Duhl and Sanchez (1999) argue that intersectoral action, sustainability, leadership and partnership are a number of characteristics and basic principles to develop an effective healthy city program (Duhl & Sanchez, 1999). This section explores the partnership movement globally as key milestones in the development of health promotion. This is important to understand it comprehensively. Therefore, below it will be explained the milestones of health promotion movement.
1978 Alma Ata Declaration
This is the first international conference that often used as a reference in health promotion and public health movement. The Alma Ata conference, sponsored by WHO and UNICEF, was held in Soviet Kazakhstan on 12 September 1978 attended by 134 nations. This is an international conference on Primary Health Care (Banerji, 2003; Baum, 2007; Hall & Taylor, 2003; Lawn et al., 2008). Alma-Ata called for all governments, health and development workers and the communities to promote Health for All (HFA) around the world by the year 2000. One important quotation of this declaration was that “the exiting gross inequality in the health status of the people, particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable and is, therefore, of common concern to all countries” (Navarro, 1984; Wass, 1994 p. 217).
To achieve HFA, the Alma-Ata Declaration implicitly stated that building partnerships to address a variety of health problems are very crucial. It can be seen from the above statement to call for all sectors (government and non government), all countries (developed and developing countries) in all approaches (politically, socially, and economically approaches). That means their involvement is required.
1986 Ottawa Conference and Charter
Following up the Alma-Ata Conference, in 1986 World Health Organization (WHO) held health promotion conference in Ottawa, Canada. This is the first international conference on health promotion (Eriksson & Lindström, 2008; McQueen, 2001; WHO, 1986, 2000a, 2011) that is more frequently called Ottawa Charter. The Ottawa Charter for Health Promotion established prerequisites for health including peace, social justice and equity and basic services such as education, food and income (Lawn, et al., 2008; McQueen, 2001; WHO, 2000a). It promoted a comprehensive framework for health including building healthy public policy; creating supportive environments; strengthening community action; developing personal skills; and re-orient health services. The recent debate at the World Health Assembly among conference participants was about intersectoral actions for health. Accordingly, they recognize the importance of the countries and decision makers to take a part in intersectoral actions to overcome diverse health problems that are faced lately.
1988 Adelaide Recommendations
Building healthy public policy was to be main issue in the Second International Conference on Health Promotion in Adelaide on 1988 (Kickbusch, McCann, & Sherbon, 2008; McQueen, 2001; Nutbeam, 1998; WHO, 2000a, 2011). This conference placed policies in all sectors affecting the health. Public policies are a key tool for actions to cut down social and economic discrepancies by ensuring fair access for health, education and food services. The Adelaide recommendations called for a political commitment by all sectors including government, private sector and Non Government Organizations and all levels both internationally, nationally, regionally and locally to enhance investments in health and considered the impacts of their actions and decisions on health (WHO, 2000a). It is clear that partnership for HFA is essential. There were four main areas for actions identified in this conference which were supporting the health of woman; improving food security; safety and nutrition; reducing tobacco and alcohol use; and creating supportive environments for health (McQueen, 2001; WHO, 2000a) .
1991 Sundsvall Statement
Supportive Environment was the main theme in the Third International Conference on Health Promotion held in Sundsvall, Sweden in 1991(WHO, 2000a, 2011). Armed conflict; uncontrolled rapid population; lack of food and security; degradation of natural resources were a number of issues identified during the conference. The Sundsvall Statement stressed more on the importance of sustainable development and encouraged social actions at the community groups in which people as main actors of development. Report from the conference also had been presented in the Rio Earth Summit in 1992 and contributed to the development of Agenda 21(WHO, 2000a).
1997 Jakarta Declaration
Jakarta International Conference held on 21-25 July 1997 was the Fourth International Conference on Health Promotion (WHO, 2011). The theme was “New Player for A New Era: Leading Health Promotion Into 21st Century”. This conference plays an important role for all sectors in particular private sector at all countries especially in developing countries. It is because that this conference was the first international conference held in developing countries and the first conference which involved business sector to support health promotion. Additionally, this conference was also a great opportunity for them to re-think effectively health promotion strategies, to review determinants of health, and to identify directions and strategies needed to face the future health promotion challenges in 21st century (Jakarta Declaration, 1997; Nutbeam, 1998; WHO, 1997).
There were five main issues identified in this conference and these were confirmed in the Resolution on Health promotion: Promoting social responsibility for health; increasing community capacity and empowering the individual; expanding and consolidating partnership for health; increasing investment for health development and securing an infrastructure for health promotion (WHO, 2000a). Therefore, based on the five major priorities as mentioned above, increasing and expanding partnership for health were one of the major issues during the conference was running. The Jakarta Declaration on Health Promotion offered a vision and focused on health promotion to face the coming century. It also reflected a strong commitment among participants for sharing various resources to handle health determinants in 21st century. Strengthening the existing partnership and developing new potential partnership are required (Jakarta Declaration, 1997).
2000 Mexico Ministerial Statement
This conference is a continuation of the previous four International Health Promotion Conferences especially the last Global Conference on Health Promotion held in Jakarta, Indonesia 1997. This fifth conference was held in Mexico on 5-9 June 2000 with the theme Health Promotion: Bridging the Equity Gap (McQueen, 2001; WHO, 2000a, 2000c, 2011). Six major issues for actions were identified in the conference: To position the health promotion as main concern at all levels (local, regional, national and international policies); to ensure actively participation of all sectors including civil society in the health implementation; to support the country-wide action plans for health promotion including providing the WHO’s expertise and its partners; to strengthen national and international networks promoting health; to advocate UN agencies to be responsible for the impact of health of their development agenda; and to inform the Director General of the World Health Organization of the progress made in the performance of the above actions (WHO, 2000c). This conference recognises the importance of partnership at all levels and sectors.
2005 Bangkok Conference
Theme of the conference held in Bangkok, Thailand was “Policy and Partnership for Action: Addressing the Determinants of Health”. This conference was the sixth International Conference on Health Promotion held on August 7-11, 2005 (Barry, Allegrante, Lamarre, Auld, & Taub, 2009; Porter, 2007; Smith, Tang, & Nutbeam, 2006; WHO, 2011). There were four key commitments identified in this conference to make the promotion of health: central to the global development agenda; a core responsibility for all of government; a key focus of communities and civil society; and a requirement for good corporate practice. The Bangkok Charter called for all peoples, groups; and organizations that interested and concerned in the health achievement including governments and politicians at all levels, civil society, private sector, international agencies and public health community. Policies and partnerships are major issues for addressing various health determinants (WHO, 2005).
2009 Nairobi Conference
The last conference carried out on 26-30 October 2009 in Nairobi, Kenya Africa also plays an important role in developing partnership for health. This conference organized and supported by WHO and the Kenya Ministry of Public Health was attended by over 600 international participants from more than 100 countries. Promoting Health and Development: Closing the Implementation Gap (WHO, 2011) was to be main theme at the conference. There were five major issues identified in the Nairobi conference as strategies and actions: community empowerment; health literacy and health behaviors; strengthening health systems; partnership and intersectoral action; building capacity for health promotion (WHO, 2011). Partnership, leadership, and empowerment were important issues discussed during the conference.
Based on the milestones in health promotion from Alma-Ata to Nairobi declaration both implicitly and explicitly, WHO and all decision makers from all levels and sectors recognize that working in partnership is essential to share resources and experts, to share risks and benefits, and to maximize health outcome. This partnership is also important for developing healthy cities globally and nationally including Indonesia.
2. Partners in healthy cities
Healthy cities partners might vary from one country to another. This section explains partners involved in healthy cities in relation to recognition of the importance of partnership in developing healthy cities. At the early section it has been explained various types of partnerships in health promotion. They depend on the levels of government and contribution, issues, public-private relations, and partners position from the community. These are also similar to healthy city development.
As an example, report and documentation of the technical discussion held in junction with the 37th meeting of CCPDM in New Delhi on August 31, 2000 attended by member countries of World Health Organization for Regional Office for South-East Asia stated the importance of relevant sector to involve in developing healthy cities. The member countries called sanitary engineers, scientists, media, architects, politicians and religious leaders for actions and take a part to build an effective coordination for healthy settings including healthy cities (WHO, 2000b). Likewise, communities, NGOs, and private sector’ involvement had to be strengthened in the areas of the prioritized settings, project monitoring and evaluation. Building a mechanism of local intersectoral management approach such as city council and community development committees was essential from all steps of healthy settings implementation: planning to evaluation. Healthy city actors had to cooperate both politically and technically (WHO, 2008, p.6).
the key sectors for healthy city collaborate each other (WHO, 1996, 2008). Each governmental body from different sectors provides a plan to support a healthy city plan in which community was a central. To achieve it, local and national policies and international initiatives such as HFA and Agenda 21 strategies need to support them. All sectors are important. However, the most important sectors and decision makers are City Mayors or Regents (WHO, 2008). Their position is very strong. They have power to encourage even enforce other sectors of government bodies to actively involve in healthy city planning and implementation. Therefore, political commitment of City Mayors is crucial to ensure the cooperation and collaboration of government agencies including industry and private sector in their areas.
Stakeholders involved in a healthy city program also depend on settings or areas in which healthy city program is developed. Edwards and Tsouros (2008) provide a guideline for developing healthy city entitled “A healthy city is an active city: A physical activity planning guide”. This book was published by WHO Regional Office for Europe. In the third section of the book, they wrote “who does what”? It explained three main stakeholders involved for creating a healthy city is an active city: public sector; civil society and voluntary sector; and private sector. Stakeholders from the public sector might include urban planners, sport and recreation, health, transport, education, and tourism while stakeholders that relate to civil society and voluntary organizations include organisations in sport, culture, nature and health, informal groups and also representative of residents and special groups. In addition, from private sector they might include employers, employees, fitness club and dance schools, corporate sponsors and mass media (Edwards & Tsouros, 2008).
Thus, an important step to develop programs including healthy city is to identify the participants and related stakeholders of the projects. Related parties for healthy city plan may include politicians, sector representatives, community organizations, urban planners, special interest groups and experts. Politicians and planners are the highest level and position in order to ensure political acceptance and implementation. Politicians and partnership have different outcome and emphasis. Politicians talk about “who gets what” while partnerships talk about “who does what” (Edwards & Tsouros, 2008).
Another example, WHO Regional Office for Western Pacific listed a number of key players of healthy cities project. They were local, provincial/state and national politicians; government service providers from a variety of sectors such as health, welfare, transport, police, public housing authority; community service providers; Non Governmental Organisations, and Community Based Organisations. Other stakeholders include consumer groups; private sectors; local government authorities; provincial/state government authorities; relevant national government authorities; community members; ethnic groups; media and educational institutions (WHO, 2000d).
One of the major lessons learnt that can be gained from regional experiences in Western Pacific is about political support for coordination and resource mobilization. Healthy cities implementation has demonstrated that strong political support from local leaders is essential to develop and maintain sustainable healthy cities project. Without a strong political commitment from Mayors, healthy cities program will face various difficulties for achieving the organizational change, building coordination across sectors and mobilizing resources. Strong political leaders bring healthy cities easier to be implemented and these are key success factors of healthy cities initiatives. Mayors from cities in Western Pacific Region have often been invited to attend the international conference or conduct study tour to know more healthy cities in the regions. The Japanese healthy cities project, for example, even is often led by Mayors (WHO, 2000d). Strong political support relates to other aspects of healthy cities implementation for instance the needs of effective leadership and active community involvement. The strong political leaders will reflect in engaging community and recognizing the importance of community involvement (WHO, 2000d).
REFERENCES
WHO. (2011). Health promotion Retrieved 5 July 2011, 2011, from http://www.who.int/healthpromotion/conferences/7gchp/en/index.html
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