Implementation of the Healthy Cities' principles and strategies: an evaluation of the Israel Healthy Cities network.

The Israel network of Healthy Cities has been operating since 1990, and the first evaluation of its performance was carried out in 2004. The objectives were to evaluate the level of implementation of the 'Healthy Cities' principles and strategies in each network city and to assess the contribution of the network to its member cities. Coordinators of 18 active healthy cities participated in the study by completing a questionnaire with the aid of key informants in the municipality. The survey covered six dimensions of Healthy Cities' principles and strategies, and each was analyzed as a sum of scores of separate components and measures, converted to a 0-10 scale. Cities were found to differ in their performances. The dimension of intersectoral collaboration received the highest mean score (8.0 +/- 1.6), while the environmental protection dimension received the lowest one (4.5 +/- 2.2). Time investment by the coordinator of > 20 h a week is significantly associated with a higher score on the management dimension (7.8 versus 4.4 where the coordinator invests 20 h a week or less, P < 0.001). Previous work experience in either public health or community work was associated with higher scores of the community participation and intersectoral partnership dimensions (6.9 versus 5.2 and 8.5 versus 6.8, respectively, P < 0.05). Political support was associated with the city equity policy dimension (8.1 versus 4.8 in cities with high versus low political support, P < 0.01). Coordinator's participation in the network's activities is associated with better scores on all the dimensions except for environmental protection. It appears that political commitment and support is a significant enabling condition, which, together with the capacity building of the coordinator, may lead to better implementation of Healthy Cities' policy. Environmental issues should be incorporated into training sessions to enhance the environmental protection dimension.