Agenda Index City of Vancouver

Appendix 4

Healthy City Initiatives Report

HEALTHY CITY INITIATIVES
OCTOBER 2001

Introduction

As urban health has been an increasing concern for local governments, Healthy City Initiatives (HCIs) have emerged as a vehicle to engage the issue.1 Underlying these initiatives is the philosophy that the health of people living in towns and cities is much more than just the availability of medical facilities, but determined by a collection of larger, inter-related environmental, economic, and social equity elements. Consequently, by approaching urban issues as a composition of these elements, HCIs attempt to improve the health of cities and those who live in them.

This paper will summarize the foundations behind a Healthy City Initiative and outline its various internal mechanisms in a Canadian context. Healthy City Initiatives and, in their more generic incarnation, Healthy Community Initiatives have been a popular instrument for local governments to engage many urban issues, especially in Ontario. To anchor this paper, it will use Toronto's Healthy City Office as an example of how one Canadian city has adapted the Healthy City Initiative model.

The History of the Healthy Communities Movement in Canada2

The international Healthy Cities movement was first conceived in Canada in 1984 as a result of the Healthy Toronto 2000: Beyond Health Care symposium, and was launched in Europe in 1986 by the World Health Organization (WHO). The movement has since spread across the globe and now involves more than 3,000 municipalities, all of which share a common objective: improving the quality of their citizens life, for and with them. In Canada, where it is called Healthy Cities and Towns in Québec and Healthy Communities in the rest of the country, the movement was officially launched in 1987, in the municipality of Rouyn-Noranda. Over a period of three years, from 1988 to 1991, Health Canada funded a Canadian secretariat to promote the development of a national network, based in Ottawa and located in the office of the Canadian Institute of Planners.

When the federal funding ceased in 1991, the national secretariat disappeared. However, the Canadian Institute of Planners continued to provide a minimum level of follow-up until 1995. At the time a private firm in Ottawa, COMSYS, with the agreement of all the parties, recovered the movement's national archives and continued to provide a minimum level of pan-Canadian exchanges, thanks to grants from Health Canada. Despite the absence of a national secretariat, the movement continued to develop throughout the country, at various speeds and in accordance with a variety of strategies. This was mainly due to provincial networks that, while experiencing ups and downs, were the movement's main driving force.

At the Connecting the Americas symposium held in Québec City in October 1996, that saw the launch of the Québec World Health Organization Collaborating Centre for the Development of Healthy Cities and Towns, a meeting took place between the representatives of the various current or potential Healthy Communities networks in Canada. Community Systems Associates (COMSYS), was given the mandate to prepare a proposal for a modest national secretariat structure. Given Health Canada's interest in ascertaining the state of the Canadian Healthy Communities movement, it was also agreed that a directory would be produced, with the financial support of Health Canada's Health Promotion Branch. The Directory of the Networks of Healthy Communities and Cities in Canada represented the sole national product of the Healthy Communities movement in the country.

What is a Healthy City?

To begin a discussion on a Healthy City Initiative, it is helpful to define what is a "Healthy City". While there are numerous definitions, this report will draw upon two examples: one from the World Health Organization and the City of Toronto.

In a World Health Organization paper, "Promoting Healthy in the Urban Context", it defines a healthy city as having the following eleven characteristics:

From these principles set up by the World Health Organizations, the City of Toronto has also produced its own interpretation of what constitutes a healthy city. In " Healthy Toronto 2000", a 1984 publication by the City's Department of Public Health, it listed a healthy city as having fourteen features:

In these two definitions of a healthy city, the determinants of urban health are much more than just the control of disease and morbidity. Good health is ultimately the product of good communities.

To achieve these good communities, there is a healthy city process. According to The Ontario Healthy Communities Coalition, the model is one by which a community determines its own issues, needs and action plans in building a healthier community.3 The model includes four characteristics:

1. Wide community participation

People from all walks of life working together towards the goal of a healthier community.

2. Broad intersectoral involvement

Business, labour, religious organizations, social services, planners, and environmental groups come together with residents to form a common vision of a healthy community. They each find ways in their day-to-day activities to contribute towards this goal.

3. Local government commitment

The mayor and local councilors should be committed to building a healthier community. Each department (i.e. parks and recreation, public works, planning) works toward the shared vision of a healthy community.

4. Healthy public policy

Healthy public policies are decisions or actions intended to have a positive effect on the health of people. Governments should take into consideration the broad range of factors that affect the health and quality of life of a community and allocate resources and funds accordingly.

An Overview of a Healthy City Initiative

As a means of facilitating a discussion on a possible Healthy City Initiative in Vancouver, this section will provide an overview on the five major components of a HCI: its mandate, functions, key policy areas, operational structures, and funding.

Mandate
Strong political support is a key element in a successful Healthy City Initiative as a clear and strong governmental mandate provides the authority and the resources for HCIs. Due to its urban nature, a HCI normally begins with a city council providing this mandate. At its basics, this mandate entails the cooperation of various departments such as public health, transportation and planning within a city government towards a particular set of urban problems or geographic areas. While it is crucial to enable a HCI the broad jurisdiction that it needs, there is also a balance to ensure that a HCI remains focused on a specific set of goals and realistic projects within an adequate timeframe. Failure to achieve tangible results beyond a research and analysis function has resulted in the breakdown of numerous HCIs across Canada.

Functions
The intended function of a HCI plays a crucial role determining the overall vision of the initiative as a HCI can operate as both a process and an entity. As a process, a HCI stresses interdepartmental cooperation and communications towards approaching urban problems. Project groups consist of diverse teams of city staff from departments such as Engineering, Planning, and Social Planning focused on a specific Healthy City problem. Basic initiatives for a HCI as process include the introduction of key city staff contacts and policy processes to other staff members. Underlying this process, there is a philosophy that urban problems can only solved through a multi-departmental, holistic approach.

As an entity, the functions of a HCI expands as it emerges as a much more complicated organization. As an entity, it would serves as both a research and analysis and a policy implementation body and be set up as a special department or individual that would be responsible for these functions. The HCI would be a facilitator towards solving city-wide problems where it would bring together a series of city departments to co-ordinate actions. It is important to stress that a HCI does not only stop at local government, but would also bring any non-governmental or private parties that have a stake in a particular issue or could participate in a solution. As a tool of policy implementation, a HCI can also directly develop programs and institutions towards implementing city policy. Another role of a HCI is act in a research and analysis capacity where it would produce a "state of a city" report as a means of measuring the effects of city policy.

Key Policy Areas
Public health remains one of the key policy areas for a Healthy City Initiative, but they also include other urban issues such as:

Operational Structures
The structure of a Healthy City Initiative varies greatly and is dependent on the size of the jurisdiction, level of governmental support, and amount of political commitment. As a process, HCIs can be a simple series of workshops that would network disparate city departments into a more cohesive body. Another structure of a HCI is a monthly meeting of all department heads focused on interagency cooperation. As an entity, HCIs can be just an individual within the City Manager's Office coordinating policy development and action or can be as sophisticated as a full fledged department with numerous staff consisting of planners, assistants, and researchers. The operational structures and policy areas will greatly depend on the amount of available funding to the HCI.

Funding
Ranging with jurisdiction and HCI commitment, funding can be part of a specific department's annual budget or, for larger HCIs, a separate line item within a city budget. The configuration and mandate of a HCI will determine the amount of funding needed. There are a few examples of HCIs funded by the federal government, particularly Health Canada, but these HCIs are led by non-governmental organizations as opposed to local government. Funding for most HCIs has been on a local level where local government with minimal contributions from other levels of government have started their own healthy city initiatives.

The Healthy City Office - Toronto, Ontario

In Canada, the most comprehensive local government example of a Healthy City Initiative is the Healthy City Office (HCO) in Toronto.4 From 1989 to 2001, the HCO was the central body for coordinating Healthy City policies for the city. However, for various reasons, the HCO is no longer in existence as a separate entity within the City of Toronto. Nevertheless, it still represented the most advanced form of Healthy Cities Initiatives in the nation.

In 1989, Toronto City Council created the Healthy City Office and came out of a conference on health and the city. The HCO was a separate office based out of the Toronto's planning department with its own line item budget. Since 1998, the Toronto Healthy City Office has been part of the Chief Administrator's Office (their version of a City Manager's Office) of the City of Toronto. Due to Toronto's amalgamation, the Healthy City Office came together with the Corporate Policy Division of the former Metro Toronto government and the Access and Equity staff from all the former municipalities to form the Strategic and Corporate Policy Division of the Chief Administrator's Office.

At its height in the early 1990s, the Healthy City Office worked on a series of projects. Some examples include Clean Air Partnership, Women's Community Economic Development Project, Young People's Advisory Board, Breaking the Cycle of Violence Grant programs, Homeless Youth Banking project and the Duke of Edinburgh Awards project. The HCO had also published a newsletter, the Toronto Healthy City News, which provided the regular updates on the work of the Office and its partners as well as published a series of reports on the state of the city in the areas of housing, pollution, transportation, community safety, and equality and access.5

In order to participate in these activities, the Toronto's Healthy City Office had a significant amount of resources. At its largest, the HCO had 6 planners, 2 researchers, a director, and administrative staff. There was also an advisory committee of which consisted of the directors of all major city departments. With staff salaries and HCO specific costs, the budgets for the Office in the mid-1990s was between $350,000 to $400,000 a year. The budget for the Office only came from the City government with no external contributions from any other level of government. However, with the mid-1990s and the changing configuration of Toronto, the Office nearly disappeared, but through some last minute negotiating the program remained until the late 1990s. By 2001, the HCO has largely disappeared and now only significantly exists as a policy process.

Bringing it home: A Healthy City Initiative and the Vancouver Agreement

The Vancouver Agreement already has many of the nascent elements of a Healthy City Initiative. Signed in 1999, the Agreement was a City, Provincial, and federal government partnership whose mandate is to work together with the community and other agencies to ensure coordinated use of funding and delivery of programs. The partnership, through its Committee structure, has developed strategies to address community health, social and economic and criminal justice issues in the City of Vancouver. The mandate of the agreement is city-wide; however, the Downtown Eastside as having the greatest need and is the first focus of the work.

The Vancouver Agreement provides a basic framework from which to establish a HCI. Given its mandate, functions, and policy areas, the Agreement has already three major elements of a HCI. The multi-departmental approach towards the Downtown Eastside is already in-line with the Healthy Cities philosophy. Moreover, the integration of economic, environment, and equity focuses of many DTES projects have followed the policy route of most HCIs. However, the two missing elements of a HCI, its operational structure and the funding, provides the most significant question towards success of a HCI in Vancouver.

The key question for Vancouver policymakers is that: would a centralized, formalized organization like a Healthy City Office within city government provide a better vehicle for policy development and implementation than the current framework? The primary advantage of pursuing a HCI is its ability to coordinate policy from a central body as opposite to having various departments pursuing the same policy objectives and duplicating efforts. An HCI and more specifically, a body within the City Manager's Office can increase efficiencies as well as the effectiveness of limited city resources between departments. At the same time, the creation of a HCI body may only add to the bureaucracy of City Hall and be an added expense to the city budget. Consequently, a cost/benefit analysis needs to be considered when pursing a HCI. Nevertheless, the most significant contribution of Healthy City Initiative is as an intergovernmental affairs office. Clearly, the necessary jurisdiction, interests, and resources for a healthy city goes beyond the traditional boundaries of local government in Vancouver. With an intergovernmental function within its mandate, an HCI could connect the city with these resources from the provincial and federal governments as well as other private and non-governmental participants. In this capacity, an HCI can make a Healthy City possible.

From the Toronto's Healthy City Office, there are several lessons for Vancouver in establishing and maintaining a HCI. The first is that political and public support for a Healthy City Initiative is crucial to its success. The dissolution of Toronto's HCO comes specifically from the political and fiscal ramifications of the city's amalgamation with its suburban counterparts. The policy approaches of the City of Toronto such as the HCO clashed with those of new vision of the city and consequently, much of the political as well as financial support for the HCI disappeared. However, the failure of the HCO is perhaps due to the body's inability to gather financial support from the provincial and federal governments. The former City of Toronto was the primary supporter of the initiative. This again empathizes the importance of multi-governmental support behind a successful Healthy City Initiative.

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(c) 1998 City of Vancouver

1 Within the literature, the terms, "Healthy Cities" and "Healthy Communities" are used interchangeably.

2 From the Directory of the Networks of Healthy Communities and Cities in Canada, http://www.ulaval.ca/fsi/oms/p2En.html#anchor105378, accessed August 16, 2001.

3 From Ontario Healthy Communities Coalition Web Site, http://www.opc.on.ca/ohcc/, accessed August 16, 2001.

4 Data for this section was gathered through an interview with Meg Shields, a former planner with the Healthy City's Office as well as various articles from the Toronto Star.

5 See City of Toronto's Healthy City Office website, http://www.city.toronto.on.ca/healthycity/initiatives.htm