Mental
A healthy city is one that gives a high priority to health in all its actions. It is the one that continuously creates and improves the physical and social environments, and expands the community resources that enable people to come together to perform all the functions of life and develop them to the fullest.
Any city can be healthy if it commits to health, has a structure to work for it and starts a process to achieve more health for its citizens. However, becoming a healthy city does not depend only on the current health infrastructure, but rather on a commitment to improve the different environments of a city (physical, social...) and the will to establish the necessary connections in the political, economic and social spheres.
It is a concept that the WHO (World Health Organization) has been promoting for years, conveying it through a global movement and network (Healthy Cities of the WHO - WHO European Healthy Cities Network) that works for put health on the social, economic and political agenda of city governments. At the same time, several state networks are deployed from this global network (currently around 30, among which the Spanish Healthy Cities Network) of which the city of Reus is part.
The promotion of health at the local level requires acting centrally on the population as a whole and on the determinants of health, both individual and collective. This means developing actions that are not only focused on the health system, but also on other areas of society.
Social determinants of health
According to the WHO (World Health Organization), "the social determinants of health are the circumstances in which people are born, grow up, live, work and age, including the health system. These circumstances are the result of the distribution of money, power and resources at the global, national and local level, which at the same time depends on the policies adopted". Therefore, it starts from the basis that the socio-economic, cultural and environmental conditions, and the activities of the different sectors (education, housing...) have an impact on people's lives and work, on their social relationships, on the social support they receive, and facilitate or hinder healthy lifestyles and lifestyles.
Thus, many of the most relevant health problems that we have to deal with as people are subject to the influence of these determinants and our living conditions. Therefore, given that health is the result of many factors (an estimated 80% of the determinants of health are outside the health system), actions aimed at improving health must act more broadly and take into account the different sectors involved, trying to influence the factors that are modifiable in such a way as to facilitate people's lifestyles that improve their health, their physical, mental and social environment.
It must be borne in mind that inequalities in health derive from social inequalities, and therefore there is a social gradient in health (the worse the social position of the person, the worse their health).
Health in all policies
Health in All Policies (STP) is collaborative work to improve the health of all by incorporating health, equity and sustainability into decision-making across all sectors and policy areas. This strategy, or approach, is based on the evidence that health depends, to a large extent, on economic, cultural, environmental, social and political factors linked to non-health policies (see the Social Determinants of Health section).
The answer to this evidence can only go through the formulation of transversal policies, the participation of citizens, work in a local governance framework and the application of specific measures aimed at improving people's health conditions and pursue health equity.
This strategy (STP) is based on the following principles:
• Health is a human right that must be guaranteed.
• The political, economic and social context, environments and living conditions of people determine health.
• Political decisions in non-health sectors shape these determinants: every sector is a health sector.
• Differences in the distribution of social determinants are accompanied by health inequalities.
• The STP approach identifies and promotes synergies that enable progress in health, sustainability and equity.
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