Farrington Jill L, Faskunger Johan, Mackiewicz Karolina
Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
PhD Exercise and Health Science, ProActivity AB, Sweden.
Health Promot Int. 2015 Jun;30 Suppl 1:i86-i98. doi: 10.1093/heapro/dav038.
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.
全球范围内，非传染性疾病（NCDs）导致的过早死亡负担巨大且不断加重。本文评估了世界卫生组织欧洲健康城市网络在其第五阶段（2009 - 2013年）的预防工作，特别是针对四个行为风险因素（烟草使用、酒精滥用、不健康饮食和身体活动不足）。借助案例研究、问卷调查回复及其他材料，本文指出了哪些城市参与其中、哪些措施有效以及哪些无效、行动的触发因素、遇到的挑战和吸取的经验教训。似乎很少有城市针对多种风险因素采取全面的非传染性疾病预防方法，或者将人群层面和个体层面的干预措施结合起来。健康食品和饮食方面的工作主要集中在教育或护理环境中的儿童，很少有城市似乎采取全面方法来应对肥胖问题。伙伴关系是所有非传染性疾病风险因素工作的一个显著特点，而且通常范围广泛，在健康饮食和食品工作方面最为多样。有与社区积极互动的有力例子，社区也参与了项目的共同设计和塑造。公平性也很突出，有多个例子表明如何关注了健康的社会决定因素。有证据表明，城市在其国家内仍然是重要的创新力量和变革驱动因素，并且强调了国家和地方层面的相互依存关系。促进身体活动的干预措施已从特定活动和项目转向与其他政策领域更紧密结合，并基于部门间合作。
