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Special Issue "Healthy Cities"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (31 January 2019).

Special Issue Editor

Prof. Dr. Hsien-Wen Kuo
E-Mail Website
Guest Editor
Institute of Environmental and Occupational Health Sciences, National Yang-Ming University, Taipei, Taiwan
Interests: nutritional psychiatry; healthy dietary patterns; fruit and vegetable consumption; food-mood connection; vulnerable population (early life, adolescent, elderly); whole-of-diet intervention
Special Issues and Collections in MDPI journals

Special Issue Information

Dear Colleagues,

Healthy Cities (HC) projects, proposed by the World Health Organization (WHO) in 1986, are the best-known of the settings-based approaches to health promotion for citizens living in cities. These projects are engaged by local governments for creating healthy populations, healthy environments and a healthy society through a process of commitment to health, political decision-making, intersectoral action, community participation, innovation and public health policy. Over 5000 cities and communities have implemented HC projects worldwide, since their inception. Based on the reference from the WHO ‘Health 2020’ strategy, HCs were encouraged to recognize their own efforts toward integrating health in all policies through a supporting team from private sectors, academia and NGO members. Knowing this, each HC should organize an HC committee and set achievable indicators to allow action plans to move forward gradually. HC indicator data should improve estimates, allowing for diagnoses of the overall needs of citizens and illuminate developing trends, thereby allowing the program to move forward appropriately, in both policy settings and in problem solving. Consequently, the indicators allow for management and improvement of the plan’s policies, creating a dynamic system within the plan. Combined understanding of citizen needs, the setup of indicators, the execution of the plan itself, and guidance of assessments lead to a standardized, rolling plan in the form of Plan, Do, Check and Action (PDCA).  Although various cities around the world have been implemented in the HC program for a brief period of time, empirical-based evidence was determined by a whole-hearted effort from the international society. It is needed to witness the effectiveness or benefits through HC programs to demonstrate to solve citizens’ needs to incrementally upgrade their health status and quality of life.  

Prof. Dr. Hsien-Wen Kuo
Guest Editor

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Health policy
  • Healthy environment
  • Healthy lifestyle
  • Health sustainability
  • Health industry
  • Mental health
  • Health safety (city safety)
  • Health equality
  • Health in all policy (HiAP)
  • Smart city

Published Papers (9 papers)

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Research

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Article
Characteristics and Challenges for the Development of Nature-Based Adult Day Services in Urban Areas for People with Dementia and Their Family Caregivers
Int. J. Environ. Res. Public Health 2019, 16(8), 1337; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16081337 - 14 Apr 2019
Cited by 3 | Viewed by 1926
Abstract
Nature-based adult day services (ADSs) for people with dementia (PwD) are well-known in rural areas. In recent years, a number of providers have started offering these services in urban contexts, e.g., in city farms and community gardens, where people with dementia participate in [...] Read more.
Nature-based adult day services (ADSs) for people with dementia (PwD) are well-known in rural areas. In recent years, a number of providers have started offering these services in urban contexts, e.g., in city farms and community gardens, where people with dementia participate in outdoor activities, such as gardening and caring for animals. At the moment, little is known about these services within an urban context, and the aim of this study is to characterize different types of nature-based ADSs in urban areas for PwD living at home, as well as to identify general and specific challenges with regard to the development of different types of ADSs. An inventory was carried out and 17 ADS providers in urban areas were interviewed about their initiatives, settings, client groups, motivations for starting their nature-based ADS, and their experiences with, competences for, and funding of urban nature-based ADS. The interviews were recorded, transcribed verbatim and thematically analyzed. Five types of nature-based ADSs were identified: (1) services offered by social entrepreneurs, (2) nursing homes opening their garden to people with dementia, (3) social care organization setting up nature-based, (4) community garden set up by citizens, and (5) hybrid initiatives. Common activities were gardening, preparing meals, and taking care of farm animals. The main activities organized by nursing homes included sitting and walking in the garden and attending presentations and excursions. General challenges included the availability of green urban spaces and acquiring funding for the nature-based services. Initiatives of social entrepreneurs depended strongly on their commitment. Challenges for nursing homes included a lack of commitment among nursing staff, involvement of PwD living at home and a lack of interaction with the neighborhood. Volunteers played a key role in the initiatives organized by social care organizations and in community gardens. However, it was a major challenge to find volunteers who know enough about care and gardening. Specific challenges for the hybrid types were related to differences in work culture between social entrepreneurs and care organizations. Different types of care-oriented and community-oriented nature-based adult day services in urban areas for people with dementia have been developed, facing different types of challenges. Care oriented initiatives like nursing homes opening their garden focus on risk prevention and their nature-based services tended to be less diverse and stimulating for people with dementia living at home. Collaboration between such care-oriented initiatives with initiatives of other types of organizations or social entrepreneurs can lead to more appealing community-oriented nature-based services. Full article
(This article belongs to the Special Issue Healthy Cities)
Article
Do Healthy City Performance Awards Lead to Health in All Policies? A Case of Taiwan
Int. J. Environ. Res. Public Health 2019, 16(6), 1061; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16061061 - 24 Mar 2019
Cited by 5 | Viewed by 1763
Abstract
The Healthy Cities (HC) Project, which was introduced by the World Health Organization (WHO) in 1986, has been recognized as the best setting approach for health promotion. However, very few studies have addressed how to use HC approaches to establish public policies in [...] Read more.
The Healthy Cities (HC) Project, which was introduced by the World Health Organization (WHO) in 1986, has been recognized as the best setting approach for health promotion. However, very few studies have addressed how to use HC approaches to establish public policies in non-health departments in cities. This paper describes the strategies for the HC Performance Awards used in Taiwan to draw attention from different departments and to sustain intersectoral collaboration for the purpose of establishing Health in All Policies (HiAP). The methods include: (1) setting up the Taiwan Healthy City Alliance; (2) establishing HC Innovation Performance Awards; (3) reviewing the award applications according to seven criteria; and (4) analyzing the topic content of the award applications. We collected 961 HC award applications during 2013–2016 to analyze their content. The results showed that the number of applications increased nearly every year while significantly more non-health departments applied for the awards compared to health departments (73.3% vs. 26.7%). The award rates of non-health departments have also increased twice from 13.9% in 2013 to 25.8% in 2016. By examining the topics of the award winners, we concluded that “HC Innovation Performance Awards” indeed provide a role and opportunity for political involvement, intersectoral collaboration, co-opetition and capacity building that is necessary for establishing health in all policies. Full article
(This article belongs to the Special Issue Healthy Cities)
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Article
Examining Stakeholder Perspectives: Process, Performance and Progress of the Age-Friendly Taiwan Program
Int. J. Environ. Res. Public Health 2019, 16(4), 608; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16040608 - 19 Feb 2019
Cited by 5 | Viewed by 1018
Abstract
Since Taiwan’s age-friendly city (AFC) program was launched in 2012, the central government has provided various resources to the country’s 22 local authorities, including budgetary support, policy advocacy, and consultation from a team of experts. This study examines stakeholder perspectives on the process, [...] Read more.
Since Taiwan’s age-friendly city (AFC) program was launched in 2012, the central government has provided various resources to the country’s 22 local authorities, including budgetary support, policy advocacy, and consultation from a team of experts. This study examines stakeholder perspectives on the process, performance, and outcome of the AFC program. A 53-item questionnaire was developed based on the World Health Organization (WHO) guideline, including mechanisms and processes (20 items), outcome evaluations (23 items), and resource integration (10 items). There was a “great difference” found among scores between facilitators and experts for “inter-exchange experience with local and international cities” (40%) and “monitor and revise indicators” (37%) in mechanisms and processes, “evaluate performance of indicators and action plans” (37%) in outcome evaluations, and “interaction between government and community” (46%) and “interaction between civil organization and senior society” (39%) in resource integration. Clearly, facilitators showed overly optimistic assessments in AFC mechanisms and processes, outcome evaluation, and resource integration. The results showed disconnect between experts’ expectations versus actual practice conducted by facilitators. Implications of these findings are to integrate top down expectations with the realities of bottom up practice to design more realistic evaluations; continue to educate stakeholders about design, implementation and evaluation; and further integrate resources from government, civil organizations, and community. Full article
(This article belongs to the Special Issue Healthy Cities)
Article
Does Health Promotion Program Affect Local Resident’ Emotions?
Int. J. Environ. Res. Public Health 2019, 16(4), 549; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16040549 - 14 Feb 2019
Cited by 2 | Viewed by 1116
Abstract
Healthy cities continuously attempt to improve residents’ health. Health is affected by psychological factors, such as happiness and emotions. Therefore, this study investigates the effects of healthy city program performance on individuals’ emotions, as well as the correlation between healthy city program performance [...] Read more.
Healthy cities continuously attempt to improve residents’ health. Health is affected by psychological factors, such as happiness and emotions. Therefore, this study investigates the effects of healthy city program performance on individuals’ emotions, as well as the correlation between healthy city program performance and emotions using personal happiness index as a parameter. We conducted a questionnaire survey of residents in areas implementing healthy city projects. A total of 596 responses were obtained. We used structural equations to analyze the relationship of structural influences. Results showed that healthy city program performance had significant static effects on emotion. This observation shows that healthy city programs decrease local residents’ negative emotions, such as stress and depression. Therefore, healthy city programs stabilize residents’ emotions by increasing health friendliness. To improve the performance of healthy city programs, it is necessary to mitigate health risk factors and positively affect individuals’ emotions. Full article
(This article belongs to the Special Issue Healthy Cities)
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Article
Interventional Effects of Weight-Loss Policy in a Healthy City among Participants with Metabolic Syndrome
Int. J. Environ. Res. Public Health 2019, 16(3), 323; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16030323 - 24 Jan 2019
Cited by 3 | Viewed by 1582
Abstract
This study aimed to establish a friendly environment of active living and healthy eating for citizens while promoting and increasing knowledge of healthy exercise. Acquisition of physical activity skills and citizens’ lifestyle changes result in reduction in rates of obesity and deaths related [...] Read more.
This study aimed to establish a friendly environment of active living and healthy eating for citizens while promoting and increasing knowledge of healthy exercise. Acquisition of physical activity skills and citizens’ lifestyle changes result in reduction in rates of obesity and deaths related to underlying metabolism syndrome. This study used a non-experimental cross-sectional design to survey residents living in Taiwan’s rural Miaoli County. The inclusion criterion was positive screening for metabolic syndrome. In total, 2068 participants were recruited, and 1886 questionnaires (91.2%) were completed. An organization-spreading strategy and home convenient Lifestyles of Health and Sustainability tactic were applied to the assessment, promotion, evaluation, and planning of the project via an obesity-causing environmental scan, oriental synergy aerobics, acupuncture points massage, guide books, broadcasting, town-based “shape-it-station”, and a vending cart created to facilitate the acquisition of healthy foods. After the intervention, results revealed that health condition, regular exercise habits, diet behavior, metabolic syndrome cognition, and body weight became better than before. Appropriate promotion of healthy cities through public health measures may effectively reduce the threat of death due to metabolic syndrome, which in turn reduces overall, and represents successful control of a typical non-communicable disease. Full article
(This article belongs to the Special Issue Healthy Cities)
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Article
Current Status and Policy Planning for Promoting Age-Friendly Cities in Taitung County: Dialogue Between Older Adults and Service Providers
Int. J. Environ. Res. Public Health 2018, 15(10), 2314; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15102314 - 21 Oct 2018
Cited by 5 | Viewed by 1799
Abstract
The World Health Organization has promoted age-friendly city (AFC) projects in response to the aging population. Taiwan has also promoted AFC policies. This study was conducted in Taitung County, where 15.37% of the population is older adults in Taiwan. The aim was to [...] Read more.
The World Health Organization has promoted age-friendly city (AFC) projects in response to the aging population. Taiwan has also promoted AFC policies. This study was conducted in Taitung County, where 15.37% of the population is older adults in Taiwan. The aim was to understand the perceptions of older adults and service providers with regard to the current status of AFC policies to influence future policies. The participants of this study were older adults and service providers in various regions of Taitung. Quantitative questionnaires were completed by older adults and qualitative interviews were held with focus groups. The older adults were the most satisfied with the AFC domains of “respect and social inclusion” and “community and health services”, and the least satisfied with “transportation” and “civic participation and employment”. Homogeneity existed between the older adults’ satisfaction levels in different regions and the service providers’ opinions; however, there were notable differences between them. Both economic development and the ethnicity of groups in different regions are influential factors that determine the success of government policies. In promoting AFC policies, local governments should consider their applicability based on local conditions and resources to meet the needs of the aging population in rural areas. Full article
(This article belongs to the Special Issue Healthy Cities)
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Article
Translation and Validation of the Korean Version of the Revised Health Care System Distrust Scale (HCSD-K) in Korean American Women
Int. J. Environ. Res. Public Health 2018, 15(9), 1964; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15091964 - 08 Sep 2018
Cited by 1 | Viewed by 1777
Abstract
Background: Trust in the healthcare system is a major contributor for racial disparities in health and health care. We aimed to formally translate and cross-culturally adapt the Korean version of the Revised Health Care System Distrust (HCSD-K) scale with a sample of Korean [...] Read more.
Background: Trust in the healthcare system is a major contributor for racial disparities in health and health care. We aimed to formally translate and cross-culturally adapt the Korean version of the Revised Health Care System Distrust (HCSD-K) scale with a sample of Korean American women and examine the psychometric properties of the HCSD-K scale. Methods: Ten Korean American women participated in the cognitive interview. A self-administered questionnaire was completed by 196 Korean American women aged 50–74 years. Instrument adaptation was performed using committee-based translation and cognitive interviewing. Construct validity, convergent validity, and internal consistency were examined to evaluate the psychometric properties of the HCSD-K scale. Results: The translated instrument was found to be semantically sound. A confirmatory factor analysis revealed a two-factor structure with an excellent fit. Convergent validity was supported by correlations between the HCSD-K scale and both the Perceived Discrimination in Health Care and Trust in Physician scales. Cronbach’s alpha for the total HCSD-K was 0.83. Conclusion: The nine-item HCSD-K scale demonstrated satisfactory reliability and validity. It is an appropriate instrument for measuring healthcare system distrust in Korean American women. Further study is needed to confirm the study results in a gender-mixed Korean population. Full article
(This article belongs to the Special Issue Healthy Cities)
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Review

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Review
Assessment Tools for Health Literacy among the General Population: A Systematic Review
Int. J. Environ. Res. Public Health 2018, 15(8), 1711; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15081711 - 10 Aug 2018
Cited by 16 | Viewed by 4119
Abstract
Health literacy is an important determinant of health, and is one of the key indicators of a healthy city. Developing and improving methods to measure health literacy is prudent and necessary. This review summarizes the findings of published tools for assessing health literacy [...] Read more.
Health literacy is an important determinant of health, and is one of the key indicators of a healthy city. Developing and improving methods to measure health literacy is prudent and necessary. This review summarizes the findings of published tools for assessing health literacy among the general population to provide a reference for establishing health literacy assessment tools in the future. In this systematic review, PubMed, Embase, and Web of Science were used to search articles regarding tools for assessing health literacy among the general population published up to 10 January 2018. Two researchers independently conducted literature screening, quality assessment of methodology, and data extraction according to preset inclusion and exclusion criteria. The quality assessment of the research was examined with the use of the specifications of the reporting guidelines for survey research (SURGE). Eleven articles met the inclusion criteria. All included instruments in monitoring the health literacy of the general population were presented through the form of questionnaires. The multistage process of making all the scales generally involved the following steps: item development, pre-testing, and evaluation of readability. However, the specific methods were different. Internal consistency for all the instruments was acceptable but with weak consistency among the subscales for some instruments. Most of the identified instruments derived from the definition of health literacy or were based on existing health literacy theory. Approximately 30% of the performed studies provided no description of the important features specified in the SURGE. This review indicates a trend in the increasing tools for assessing the health literacy of the general population by using multidimensional structures and comprehensive measurement approaches. However, no clear “consensus” was observed in the dimensions of health literacy tools. Full article
(This article belongs to the Special Issue Healthy Cities)
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Other

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Brief Report
Epidemiological Surveillance System on Foodborne Diseases in Brazil after 10-Years of Its Implementation: Completeness Evaluation
Int. J. Environ. Res. Public Health 2018, 15(10), 2284; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15102284 - 17 Oct 2018
Cited by 6 | Viewed by 1452
Abstract
This study aimed to evaluate the data quality of the Brazilian Epidemiological Surveillance System on Foodborne Diseases (VE-DTA) through the evaluation of the completeness of the record after 10-years of its implementation. The study evaluated the measurement of completeness by quantifying ignored, incomplete [...] Read more.
This study aimed to evaluate the data quality of the Brazilian Epidemiological Surveillance System on Foodborne Diseases (VE-DTA) through the evaluation of the completeness of the record after 10-years of its implementation. The study evaluated the measurement of completeness by quantifying ignored, incomplete or blank responses of the data items filled. The evaluation used the percentage of completion of these items regarding the total number of notifications registered in the system. We organized the results according to the general Category of completeness of the database, by year of notification and region of occurrence. We also evaluated the overall completeness percentages of the database and the completeness levels according to the degree of recommendation of completion of each variable (mandatory, essential, and complementary) by the VE-DTA manual. The system presented 7037 outbreaks of foodborne diseases. According to the completeness classification, the database presented general classification as Category 1 since it has 82.1% (n = 5.777) of variables with the level of completion up to 75.1%. We observed that 8.6% of the database was classified as category 2; 9.2% as category 3 and 0.1% as category 4. The improvement on database quality regarding completeness can positively impact on public health and public policies, reducing the number of FBDs deaths. Full article
(This article belongs to the Special Issue Healthy Cities)
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