance, University of the West of England,Faculty of the Built Environment, Bristol, United Kingdom.

2 Barton H, Tsourou C. Healthy urban planning – a WHO guide to planning for people. London, E&FN Spon, 2000.

INTRODUCTION AND CONTEXT . 7


terminants of health3 together with a recognitionthat attempts to change personal behaviour with-out changing basic social, economic and environ-mental conditions are likely to have little suc-cess.4 The third phase of the WHO EuropeanHealthy Cities Network (1998–2002) therefore em-phasized the need to promote health through ur-ban planning.5

The foundations for this initiative were laid inthe mid-1990s with the involvement of the WHOEuropean Healthy Cities Network in the EuropeanSustainable Cities & Towns Campaign. The Cam-paign recognized the interrelationship betweenhealth and sustainable development6 and triggeredgrowing interest in the links between health andplanning policy. The historical connection betweenpublic health strategies and urban planning hadbeen severed in most cities, at some cost to people’shealth, especially in terms of healthy exercise androad safety. At the same time, in the aftermath ofthe United Nations Conference on Environmentand Development in Rio de Janeiro in 1992, localauthorities have been asked to produce LocalAgenda 21 strategies. Urban planners became in-creasingly conscious of the need to plan explicitlyfor the quality of life and sustainable development.

WHO began regular work with urban planningpractitioners and academics in 1998. As a firststep, in 2000, Healthy urban planning – a WHOguide to planning for people7 was published – the re-sult of seminars and consultations across the

movement. It advocates human health and well-being as a key goal of town planning and provides12 key health objectives for planners. It alsoshows how healthy cities principles such asintersectoral cooperation, community involve-ment, equity and political support are equally rel-evant to planning. It sets out robust policy guide-lines for development projects, neighbourhoodsand cities.

The publication noted the gulf between princi-ple and practice. It reported (in Chapter 3) a sur-vey of chief planners from the cities participatingin the second phase (1993–1997) of the WHO Eu-ropean Healthy Cities Network. This showed thathealth and planning agencies regularly cooperatedin only 25% of the cases. The chief planners – per-haps surprisingly, given their position – consid-ered that planning policies were actually incom-patible with health in certain ways. Many citedrigid standards for location and zoning as reasons.They also highlighted health problems in relationto transport and traffic, social segregation and thefocus on private and public profit and budgetsrather than the everyday needs of citizens. If suchpractices were prevalent in cities in which healthalready has a high profile, then they are likely tobe even more so elsewhere.

Given this conspicuous lack of integration be-tween planning and health, a group of cities thathad cooperated in producing the book decided togo a step further. At a meeting in October 1999,8 ur-

3 Duhl LJ, Sanchez AK. Healthy cities and the city planning process – a background document on links between health and urban plan-ning. Copenhagen, WHO Regional Office for Europe, 1999(http://www.euro.who.int/healthy-cities/Documentation/20020514_1, accessed 17 September 2003).

4 Lawlor D et al. The challenges of evaluating environmental interventions to increase population levels of physical activity: thecase of the UK National Cycle Network. Journal of Epidemiology and Community Health, 2003, 57:96–101.McCarthy M. Transport and health. In: Marmot M, Wilkinson, R, eds. Social determinants of health. Oxford, Oxford UniversityPress, 1999.

5 WHO Healthy Cities project Phase III: 1998–2002. The requirements and the designation process for WHO project cities. Copenhagen,WHO Regional Office for Europe, 1997 (http://www.who.dk/healthy-cities/Documentation/20020617_1,accessed 9 September 2003).

6 Price C, Dubé C. Sustainable development and health: concepts, principles and framework for action for European cities and towns.Copenhagen, WHO Regional Office for Europe, 1997 (http://www.euro.who.int/healthy-cities/Documentation/20010918_11,accessed 17 September 2003).

7 Barton H, Tsourou C. Healthy urban planning – a WHO guide to planning for people. London, E&FN Spon, 2000.8 Healthy urban planning: report of a WHO seminar. Copenhagen, WHO Regional Office for Europe, 1999

(http://www.who.dk/eprise/main/who/progs/hcp/UrbanHealthTopics/20020604_1, accessed 8 September 2003).

ban planners from cities in Europe agreed, with en-couragement from WHO, to form a group to testthe book’s ideas and provide an opportunity toshare their developing experience. This providedthe momentum for the foundation of the WHOCity Action Group on Healthy Urban Planning.

The City of Milan volunteered to lead and sup-port the work of the WHO City Action Group onHealthy Urban Planning. At the first meeting inJune 2001, urban planners and healthy city coordi-nators from 11 cities across Europe explored theirperspective and knowledge. The initial membershipincluded cities from northern, southern, easternand western Europe: Gothenburg (Sweden),Horsens (Denmark), Sandnes (Norway), Turku (Fin-land), Sheffield and Belfast (UK), Milan (Italy),Seixal (Portugal), Vienna (Austria), Geneva (Switzer-land), Pécs (Hungary) and Zagreb (Croatia). Thisgroup has carried forward WHO’s work on healthyurban planning in a process that has involved arapid learning curve for some cities.

Since 2001, this group of cities has been the fo-cus for WHO’s developing work on healthy urbanplanning.9 Group meetings have provided a forumfor sharing knowledge and experience of exactlywhat healthy urban planning implies in practiceand how it affects day-to-day planning processesand outcomes. These planners have developed un-derstanding not just of each other’s differences andunique perspectives but of their common situationand of the general relevance of their experience toother European cities. Together they have begun toexamine and experiment with how urban planning

can promote health, well-being and the quality oflife and to discuss the many challenges and difficul-ties. Although several cities have dropped out dur-ing the process, the experiences of the remainder intackling problems associated with redefining plan-ning processes and working on specific thematic is-sues have been invaluable. In addition, six interest-ing case studies have emerged.

The case studies demonstrate the degree towhich health can inspire coordinated socially re-sponsible policy-making and implementation bylocal authorities. There is no one template, how-ever, in relation to either the process or the policyfocus.

Barton et al.10 further analyse the WHOhealthy urban planning initiative, examining itscontext and rationale.

Principles of healthy urban planningIt is ironic that, although the environment is gener-ally recognized as a fundamental determinant ofhealth,11 most environmental initiatives in publichealth have attempted to change the behaviour ofindividuals and small groups, reaching only a mi-nority, and are seldom sustained in the long term.12

Economic pressure and broad land-use and trans-port policies often cause the problems, but the solu-tions are being sought at the individual or commu-nity level. This is happening not because the profes-sionals – in health, planning and transport – are notaware of the causal processes, but because breakingdown barriers between agencies and achieving inte-grated programmes are difficult. Policy inertia leads

9 First meeting of the City Action Group. Report on a WHO Meeting; Milan, Italy, 24–25 June 2001. Copenhagen, WHO Regional Officefor Europe (in press).Second meeting of the WHO City Action Group on Healthy Urban Planning. Report on a WHO meeting, Milan, Italy, 23–24 May 2002.Copenhagen, WHO Regional Office for Europe (in press).

10 Barton H, Mitcham C, Tsourou C. Healthy urban planning. In: WHO Healthy Cities in Europe: a compilation of papers on progressand achievements. Working document prepared for the 2003 International Healthy Cities Conference, Belfast, United Kingdom, 19–22October. Copenhagen, WHO Regional Office for Europe, 2003 (Centre for Urban Health).

11 Lalonde M. A new perspective on the health of Canadians. Ottawa, Health and Welfare Canada, 1974.Whitehead M, Dahlgren G. What can we do about inequalities in health? Lancet, 1991, 338:1059–1063.

12 Lawlor D et al. The challenges of evaluating environmental interventions to increase population levels of physical activity: thecase of the UK National Cycle Network. Journal of Epidemiology and Community Health, 2003, 57:96–101.McCarthy M. Transport and health. In: Marmot M, Wilkinson, R, eds. Social determinants of health. Oxford, Oxford UniversityPress, 1999.



to progressive deterioration in some aspects ofhealth. The essential principle of healthy urbanplanning, therefore, is interdisciplinary, inter-agency and intersectoral collaboration: shared rec-ognition of the problems and shared determinationto tackle them. As with other healthy city initia-tives, the shared determination can only happen ifthe top is committed: especially cross-party politicalcommitment within the authorities responsible forland-use and transport planning. The case studiesin this book give examples of the difficulties ofachieving coherent healthy urban planning strate-gies and examples in which collaboration devel-oped over several years has led to integrated pro-grammes of action and policy.

Achieving coherent strategies depends not onlyon the processes of policy-making and implemen-tation but also on shared concepts and under-standing. Healthy urban planning – a WHO guide toplanning for people attempted this in two ways – bypromoting an agreed, negotiated list of key healthobjectives for planning and by emphasizing con-sistent approaches at a range of scales – fromsubregional planning down to specific buildingprojects. The objectives, expressed as questions,are set out below.

Do planning policies and proposals encourageand promote:1. healthy exercise?2. social cohesion?3. housing quality?4. access to employment opportunities?5. accessibility to social and market facilities?6. local low-impact food production and distribu-

tion?7. community and road safety?8. equity and the reduction of poverty?9. good air quality and protection from excessive

noise?10. good water and sanitation quality?11. conservation and decontamination of land?12. climate stability?At each scale of operation and decision-making,

these criteria must be interpreted appropriately andmechanisms implemented to ensure that health isgiven due weight. At the broad level of whole settle-ments or city regions, the key issues are related togeneral economic and social trends and the overallpattern of spatial development. Consistency andmutual reinforcement of policies are essential butcan be difficult to achieve. For example, access togood housing is a significant health factor, but ifthe housing supply is constrained (perhaps for con-servation reasons), prices will rise, which will influ-ence disposable household income, locationalchoice and dwelling adequacy in relation to need.Policy has to recognize this tension and deal with itso that health is not compromised.

The neighbourhood level has a similar need forpolicy consistency, but working with local com-munities is also a priority, especially in poorer ar-eas, such that people feel empowered and socialcapital (which is important for mental well-being)is boosted.13 The case studies give many inspiringexamples of this process at work.

Implementation actually happens at the levelof individual projects. Healthy urban planning – aWHO guide to planning for people provides a chal-lenging checklist of criteria for proposals to satisfy,tying in with broader strategies. This is only likelyto be successful if enterprises, institutions and de-velopers understand (and eventually accept) thepolicies entailed. This, in turn, relies on a collabo-rative approach.

The background philosophy at all levels mustbe that projects, plans and policies are there toserve the interests of people. Settlements comprisethe human habitat, and this habitat should enablepeople to provide for their needs – physical, so-cial, economic and psychological. A focus onhealth within urban planning greatly assists therecognition, inherent in the definition of sustain-able development of the World Commission onEnvironment and Development, that people – notprocedures or profit or even the environment perse – are the focus of our efforts.

13 Barton H, Grant M, Guise, R. Shaping neighbourhoods for health, sustainability and vitality. London, E&FN Spon, 2003.

2.Getting started: the experience of Seixal, Portugal

Natália Madureira14

Seixal is a recent convert to the idea of healthy urban planning. In a context where planning legislation is weak,Seixal illustrates how concern for health can be a powerful motivating force for innovative policies.

City profileSeixal is a municipality with 150 thousand inhabit-ants that is part of the Lisbon Metropolitan Area.Lisbon is the capital of Portugal. This region, where27% of the Portuguese population lives, is locatedon the coast, near the Atlantic Ocean. The TagusRiver flows through Seixal. The Tagus is a long riverthat originates in Spain and flows into the AtlanticOcean near Lisbon. Seixal is located on the southbank of the Tagus River, opposite Lisbon (Fig. 2.1).

Until the early 20th century, the inhabitants ofSeixal performed activities related to water – fish-ing, shipbuilding and also milling in tidemills,taking advantage of the tides. Seixal was a port for

agricultural products coming from southern Por-tugal such as cork and cereals. Benefiting from itscloseness to Lisbon and attracted by the naturallandscape, the upper classes of Lisbon had someof their leisure and weekend farms in Seixal.In the early 20th century, industry in Seixalboomed. The main activity was processing cork butincluded the spinning, glass and soap industries.

In the 1960s, the first and the only steelworksin Portugal was created in Seixal and the firstbridge connecting the two banks of the TagusRiver and a highway were built, making Seixalcloser to Lisbon. These improvements startedstrong population growth in Seixal, which re-ceived a heavy flow of the migrants to the LisbonMetropolitan Area (Fig. 2.2). In the 1960s and1970s, Seixal became a bedroom community. Inrecent years, the number of jobs in industry hasbeen decreasing and has been replaced by jobs intrade and services. However, half of Seixal’s labourforce works elsewhere, mainly in Lisbon.

In 1974, the resumption of constitutional gov-ernment in Portugal increased the remits and finan-cial resources of local authorities. Municipalitiesnow solve local problems more directly. Municipali-ties are committed to developing their cities andimproving the living conditions of the inhabitants.The Municipality of Seixal has given priority tosolving one of the main problems of Seixal bybuilding a wide network of basic sanitation infra-structure to offer to an ever-growing population.

Fig. 2.1. Seixal in the Lisbon Metropolitan Area

14 Urban Planner, Municipality of Seixal, Portugal.



The urban development of Seixal was markedby extensive and scattered low-density settlementalong the main roads. This model requires consid-erable money for building and maintaining a widenetwork of facilities and roads.

An attractive aspect of Seixal is its landscape: itis near the river and the ocean, it has very mildweather and the fauna and the flora in themarshlands is very diverse. Its historical heritageincludes the tidemills from the 15th century.

Seixal offers great cultural diversity. Seixal in-habitants come from all over the world: from Por-tugal, several Portuguese-speaking countries in Af-rica, Brazil and lately even central and eastern Eu-rope. Many associations of young and elderly peo-ple and those promoting sports and protecting theenvironment have been successful in integratingthe new residents into the social context.

Urban planning in SeixalIn urban planning, the Municipality is responsiblefor preparing a land-use plan and other plans suchas renovation plans and detail plans.

The Strategic Development Plan of the Lisbon Met-ropolitan Area establishes the main strategic objec-tives and development guidelines for the wider regionin which Seixal is located. A main objective of this re-gional plan is containing urban expansion, reversingthe sprawl of the last quarter of the 20th century.

Seixal has had a land-use plan since 1993 stipu-lating zoning. The main concern of the urban

planners in 1993 was to establish regulations fordevelopment. These regulations allowed a balancebetween urban and non-urban land uses and at-tempted to protect natural resources and improveenvironmental quality.

This land-use plan is now being revised. Themain aim is to lay down a development strategy toimprove this suburban territory that integrates ur-ban uses of land with rural uses, improves the qual-ity of the urban environment, reduces excessive caruse and creates a policy of promoting a public trans-port network. Now people are the real aim of thisplan and the main concern of urban planning.

The Municipality also has authority to approveresidential and industrial development. Its respon-sibility has been extended to building nursery andprimary schools and sports, cultural and otherpublic facilities as well as designing and maintain-ing open spaces. In addition, it has the authorityto grant permits for all construction within Seixal.

The healthy urban planning projectThe Municipality of Seixal has belonged to theWHO European Healthy Cities Network since 1998.The invitation to Seixal to join the WHO City Ac-tion Group on Healthy Urban Planning drew atten-tion to another range of problems relating health tothe daily practice of urban planning. It also madethe Municipality think about how the design of ur-ban projects affects people’s quality of life.

In the past, the rapid growth of Seixal made itdifficult for urban planners and other colleaguesto share information and to discuss the methodsand the solutions used in urban planning. Therewere no opportunities to evaluate how the chosenoptions affect the urban environment. The firstquestion raised when we got together to discussthe principles of healthy urban planning wastherefore to find out the best way to get around,to talk about each other’s work and to be able toconsider the possibility of coordinating efforts topromote healthy conditions. This was achievedthrough specific projects, but the first step was tojoin with colleagues from relevant departments ina joint working group.

Fig. 2.2. Population of Seixal, 1960–2001

The group members have been identifyingproblems that really worry us; The Healthy SeixalProject Office was already working on some wewould like to solve in an urban context.

Transport, mobility and accessibilityThe Healthy Seixal Project Office already identi-fied transport, mobility and accessibility as beingfundamental to people’s health and well-being.Seixal’s urban growth pattern is closely related tocar use. Public transport is inadequate. The exist-ing services are predominantly tailored to peoplewho commute to Lisbon, but public transport be-tween different neighbourhoods of the city is al-most nonexistent. In addition, the scattered settle-ment encourages people to drive almost every-where – school, work, shopping and leisure activi-ties.

Many spatial obstacles make mobility difficult.In 2001, 23% of Seixal’s population had a mobil-ity problem and needed practical and well struc-tured networks that would allow them to movefreely and easily (Fig. 2.3). Spotting this mobilityproblem allowed us to establish several regula-tions that should be kept in mind in designingstreets and public spaces.

The mobility and accessibility problem is beingcarefully studied in the process of revising theland-use plan to increase the number of residentswithin walking distance to the railway stations.

To avoid traffic jams, we are also studying improv-ing the road network system by building new roads.

Together with the existing ones, they will strengthenthe network. Meanwhile, a new means of transport –a light rail system – is being built. This non-pollutingtransport will transport many passengers.

The municipal working group for healthy urbanplanning has been tackling other matters such asestablishing new practices in the resolution of prob-lems related to social rehousing, establishing amethod for renewing the historical urban centres,identifying green spaces that should be protectedand included in the municipal ecological networkand revitalizing urban allotment gardens (Box 2.1).

ConclusionsWe believe that the concept of healthy urban plan-ning opens new ways to a more integrated ap-proach to spatial planning and allows stronger in-volvement of the population (as users), urban plan-ners and politicians in urban issues, contributing toimproving the quality of the urban environmentand of public space. Seixal has been creating theconditions for increasing the involvement of deci-sion-makers in implementing projects that contrib-ute to the well-being of the population. Our meet-ings with the population have clearly demonstratedtheir concern in warning the administration aboutproblems they want to see resolved. Technical staffare also becoming more critical about their ownprojects, contributing to the adoption of urbanplanning policies favourable to health.

Analysis of the local situation and new societalvalues are contributing to designing the new mu-nicipal land-use plan, which is in its initial phase.The success of the new proposals cannot yet beevaluated; the concepts and new strategic goalsare being set up. For this reason, we do not yethave any feedback on the new proposals, but pub-lic participation has gathered together residents,institutions and developers and encouraged ses-sions organized around thematic panels of ex-perts. The local newspaper publishes informationon the main issues being discussed every 2 weeks.The main objectives are related to environmentalquality, sustainable development and promotingpublic transport.

Fig. 2.3. Seixal residents considered to have especiallyreduced mobility

GETTING STARTED: SEIXAL . 13


Box 2.1. Reviving allotment gardensSeixal has a wide waterfront. A vast networkof streams is dispersed across Seixal, makingthe soil fertile and suitable for agriculture. Formany years, some Seixal inhabitants havededicated themselves to cultivating small al-lotment gardens that provide them with veg-etables for their own use. The number of peo-ple dedicating themselves to this activity hasincreased recently. This is occurring not onlybecause retired people still possess the vitalityand energy to work but also because agricul-ture is seen as a way of relaxing after a work-ing day or on the weekend and contributes topromoting healthy lifestyles. In addition, theproducts benefit low-income families eco-nomically.

During the period of peak populationgrowth, this kind of activity was not properlyvalued. However, today the concept ofhealthy and sustainable development, whichis the basis of the urban municipal policy,pays special attention to protecting naturalresources and to the interaction with the ur-ban fabric. It is therefore important to createthe right conditions so that the quality of theallotments can be developed to promotehealth by guaranteeing the quality of theproducts. Urban allotments are also a part of

the municipal ecosystem and thereby contrib-ute to its quality.

The municipal working group on healthyurban planning has been studying how to pro-mote an urban allotment network in Seixal.The first step was to carry out a survey near itsusers. The inventory found 644 allotments,some of which are isolated and others groupedin small plots. Most of the allotments (87%)are located in valleys and slopes and withinprivate property. The size ranges from 21 to4460 m2, but 70% have less than 800 m2. Allgardeners grow vegetables for their own use,42% have fruit trees and only 13% have orna-mental plants. The watering is done manually,with water from reservoirs and wells. Most gar-deners are Portuguese (87%), retired, men andolder than 60. The choice for the location ofthe allotment is directly related to where peo-ple live.

The next step will be establishing a part-nership between the Municipality and its gar-deners that considers the quality and value ofthese spaces, including them in wider projectsof revitalizing open space. The allotment gar-den project aims to be a new resource forhealthy urban development in Seixal.

3.A progressive, learning approach: the experience of Milan, Italy

Paola Bellaviti, Laura Donisetti, Alessandro Balducci & Emilio Cazzani15

Milan’s decision in 1999 to initiate healthy urban planning led to intense activity to establish joint planning pro-cedures and projects involving three city departments. This was reinforced by research links with the Politecnico diMilano Technical University, which have helped to ensure that both the opportunities and the problems are recog-nized and learned from.

City profileThe City of Milan has 1.3 million inhabitants, butthe conurbation accounts for 4 million people(the province) and the wider Lombardy Regionabout 9 million. The number could be evenhigher depending on the boundaries drawn forone of the largest urban regions in Europe.

Milan is the historical economic capital of Italyand was the main industrial centre until recently.Economic trends have induced substantial transfor-mation, with traditional industrial activities wan-ing (moving to peripheral areas) and new economicand urban functions for industrial activities. A neweconomic, social and urban profile has beenshaped. Milan has become the most important cen-tre for industrial services in Italy, especially in fi-nance and management, publishing, fashion, de-sign, culture, universities, research and health care.

The transition from an industrial city towards apostindustrial city caused a crisis in Milan’s iden-tity and in its socioeconomic and spatial relation-ships. The system of production and the localpublic authorities have slowly started to mitigatethis crisis.

Attempts have been made to tackle the mostrelevant problems by implementing various pro-grammes of urban regeneration that reuse formerindustrial sites for new dwellings, urban parks andstrategic urban functions (a congress centre, the

15 Paola Bellaviti, Department of Architecture and Planning, Politecnico di Milano Technical University, Milan, Italy; LauraDonisetti, Coordinator, Milan Healthy City Project, Milan, Italy; Alessandro Balducci, Dean, Politecnico de Milano TechnicalUniversity, Milan, Italy; Emilio Cazzani, Head, Urban Planning Department, City of Milan, Italy.

European Library of Information and Culture anda new auditorium). Nevertheless, Milan has manyof the current problems of metropolitan cities:traffic, pollution, unsafe conditions, housing andsocial insecurity, poverty, immigration, poor envi-ronmental quality and poor quality of life.

The Milan Healthy City ProjectMilan has participated in the WHO EuropeanHealthy Cities Network since 1987. During 10years of activity, the Milan Healthy City Office haspromoted substantial research to help prepare ahealthy city plan for Milan. In addition, the re-search provided opportunities to establish newpartnerships among private and public urban ac-tors. The Milan Healthy City Office has preparedplans on some emerging themes (HIV/AIDS, alco-hol and mental health). An integrated and partici-patory approach to urban design was also pro-moted through an urban children project on avery small scale.

In 1999, the city government decided to par-ticipate in healthy urban planning, leading theWHO City Action Group on Healthy Urban Plan-ning from 2000 to 2002. This has given the Cityan important opportunity to develop the MilanHealthy City Project even further, focusing on amore integrated approach that can introduce

A PROGRESSIVE, LEARNING APPROACH: MILAN . 15


health concepts into urban planning. A researchprogramme was created ad hoc and implementedat the local level to experiment concretely withhealthy urban planning: learning by doing in-stead of analysis. Continual dialogue with interna-tional partners has supported the city leadership,allowing further developments.

The healthy urban planning storyStarting the processThe Social Care Department (where the MilanHealthy City Project is located) joined with theUrban Planning Department in committing thecity government to working on healthy urbanplanning. This important choice motivated theheads of the Departments to seek an alliance withuniversity researchers to set up a competent staffand a specific work programme.

In particular, during 2000–2002, the Depart-ment of Architecture and Planning of thePolitecnico di Milano Technical University formu-lated a research programme to turn the healthyurban planning approach into a practical pilot ac-tion and to set up a work group at the MilanHealthy City Office.

The process began based on this collaborationbetween the city government and the Universityand on a programme that proposed moving intwo directions: within the city government and inthe broader community.

The efforts within the city government in-cluded starting joint, intersectoral planning proce-dures with the people responsible for sectoral poli-cies aimed at creating the conditions and opportu-nities for establishing integrated projects. This isbased on the evidence that implementing urbanpolicies inspired by the principles of a healthy cityrequires an intersectoral approach to all sectors ofpublic administration, such as policies on urbanplanning, social services, environment, the labourmarket and training. The current public adminis-tration lacks integration among sectors and the re-lated tasks and objectives.

A second target was the local community,where it was agreed to look for practices of urban

transformation that would be innovative with re-spect to the actors (associations, clients of theservice sector, private business operators and agen-cies) and the methods used.

The processMilan’s healthy urban planning programme was de-veloped over 3 years. It was mainly centred on ex-perimenting with practice by setting up an increas-ingly broader network with (and between) officialsand heads of the municipal sectors most directly af-fected by and involved in the initiative and be-tween them and the actors in urban planning, withthe aim of implementing and reflecting.

Identifying good institutional and spatial practicesSince the objective was to try out intersectoralwork methods to build integrated projects,projects and initiatives planned or already startedup in Milan that combine physical, social and en-vironmental aspects were reviewed.

This review led to an atlas of the projects for ahealthy and sustainable city (Box 3.1), which of-fers a broad view of the most important experi-ences and the good practices taking place for im-proving health and the quality of life in Milan.

Taking an intersectoral and participatory approach inthree pilot projectsBased on the atlas, the heads of the city depart-ments chose three pilot projects in which anintersectoral and cooperative design method couldbe applied. The objective was to develop pilot inter-ventions as examples to demonstrate the practical-ity and potential of the integrated approach. Theyinclude some districts with crucial problems thatare virtually impossible to tackle with a sectoral ap-proach: physical degradation of public housing to-gether with social disadvantage among the resi-dents; the concentration of marginal activities andpopulations in abandoned and polluted districts;and the degradation of settings of great historical,cultural and environmental value.

For each project, joint planning procedureswere instituted with the department heads and

Box 3.1. Atlas of the projects for a healthy and sustainable cityThe atlas of the projects for a healthy and sus-tainable city creates a cognitive picture of theoverall initiatives that can offer analyticaland operational support to formulating astrategy on urban planning for a healthiercity, a shared heritage on the good practicesin the institutional and voluntary sectorsaimed at promoting innovative and inte-grated urban planning procedures.

The Atlas includes urban planning projectsand other projects of different origins inwhich intersectoral work can potentially fo-cus on improving health. The urban planningprojects deal with several problematic dimen-sions such as housing, economics, greenspaces and spatial organization. The atlastherefore has many of them. Many are urbanregeneration programmes, some extensive ur-ban projects, renovation of old public hous-ing, projects for green spaces and publicspaces and environmental projects.

The social service projects are almost al-ways strictly sectoral but are sometimeslinked to urban planning or are situated in ar-eas affected by projects of another nature. Forexample, in this district the following wereselected: the Calvairate Psychiatric Project,which promotes mental health in disadvan-taged neighbourhoods; economic support fordistricts with urban degradation; and socialprotection projects in deprived public hous-ing neighbourhoods. The Environment and

Transport Department selected a series of po-tentially interesting projects: projects for sus-tainable mobility and projects on EcologicalSundays. The Portal initiative funded by theEuropean Union Urban II programme hasalso been considered. Finally, some projectsled by the City Department of Decentraliza-tion, such as an urban security and quality ofliving project and a neighbourhood watchproject, have been researched.

The initiatives of the local communitywere also explored. This aimed to determinethe topics of action from the viewpoints ofthe problems dealt with and the methods andtools used. In particular, we try to identify themost innovative actions, both in promotingactors and practices. These actions proposenew solutions – thematic, organizational andprocedural – to the emerging problems in theurban policies of the metropolis, and theprojects located at the crossroads between theproblematic dimensions are always consid-ered. These examples were useful in rational-izing the possibility of a more structured andfertile relationship between public operationsand the initiatives of the voluntary sector inMilan.

The atlas for a healthy and sustainable cityhighlights the richness and variety of plansand projects drawn up by the city govern-ment and the community.

some noninstitutional actors to identify the ap-propriate content and implementation measuresthat could enrich the projects through an inte-grated approach.

This innovative method (Box 3.2) enabled inte-grated proposals to be structured for the three dis-tricts and future action to be outlined in slightlymore than 1 year. Some of this action has alreadybeen started.

From experimentation to strengthening integratedplanning activity in MilanThe intersectoral and cooperative design associ-ated with the pilot projects produced positive op-erational results and also influenced the work andmethods of operation of the city administration.

In fact, the joint planning activity linked abroad group of government officers who custom-arily worked in separate sectors with no mutual



Box 3.2. Collaboration at work: initiating the pilot projectsTo formulate the pilot projects, we invited thedifferent officers responsible for sectoralprojects within the selected areas and otheractors active in the same areas to severalround-table discussions. Through structuredgroup discussion, we firstly identified thecritical points and the picture of the projectsunderway, verifying where they intersected,where they were at odds, aspects that dealtwith poorly or not at all and then the oppor-tunities to redefine, integrate and compile theresources and co-funding (seek additional re-sources). All participants brought to thesemeetings their own project (sector) and theirown vision (partial) of the problems. A collec-tive image of the territory and the action op-portunities of the pilot project was producedthrough a process of comparison and recipro-cal hybridizing.

The round-table discussions (five sessionsduring 1 year) marked each stage of the jointplanning project, from initially exploring theproblems and the existing opportunities toact to reconstructing integrated and enrichedproposals.

Between meetings, we had individual meet-ings to thoroughly investigate the varioushighlighted elements with all the participantsand with other actors, and the opportunity forinvolvement during the group discussionslowly emerged. The work parties were thusprogressively enlarged, bringing together abroader and broader complex of sectoral andintersectoral competencies. The participationof some associations and committees active lo-cally in the discussions brought the viewpointof the inhabitants to the working parties andhad a decisive role in the (re)construction ofthe planning process, its rules and its results.

For example, the sequence of working par-ties for the Molise-Calvairate pilot project wasas follows.

During the first meeting (November 2001),the healthy city and the healthy urban plan-ning initiatives were presented, and we ex-plained what we proposed to obtain throughthe working parties. Each participant thencontributed his or her own experience andknowledge of the neighbourhood and itsproblems.

During the second meeting (February2002), an initial proposal for formulating thedistrict project was presented, formulatedbased on personal meetings with the partici-pants. The intention to continue to constructan integrated project for the neighbourhoodwas outlined, both with the economic re-sources already available and with possibleadditional resources to be sought.

The third session (April 2002) took place asa workshop. The participants were dividedinto two groups to deal with the theme onthe agenda – an initial reflection on defininga grant proposal for a ministry neighbour-hood contract programme financing the re-generation of degraded neighbourhoods.

During the fourth session (June 2002), aninitial proposal of the Molise-Calvairate pilotproject was presented and modifications andadditions to the proposal were discussed toformulate a final document to present to thecity government.

In the last session (December 2002), the fi-nal proposal of the pilot project was pre-sented and discussed and the outline for itsimplementation was created, in particularthrough the neighbourhood contract tool butalso through other intermediate initiatives.

Overall, almost 20 council officers and 5representatives of external actors participatedin this process.

A scientific manager, an operations man-ager and two junior researchers from the De-partment of Architecture and Planning of the

communication. Community groups. which areusually excluded from policy-making, were alsoinvolved in this process, which demonstratedgreat effectiveness. Further, the process increasedthe interest of department heads in transferringthis approach to and anchoring it in the broadercontext of the city government.

As the first step, the City Manager and other sen-ior managers requested that a management docu-ment be formulated aiming to promote anintersectoral and cooperative approach focusing onpromoting health within urban policies. TheHealthy City Project staff therefore formulatedguidelines on promoting health in urban policies


Politecnico di Milano Technical University or-ganized this joint planning process togetherwith the staff of the Milan Healthy City Of-fice: the Healthy City Project Coordinator, asecretary and a consultant. This is a minimaland weakly structured organization that stillmanaged to initiate an increasingly structuredand legitimized process.

Finally, this planning process was accom-panied by a series of meetings with the topexecutives of the Milan Healthy City Project(the central manager of the Social Care De-

partment and that of the Social Services Sec-tor for adults, together with the heads of theother central departments most directly in-volved in the initiative, the Urban PlanningDepartment and the Environment and Trans-port Department) to present the work carriedout and the results gradually attained and tooutline possible developments. Intersectoralstructuring was thus also tried at this level, al-though with no formal coordination, and thisprovided the necessary decision-making sup-port for the trial.

Box 3.3. Guidelines on promoting health in urban policiesThe guidelines on promoting health in urbanpolicies at the city level in Milan identify the12 objectives from Healthy urban planning – aWHO guide to planning for people17 as the mainones to define the urban policies oriented to-wards well-being and improving the qualityof life. Indicators have been selected to guidethe city departments in assessing their activi-ties based on WHO documents, Agenda 21and some Italian documents.

The guidelines are the first scheme draftedto support Milan’s city health developmentplan by becoming the basis for interdepart-mental discussions and partners’ research.

The draft guidelines were developed in fivephases:

• identifying targets, criteria and indicatorsrelated to the principle of well-being andquality of life in key documents inside theWHO Healthy Cities project that could actas a reference point for public activity;

• organizing joint debates with the depart-ment officers directly involved in imple-menting policies and action aiming at de-veloping criteria and indicators;

• advancing the experimentation, withinsome pilot schemes, of an intersectoral andcooperative approach;

• incorporating the outcome of the experi-mental activity in the local guidelines; and

• adopting the guidelines as a common basisfor the city health development plan.



based on WHO documents16 and on the ideas andpractice developed in the pilot projects. The guide-lines provide a grid of principles, objectives, prioritycourses of action and indicators to orient the differ-ent departments towards improving health, well-being and sustainability in Milan (Box 3.3).

As the second step, the City Manager asked thatthe experimental stage of the integrated approachto urban policies be consolidated to establishwithin the City this innovative method of publicaction.

This perspective encouraged reflection on anew organizational solution that can embed pre-vious experience.

The Milan Centre for the Promotion of Inte-grated and Participatory Planning was thereforeproposed as the future healthy city structure: a re-search and development office of the City dedi-cated to compiling integrated projects to improvethe quality of life in Milan (Box 3.4).

Specific application: the pilot projectsThe pilot projects represent the most advanced ex-perience of the healthy urban planning processbegun in Milan. Its specific field of application in-cludes three districts characterized by interrelatedproblems.

Molise-Calvairate. Molise-Calvairate is one ofthe largest neighbourhoods (with more than 5000inhabitants) of public housing in Milan. It is situ-ated near the city centre; some of the district hasbeen influenced by major urban andinfrastructural projects designed to solve some lo-cal problems, but other parts are in crisis: seriouslyphysically degraded and the residents have socialand health disadvantages. For example, 12% ofthe population has mental disorders and many re-source-limited elderly people and long-term un-employed people live there.

Cascina Merlata – Via Barzaghi. Cascina Merlata– Via Barzaghi is a large district that surrounds thelargest cemetery in Milan. It has been designatedby urban zoning as a park, but illegal and at times

dangerous activities, functions and marginalpopulations have settled in, in particular verylarge groups of Roma, who create a situation of se-rious social and environmental emergency.

Chiaravalle–Nosedo–Ex Porto di Mare. Chiara-valle–Nosedo–Ex Porto di Mare is an extremelysprawled district at the south-eastern edge of Mi-lan, where the first sewage treatment plant in thearea is being built. The district has distinctive en-vironmental, landscape and historical assets. Con-nected to the settlement of the Cistercian Abbeyof Chiaravalle and the surrounding farming eco-system, this heritage is being seriously compro-mised by the processes of environmental and so-cial degradation brought on by urbanization.

Round-table discussions among institutionaland noninstitutional actors helped in definingsome integrated district projects for these threedistricts: the critical aspects to deal with, thepresent planning framework and the integratedaction proposals. These are articulated in prioritycourses of action that compile a series of specificactions and possible progress in implementation,including communication and activities aiming toinvolve local actors.

The pilot project for Molise-Calvairate in par-ticular proposes integrating operations to improveliving conditions and to alleviate and prevent so-cial disadvantage through a participatory processto enable the residents and local actors to definethe priorities and the structure of the integratedproject. To facilitate the process and to make surethe project could be realized, the healthy urbanplanning office is investigating submitting a pro-posal for financial support from the second roundof a ministerial programme for neighbourhoodcontracts, which allocates funds to regenerate de-graded neighbourhoods physically and socially.

The Cascina Merlata pilot project focuses on aproposed unconventional park that, together withthe green space and facilities for the surroundingneighbourhoods, will attempt to try out innovativemethods of action to deal with the disadvantage



Box 3.4. Proposal for a Milan Centre for the Promotion of Integrated and ParticipatoryPlanning

The priority tasks of the Milan Centre for thePromotion of Integrated and ParticipatoryPlanning (Fig. 3.1) will be:• integrating projects, beginning from the

sectoral plans underway, requiring anintersectoral approach open to the partici-pation of local actors that would then be

reinserted in the various parts of the citygovernment affected by their implementa-tion, which would maintain managementof the process;

• obtaining additional resources to supportthe implementation of projects, especiallyfunding from the European Union and Ita-ly’s ministerial programmes; and

• implementing neighbourhood or districtmanagement to implement local integratedprojects and especially to manage the par-ticipatory planning activities.

The Centre will link different sectors ofthe city government, especially those in-volved in the pilot projects in relation tothe specific projects.The Centre must develop and maintain re-lations with the actors and experiences ofthe local social actors that could be use-fully involved in the government projects,thus performing the functions of facilita-tion, support and coordination that are es-sential for effective involvement of the lo-cal community in public policies.

This is an initial hypothesis that stillneeds to be evaluated and developed furtherbased on similar experiences in other cities.

Fig. 3.1. Organizational dynamics intended toresult in the Milan Centre for the Promotion of

Integrated and Participatory Planning

and residential and social exclusion of marginalizedpeople, especially the Roma present in the district.This project was called, a bit defiantly, Social Cam-pus, to try to stimulate the search for innovativeideas related to the themes and problems that cur-rent policies often deal with poorly. In this case, wealso tried to provide effective operational output forthe proposal with the (few) existing resources andwith possible additional resources, for example,from the European Union Urban II Programme.

The proposal for the Chiaravalle–Nosedo–ExPorto di Mare pilot project reviews and orders the

different problems and projects advanced by vari-ous institutional and nongovernmental organiza-tions for these areas. The proposal articulates themalong priority action axes: promoting the cultural,social and spiritual aspects of Chiaravalle; givingpriority to the ecological, environmental and land-scape aspects of Valle della Vettabbia; and upgrad-ing the former Porto di Mare. The City Council orthe regional government had already approved andfunded some of these projects. The healthy urbanplanning staff therefore decided to concentrate onensuring integration and spatial continuity in sev-


eral project areas (the area of the sewage-treatmentplant, the Porto di Mare and Sports Village area, Ab-bey and the Village of Chiaravalle) and on strength-ening collaboration between the city governmentsectors involved in the various projects and sup-porting communication between institutions andsocial needs, improving the capabilities and skills ofthe local actors.

Problems and solutionsSimilar to other experiences of integrated policyprojects in neighbourhoods, this one also facedthe resistance to change by the sectoral apparatusof the city government. From this viewpoint, thecity government of Milan has only marginally de-veloped intersectoral approaches to urban plan-ning.

In the healthy urban planning process, the par-ticipation of council officers was basically volun-tary, being only allowed or suggested by the dis-trict executives and not provided for formally. Wetherefore had to promote their participation.However, we found fertile ground: almost all theofficers contacted participated in the entire proc-ess, often with enthusiasm, willingness and con-viction towards the validity of the intersectoralapproach adopted.

This work “with” and “on” the officers,through their involvement in a reflective processof learning, is one way to overcome resistance andinertia within the city government towards the in-tegrated approach. In fact, this can promote achange in administrative culture by creating alasting work style. Nevertheless, if this directionlacks organizational support, it risks being limitedin development. A new organizational solutionhas therefore been proposed to consolidate the in-tegrated approach.

Another problematic aspect was the interactionbetween council officers and local actors and be-tween the local actors and the researchers: the dif-ferent rationality and difference in language makethe relationship with the local actors especiallycomplex and demanding, certainly one of themost delicate knots of the entire process. Never-

theless, it is precisely the interaction with theseactors that inevitably slows down the process andredefines the problem with its occasionally disrup-tive cognitive and creative contribution. Thisvastly improves the quality of the planning,which is no longer solely an exercise in compari-son and interrelation between technical and pro-fessional knowledge and sectoral projects but alsointegration and comparison with the local knowl-edge, thereby increasing interpretive capacity andproducing effective planning solutions.

Opening the planning process to local actorsand networks is therefore a direction that shouldbe developed using suitable tools, capacities andsensibilities.

ResultsAchievementsThe process started in Milan of directly experi-menting with healthy urban planning is stillunderway; no final conclusions can be reached.Nevertheless, some initial achievements haveemerged at different levels.

The pilot projects are especially significantgiven the wide range of involvement of the cityofficers in the experimentation. This process of in-stitutional learning involving different depart-ments in multidimensional action might repre-sent a common basis for the potential develop-ment of an intersectoral approach to public ad-ministration.

Secondly, the results of these pilot projectscould ensure the durability of the process. In par-ticular, the Molise-Calvairate pilot project hasbeen chosen as a proposal for a government grantfor physical and social regeneration in disadvan-taged public-housing districts. This is an ex-tremely satisfying result and even somewhat un-expected. The other two projects also have goodopportunities to move on to implementation.

More generally, introducing this innovativemodel of experimentation on healthy urban plan-ning has aroused interest in the city administra-tion to reflect on the possible consolidation anddevelopment of this experience.

The City Manager requested guidelines on pro-moting health in urban policies to introduce theseprinciples into a wide range of public policies. Theidea of establishing a new unit to promote the in-tegrated planning process has also been drawninto the aim of making the pilot activity perma-nent. This project has only just been devised, butthe process is on the way.

Lessons learnedIntegrating the health dimension (in its broadestsense) into urban policies, especially planning, re-quires great conceptual and organizational effort.Some themes such as environmentalsustainability, the spatial quality of new settle-ments, reducing pollution, green spaces and facili-ties and regenerating physically degraded and so-cially disadvantaged districts already have an im-portant role in defining policies and projects. Nev-ertheless, the integrated treatment of differentproblems, including urban planning, health andthe environment, with a multidimensional refer-ence required by the concept of health, still needsto be developed.

The pilot projects demonstrate the potential ofthe integrated approach but highlight the prob-lems this entails. Dealing with problemsmultidimensionally enables planning processes tomore effectively improve the quality of life andhealth of local residents. This includes integratingphysical upgrading with social, environmental,cultural, training and occupation interventions.

Compiling the various policies of the city gov-ernment is not a simple summation of sectoral ac-tivities but requires creating a new framework foraction that generates innovative and effective po-tential, as the round-table discussions between of-ficers demonstrated well. Integrating the interven-tions promoted by the city government with theactivity of the local actors and with the needs andrequests of the community is more likely to meetthe real local need, to produce a sense of belong-ing in the local community and to build up rela-tions of trust between local actors, inhabitantsand institutions.

Collaboration is required to proceed alongthese directions: constructing agreements and me-diating any conflicts between the public and pri-vate actors involved in the processes. This meansthorough innovation in the operating methods ofthe public administration, especially in its rela-tionship with private actors. This may lead tomany conflicts and problems. Officers have dem-onstrated considerable interest in the intersectoralwork within the city government, but consoli-dated methods of operation tend to counteract in-novative change. In addition, interaction with thelocal practices and the involvement of residents inplanning processes is made difficult by poor recip-rocal trust and even conflict.

Nevertheless, the development of the healthyurban planning project in Milan demonstrates thepossibility of the positive evolution of participa-tory intersectoral models. In the future, the prob-lem is how to turn this “extraordinary” way of op-erating into ordinary practice.

Development prospectsThe healthy urban planning project in Milan hasmany development prospects, although they areall linked by the guiding idea of disseminating theintegrated approach in Milan’s urban policies, tomaintain all the resources (cognitive, relationaland technical skills) built up so far in the experi-ments carried out.

In this sense, one possible direction of strategicdevelopment is to consolidate the organizationalwork formula that has been gradually structuredaround the formulation of the pilot projects. TheMilan Centre for the Promotion of Integrated andParticipatory Planning is a proposal to move to-wards this, to try and take on this problem ratherthan to foreshadow an already defined solution.In fact, we plan to start discussing and evaluatingthe various hypotheses of consolidation and to tryout organization formulas for establishing andpromoting the pilot projects in the city govern-ment structures.

The development of the already defined pilotprojects is another fundamental perspective, ac-



companied by the idea of progressively extendingthe number of integrated projects, until a truefleet of integrated projects can be built up to inter-cept the opportunities of implementation andfunding offered by European Union programmesand the programmes of Italy’s ministries.

Finally, another important development pros-pect is to be able to transform the guidelines forpromoting health in urban policies into the for-mulation of a city health development plan that

delineates the more relevant areas of operationand sets priorities among the common actions ofthe city government but also of other economicand social components, according to what hasbeen suggested in the Milan Healthy City Project.This must still be constructed, placing the healthyurban planning approach in relation to the otherpolicies of the city government, especially formu-lating the new services plan for Milan.

4.Decentralized integration: the experience of Gothenburg, Sweden

Ingrid Sondén18

Gothenburg has achieved an impressive integration of planning and health at all levels of operation, breakingdown traditional institutional barriers. Especially interesting is how planners are involved alongside social work-ers, health workers, the police and voluntary groups in local health groups across Gothenburg.

City profileGothenburg (Göteborg in Swedish) is Sweden’ssecond largest city, with 475 000 inhabitants. To-gether with 12 surrounding municipalities, itforms the Gothenburg Region with 850 000 in-habitants. The city is located on the west coast ofSweden at the mouth of the River Göta. The city isvery green with large parks and green spaces, evenclose to the city centre. The nearby sea and an ar-chipelago give good opportunities for leisure ac-tivities. By tradition, Gothenburg is a trade andmanufacturing city. Even after the shipyard indus-try has closed, almost one fifth of the labour forceis working in manufacturing, mostly car manufac-turing and biochemical industry. The service sec-tor is the most rapidly growing sector. Gothen-burg is also an important university city withabout 30 000 students, which gives the city ayoung population. About one fifth of the citypopulation was born outside Sweden.

The population is increasing, and Gothenburgis planning for many new dwellings, businessesand new infrastructure. Settlement has been dis-persed during recent decades, and car transport isextensive. The topography with rocky hills andriver valleys with large roads in between contrib-ute to a problem with air quality. Reaching ourenvironmental targets will be difficult unless wemake efforts to invest in infrastructure for publictransport or manage to reduce car transport andair pollution in other ways.

Another problem also linked to spatial plan-

18 Senior Executive, City Planning Authority, Gothenburg, Sweden.

ning is housing segregation. Sweden has long at-tempted to equalize wages and living conditions,but in the past decade the gap between classes hasincreased. People with higher incomes move fromthe less attractive districts of the city, and peoplewith low income, including many immigrants, areconcentrated in these districts. People’s healthalso differs in different parts of the city. Thechanges in fiscal policy have contributed to thedisparity even if the resource distribution com-pensates to some extent. Both the city and the re-gion consider the disparity to be a great problem.

The planning systemThe municipalities in Sweden are responsible forurban planning, and the municipal council takesthe broad planning decisions. The state, throughits regional administration, provides guidance andsupervises national interests. Every municipalityhas to make a municipal comprehensive plan thatcovers the whole territory of the municipality. Ithas to be revised every 4 years. The municipalcomprehensive plan, which deals with the long-term strategic aspects of land use, is not legallybinding. Detailed development plans cover onlyan area that is to be developed in the near future.They are more detailed and include the right todevelop in accordance with the plan. In Gothen-burg, the City Planning Authority deals with plan-ning and building issues. The municipal compre-hensive plan as well as detailed development

DECENTRALIZED INTEGRATION: GOTHENBURG . 25


Box 4.1. The Gothenburg Council – Safer, Better and More SecureThe crime rate in Gothenburg is not veryhigh. The reported crime per capita is lowerthan in the other two largest cities in Swe-den, Stockholm and Malmö. Nevertheless,the citizens are dissatisfied and concernedabout the crime situation.

To channel people’s urgent concern aboutthe crime situation, the Gothenburg Council– Safer, Better and More Secure was estab-lished in January 2001. Its mission is to coor-dinate, increase knowledge of and createopinion around crime prevention. The Coun-cil works with direct social work–oriented ef-forts and with the physical environment.

Such projects take a wide approach, andthe Council cooperates with the districtcouncils for crime prevention, the publichealth council, the police, traffic and publictransport office, art administration, the uni-versity and institutes of higher education, the

correctional services, businesses, youth work-ers, drug prevention organizations and localclubs and associations and especially with theCity Planning Authority.

A planner from the City Planning Author-ity works half time for the Council and thesecond half for the City Planning Authoritywith safety questions. The Council is a greatresource for urban planning. It provides inter-faces with research and continuing education.Several conferences and seminars have beenarranged that many planners have attended.The cooperation has also resulted in a mapdatabase over reported crimes that needs tobe analysed together with the police. Usingthe competence of the group and implement-ing knowledge in the planning processes areimportant. The city government considers thework very urgent and has just decided to ex-tend the project.

plans integrate planning for roads, railroads andtraffic with land use. The City of Gothenburg co-operates closely with the state, which is responsi-ble for large roads and railroads, as well with themunicipality-owned company that provides pub-lic transport for the region. Many agencies are in-volved in urban planning, such as the depart-ments responsible for transport, park and land-scape administration, property management andenvironment and the 21 district committees.

The healthy urban planning storyGothenburg has been a member of the WHO Eu-ropean Healthy Cities Network since 1988 and hasinitiated many activities to improve health. Allcity departments have been engaged in differentways over the years. In Gothenburg’s healthy citypolicy, the planning departments showed theircontributions to improving the health of the in-habitants. In the third phase of the WHO Euro-

pean Healthy Cities project, when healthy urbanplanning was one of the special themes, the plan-ning departments have been more engaged in thehealth issue. Healthy urban planning has alsobeen on the agenda at the national level in Swe-den, with several conferences and documents onthis concept.

There is a consensus among politicians andplanners in Gothenburg that paying attention tohealth implications is important in shaping thephysical surroundings. Health aspects in planningare not new, but health and security inGothenburg’s planning documents were previ-ously more linked with factors directly linked tohealth and safety such as drinking-water quality,sanitary conditions, road safety, noise and con-struction stability. Gothenburg also has a long tra-dition of working with social and welfare issues inplanning and of using many concepts related to awider definition of health.

In the past decade many aspects and perspec-tives have been in focus for the planning inGothenburg, as in many other cities. For example,we have worked for many years with the genderperspective and, through this, worked on safety is-sues. We have also strongly emphasized environ-mental issues for many years and have introducedenvironmental impact assessment, includingsome health issues, in the detailed developmentplans. We have worked with social aspects andsometimes placed democracy as the main princi-ple for a plan. The focus has gradually changed toa citizen perspective. The latest municipal com-prehensive plan in 1999 has empowerment as oneof the most important objectives besidessustainability and competition. Empowermentmeans that everyone can live an active and mean-ingful life. It emphasizes that the city is not only aphysical structure but also, perhaps most of all,the sum of its citizens.

Healthy urban planning was a new planningconcept discussed at the First Seminar on HealthyUrban Planning in Milan in October 199919 andthrough Healthy urban planning – a WHO guide toplanning for people,20 the book produced after-wards. WHO’s definition of health, in whichhealth is not only the absence of disease but in-cludes human well-being and the quality of life, isa valuable aim of planning activities. It put themost central mission in focus and integrates manydifferent aspects of planning principles.

When Gothenburg joined the WHO City Ac-tion Group on Healthy Urban Planning, westarted a Healthy Group at the City Planning Of-fice, with the special task of improving our workwith the health aspects of planning and buildingactivities. The Healthy Group consists of peopleworking in different stages of the developmentprocess: planning, building permits and buildinginspection. The Group studied Healthy urban plan-ning – a WHO guide to planning for people and

found that most of the content applies to ourplanning. The Group discusses different plans andbuilding permits from a health viewpoint andtries to find a way to use the opportunities forevery level in the planning process. In recentyears the question of safety and security has beenin focus in the city, and the Group has taken anactive part in this work. The Group cooperatesclosely with the special organization CouncilGothenburg – Safer, Better and More Secure (Box4.1). Through contact with them and the local po-lice, we improve people’s knowledge of how to re-duce crime and improve safety.

Another form of cooperation that has developedin recent years is with the local public health groupsunder the district committees, which are responsi-ble for public health. It gives the planners goodknowledge of local conditions and opportunities tocontribute to improving the environment.

Increasing the level of awareness and knowl-edge of the opportunities to improve the qualityof the urban structure and neighbourhoods is im-portant. In the past year, the City Planning Officehas arranged a series of seminars on varioushealth themes, such as green spaces and their im-portance for health, how to decrease car use invarious ways and how to create a safer citythrough planning (Boxes 4.2, 4.3).

Cooperation and knowledge is important aswell as common objectives. Gothenburg does con-siderable work to integrate health aspects in awider sense into planning. The concept of healthis beginning to be used more frequently in ourplanning documents, but we need better instru-ments to follow it up correctly. Even if getting ac-ceptance for health considerations is easy intheory, following them up in practice is not al-ways easy. Many things must be in focus andother factors, often economic, take over. Some-times even different health considerations can becontradictory.


19 Healthy urban planning: report of a WHO seminar. Copenhagen, WHO Regional Office for Europe, 1999(http://www.who.dk/eprise/main/who/progs/hcp/UrbanHealthTopics/20020604_1, accessed 8 September 2003).



The concept of healthy urban planning is a use-ful concept and sounds very good in English.Finding a good translation in Swedish is more dif-ficult. Such terms as well-being and the quality oflife can be more useful. Having a leading themefor the planning and a concept that can integrate

Box 4.2. A safe and beautiful city (trygg vacker stad)The City of Gothenburg is working on vari-ous fronts and in various ways to improve thecity environment to make it more attractiveto residents and visitors.

Trygg vacker stad is collaboration betweenvarious city bodies and private organizationsto ensure that Gothenburg becomes a safe,clean and attractive city.

Each body has different assignments, re-sponsibilities and various competencies. Thecommon objective is to increase the qualityof public space and to provide a nice, beauti-ful and safe urban environment, with poten-tial for economic growth and increased wel-fare for the citizens.

Striving together towards the common ob-jective provides synergy, which benefits thecause and is far more effective than indi-vidual efforts made by each administration.The idea is to focus on and to give priority tocertain matters.

In top focus today are questions of safetyand beauty.

Within the framework for the collabora-tion there are various projects in progress. In

a long-term perspective, there is work withpolicies and programmes.

This includes an urban design programmeensuring that the appearance of public spacesin each district reflects the individual charac-ter of the district. It also includes a policy forlighting the city and actions against graffitietc.

Trygg vacker stad also includes concrete ac-tions linked to certain funds directed to ur-ban renewal.

A present project is upgrading the environ-ments for pedestrians in urban districts: pro-viding good lighting, park benches and litterbaskets and pruning the vegetation. The aimis that people will feel more comfortablewalking around at any hour without incon-venience. Special care is taken on main pathsand streets that connect public housing areaswith public transport stops.

This project involves the City Planning Au-thority, the Traffic and Public Transport Au-thority, city district administrations and prop-erty owners in a joint effort.

the many different aspects required to create ahealthy city is important. We will probably startto work with our next municipal comprehensiveplan and anticipate that health will be a centraltheme in that plan.

Box 4.3. Manual for safe and secure walksThe City Planning Authority had collaboratedclosely with local public health groups in re-cent years to improve the quality of the envi-ronment and make it more safe and secure.Through this work, we have come in touchwith many local groups and people interestedin improving the environment. We started tomake inventories of the neighbourhoods toidentify places where people felt unsafe towalk or stay. Many people were involved inthese “safe and secure walks”.

Public health workers or other people fromthe city district administrations usually takethe initiative for the walks, but sometimeseven district councils for crime prevention orindividuals can do this. People who live orwork in the area have the best knowledgeabout their own environment, and listeningto them is important. We wanted to share theexperience from these first walks and decidedto publish a manual.

The manual makes effective safe and securewalks easier. The manual includes what to

think about before the walk, a checklist aboutwhat to observe during the walk and how itcan be followed up.

The manual recommends observing threeperspectives: maintenance, design of build-ings and structures and design of city plans.Maintenance. For example, where does veg-etation need to be pruned to improve visibil-ity? Where are the lamps broken? Where arepaths, stairs and banister repairs needed?Where are more park benches and wastepaperbaskets needed?Design of buildings and structures.Where do walls block the view and where arethere dark and creepy car parks? How are en-trances, lighting, subways and bus and tramstops designed?Design of city plans. Are there any deso-lated, unsafe and insecure spaces? Is it diffi-cult to orient oneself between the blocks? Arethere barriers to moving between neighbour-hoods?



5.Health-integrated spatial planning: the experience of Sandnes,NorwayMarco Zanussi21

Participation in the WHO City Action Group on Healthy Urban Planning led to Sandnes’ health planning processbeing integrated with the spatial development plan, bringing considerable benefits not only in policy consistencybut also in public and political involvement in the overall health strategy.

Sandnes is centrally located in the region. Thetown centre lies at the bottom of a fjord withsteep hillsides – a challenging topography for de-velopment. Forests and mountains close to thetown are attractive for all kind of outdoor activi-ties. A coastline of about 100 km is an excellentrecreation area for all inhabitants of the region.Sandnes is expanding very rapidly, with an annualpopulation growth rate of nearly 2%.

Sandnes is a transport centre in the region. Themain roads through Nord-Jæren, E39, and routes44 and 13, all meet in Sandnes and then split todifferent parts in the district. This is both an ad-vantage and a challenge for the town.

During the last two decades, Sandnes has trans-formed from an industrial town to a service andcommercial town with a high rate of employmentin oil-related activities and consultant services. Re-tail trade is well developed, and Sandnes is one ofthe two regional centres for more specialized retailtrade with a modern and varied selection of mer-chandise. The centre of Sandnes is mainly a com-mercial centre and has been extensively modern-ized in recent years, although it has maintainedits architectural characteristics. The centre still hasa great potential for development and moderniza-tion.

The Nord-Jæren region is one of the most rap-idly expanding in Norway as a result of a flourish-

21 Senior Planning Officer, Municipality of Sandnes, Norway.

ProfileSandnes has about 55 000 inhabitants. It is part ofthe Nord-Jæren region, a continuous conurbationof about 200 000 inhabitants in four municipali-ties. The capital of the region is Stavanger, with105 000 inhabitants.

ing economy mainly connected with oil-relatedactivities. At the same time, because of challeng-ing geography, the region lacks new, centrally lo-cated expansion areas, except for high-value agri-cultural land and natural recreation areas. In fact,Sandnes is the only municipality with relativelygood expansion potential to satisfy the demand ofthe whole region. Sandnes is also important foragricultural production, however, and the mainchallenge for development planning today is con-flict between local expansion plans and nationalobjectives for preserving agriculture.

Norway’s political system is based on the na-tional, regional and municipal levels. Local devel-opment planning at the municipal level is influ-enced by national policy guidelines aimed at pro-tecting overall national interests such as protec-tion of the cultural heritage and agricultural land,

integrated planning of land use and transport andmaintaining the main road and rail system.

The regional level influences local planningthrough county plans that include the publictransport system, land use and retail trade and in-dustrial development.

National and regional bodies more strongly in-fluence local community planning and develop-ment than in many other countries through direc-tives and regulations that are often very detailed.

Sandnes as a healthy citySandnes joined the WHO European Healthy CitiesNetwork in 1991, at first as an integrated part ofthe municipal administration, and later in 1994 asa separate Healthy City Office. Many initiativesand projects aimed at improving health and envi-ronment protection have been carried out since

HEALTH-INTEGRATED SPATIAL PLANNING: SANDNES . 31

Box 5.1. Sandnes Bike CityThe aim of Sandnes Bike City was to profileSandnes as one of the two cycle towns in Nor-way, to promote cycling as the main means oftransport for as many residents as possibleand to reduce motoring in privates cars.

Many projects have been carried out underthis common name since 1991, to promotecycling and to create facilities for cyclists. Ad-ministrators and politicians at all levels havebeen involved in various projects such as:• planning and building the main cycle pathsystem for the city centre and for the periph-eral neighbourhoods;• planning and building parking stands forcyclists;• making a cycle map for Sandnes and theregion;• implementing several campaigns promot-ing cycling;• planning recreation routes for cyclists; and• planning and carrying out a city-bike sys-tem that is free of user charges.

The main purpose of the project was to en-

courage daily cycling and reduce car-drivingboth for commuting and for recreation. Thishas an environmental protection componentand a health component. The health compo-nent is in terms of daily exercise, fewer roadaccidents and less air pollution.

About 70 kilometres of cycle lanes and 400parking stands with space for about 400 bicy-cles have been built. Sandnes was the firsttown in Norway offering free city bikes in1996. A special bicycle and a special elec-tronic lock system were constructed, and 225city bikes are now spread throughout thetown centre in 40 racks.By implementing measures to facilitate bicy-cling in the urban area, Sandnes has gainedexperience that could be useful to other Euro-pean towns. Sandnes is participating in aseparate project (SAVE II) under the directionof WHO and the European Union, in which itwill work closely with one or two Europeantowns that want to give priority to promotingthe increased use of bicycles.


1991, both at the regional and local levels.In the early 1990s, Sandnes joined a national

project launched by the Ministry of the Environ-ment involving the ten largest urban regions. Thisproject has been clearly linked with healthy urbanplanning, the main objective being to reduce cartransport and to encourage cycling, walking andpublic transport.

The project’s main strategy has been to pro-mote sustainable development through a plan-ning process in which land use, transport and en-vironmental protection were integrated in a long-term perspective. Based on the results of theproject, the Ministry of the Environment grantedfunding to the region and the municipalities forimplementing road safety initiatives, public trans-port lanes and cycle and pedestrian paths.

Sandnes Bike City (Box 5.1) started within thiscontext, and Sandnes became one of the two cycletowns in Norway.

As a result of strong national directives and the

Municipality’s engagement in the healthy citiesmovement and Agenda 21, in the early 1990s theSandnes Municipal Council instituted both a Chil-dren’s Representative in political bodies and theChildren’s City Council.

The Children’s Representative in political bod-ies was introduced in Sandnes’ political life as aresult of changes in the Planning and Building Actrequiring municipalities to appoint an officer withspecial responsibility for managing the interests ofchildren (0–17 years of age) in planning. This ar-rangement is now well integrated in the politicalsystem of Sandnes. The Children’s Representativeattends the meetings of the Urban DevelopmentCommittee and makes statements and commentsabout all local development plans involving chil-dren’s interests.

The Children’s City Council was instituted inabout 1995 to stimulate young people to increasetheir understanding for and participation in theMunicipality’s political activity and to give them

Box 5.2. The Children’s City CouncilThe Children’s City Council was instituted toencourage young people to increase their un-derstanding for and participation in the Mu-nicipality’s political activity and to give themthe opportunity to manage their own inter-ests in planning.

Every year the Sandnes Municipal Councilallocates money that the Children’s CityCouncil may grant for short-term projects.Each class in primary and secondary schoolmakes proposals for how to use the budgetedmoney and prepares questions to be answeredby the Municipality.

The school council sets priorities and pre-pares the school’s proposals and questionsand elects two delegates to the Children’sCity Council.

Every year in November, two delegatesfrom each primary and secondary school inSandnes gather in the town hall:

• to pass resolutions on the use of the moneyallocated; and• to question the municipal leaders on issuesrelated to children’s interests.

The Children’s City Council is an excellentway for the Municipality to obtain an under-standing of what is important for children.Children get an understanding of how de-mocracy and the Municipality works.

Since 1997, Sandnes has been cooperatingwith five upper secondary schools in Latviaand five in Croatia together with the StrandSecondary School in Sandnes and with sup-port from Rogaland County and Norway’sMinistry of Foreign Affairs. The backbone ofthis scheme to promote children’s democraticparticipation is the Children’s City Council inSandnes. Models for increased school democ-racy inspired by the work in Sandnes havebeen established in both Croatia and Latvia.

the opportunity to manage their own interests inplanning (Box 5.2).

Between 1998 and 2000, Sandnes was involvedin making a regional land-use and transport planin following up the national project mentioned.One of the main postulates of the plan was thathigh density in urban settlements permits sustain-able land-use planning and sustainable transportsystems. Towns should therefore mainly developwithin their current boundaries instead of ex-panding outwards into valuable rural areas andpotential recreation areas. By concentrating newresidential and workplace areas alongside high-ca-pacity and high-frequency public transport arter-ies, mainly within current boundaries, the re-

gional plan aimed at reducing car transport andincreasing public and non-motorized transport.

Another important project related to healthyurban planning for children was carried out be-tween 1999 and 2001: the children’s trails project.

The Municipality extensively registered chil-dren’s trails. These are areas and tracks that areimportant for children’s games and physical ac-tivities. The municipal comprehensive plan con-tains separate targets and initiatives aimed at en-suring that areas defined as important for thephysical activities and development of children inthe children’s trails project are considered andpossibly preserved through spatial planning anddevelopment (Box 5.3).


Box 5.3. Children’s trails projectThe objectives of the children’s trails projectwere:• to strengthen and make visible the inter-

ests of children in municipal planning;• to give children the opportunity to partici-

pate in and influence how their environ-ment is used and shaped;

• to provide a better decision platform for fu-ture land use; and

• to carry out national directives for manag-ing children’s interests in planning.

Children 8–13 years old, schoolteachers andnursery school teachers were involved in theproject. A steering group from the municipaladministration was responsible for overall de-cisions and budget. A reference group pro-vided professional advice, and a project leaderwas responsible for carrying out the project.The Sandnes Municipal Council endorsed theproject’s final report and decided that all spa-tial planning should take it into account.

The project included several steps. Chil-dren in all schools were asked to record onmaps their own use of all kinds of areas. As asupplement to map registration, childrengave qualitative information about areas and

paths. What was positive about the areas?Why is it good being there? Is there anythingthat can be done to improve the areas? Allthe mapped information has been trans-formed into digital form and is availablethrough the municipal mapping program andintranet system.

Managing children’s informal play andmoving areas improves children’s quality oflife and makes them identify with the localneighbourhood and thereby improves theirwell-being and health.

Children’s trails registration is now consid-ered and evaluated as a permanent routine inall spatial planning processes.

Municipal and private planners proposinglocal development plans are strongly re-quested to use the mapped information fromthe project in their planning, to take into ac-count and possibly include in their plans in-formal children’s paths and play areas.

The Children’s Representative in the Mu-nicipality ensures that the registered chil-dren’s trails and playing areas are taken intoaccount.


The Healthy City Office had been working on adraft proposal for a health development plan forSandnes when the work of the WHO City ActionGroup on Healthy Urban Planning started in June2001. The preparation of the municipal compre-hensive plan had also started.

Since the municipal comprehensive plan is the

main long-term document directing the Munici-pality’s activity, the working group for the munici-pal comprehensive plan realized that using theproposal for the health development plan as achapter of the municipal comprehensive planwould be the best way to introduce the concept ofhealthy urban planning in Sandnes. The compre-

Fig. 5.1. Relationship between the municipal comprehensive plan and city health development plan in Sandnes

hensive participation process usually carried outfor the municipal comprehensive plan would en-sure that the concept of healthy urban planningreached all politicians, all institutions and organi-zations and most of the citizens. Regional and na-tional authorities would also be involved in theparticipation process.

Thus, the working group proposed a scheme forrelating the two plan documents to the municipalcommittee responsible for the municipal compre-hensive plan (Fig. 5.1).

Healthy city: nature, culture and health wouldbe one of three in-depth subjects included in therevised municipal comprehensive plan (Box 5.4).This in-depth area would constitute the main coreof the city health development plan, and thus itwould become an integrated part of the overallmunicipal governing document (the municipalcomprehensive plan) as well as a separate plan-ning document.

Thus, the city health development plan wouldessentially be an action plan dealing with con-crete initiatives and actions The plan’s key princi-ples, objectives and strategies would be deeplyrooted in the municipal comprehensive plan andachieve institutional weight because of this.

The municipal comprehensive plan committeeand later the Sandnes Municipal Council acceptedthe proposed scheme. The municipal comprehen-sive plan for Sandnes was adopted on 5 November2002. Its main strategies for land use were:• to give the town good growth opportunities in-

side and near existing built-up areas using exist-ing infrastructure while preserving valuable ag-ricultural land, natural recreation areas and ar-eas important to biological diversity;

• to contain expansive land use by promotinghigh density in new development areas and byregenerating existing built-up areas such as dis-used industrial districts near the old centre;

• to contain any further increase in car traffic bylocating new dense development alongside ex-isting and future public transport arteries suchas existing local railways and a future light-railsystem connecting the whole region; and

• to ensure good non-motorized transport be-tween the different parts of the town and be-tween the town and the region through a strongand continuous regional green space network.

The chapter on healthy city: nature, culture andhealth is an important part of the municipal com-prehensive plan and is clearly related to some ofthe plan’s main objectives such as sustainable de-velopment, good and equitable living conditionsand efficient local democracy. The philosophy be-hind the chapter is simple and clear.

In Norway’s affluent and well-organized soci-ety, human health and well-being depend verymuch on how everyday life is organized. Do Ihave to commute by car? What kind of contactcan I have with nature? What cultural and recrea-tional activities can I join? Is my neighbourhoodsafe? Are there pedestrian and cycling routes be-tween my home, workplace, the city centre, localopen space and natural recreational areas such asagricultural land, forests and the seashore? Do Ifeel at home in my neighbourhood? Is it a healthyand attractive place to live? Do I feel safe when Iam in the town centre? Is it easy to meet friendsand to join cultural and social activities withouttoo much stress, noise and insecurity? Good spa-tial planning should provide appropriate answersto these questions.

The main strategies outlined in the chapter onhealthy city: nature, culture and health are:• integrating health, well-being and environmen-

tal protection as central principles for the Mu-nicipality’s service delivery and achieving thisthrough continual monitoring and develop-ment of tools, methods and cooperation;

• introducing permanent routines to ensure re-spect for health and the environment in plan-ning and service delivery;

• continuing efforts to promote health, well-be-ing and environmental protection through theinvolvement and participation of all parts ofthe municipal organization;

• actively participating in cooperative projectswith other towns and municipalities in Scandi-navia and Europe to share experiences and to



encourage efforts to promote health and envi-ronment protection;

• continuing cooperation with municipalities incentral and eastern Europe to strengthen de-mocracy both there and in Norway;

• actively assisting other European municipalitieswith experience about improving cycling intowns;

• working for good conditions and accessibilityfor disabled people;

Box 5.4. Policies in the municipal comprehensive plan – examples from the chapter onnature, culture and healthIntegration of health and theenvironment• Integrate health, well-being and the envi-

ronment as central values for the Munici-pality’s provision of services. The integra-tion work is to take place through continu-ous testing and development of workmethods and cooperation.

• Introduce regular routines to ensure con-sideration of health and the environmentin the planning and provision of services.For example, use a separate checklist to as-sess the likely effects on health and the en-vironment in connection with local devel-opment plans and planning applications inaccordance with the environmental planfor Sandnes.

Continue the work to improve health, well-being and the environment through the in-volvement of and participation by all parts ofthe municipal organization.

Internationalization and solidarity• Sandnes will participate actively in joint

projects with other towns and local au-thorities in the Nordic countries and therest of Europe to exchange experience andpromote the work aimed at improvinghealth and the environment in Norwayand elsewhere.

• Sandnes will continue its cooperation withcities in central and eastern Europe tostrengthen democracy both there and inSandnes. This cooperation is linked withthe Children’s City Council in Sandnes.

Sandnes will actively assist other cities in Eu-rope in the effort to promote increased cy-cling in urban areas.

Disabled people• Adapt public buildings, means of transport,

areas and services to ensure that disabledpeople can use and gain access to theseservices in the same way as people withoutdisability.

• Prepare and follow up a separate plan formunicipal tasks in relation to disabled peo-ple.

• Endeavour to ensure that more disabledpeople can obtain employment.

Impose requirements relating to life-cyclestandards for a percentage of homes in all de-velopment plans.

Ensure the well-being of children• Sandnes will stimulate and make arrange-

ments to ensure the well-being of childrenand provide safe, stable and challengingactivities in urban areas.

• Cooperation with parents, the volunteersector and the adult population in generalis especially important to achieve positiveresults in this type of work.

• In particular, Sandnes will ensure thatavailable knowledge about the wishes andneeds of children forms the basis for priori-ties and initiatives (including input fromthe Children’s City Council).

• Let adolescents assume responsibility fortheir own choice of lifestyle and relevant

lifestyle-related problems associated withtheir own health and well-being.

• Support the schools in teaching, guidanceand cultural education.

• Help ensure that as many young girls aspossible finish their education.

• All children in Sandnes will be offeredyouth centres near the areas where theylive.

All new schools will be planned and adaptedto a broad range of activities in their localcommunities (local community facilities).Provide and develop good residentialand local communitiesOn its own initiative, in cooperation with thevolunteer sector or other public bodies, theMunicipality of Sandnes will endeavour:• to establish meeting venues;• to develop local cooperation forums, such

as welfare organizations;• to develop good quality green spaces;• to develop interesting activities for chil-

dren; and• to help to develop residential areas with a

high technical and aesthetic quality.The Municipality will work together withhousing cooperatives in developing guide-lines for planners, decision-makers, develop-ers and inhabitants about considerations thatare important in developing good residentialareas.

Stimulate outdoor activities andadventures in the local community• Sandnes will make arrangements for and

promote bicycle riding in the town and ru-ral districts to improve general health, tocreate a pleasant urban environment andgood local communities and to reduce pol-lution and accidents resulting from the useof private cars.


• Sandnes will make provisions for and in-form about the opportunities for an all-round outdoor life.

Stimulate physical activities, for instancethrough such projects as Healthy in the Out-doors.

Work to improve safety and preventaccidents• The Municipality of Sandnes will endeav-

our to reduce to a minimum the human,material and societal costs caused by acci-dents.

• To ensure the best possible road safety,Sandnes will actively follow up theadopted traffic safety plan.

• Sandnes will prepare a separate strategy forimproved safety and security in Sandnes by2002. The strategy will be based on currentplans for accident prevention in Sandnesand will focus on the opportunities for co-operation with private citizens, volunteersand other public agencies.

• Residential areas will be planned to achievethe best possible safety and security interms of traffic, play, everyday life andcrime prevention.

Refugees and immigrants• Sandnes will implement initiatives in ac-

cordance with the adopted action plan forimmigrants and refugees.

• Sandnes will make arrangements to ensurethat immigrants have a good and inte-grated life in their local communities.

• Sandnes will inform and help immigrantsin relation to the requirements and chal-lenges of Norwegian society.

• Sandnes will follow up the plan for coop-eration, participation and qualification.

Make arrangements to ensure that more im-migrants and refugees obtain gainful employ-ment.


• promoting safe, stable and challenging condi-tions in which children can grow up;

• providing good and safe community environ-ments;

• encouraging activities and experiences in thenatural environment; and

• promoting safety and accident prevention.

Prospects and conclusionsThe most important result in the attempt to im-plement healthy urban planning in Sandnes isthat health and environmental protection arenow fully integrated as a main topic for Sandnes’further work with urban development and provi-sion of services.

A healthy city has become one of the three in-depth subjects of the municipal comprehensiveplan. As this plan is the main long-term docu-ment directing the Municipality’s activity, all sec-tors will be involved in fulfilling these strategies.

To ensure that health and good living condi-tions are given due consideration in planning,Sandnes has introduced a checklist for health andenvironmental impact to be used for all local de-velopment proposals and plans.

We have come a long way in establishing rou-tines for providing good living environments. Wehave also made considerable efforts in shieldingresidential areas from traffic noise, and we areworking efficiently and purposefully to ensurethat everyone has a satisfactory water supply.

The inhabitants have even better opportunitiesfor adventure and recreation in their local envi-ronment, as more areas have been prepared forrecreational use. Cycling opportunities are con-tinually improving in Sandnes. The endeavour toimprove the indoor climate in the schools is animportant contribution to improving publichealth.

6.Prizing open the barriers: the experience of Belfast,United KingdomVictoria Creasy22

Belfast is still a divided city, and in 2003 the central government still makes decisions. In this situation, thehealthy urban planning initiative is breaking down barriers to cross-agency cooperation and developing techniquesof assessing the quality of life and encouraging participation.

The City of BelfastThe City of Belfast lies at the head of BelfastLough on the River Lagan and has a striking land-scape setting, flanked by hills and mountains. Itbecame the capital of Northern Ireland in 1921.The area covered by the local authority, BelfastCity Council, has a population of 280 000. So-cially, Belfast underwent tremendous change overthe last three decades of the 20th century. Civil

unrest created bitter divisions and left Belfast oneof the most deeply segregated cities in Europe.The violence, coupled with massive public hous-ing redevelopment, led to a huge exodus of peoplefrom Belfast from 1971 to 1991, with most mov-ing to satellite towns on the fringe of the city. As aresult, the population of the city decreased by onethird during this period. The population level,however, has gradually stabilized in recent years.

Belfast has traditionally been an industrial city,the main industries being shipbuilding, aircraftmanufacture, textile production and engineering.Many of these traditional industries, however,have either disappeared or are in decline. Unem-ployment is concentrated in particular disadvan-taged areas of the city, with 12 of Belfast’s 51wards (24%) accounting for 40% of total unem-ployment within the city.

Politically Belfast has seen a dramatic transfor-mation over the past 6 years. As part of the peaceprocess, a new power-sharing local assembly wasestablished, which returned decision-making pow-ers to the politicians of Northern Ireland for thefirst time in 30 years. At the time of writing, theAssembly has been temporarily suspended becauseof political disagreement, and central governmentin London has resumed responsibility for key de-cision-making. Discussions are currentlyunderway to restore the Assembly.

22 Health Development Manager, Belfast Healthy Cities, Belfast, Northern Ireland, United Kingdom.

PRIZING OPEN THE BARRIERS: BELFAST . 39


Planning in BelfastThe City of Belfast has been a member of theWHO European Healthy Cities Network since1988. One of the key requirements of the thirdphase (1998–2002) was promoting healthy urbanplanning, and Belfast Healthy Cities saw this ashaving an important role to play in placing healthand the quality of life on the broader planningagenda. Belfast is hosting the 2003 InternationalHealthy Cities Conference in October 2003, whichwill mark the end of the third phase and will pro-vide a platform for sharing experiences of inte-grating health into urban planning.

Much has been achieved in healthy urban plan-ning in Belfast over the past decade. Health issuesare now very much part of the urban planningagenda. The main policy document for NorthernIreland, Programme for Government, suggests po-litical commitment to the principle of healthy ur-ban planning in its acknowledgement of the needto tackle the wider determinants of health and en-sure that the environment promotes healthy liv-ing. Planners have now explicitly recognizedhealth-related issues in development plans. Thischapter outlines some of the successes of integrat-ing health into planning and considers some ofthe limitations of doing this in Northern Ireland.

Planning in Belfast is carried out across manydifferent government departments and agencies.This is primarily a consequence of the fact thatBelfast City Council has limited powers and mostof the major government functions are carried outat the regional level. Thus, although the mainwork of urban planning is carried out within theDepartment of the Environment Planning Service,other departments play an important role in pro-moting healthy urban planning. The Departmentfor Regional Development, for example, is respon-sible for regional planning and transport, whereasthe Department of Social Development is respon-sible for regeneration and housing. In addition,Belfast City Council has a statutory consultativerole on planning issues.

Urban planners in Belfast contribute to healthyurban planning in two main ways:

• by incorporating health issues into regional andarea plans; and

• by being represented and seconded to otherbodies, such as the Strategic Planning Group onTransport, Environment, Planning and Housingof Belfast Healthy Cities and the West Belfast/Greater Shankill task forces.

Integrating health into strategic plansThe Department for Regional Development has re-cently published the Regional Development Strat-egy for Northern Ireland 2025, which sets out apicture of how the region might look in 25 years.This is important because it provides anoverarching strategic framework for all develop-ment plans, including the Belfast MetropolitanArea Plan, which is currently being prepared.

The Regional Development Strategy contributesto healthy urban planning in many differentways. It sets out a vision for strategic planningguidelines that aim “to change the regional travelculture and contribute to healthier lifestyles” and“to create healthier living environments and tosupport healthier lifestyles”. The Regional Devel-opment Strategy also contains a chapter relatingspecifically to the Belfast Metropolitan Area thatsets out guidelines to revitalize the city of Belfast,to promote an urban renaissance, to develop andenhance the metropolitan transport corridor net-work, to improve the public transport service andto manage travel demand within the metropolitanarea. Healthy urban planning and the vision of ahealthy city are intrinsic aspects within all ofthese guidelines.

The Belfast Metropolitan Area Plan provides themain focus of healthy urban planning in Belfast.It covers six local administrative districts includ-ing Belfast City Council and contains a popula-tion of about 650 000, almost 40% of the North-ern Ireland population. The draft Plan will be pub-lished in 2003 and, following a public inquiry, thefinal Plan is anticipated to be adopted in 2005. Inaddition to providing guidance for future develop-ment and investment in the city, the Plan willalso provide the context for health-related urban

policy initiatives and set a land-use framework forneighbourhood renewal programmes and localarea strategies. Improving the coordination of re-newal and regeneration is anticipated to improvehow the needs of local people are met and conse-quently improve their health.

In December 2001, the Planning Service pub-

lished a issues paper on the Belfast MetropolitanArea Plan, the aim of which was to promote wide-spread public debate on issues of strategic signifi-cance and the shape of future development withinthe plan area. The issues raised include health-re-lated issues of regeneration and social inclusion,recreation and open space, the quality of the envi-

Box 6.1. Belfast Metropolitan Area Plan – public consultationThe public consultation process on the BelfastMetropolitan Area Plan was a critical and fun-damental element of the overall formulationof the draft Plan. It was designed to encour-age involvement and ownership by localcommunities wishing to influence the futuredevelopment of their districts and neighbour-hoods.

The consultation was based on a detailedand comprehensive issues paper published bythe Department of the Environment, BelfastMetropolitan Area Plan team in December2001, which set out the main issues on whichviews were being sought.

The consultation included initial publicmeetings across the Plan area to brief and in-form the public of the issues and the process,public meetings across the area to discuss anddebate the issues and targeted focus meetings

with particular groups who were not expectedto be well represented at the public meetings.A total of 37 public meetings and focusgroups were held attended by more than1500 people representing a broad cross-sec-tion of the population living in the area. Asecond stage was then carried out to covergaps in the process. This consisted of four fo-cus groups with disadvantaged communitiesand four workshops with a mix of differentinterest groups.

The following key issues relating to healthyurban planning emerged from the exercise:• the need for types of housing to meet

needs rather than demand;• the need to move away from building

houses and towards building communities;• the need for well designed neighbourhoods

with good lighting, community safety,visual coherence alongside focus and iden-tity;

• more sustainable use of public services;• the need to link land-use planning and

transport and shift from a car culture to anew integrated public transport system;and

• the recognition that regeneration shouldbe fairly distributed across the city and thatregeneration should not be fragmented orfocused on showcase sites.

The task of the Belfast Metropolitan Area Planteam now is to ensure that the principles ofhealthy urban planning are embodied withinthe published Plan.

There needs to be a shift from building housesto building communities



ronment and accessibility. As with the RegionalDevelopment Strategy, issues of healthy living arevery much at the forefront of the Belfast Metro-politan Area Plan approach (Box 6.1).

Before the draft plan is published, the policiesand proposals within the Belfast MetropolitanArea Plan will have to be tested against a range ofhealth-related indicators, including new targetingsocial need, equality impact assessment and stra-tegic environmental assessment.

1. New targeting social need. New targeting so-cial need is the Northern Ireland Executive’s mainpolicy for combating social exclusion and poverty,which are key determinants of health. It aims to dothis by targeting efforts and available resources to-wards people, groups and areas objectively defined

as being in social need. The Department of the En-vironment Planning Service is not a major spend-ing agency, but new targeting social need consid-erations will be influential in creating a land-useframework that will allow investment to take place.

2. Equality impact assessment. The NorthernIreland Act 1998 requires public authorities tocarry out their functions in such a way as to pro-mote equality of opportunity between variousgroups of people. The equality impact assessmentwill allow the policies and proposals contained inthe plan to be assessed with respect to their im-pact on these various groups.

3. Strategic environmental assessment. Stra-tegic environmental assessment is a process that

Box 6.2. Quality of life matrixIn February 2002 Belfast Healthy Citieslaunched its city health development plan,Planning for a Healthy City. This publicationwas the result of an extensive consultationprocess involving more than 1000 peoplefrom 250 organizations, from which four re-curring themes or priorities were drawn, oneof which was transport, environment, plan-ning and housing. An intersectoral strategicplanning group was formed to translate thesepriorities into an action plan.

The group identified the need for a toolthat could be used to assess the effects ofland-use plans on people’s quality of life. Itwould therefore promote the quality of lifeand contribute to reducing inequality. Such atool would take the form of a matrix thatwould outline actions with positive and nega-tive effects on people’s quality of life.

Since the Belfast Metropolitan Area Planteam was in the process of drawing up a land-use plan for the Belfast Metropolitan Area,the matrix was designed to assess quality of

life issues specific to land-use planning in thisarea. Belfast Healthy Cities was identified asthe lead agency for this action, and a smallworking group came together to design andproduce the matrix, using as a starting-pointenvironmental impact assessment reportsfrom across Northern Ireland, strategic envi-ronmental assessment reports from Kent, Lan-cashire and Exeter and Healthy urban planning– a WHO guide to planning for people.23 Localuniversities contributed their expertise.

The matrix was completed in December2002, and in January 2003 it was formallysubmitted to the Belfast Metropolitan AreaPlan team as a tool for assessing the Plan.

Although the quality of life matrix was de-veloped to be used with a land-use plan in aspecific area, the framework can be used todevelop a more general matrix. It is availablefrom Belfast Healthy Cities as a print publica-tion that also illustrates the positive andnegative aspects of land use in photographsdepicting sites in and around Belfast.


anticipates and evaluates the environmental, so-cial and economic consequences of policies andproposals such as those that will be containedwithin Belfast Metropolitan Area Plan. BelfastHealthy Cities has produced a quality of life ma-trix (Box 6.2) that outlines not only environmen-tal considerations but also social and economicconsiderations that can affect the quality of life.The matrix was submitted to the Belfast Metro-politan Area Plan team for consideration in theirassessment of the Plan.

The second way urban planners in Belfast contrib-ute to healthy urban planning is through their in-volvement and participation in other health-re-lated initiatives. The role of urban planning inother initiatives and groups has allowed a cross-fertilization of ideas and has advanced the con-cept of healthy urban planning in Belfast signifi-cantly.

The Belfast Metropolitan Area Plan team hasbeen represented on the Strategic Planning Groupon Transport, Environment, Planning and Hous-ing of Belfast Healthy Cities. This group includedrepresentatives from relevant public bodies, aca-demics and interest groups and was established toconsider effects within these topic areas on thehealth of the people of Belfast and to develop in-tegrated action plans to improve health. The is-sues considered have included sustainability andcompact urban forms, health impact assessment,public consultation, promotion of healthiermodes of transport, air quality and noise pollu-tion, waste management, open space and commu-nity safety. The action plans developed formedpart of the city health development plan Planningfor a Healthy City, which was implemented dur-ing 2002–2003. Representation of planners on thisGroup contributed to good working relationshipsbetween organizations and sectors and increasedthe success of the actions implemented.

A further example of the contribution of urban

planning to a health-related initiative in Belfast isthe West Belfast/Greater Shankill task forces (Box6.3). The Minister for Employment, Trade and In-vestment and the Minister for Social Developmentset up the task forces jointly. In this disadvantagedpart of the city, the link between socioeconomicissues and health is paramount.

The future of healthy urban planningin BelfastTo what extent can this integration of health intoplanning be expected to prove sustainable? Invest-ing for Health, the public health strategy forNorthern Ireland, calls for a partnership approachto health, acknowledges that “the range of factorsinfluencing health extends far beyond the remitof the Department of Health” and states that thestrategy will be implemented based on the experi-ence of Belfast Healthy Cities and other partner-ships in using an intersectoral process. It statesthat the work of the Department of the Environ-ment “clearly has significant potential implica-tions for the health of the public”. Such high-levelacknowledgement of the role of this Departmentin improving health leads the way for increasedintegration of the Department’s work, such asplanning, with other health-related areas.

The current review of public administration be-ing carried out in Northern Ireland is also antici-pated to affect the nature of planning, in that itquestions the current structure of service delivery,highlighting planning services, and considers theoption of transferring development control to lo-cal authorities. A further step might then be todelegate to local authorities the authority to pre-pare area plans. Returning all statutory planningpowers to local authorities for the first time sincethey were withdrawn in the early 1970s would belikely to improve the coordination of health-re-lated functions at the local level and provide in-creased opportunities for addressing the needs oflocal people.



Box 6.3. Task forces for West Belfast and Greater ShankillTwo intersectoral task forces were set up tobring forward recommendations aimed at re-ducing unemployment and poverty in a dis-advantaged area, identifying recommenda-tions that could be implemented both by lo-cal groups and government agencies and thathave measurable inputs and outputs. TheMinister for Employment, Trade and Invest-ment and the Minister for Social Develop-ment set up the task forces as an interdepart-mental initiative. A Planning Service repre-sentative sat on the technical support groupfor infrastructure and planning services. Thefact that the task forces reported directly toministers encouraged members to believe thatthe recommendations they gave would be im-plemented with urgency.

Although the key driver for change wasstated to be economic, the task forces werealso asked to consider the broad social costsof unemployment and poverty and the ben-efits of full employment, including the indi-rect costs of social problems such as alcohol-ism and family break-up. A key feature wasthat planning services would create a clearframework for regeneration that is relevant tothe demands of the 21st century and that thiswould be linked to the infrastructure invest-ment provided. Planning and socioeconomicissues were therefore integrated from the out-set of the initiative.

The report of the task forces included thefollowing recommendations.

• In the absence of a current land-use plan,an immediate local area plan should bedrawn up to influence and guide develop-ment and regeneration efforts.

• Defined areas should be earmarked forcommercial and industrial development.

• Current planning policies that restrict thescale of office and commercial develop-ment outside the city centre should beamended.

• The need to protect the physical environ-ment should be considered.

Overall, there was willingness to work to-gether, increased understanding that no oneorganization has exclusive ownership of anypart of the process and that the delivery ofmajor infrastructure projects does not changeovernight. The learning and personal devel-opment that took place came largely fromhaving the opportunity to work with a di-verse range of people and meant that peoplegot a wider view than they would usuallyhave. Task force members reported findingthe experience intense but rewarding.

The report is anticipated to catalyse posi-tive change in the West Belfast and GreaterShankill areas over the next decade.

7.Health as the goal of planning: the experience of Horsens,DenmarkBjarne Gregersen24

The Municipality of Horsens has a very well developed and integrated approach to healthy urban planning.Health is a general and fundamental objective for all activities of the Municipality. Decision-making is open andtransparent, with local people actively sharing ownership of the process. Equality and sustainability are axiomaticin a healthy city.

City profileHorsens has about 60 000 inhabitants and is apart of the eastern Jylland region with about700 000 inhabitants.

The city is managed by a democratically electedMunicipal Council of 25 members. The MunicipalCouncil regularly works with professional organi-zations, interest groups and a citizens’ councilwith democratically elected representatives.

Horsens is situated on an attractive fjord about40 km south of Aarhus, Denmark’s second largestcity. The infrastructure is well developed with har-bour, railway connections and an extensive roadnetwork including a motorway west of the city.The terrain is gently undulating hills between flatrural plateaus and broad river valleys.

The city, an old market town with a history ex-tending back many hundreds of years, suffered se-verely in the financial crises of the 1920s and1930s. Large industrial companies went bankrupt,causing extensive unemployment and social prob-lems that still characterize the city to some extentmany years later, as a type of social heritage. Thecity’s current commercial structure is character-ized by a strongly developed production base anda relatively weakly developed service sector, andthe city is therefore especially vulnerable in peri-ods of economic downturn and poor market con-ditions. Numerous new dwellings are being con-structed, older residential areas are being reno-

24 Head Urban Planner, Municipality of Horsens, Denmark.

vated and businesses are expanding, while majornew companies are moving into the city.

The Municipality is not in as good a fiscal posi-tion as many cities of comparable size; one reasonis a smaller tax base.

The Municipality has been striving for manyyears to improve its social conditions and to breakdown its negative social heritage, improve the city’simage and economy and raise the level of educa-tion. Numerous initiatives have been taken in aworking relationship between the Municipal Coun-cil and groups of citizens to improve social condi-tions in the city and to change the city’s image in amore positive direction, but much work remains tobe done. The city’s life is still marked by the nega-tive social heritage, and intensive long-term work isbeing carried out to break this pattern. The Munici-pality is attempting to generate positive change inclose collaboration with its citizens. Ways includeactive pursuit of Agenda 21 and health for all objec-tives and strategies based on longstanding partici-pation in the WHO European Healthy Cities Net-work. Citizen involvement is therefore very wide-spread within the city.

The national government is emphasizing bal-anced spatial planning with a fair degree of au-tonomy for self-management in the individualmunicipalities. Concepts such as Agenda 21, citi-zen involvement, municipal self-management,

HEALTH AS THE GOAL OF PLANNING: HORSENS . 45


sustainability and good conditions for citizensand business are central to national policy.

The Municipal Council formally makes deci-sions on all matters concerning the Municipality’spolicy areas within the authority assigned by thecounty and the state. Citizens are actively in-volved, including via the citizens’ council, studygroups and various forums. Every fourth year theMunicipality prepares a general municipal planwithin all policy areas, and a intersectoral healthycity group and the planning group with repre-sentatives from all administrations actively par-ticipate in the planning work. The Municipality isgenerally responsible for all local spatial planning.Planning must, however, comply with regionalplanning guidelines and relevant legislation.

Healthy urban planning in HorsensHealth is the general goal and a fundamental re-quirement for all municipal planning in Horsenstoday. Adopted as a goal by the Municipal Coun-cil, health is part of the daily activities of all ad-ministrations.

Healthy urban planning means creating healthyliving conditions (the WHO definition), includingvia planning that includes citizens. Joint ownershipof plans and results increases citizens’ awareness ofquality and context. Only with the support of thecitizens can healthy urban planning be imple-mented in the city and break down barriers be-tween key players and administrations.

This is a prerequisite for attaining developmentin which people are equal and sustainability isaxiomatic.

Health has been integrated into planning inHorsens for many years. One of the reasons forthis is Denmark’s social welfare system, in whichgovernment ensures the individual a basic level ofsound living conditions. Denmark’s planning leg-islation include provisions that seek to ensure agood environment and sound living conditions.The Municipality of Horsens has built on thisplanning legislation with health for all, a cleanand sustainable environment, beautification ofthe city and the open countryside, an active urban

development and redevelopment strategy andcomprehensive citizen involvement via quadren-nial planning processes.

Interdisciplinary project and developmentgroups have been established involving adminis-trations, local associations and groups of citizensin the city. The tradition of collaboration is exten-sive, and the planning process is open and visible.

The most important themes in the newlyadopted municipal plan are urban and residentialpolicy, youth policy, health and senior citizens.

The Municipal Council has unanimouslyadopted municipal plans in which health for all andAgenda 21 are the general objectives and strategiesfor the city’s development and its activities. The mu-nicipal plan is a strategic plan expressed concretelyin action plans carried out by the individual admin-istrations, often in collaboration involving adminis-trations, external organizations and groups of citi-zens. The plan is re-evaluated every year. Health is aconcept that enters all policy areas and the work ofall administrations. The Municipal Council isunanimous in these endeavours, but there is somelack of unanimity in the debate on the most effec-tive way of achieving the objectives.

The Municipality has thus been working formany years with extensive citizen involvement onthe basis of numerous models and methods andhas created a very open, strategic and comprehen-sive system of plans. The results of the plans in-clude wide-ranging meetings of citizens in all dis-tricts in connection with planning, including so-liciting ideas from citizens, establishing a strategicplanning system with formulated objectives, areasof initiative, action programmes, inclusion inbudgetary planning, the administrations’ actionplans and an annual evaluation in which resultsare described and explained. Citizens’ groups, acitizens’ council and forums have also been estab-lished with the objective of improving coopera-tion and dialogue between the Municipality andits citizens. All conceivable methods of dissemi-nating information are used, such as briefings andinvitations to citizens via the local press, local tel-evision, the Internet, folders delivered to homes,


Box 7.1. Neighbourhood regeneration and renewalNeighbourhoods are places where people live.They imply a sense of belonging and of com-munity, with shared educational, shoppingand leisure activities that provide a focus forsocial life. Regeneration implies an integratedapproach to solving urban problems (urbanplanners working in partnership with otheractors to achieve social, physical, environ-mental and economic improvements). Re-newal emphasizes a process of physicalchange to support the social, environmentaland economic goals of regeneration.

Renewal and revitalization of theVestergade districtIn 2001, the Municipality of Horsens began a7-year social and physical urban renovationproject in the Vestergade district, the city’s so-cially and economically most disadvantagedarea with about 3500 residents. With finan-cial support from the national governmentand the Municipality, work will continue fora number of years on improving conditionsin the district in all areas: better dwellings, es-tablishing attractive and safe streets, squares,open areas, recreational options and commu-nal facilities and network-promoting activi-ties for the residents.

The project’s general objective is to trans-form the area from the city’s most disadvan-taged to an exciting modern active suburb inwhich the original residents can remain withnew and improved conditions while becom-ing empowered: developing new personalcompetencies via active participation in thedistrict’s development.

The urban revitalization project involves avery broad spectrum of stakeholders. Theseinclude the Municipal Council, officials andthe heads of relevant administrations, interestorganizations, Healthy City and a very broadspectrum of citizens and citizens’ groups, gov-ernment interests and representatives of pri-vate business.

The course of the projectMeetings were held in the district after theproject organization was established. Severalhundred citizens participated in these intro-ductory meetings, and 12 citizens’ workgroups were subsequently established, distrib-uted according to a range of relevant themesthe citizens in the district desired. The initia-tives were ranked by consensus and beganwith the more detailed planning and imple-mentation based on this consensus ranking.This is where the project currently stands.The project is under continual evaluationbased on predefined criteria of success and in-terim targets and indicators.

From the project’s start, health has been akey parameter and one of the project’s gen-eral objectives. One of the objectives is thusthat people in the district will increase theircompetence in a wide range of areas and feela greater sense of identity with and owner-ship of the district.

The entire conceptual basis of the projectand the way it has developed are a result ofthe Municipality’s commitment and priority-setting in relation to health for all and equityin health.


telephone contact, study groups, future-orientedworkshops and the like.

In the Municipality’s experience, people arehappy to participate actively when their own localarea is concerned, but citizen participation is verylimited for more general strategic planning initia-tives and principles.

The formation of such citizens’ councils as thesenior citizens’ association, the village associationand the suburban association has created a highlevel of empowerment, and interest in strategicplanning has grown through this. The Municipal-ity has also initiated many project initiatives, es-pecially via Healthy City and the healthy cityshop.

The Municipal Council has determined that alladministrations are to incorporate health andAgenda 21 in their daily work. A intersectoralplanning group has been established and ahealthy city group has been formed with membersfrom the various administrations that contributeto the general planning. The Municipality pre-pares a health statement and a health plan as partof its work on the municipal plan. There is a wide-spread tradition of informal contacts between sec-tors and administrations, and many different pro-fessions are involved.

Horsens has used indicators to measure resultsin numerous projects and plans. The goalsachieved in certain project forms, especially con-cerning the social sector, have been difficult tomeasure, and work is therefore continuing on thedevelopment of usable and reliable indicators.

The health impact assessment system is regu-larly used in connection with planning and im-plementation and is generally a part of ourmethod of work with respect to planning and im-plementation.

Prospects and conclusionsBased on the many years of experience of the Mu-nicipality, involving citizens is difficult when spa-

tial planning is debated at the strategic level buteasy when planning is local and concrete. The es-tablishment of joint ownership of the plans by in-volving public and private stakeholders is impor-tant. Projects can only be anchored and imple-mented via joint ownership and understanding.

Finding financial support to realize plans is dif-ficult if the plan’s general objective is principallyto promote health and better living conditions.Health must therefore be anchored in more ra-tional cost–benefit considerations such as the factthat health is good business, is a positive param-eter of competition and improves image.

Horsens is undergoing a positive transforma-tion via urban renovation and renewal and archi-tectural policies for construction and facilitiesgenerally in the city (Box 7.1). This includes urbandesign and outfitting, improved options for per-sonal recreation and improved cooperation be-tween the Municipal Council, associations, citi-zens and business through the active involvementof citizens. The aim is to make Horsens a goodplace to live and work in accordance with theAgenda 21 and health for all strategies.

The planning and initial implementation ofnew recreational green options for everybody inthe city (Box 7.2) is in full swing together with animprovement of conditions in the villages and asignificantly enhanced working relationship be-tween residents of the villages and the Municipal-ity of Horsens.

A comprehensive transport plan for the entiremunicipality is being prepared in which the mostimportant objectives are road safety, mobility, thebeautification of roads and surroundings, noise re-duction, sustainable transport and reducing car-bon dioxide emissions.

Environmental planning has been intensifiedsignificantly. Projects are intended to improve theenvironment in the form of cleaner watercourses,lakes and fjord, to ensure biological diversity andto reduce air and noise pollution.

Box 7.2. Open space planningOpen space refers to the many different typesof public open spaces in cities. It includes for-mal and informal areas, green spaces, play ar-eas, sports fields, squares and parks, naturalplaces, riversides, lakes and beaches. It alsocovers areas of all sizes, from large municipalparks used as resources for whole cities tovery small local parks and spaces on neigh-bourhood streets.

After public hearings on the municipalplan in the late 1990s, Horsens MunicipalCouncil decided that the city should be madegreener and more recreational for its citizens.After ideas from citizens were solicited, morethan 300 suggestions for improving the city’sgreen profile were received. The MunicipalCouncil decided based on these to prepare agreen structure plan for the entire municipal-ity, and work on the structure plan is now infull swing. Parts of the plan have already beenimplemented. The green structure plan isbased on the many suggestions from citizenstogether with the Municipality’s objectives inaccordance with health for all and Agenda 21.Apart from the aesthetic treatment of thecity’s areas and open spaces via these greeninitiatives, health, environment andsustainability are considered on an equalfooting. The plan will initially be designed asa discussion paper for debate with citizensand then the Municipal Council will adopt itin final form. The plan is being prepared incooperation with private interest organiza-

tions and groups of citizens who representsmaller local areas. An action plan was pre-pared to finance the implementation of thegreen structure plan.

An early concrete result was the establish-ment of a major new recreational forest areasouth of the city so that all the city’s residentscan have easy access to green spaces. Novelrecreational pathways were also created in allsuburbs, thus making exercise, adventure andfresh air for everybody a real option. By in-volving citizens in the process, the Municipal-ity has ensured appropriate design, a realisticlevel of ambition and joint ownership of thegreen areas – an important element in theAgenda 21 and health for all strategies. Thegreen structure plan will cover all types ofopen space from the smallest to the largest inthe city, in the open countryside and in thevillages.

The general objective of the green structureplan is to make the city and its surroundingsmore beautiful and greener. Reasons includemaking the city a highly attractive area inwhich to settle, creating improved recrea-tional options for citizens based on a princi-ple of equity and improving environmentalconditions in general.

In particular, the planning of major recrea-tional areas south of the city is a result of acareful consideration of health, emphasizingequity in health – here in the form of equalaccess to green recreational areas.



8.Analysis and evaluation

Claire Mitcham25

Implementing healthy urban planning:common themes and issuesThe experience of urban planners from citiesacross Europe conveys an overriding impression ofexperimentation. For most of the group, the spe-cial emphasis on health as a central goal of urbanplanning has been a new feature of their work,and the first phase of work with healthy urbanplanning has included becoming familiar with theconcept and testing practical ways to implementthe ideas.

Discussion and debate during group meetingsprovided an opportunity to learn about the differ-ent perspectives and experiences of each groupmember, and to share opinions about whathealthy urban planning implies, both in theoryand in practice.26 Group members quickly agreedthat healthy urban planning should involve agreater focus on people. The importance of creat-ing healthy environments and supportinghealthier lifestyles has been a central objective forthese cities along with an emphasis on the impor-tance of joint ownership of plans and policiesamong various sectors and among citizens.

The cities of the WHO City Action Group onHealthy Urban Planning differed substantially insize and situation (Table 1).

These cities approach urban planning activitiesdifferently on several levels, and these have influ-enced how each has approached integratinghealth issues into their work. Such differences in-clude historical, geographical and cultural charac-

teristics, legal and institutional frameworks, exist-ing national, regional and local policy agendasand different urban planning traditions.

When the Group began its work in mid-2001,the level of experience in trying to incorporatehealth issues into urban planning work also var-ied. Some cities had several years of experiencesupported by national and regional governmentinitiatives and a history of involvement with theirlocal healthy city project, whereas others em-

Popula-City tion Description

Northern Europe

Gothenburg 475 000 Medium-sized city

Horsens 60 000 Small city in a rural context

Sandnes 55 000 Small municipality, part ofmedium-sized conurbation(200 000)

Southern Europe

Milan 1 300 000 Large internationalconurbation (4 millionin a wider area)

Seixal 150 000 Medium-sized municipality– part of the LisbonMetropolitan Area

Western Europe

Belfast 282 500 Medium-sized city – capitalof Northern Ireland

25 Urban planner, postgraduate student, University of the West of England, Bristol, United Kingdom; focal point for urban plan-ning at the WHO Centre for Urban Health (until 2002).


Table 1. Members of the WHO City Action Group onHealthy Urban Planning

braced the concept as something completely newfor their city and an opportunity to add some-thing of unique value to their existing planningwork.

As a result of these influences, each Groupmember has taken a different approach to imple-menting the ideas associated with healthy urbanplanning.

Belfast has emphasized integrating health intostrategies and plans. Several departments of thenational government carry out urban planning ac-tivities, and this work is strongly plan-led. The De-partment of the Environment and Belfast HealthyCities have jointly carried out the work to incor-porate health into the urban planning process,with additional involvement from departmentsresponsible for related issues such as regeneration.The approach is reciprocal, with the BelfastHealthy Cities team providing input into urbanplanning processes and urban planners providinginput into complementary initiatives developedby Belfast Healthy Cities. This has therefore beena joint approach focusing on preparing plans andpolicies and on building relationships betweenvarious policy sectors and initiatives within thecity.

Gothenburg has made significant progress sincetaking the initiative to focus on health in plan-ning in 1999. A key step was the establishment ofa health group within the City Planning Author-ity. This has helped to integrate health and qual-ity of life issues into a wide range of day-to dayplanning work, including preparing the detailedplans for new development on specific sites andthe use of environmental impact assessment ofplanning proposals. Much work has been donewith the healthy city project to raise awarenessabout the ideas within the City and to increasecitizen empowerment. The City is also followingup a specific interest in issues of safety and secu-rity.

In Horsens, work to integrate health into urbanplanning processes has been ongoing since theearly 1990s. With the support of the national gov-ernment, the concepts of health for all and

Agenda 21 have become central to the work of thewhole Municipality. During this period, healthhas become integrated into urban planning docu-ments and specific initiatives, and citizen empow-erment is especially emphasized.

Milan has also taken a joint approach. The Ur-ban Planning Department and the Healthy CityProject have worked together, with input from thePolitecnico di Milano Technical University, to takeforward the work. The city has chosen three pilotprojects to test the implementation of healthy ur-ban planning principles. This work has focused ondeveloping an intersectoral approach to preparingproposals for regenerating and developing threespecific urban areas. The challenge now is to im-plement these ideas on a wider scale.

Sandnes has been working with healthy urbanplanning ideas for several years, implementingspecific projects as part of its healthy city initia-tive. After attending the First Seminar on HealthyUrban Planning in Milan in October 1999,Sandnes began a process of integrating healthfully into the municipal comprehensive plan, andthis is now one of three key themes of the plan.

Seixal began to work with healthy urban plan-ning in 2001 and has since established anintersectoral working group to take forward theideas. Early work has identified specific initiativesand projects, and this is now being followed by aprocess of incorporating health issues into thenew plan for the municipality.

Experimentation with healthy urban planninghas focused on two key areas: (1) incorporatinghealth principles and objectives into documentsand policies that guide development and (2) im-plementing specific projects and initiatives thattest out principles such as intersectoral action andcommunity participation or that aim to advanceunderstanding in relation to specific thematic ar-eas. Individual cities have adopted quite differentmethods and have begun to develop their owntools and processes to support the work. In manyways, these methods reflect the context withinwhich each city is working. They include such ini-tiatives as: a quality of life matrix (Belfast), a

ANALYSIS AND EVALUATION . 51


health monitoring group (Gothenburg), anintersectoral working group (Seixal), collaborationwith academics and between sectors (Milan) andestablishing community or children’s councils(Horsens and Sandnes). Several cities have workedtogether with the healthy city project or the pub-lic health sector to explore how health principlescan be integrated into urban planning work. Inaddition, some cities have carried out specific ini-tiatives to raise awareness within their own de-partments.

Discussions and exchanges with members ofthe City Action Group have clearly showed thatcities are struggling to translate their interest andbelief in healthy urban planning into practice in ameaningful way. Much has been achieved, butthere is a sense that cities are feeling their way,and significant barriers to progress remain insome cases. There are practical difficulties in everycity in realizing the two underlying principles ofcommunity involvement and intersectoral action.The intersectoral approach is difficult to developand requires continuous effort and input, evenwhen well established. People working in differentsectors often speak different languages, and effortsto work together can be thwarted by bureaucraticnorms and procedures and resistance among somestaff and politicians. This can reinforce verticalprocedures and prevent intersectoral discussionand action. Several cities commented on the desir-ability of citizen involvement and the importanceof increased trust and empowerment, linking it tothe successful implementation of projects. Never-theless, poor mutual trust could sometimes be abarrier to successful community involvement.Several Group members noted that they hadfound it very difficult to engage citizens in discus-sions on strategic planning processes, althoughengaging people in debate on specific and local is-sues was much easier. Several cities emphasizedthe importance of raising awareness among citi-zens about the wider objectives of healthy urbanplanning, commenting that public attitudes andpractices were a barrier to the success of some ini-tiatives. For example, getting people to cycle and

use public transport, even when this was well pro-vided for, sometimes required constant publicityand promotion.

Several cities noted ongoing practical difficul-ties and disagreements among staff, politicians,and citizens. Even when there was unanimouscommitment to objectives and principles, therewas not always agreement on how these should beachieved. A particular stumbling block was the re-lationship between economic objectives and ob-jectives related to health and the quality of life.Several cities noted that, even when health con-cerns were integrated into plans and policies, poli-ticians sometimes had difficulty in giving priorityto less easily quantifiable health benefits overshort-term economic gains. Nevertheless, experi-ence had also shown that obtaining funding forpromoting health and improving living condi-tions may be more likely if this is linked to widereconomic goals (good health is good business).

All members of the Group that completed thequestionnaires feel positive about the progressthey have made. Inevitably, their achievementsare linked to how long they have been workingwith healthy urban planning ideas. Cities such asHorsens and Sandnes, who have emphasizedhealth, well-being and quality of life over a longperiod, felt that they were now seeing improvedliving conditions and a large number of “concreteimprovements”. Joint ownership of plans andpolicies was seen as the key to success. The citiesin the early stages had, quite rightly, focused onbuilding relationships and laying foundations forfuture work, but they had also seen some realchanges in working practices. For these cities, per-haps the most important achievement was thatstaff recognize that health is key to urban plan-ning and that it should be explicit and not im-plicit in urban planning work. Group membershad taken the ideas and experience discussed dur-ing meetings and tried to integrate these intotheir own working practices. Cities in whichintersectoral cooperation was a new approach re-ported that staff participated in the work with in-terest and enthusiasm and noted the synergistic

value in this approach. A cultural change was be-ginning to take place, and the planning processwas becoming more open and accountable (Milanand Seixal). Many people attending meetings orconferences return home and put these new ideasor examples on a shelf and gradually forget their

enthusiasm. These planners have not done this;they have really tried to do something practical,and step by step, they are beginning to see the re-sults of their efforts.

ANALYSIS AND EVALUATION . 53


9.Emerging principles and prospects

Hugh Barton27

Certain themes and principles are reiteratedthroughout the case studies. It is far from easy,however, to extract principles in a way that doesjustice to the impressive and diverse approachesexemplified by the six cities and draws out lessonsfor other municipalities who may be moved tofollow their lead. Below is one attempt at a seriesof nine summary principles – drawing not only onthe case studies but also previous WHO publica-tions, especially Healthy urban planning – a WHOguide to planning for people.28

1. Human health as a key facet ofsustainable development

The focus on human health and well-being offersa means of refining and sharpening what is meantby social sustainability and the quality of life inthe debates about sustainable development.Health, with its relationship to income, equity, so-cial capital and environmental quality, providesan human-centred perspective on sustainable de-velopment.29

Several of the case study cities make this con-nection explicit: for example, Horsens andSandnes with their full integration between healthand planning, and Belfast with its quality of lifematrix. Health is a more user-friendly term thansustainable development and can thus offer com-mon ground for different interests and agencies. Ifpolicies are declared to be unsustainable, this isopen to much equivocation because of the many

different facets of sustainability. If they are de-clared to be unhealthy, with some evidence toback this, fewer will argue. Thus, we recommendusing the principle of health to build constituen-cies of support for good urban planning.

2. Cooperation between planning andhealth agencies

Cooperation between planning and health agen-cies is essential in developing effective integratedprogrammes. This is a two-way affair: publichealth experts can advise planners on the effectsof policy, and planners can advise health officialson the opportunity for intervention in relation tothe determinants of health.

All the case studies demonstrate this principle.Milan, for example, has a very well orchestratedstrategy for building cooperation between key de-partments. Gothenburg has taken this to a neigh-bourhood level. The healthy city team in Seixal,starting from a general segregated structure of de-partmental responsibilities, has used specificprojects to build bridges.

3. Cooperation between the public,private and voluntary sectors

Broader intersectoral cooperation is vital to ensurea coordinated programme, without one agencyundermining others. This applies, for example toeducation authorities, health and social services inrelation to equitable access. It applies to transport

27 Executive Director, WHO Collaborating Centre for Healthy Cities and Urban Governance, University of the West of England,Faculty of the Built Environment, Bristol, United Kingdom.

28 Barton H, Tsourou C. Healthy urban planning – a WHO guide to planning for people. London, E&FN Spon, 2000.29 Price C, Dubé C. Sustainable development and health: concepts, principles and framework for action for European cities and towns.

Copenhagen, WHO Regional Office for Europe, 1997 (http://www.who.dk/document/e53218.pdf, accessed 8 September 2003).

authorities working with land-use authorities. Itapplies to major investors in the private and vol-untary sectors recognizing their social and envi-ronmental responsibilities.

In a pluralist society, achieving healthy and so-cially inclusive cities is difficult unless businessesand public sector investors accept some shared re-sponsibility with planning and health agencies.Horsens, for example, has a long tradition of con-sensus-building between sectors. Success relies onthe central authorities acting transparently, beingwilling to pool responsibility and coordinate ac-tion.

4. Community consultation andempowerment

Public consultation and involvement are keymeans of empowering local communities and oftrying to ensure the responsiveness of policy to lo-cal needs.

Empowerment – ensuring that people have asense of their ability to control their own environ-ment – has direct health benefits. Sandnes, for ex-ample, has worked extensively with children.More generally, planning policy is littered withexamples of initiatives that failed to recognize ba-sic human needs, and the participants respondingto the questionnaire highlighted this. Public par-ticipation (such as that being developed by Bel-fast) is a means of reducing the risk of devisingunhealthy policies.

5. Political commitment at the highestlevel

Political backing from the top tier of the city gov-ernment is an essential prerequisite for the devel-opment of long-term programmes and for effec-tive liaison between departments in a situation inwhich each department tends to have its own spe-cific remit and professional perspective.

This is a theme common to all healthy cityprojects, illustrated particularly well by Milan,with its coordinated programme. It is essentialthat the politicians have something to gain interms of profile and prestige and something to

lose if support is withdrawn. This political visibil-ity is also good for intersectoral working and pub-lic participation, raising awareness generally.

6. Health-integrated plans andpolicies

The critical factor that will help to ensure thatplanning policy is aimed towards health is absorb-ing health into the mainstream of plan-makingand plan implementation activities. Merely tag-ging on a health objective or retrospectively as-sessing health impact is not enough. The plansshould be geared to health through and through.

Planning systems differ widely in each country,so that practical problems of achieving health-in-tegrated plans are greater in some places than oth-ers. The case study cities are at different stages inthe process. But the long-term objective for all isfull integration, so that health is a central goal ofplans governing land use, transport, open space,housing and economic development. This shouldcertainly involve some form of health assessmentof emerging plans, policies and projects, but allthe evidence suggests that it is far more importantto set the right (health-promoting) objectives atthe outset, so that the decisions flow from thoseobjectives.

7. Health integration at all scales frommacro to micro

The strategic plan (or plans) for a city region setsthe broad policy and investment strategy that keyimplementing agencies need to work with posi-tively. The neighbourhood, town or communityplan is the level at which local people can becomeactively involved. Each new development projectis significant in moving towards (or away from) ahealthy human environment. All three levels ofoperation are essential, each reinforcing the oth-ers.

The case study cities are all working towardsthis consistent approach, although for some theinstitutional context set by government can makethis awkward. At the strategic level, the main pri-ority is that of increasing the realistic choices

EMERGING PRINCIPLES AND PROSPECTS . 55


open to excluded groups – choices in terms oftransport options, housing opportunities, workand recreation – to reduce the health penalties ofpoverty, immobility and other disadvantage. Atthe neighbourhood level, the key priority is to en-sure local accessibility by foot and bike to a widerange of facilities in a safe and pleasant environ-ment, encouraging healthy lifestyles and support-ive social networks. At the project level, the prior-ity is to ensure that established health-orientedpolicies are not compromised for short-term gainor expediency.

8. A comprehensive approach to thedeterminants of health

Planning policy documents (briefs, plans andguidelines) and policy assessment processes needto recognize the full breadth of relevant healthyobjectives.

Some of the most important are:• opportunity for healthy lifestyles (especially

regular exercise);• social cohesion and supportive social networks;• access to diverse employment opportunities;• access to high-quality facilities (educational,

cultural, leisure, retail, health and open space);• opportunity for local food production and

healthy food outlets;• road safety and a sense of personal security;• an attractive environment with acceptable

noise levels and good air quality;• good water quality and sanitation; and• reduction in emissions that threaten climate

stability.

Some case study cities have had time to develop acomprehensive approach. Others are more tar-geted, focusing on specific issues. A significant re-alization is that these objectives are not somecompletely new health-related set separated fromnormal planning objectives. On the contrary, theytend to reinforce these “normal” aspirations –which are also there for other reasons, sometimeshistorical. But the health angle gives added weight

to certain objectives, such as the opportunity forhealthy exercise, which can otherwise get sub-merged in the rush for development.

9. Evidence-based planning for healthPlanning agencies must be able to learn from ex-perience, monitoring the actual effects of policy,basing policy review as far as possible on evidenceand not hunch or vested political, commercial orNIMBY (not-in-my-backyard) interests.

One of the great strengths of linking the publichealth and urban planning professions is the po-tential it gives to draw on both medical and envi-ronmental evidence and research, so that policiescan be more rigorously assessed. Can they be im-plemented? Do they affect behaviour as intended?Do they have tangible health benefits?

Future prospectsHealthy urban planning represents a multifacetedfield that still needs to be explored to its full con-ceptual depths as well as policy and practical im-plications. It intrinsically appeals to decision-mak-ers and professionals who are experiencing the illeffects of unhealthy and unsustainable planningon a daily basis. Commitment to health and sus-tainable development cannot be comprehensivewithout addressing planning practices. Planningfor people is not just an attractive slogan. It epito-mizes the imperative to redirect developmentpolicies and practices to have regard for the qual-ity of life, equity, health and well-being. Takingthe healthy urban planning work forward to amore visible and dynamic stage requires explicitcommitment on a larger scale. This is why theWHO Regional Office for Europe has madehealthy urban planning a core developmentaltheme of the fourth phase (2003–2007) of theWHO European Healthy Cities Network. Thismeans that all European Network cities will havethe opportunity to work on this topic systemati-cally: developing, implementing and experiment-ing with different approaches and initiatives.Healthy urban planning principles will be applied,tested and linked to different issues of priority in-

cluding the needs of children and older people,neighbourhood planning, access to services, urbanregeneration and democratic and participatorygovernance. Thus a central aim of the fourthphase is to work with city politicians, planners, ar-

chitects, environmentalists and public health pro-fessionals to apply and further explore the con-cept and principles of healthy urban planning anddevelop knowledge, skills and tools that can beused in cities across the European Region.

EMERGING PRINCIPLES AND PROSPECTS . 57

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