IntroductionSince 1986, the World Health Organization has promoted a Healthy Communities/Healthy Cities initiative, also known as the Alliance for Healthy Cities, with hundreds of participating municipalities across the world (Hancock, 1993; World Health Organization, 2018). The purpose of the Alliance for Healthy Cities is to encourage local governments to incorporate health promotion into all areas of public practice, economic policy, and urban development (World Health Organization, 2018). Goals of the Healthy Communities/ Healthy Cities approach include reducing public health risks including obesity, and promoting healthy lifestyles, public safety, and health equity. The success of Healthy Cities programs and policies directly depends on the empowerment of nurses at all levels of practice, including community-based nurses. Because each community presents different needs, goals, and challenges, nurses in each community can collaborate with partners and stakeholders to promote and reach realistic public health goals.
Healthy Communities: Relevance to the Nursing Profession
The Healthy Communities/Healthy Cities approach is based on the ecological model of public health and nursing, which is systemic in approach. Individual health is viewed as part of a whole; the individual is influenced by socioeconomic and cultural factors as well as by issues related to quality of life in the community. Public infrastructure, clean air, and normative behaviors all have a strong impact on individual decision-making, lifestyle, and attitudes towards health, healthcare, and wellness (Bowen, Barrington & Beresford, 2015; Story, Kaphingst, Robinson-O’Brien, et al., 2008). Nurses also treat patients within the same normative environment; when nurses make lifestyle recommendations for patients, those recommendations are much more meaningful and easier to act on when the patient is supported by community infrastructure and health-seeking paradigms. Community health approaches like the Healthy Cities/Healthy Communities projects are grounded in evidence-based practice Bowen, Barrington & Beresford, 2015; Story, Kaphingst, Robinson-O’Brien, et al., 2008). While the majority of studies focus on the impact of public policy and community nursing on obesity and related health issues, a growing body of evidence also supports public health approaches and nursing policy to reducing violence and extremism too (Weine, Eisenman, Kinsler, et al., 2016). The Healthy Communities/Healthy Cities approach is flexible, taking into account the diverse needs of heterogeneous communities and has proven successful all over the world (Hu & Kuo, 2016; Rice, Franseschini, Wallerstein, et al., 2017). Because participation in the initiatives is fully voluntary, the implementation of the Healthy Communities approach to health promotion is generally achieved in a bottom-up fashion, although some municipalities find that a top-down approach to implementation works better. Ultimately, the mechanisms of action and specific methods of policy implementation can be
adaptable to suit the needs of individual communities, their residents, and business owners.
Financial Impact
The financial impact of healthy cities initiatives varies depending on how the policy is implemented at the local level. In most cases, executing a Healthy City/Healthy Community plan requires the participation of both public and private sector, creating opportunities for strategic partnerships. Healthy Cities initiatives involve public works and urban planning projects that have the dual effect of promoting health behaviors and stimulating economic growth and development in the area. Similarly, municipalities that adopt a healthy communities approach also build alliances with businesses that are committed to social responsibility. Improving public health in the community has a positive effect on economic growth by encouraging community involvement in local businesses, encouraging foot traffic through walking and bicycle paths through the community, and also, improving health outcomes. Improving health outcomes in targeted communities reduces unnecessary healthcare expenditures, liberating healthcare resources for making improvements to critical care.
Values and Ethical Principles
Ethical principles guide the nursing profession. When nurses actively participate in policy development related to the creation of Healthy Cities/Healthy Communities, they fulfill most of the core ethical objectives of the profession including patient autonomy, beneficence, equity, and social justice. Nurses are committed to care at every level of delivery: the individual, family, and community (Pope, Hough & Chase, 2016). The principle of beneficence means that nurses act in ways that benefit their patients, including their extended families, not through paternalistic actions but through patient empowerment. Patient empowerment depends on knowledge and information, but also on awareness and access of public health services. Communities that have robust healthy infrastructure are beneficent communities, and nurses have an ethical obligation to participate in urban planning that reflects the core goals of public health and health promotion. The beneficent parameters of a healthy city include features like high...
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