The conference program was designed around the most challenging health topics confronting cities today, namely addressing the needs of vulnerable populations, which included discussion of public assistance support for poor neighborhoods and promotion of healthy lifestyles. In addition, thematic strands focused on building strong partnerships, alliances, and networks and on creating effective policies, strategies, and tools to address the issues of health.

"Building a healthy city starts from building a better community," advocates Bernice Bennett, former AIHA program officer who organized a conference workshop on ways to support healthy community partnerships in the countries of the former Soviet Union and Eastern Europe.

Bennett began the session, which was moderated by Alyona Gerasimova, AIHA regional director for West NIS, with a presentation on the AIHA's experience in facilitating international partnerships to build healthier and more vital community programs. Bennett, who developed AIHA's Healthy Communities approach and has mentored the partnerships involved in this process since 1995, introduced the partnership model and discussed how it works collaboratively with the healthy communities concept. She illustrated how this approach has proven its effectiveness through AIHA programs that range from a community-based, primary healthcare concept, in which patient education is provided inside the hospital, to a healthy communities partnership program, which moves partners outside hospital walls into the villages and cities they are seeking to serve.

Bennett's talk was followed by presentations from four partners, representing different models for involving communities in various topics. "The session organized by AIHA offered participants an opportunity to discuss the process and best practices in facilitating international partnerships to build healthier and more vital community programs," says Gerasimova.

During the workshop, attendees had the opportunity to learn about how AIHA's healthy community programs work hand-in-hand with a host of community stakeholders—from teachers and religious leaders to business owners and government officials—in an effort to assess and prioritize problems, address vital issues, and implement solutions focused on quality of life and the medical and social concerns of the population. These strategies engage and empower members of the community to play an active role in health promotion and enhance the social safety net.

Partners Share Experiences

Sharing their experience, AIHA partners presented the most successful and time-tested models implemented through their partnership programs to improve the health and social welfare of their communities.

Vesna Zec, psychologist at the Split Social Welfare and Health Protection Department and CEE coordinator of the Split/New Jersey partnership, described the community-centered projects implemented in Split, Croatia, that raise awareness of teenagers about tobacco and alcohol use. (For more information about the project, see: "AIHA Partners Work in Schools to Curb Adolescent Drinking and Smoking"). The School of Public Health and the University of Medicine and Dentistry of New Jersey cooperated with Split-Healthy City program to implement an anti-substance abuse project, based on Project Northland, developed by the US National Institute on Alcohol Abuse and Alcoholism of the National Institute of Health. The project incorporates behavioral curricula for use in schools, parental involvement programs, extracurricular peer leadership, and community-wide efforts that target adolescents in the sixth through eighth grades. The replication of this program in Split involved 24 schools and educated 1,300 at-risk students about substance abuse, as well as increased parental and community involvement in addressing problems associated with adolescent alcoholism.

Another example of a successful program was presented by Daniel Verman, counselor at the Ministry of Health of Romania and Constant/Louisville CEE partnership coordinator, who spoke how his community increased the awareness of women about domestic violence and worked on the prevention of depression and the transmission of STIs. (For more information, see: "Healthy Communities Dissemination Conference Stress Mobilization, Empowerment"). According to Verman, the efforts of the community, encouraged by the partnership, resulted in the establishment of an Office for Women, which serves as a referral center for domestic violence victims, and the creation of a city commission to fight abuse in families.

In addition to AIHA's experiences in replicating community-oriented programs in Croatia and Romania, Volodymyr Kolodenko, professor and head of the Department of Hygiene at Odessa State Medical University gave a presentation on how a similar program was implemented in Ukraine. He spoke about how the Odessa/Boulder partners established the Community Health Council to coordinate work by local policy makers, educators, health professionals, and various social service and non-governmental organization representatives, in such highly prioritized areas as health reform, environmental health, and HIV/AIDS awareness.

A model for creating a healthy community through committed leadership was demonstrated by Yulia Abrosimova, national network coordinator for the Healthy Cities Project at the Healthy Cities Supporting Centre in Russia and Moscow program coordinator for AIHA's 2002 Community Leadership Development Program. This program was initiated by the Open World Leadership Center at the US Library of Congress in cooperation with AIHA to build mutual understanding between the United States and the Russian Federation and to assist Russia's democratic and economic reforms by involving multidisciplinary teams of community leaders from government, business, and non-profit sectors in the building of healthy communities, intersectoral collaboration, and strategic planning.

"AIHA's success with the healthy communities partnerships is based on a shared vision of community ownership of the problem and the solution," explains Bennett. According to her, a history of mobilizing communities for change started in 1995 with first healthy communities partnerships in Slovakia where AIHA was able to integrate planning activities with an existing Healthy Cities program and non-governmental organizations.

"We found that by working with existing Healthy Cities networks, we could integrate various techniques and planning tools to strengthen the skills of the healthcare coordinators. Slovakia is a great example of how this strategy works. Later we worked with the Hungarian Association of Healthy Cities and the Croatian Healthy Cities Network to identify potential partners and to, in turn, help support the activities of each network through our additional programs and activities."

AIHA partners did not always tap into existing Healthy Cities structures however. "We are very proud of the work of the Romanian partners because a healthy cities network did not exist in Romania prior to the partnership," says Bennett, adding that "We forged ahead anyway with this concept and through the strong teamwork of the Constanta and Louisville partners, a viable project for domestic violence reached beyond that community to the entire country."

Plans for the Future

In her part, Alyona Gerasimova thinks that "AIHA plays a crucial role in developing communities and establishing national networks of healthy communities." In her opinion, many of the West NIS partnerships established through the AIHA community-based, primary healthcare initiative have the potential to expand and sustain their programs by joining the WHO network of Healthy Cities. According to the Regional Director for West NIS, next spring partners representing community-based primary care programs in the region will get together in Kiev to attend a workshop on the development of sustainable programs. In addition to giving the participants some practical skills and introducing tools and techniques that will help to ensure program sustainability, the workshop will also present an overview of the WHO Healthy Cities Project and will provide guidance on how to join the WHO Healthy Cities network.

"The timing is right," says Gerasimova, "Because WHO has just announced the beginning of Phase IV of the Healthy Cities Network (2003-2007). The cities participating in the fourth phase will be working in two main area: healthy urban planning and health impact assessment. In addition, there will be a complementary focus on healthy aging."

"Not only will our partners from Ukraine and Moldova participate in the workshop, but we also plan to invite mayors or representatives from the mayors' offices from the cities where AIHA partnerships are active. It is crucial to get local governments' support in developing and sustaining a successful healthy city program," concludes Gerasimova.

Summing up the conference, Bennett says, "AIHA's participation at the International Healthy Cities conference served to solidify our expertise and showcase our partners. In addition, the networking opportunity was an enormous plus for all of us!"

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