Abstract
The aim of this study was to utilize the 20 steps in the three phases from the book, 'Twenty steps for developing a Healthy Cities Project $2^{nd}$ Ed., 1995, WHO/EURO' to survey Healthy Cities to identify the similarities and differences by implementation rates and perceived significances among Healthy Cities worldwide. For this study, a self-administered questionnaire was developed based on the book. The questionnaires were delivered by air-mail and e-mail to 213 Healthy City coordinators or directors in 43 nations from Jan 13 to Feb 10, 1999. The responses were gathered up until March 31 from 40 Healthy Cities in 17 nations, mostly in the USA and in the European regions. The main results are as follows; Overall the perceived significances were higher for healthy cities with higher implementation rates and there were significant differences for 'set-up office', 'plans strategy', 'increase health awareness', 'mobilize intersectoral action', and 'secure healthy public policy'. 1. According to national health system, the implementation rate, perceived significance and implementation ability of the 20 steps were higher in the healthy cities with a comprehensive-type health system as compared to those with an entreprenetrial & permissive health system. Overall there were significant differences in the steps 'mobilize intersectoral action', and 'secure healthy public policy'. steps which were predominant in the healthy cities with a comprehensive-type health system. There was no concordance in the ranks of implementation rate and perceived significant score. 2. According to the length of implementation time, the perceived significance and implementation ability were higher in healthy cities with more than 6 years compared to those with less than 6 years, although implementation rate was the same. Overall there was a significant difference in 'secure healthy public policy' the step which was predominant in the healthy cities with more than 6 years of implementation. 3. According to population covered by the Healthy City Project, the implementation rate and implementation ability were higher in healthy cities with more than a population of 100 thousand. There was no significant difference in perceived significance, but there were differences in the following, 'find finances', 'set-up office'. 'mobilize intersectoral action' in the implementation rate and implementation ability. These three steps were predominant in the healthy cities with a population of more than 100 thousand. 4. The population covered by the Healthy City Project was the only effective factor influencing the total implementation ability of each healthy city, and it was higher for those cities with a population of more than 100 thousand. In Conclusion, the implementation rate, the perceived significance and the implementation ability were higher in cities with a comprehensive -type health system, with more than 6 years of healthy city experience and with a population of more than 100 thousand. To increase the reliability and the validity of the questionnaire and the results of this study arising from lack of sufficient data, repeated study needs to be considered with a more refined questionnaire delivered to more healthy cities worldwide.
(College of Medicine Yonsei University)