HEALTHY CITIES MEASURES AND INDICATORS THE ISRAELI NETWORK EXPERIENCE

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HEALTHY CITIES MEASURES AND INDICATORS THE
ISRAELI NETWORK EXPERIENCE

• Milka Donchin, MD, MPH
• Braun School of Public Health, Hadassah and the
  Hebrew University, Jerusalem, Israel

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Background

• The Israel network of healthy cities has been
  operating since 1990.
• As of 2005, the Israeli network includes 37 local
  authorities, 1 regional authority 4 ministries,
  
• 8 institutions and several individuals.

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measures and indicators - why

• for operating a healthy city
• a City Health Profile, as the basis for
• a comprehensive health development plan, based on
  Health for All principles and targets
• a Local Agenda 21 for sustainable development.
• for evaluating its efforts and achievements
• For evaluating the level of implementation of the
  Healthy Cities' principles and strategies

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measures and indicators - what
Health 21 Agenda 21 Habitat Agenda

HC
City coordinator Political support Steering
committee Finance
Intersectoral partnerships Community
participation Enabling processes Activities
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measures and indicators - how

• National sources Central Bureau of Statistics,
  Ministry of Health, National Insurance Institute.
• Local sources data held by Local Authority
  departments (including a questionnaire to the
  city coordinator) and by local service agencies.
• Population survey.

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measures and indicators - what
Health 21 Agenda 21 Habitat Agenda

HC
City coordinator Political support Steering
committee Finance
Intersectoral partnerships Community
participation Enabling processes activities
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Source Healthy Sheffield adapted from Dahlgren
Whitehead
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Health 21, Agenda 21Habitat Agenda

• Socioeconomic indicators
• Health behaviors (smoking, physical activity,
  nutrition, exposure to the sun, screening tests)
• Morbidity and mortality
• Physical Environment Indicators (Housing, air
  pollution, drinking water quality, energy
  consumption, water consumption, sewage and waste,
  accessible green areas, transport)
• Residents Satisfaction (with cleanliness,
  exposures, with public transport, their
  residential neighborhood, with city services)
• Mapping Services Available and their Utilization

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Population distribution by age
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Selected measures
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Health behaviors population surveys in 3 cities
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Perceive as a big nuisancepopulation surveys in
2 cities
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measures and indicators - what
Health 21 Agenda 21 Habitat Agenda

HC
City coordinator Political support Steering
committee Finance
Intersectoral partnerships Community
participation Enabling processes activities
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Process measures

• Intersectoral partnerships within the
  municipality and with other bodies in the city
  (scope and level of partnership)
• Community participation (level of participation)
• Enabling processes equity policy, city bylaws
  and their application.
• Health promotion programs scope and the level
  they fulfill the expected best practice.

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measures and indicators - what
Health 21 Agenda 21 Habitat Agenda

HC
City coordinator Political support Steering
committee Finance
Intersectoral partnerships Community
participation Enabling processes activities
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Structure

• City coordinator his position in the
  organizational hierarchy, time dedicated for
  coordinating healthy city's activities,
  professional background, assignments.
• Political support by the mayor, other political
  representatives, city council members participate
  in steering committee and in health promotion
  activities.
• A steering committee exists, is
  multi-professional and intersectoral, its
  chairperson hierarchy level, number of annual
  meetings.
• Budget for activities, salary or both.

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A City Health Profile, as the basis for a
comprehensive health development plan

• Haifa as an example

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Haifa
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Haifa - a healthy city

• January 1995 city council decide to accept the
  idea.
• Mayor says I understand that it is not another
  project, it is a conceptual outlook, it is
  appropriate for us.
• Mayor nominates the municipal strategic unit to
  lead the process.

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Haifa selected data

• Population 270,900
• 17.4 at the age of 65 (9.8 in Israel)
• Jewish 85
• New immigrants 23 of the population
• 13 of Children are in single parenthood
• families (7.7 in Israel, 2000)

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Mortality rates of Acute MI, by age1992-97
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Socio-economic level by statistical regions in
Haifa, 1995
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Unemployment by neighborhood
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Age adjusted self assessed as not in good
health by neighborhood
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Strategic health development plan

• Based on the city health profile, the vision and
  WHO targets of health 21
• Decrease morbidity and mortality of
  cardiovascular diseases
• Health promotion of the elderly
• Health promotion of children and youth
• Narrowing the social and health gaps
• Develop a supportive physical environment

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Haifa - a healthy city
Narrowing gaps, answer needs, improving quality
of services
Reduce injuries Improve the environment Awareness
Reduce smoking Physical activity
Schools kindergartens
Community centers
Work places
municipality
Health services
Deprived neighborhoods
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Follow-up

• Measures of success were formulated to evaluate
  achievement of targets.
• Benchmarks were defined for process evaluation.
• Common indicators are needed for quick periodic
  evaluation of all network cities.

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A process evaluation of the Israel Healthy Cities
Network

• Milka Donchin MD, MPH
• Annarosa Anat Shemesh MA, MPH
• Pamela Horowitz MSW, MPH
• Nihaya Daoud RN, MPH
• Braun School of Public Health, Hadassah and the
  Hebrew University Surveys and Evaluation Unit,
  Ministry of Health

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Objectives

• To evaluate the level of implementation of the
  Healthy Cities' principles and strategies in each
  network city.
• To assess the contribution of the network to its
  member cities.

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Methods

• A questionnaire was distributed to city
  coordinators, covers six dimensions
• Equity policy and political support
• Management
• Health promotion programs in the city
• Community participation
• Intersectoral partnerships
• Environmental protection activities

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Some results
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scoring of four cities
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Dimension's scores by the coordinator's working
hours
w/ 20 lt
w/ 20 ?
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Dimension's scores by political support
high
low
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Dimension's scores by participation in network
activities
high
low
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Conclusions

• a high level of political commitment and support
  is a significant enabling condition
• The network should invest more in
• capacity building of the coordinators.
• institutionalize the role of the coordinator as a
  formal job description in the local authority.
• Environmental issues and sustainable development.

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thanks