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The Concept
The concept of
Healthy Settings aims at establishing more effective work relations between
the health sector and other sectors to create a healthier environment by
solving health and related problems closer to their source. This concept recognizes that people form an
integral part of the earth’s ecosystem, and therefore their health is
fundamentally interlinked with the total environment. A healthy and productive life is determined
by two set of factors; those factors and risks within the control of
individuals like health behavior, and those caused by existing social,
physical and economic environment surrounding the individuals. The latter set of determinants
are addressed in the Healthy
Setting concept.
The Healthy Settings has its origins in the Healthy Cities
movement. This Healthy Cities movement
started in the developed countries in the mid 1980’s, but was successful in
spreading to the developed world only in the early 90’s. The Healthy Cities movement has its origins
from deliberations of a number of consultations and instruments like the
Ottawa Charter for Health and Development (1986), the European Charter on
Environment and Health (1989), and Agenda 21 (1992). These, and other, initiatives recognize the
principal of ‘anthropocentric development’ and the fundamental importance of
the role of communities in bringing about change.
The Healthy Settings concept recognizes the complex
connections and inter-linkages between existing human settings and health
risks. In fact, recognizing these
linkages the concept of healthy settings has been introduced in the region
since 1992. The emphasis on these
linkages was further highlighted in the International Conference on Health
Promotion in Sundsvall. Here it was emphasized that the supportive
environment for any setting would include both the physical and social
aspects of the settings and consists of the home, neighborhood, place of work
and recreation. Therefore, for
effective and sustainable solutions action needs to be coordinated at the
local, regional, national and global levels.
Furthermore, the supportive environment should also include the
social, political, and economic dimensions, and also need to recognize
women’s skills and knowledge.
The Settings
The Healthy Settings approach is possible to extend to a
number of settings. While Healthy
Cities may be regarded as a precursor to Healthy Setting, a number of
settings including cities, districts and schools are encompassed in the
overall framework of Healthy Settings.
The WHO Healthy Cities
Programme has emerged in response to the deteriorating health conditions
linked with urbanization. The WHO
Healthy Cities Programme was launched in the SEAR region in 1994. This WHO programme aims at realizing it is
objectives through partnerships between public, private, and voluntary
agencies. The WHO Healthy Schools initiative was launched in 1995 at the global
level. At the regional level it was in
1997 that the SEAR countries recommended, recognizing the capacity of schools
to promote health, the need for a clear policy to provide comprehensive
school health education and establish a national network of health promoting
schools. The Healthy Settings concept
has also been extended to the Healthy
District programme. Districts,
being comprehensive administrative units, have an enormous potential for
providing support for healthy settings.
Furthermore, with the current emphasis on decentralization in most
countries, districts provide an ideal setting for delegating of responsibilities
and defining priorities to local government.
Framework for Action
Based on a regional consultation on Healthy Cities in the
SEARO region a framework for action for Health Cities
project was developed. This framework
is also possible to adapt to other settings and is briefly described
here.
 Development of a Local Task force (LTF). This could include members of the Central
and local government, charismatic individuals, NGOs, community groups,
training institutes etc.
Awareness raising and building public
support. The LTF then needs to
develop, with the support of the people impacted by the programme, a vision
for the Healthy Setting. This would need
the articulation of the setting concept to the population, creating
acceptance for it, and the inclusion and involvement of people.
Identifying priority issues. Here again the LTF, with the people would
priorities issues that would have been raised while building a vision for the
Healthy Setting Concept in the area.
Also, health and environment departments would need to be involved in
identifying linkages and in planning priorities issues for the programme.
Obtaining approval from the Government. If not already received in the start-up
phase it would be essential to receive approval from the government for the
programme. This would also help create
a harmonious working relation between the civil authorities and the local
communities.
Appointment of Partnership Task Force,
coordinators and office. A number of
members of the LTF may become members of this task force. There would also be a need to set up the
programme office and appoint coordinators to execute the plan. Also, there may also be a need to set up
working committees to address priority issues.
Preparation of the Programme Plan and creation
of awareness on it. To start with
there would be a need to collect baseline data. Equally, it would be important to note that
the identification of action would need to be a dynamic process and changing
with requirements and not a one off exercise.
Since the plan is a tool for creating discussion and raising awareness
for possible alternative living conditions and lifestyles in communities to improve
through cooperative efforts and partnerships, there would be a need for high
profile activities and awareness creation.
Plan implementation. After the development of the plan and the
prioritization of issues, it would be time to mobilize resources from
different sources like the community, government and private sector and
implement the plan.
Evaluation and assessment. After the activation of the plan for a
while it would be important to evaluate it both to understand its impact and
progress. The evaluation should be a
part of a dynamic process to help make necessary adjustments and improvements
in the plan implementation.
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