Healthy Cities in a global and regional context.

Since the beginning of the WHO European Healthy Cities Network in 1987, the global and regional contexts for the promotion of health and well-being have changed in many ways. First, in 2000, the United Nations Millennium Goals explicitly and implicitly addressed health promotion and prevention at the global and regional levels. Second, the concern for sustainable development at the Rio Conference in 1992 was confirmed at the World Summit in Johannesburg in 2002. During the same period, in many regions including Europe, the redefinition of the roles and responsibilities of national, regional and local governments, reductions in budgets of public administrations, the privatization of community and health services, the instability of world trade, the financial system and employment, migration flows, relatively high levels of unemployment (especially among youth and young adults) have occurred in many countries in tandem with negative impacts on specific policies and programmes that are meant to promote health. Since 1990, the European Commission has been explicitly concerned about the promotion of health, environment and social policies by defining strategic agendas for the urban environment, sustainable development and governance. However, empirical studies during the 1990s show that urban areas have relatively high levels of tuberculosis, respiratory and cardiovascular diseases, cancer, adult obesity, malnutrition, tobacco smoking, poor mental health, alcohol consumption and drug abuse, sexually transmitted diseases (including AIDS), crime, homicide, violence and accidental injury and death. In addition, there is evidence that urban populations in many industrialized countries are confronted with acute new health problems stemming from exposure to persistent organic pollutants, toxic substances in building structures, radioactive waste and increasing rates of food poisoning. These threats to public health indicate an urgent need for new strategic policies and research agendas that address the complex interrelations between urban ecosystems, sustainable development, human health and well-being. The WHO Healthy Cities project is one important vector for achieving this objective at both global and regional levels.