The Healthy Cities approach seeks to put health high on the political and social agenda of cities and to build a strong movement for public health at the local level. The concept is underpinned by the principles of the Health for All strategy and Local Agenda21. Strong emphasis is given to equity, participatory governance and solidarity, intersectoral collaboration and action to address the determinants of health.

Healthy Cities is a dynamic concept and it has responded to new global and WHO priorities and to new needs and sociopolitical changes in Europe. The Healthy Cities Programme in Europe has evolved over five year phases, each giving special attention to a number of priority themes. Phase IV (2003–2008) has three main themes: healthy ageing, healthy urban planning and health impact assessment and an additional complementary theme: physical activity and active living.

Successful implementation of this approach requires innovative actions addressing all aspects of health and living conditions, and extensive networking between cities across Europe and beyond. This entails:

• explicit political commitment;
• leadership;
• institutional change;
• intersectoral partherships.

These are characterized as the four elements for action.