title: Evaluation of risk factor reduction in a European City Network.
abstract: There is a substantial and growing burden of premature mortality caused by non-communicable diseases (NCDs) globally. This paper evaluates the preventive efforts of the WHO European Healthy Cities Network during its fifth phase (2009-13), specifically for four behavioural risk factors (tobacco use, alcohol abuse, unhealthy diet and physical inactivity). Drawing on case studies, questionnaire responses and other materials, it notes which cities were involved, what worked and did not, the triggers for action, challenges met and lessons learnt. Few cities appeared to have taken comprehensive approaches to NCD prevention across multiple risk factors, or have combined population- and individual-level interventions. Work on healthy food and diet predominantly focused on children in educational or care settings, and few cities appeared to take a comprehensive approach to tackling obesity. Partnerships were a strong feature for all the NCD risk factor work, and were frequently extensive, being most diverse for the Healthy Diet and Food work. There were strong examples of engagement with communities, also involved in co-designing and shaping projects. Equity also featured strongly and there were multiple examples of how attention had been paid to the social determinants of health. There was evidence that cities continue to be significant innovative forces within their countries and drivers of change, and the mutual dependency of the national and local levels was highlighted. Interventions to promote physical activity have shifted focus from specific events and projects to being more integrated with other policy areas and based on intersectoral collaboration.
authors.affiliation: Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK j.l.farrington@leeds.ac.uk.
authors.forename: Jill L
authors.initials: JL
authors.lastname: Farrington
authors.affiliation: PhD Exercise and Health Science, ProActivity AB, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Faskunger
authors.affiliation: Baltic Region Healthy Cities Association-WHO Collaborating Centre for Healthy Cities and Urban Health in the Baltic Region, Turku, Finland.
authors.forename: Karolina
authors.initials: K
authors.lastname: Mackiewicz
mesh_terms: D000437:Alcoholism; D002908:Chronic Disease / Q000517:prevention & control*; D002947:Cities; D004032:Diet; D005060:Europe / Q000453:epidemiology; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods / Q000458:organization & administration; D006801:Humans; D009026:Mortality; D019982:Organizational Case Studies; D015397:Program Evaluation; D015980:Public Health Practice; D012307:Risk Factors; D040242:Risk Reduction Behavior; D057185:Sedentary Behavior; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires; D014504:Urban Health; D014944:World Health Organization
keywords: healthy cities; non-communicable diseases