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In this article we reflect on the quality of a realist synthesis paradigm applied to the evaluation of Phase V of the WHO European Healthy Cities Network. The programmatic application of this approach has led to very high response rates and a wealth of important data. All articles in this Supplement report that cities in the network move from small-scale, time-limited projects predominantly focused on health lifestyles to the significant inclusion of policies and programmes on systems and values for good health governance. The evaluation team felt that, due to time and resource limitations, it was unable to fully exploit the potential of realist synthesis. In particular, the synthetic integration of different strategic foci of Phase V designation areas did not come to full fruition. We recommend better and more sustained integration of realist synthesis in the practice of Healthy Cities in future Phases. [ABSTRACT FROM AUTHOR]

A focus on good governance in the WHO European network of Healthy Cities mirrors the WHO Region's strategic emphasis—its member states in the Health 2020 strategy espouse governance for health as key. Healthy Cities adopted governance as a key value and approach to delivering specific health programmes and policies. This article reviews the extent to which they actually introduce and align governance concepts and approaches with their local government commitments. Healthy Cities show that better participation, policy-making and intersectoral action result from an emphasis on governance. This happens across the designated cities and is not limited to a certain class (in terms of population or geographical location) or the time they have been designated. The support of WHO in driving the governance agenda seems important, but no data are available to show that European Healthy Cities are different from other urban environments. [ABSTRACT FROM AUTHOR]

This paper assesses policy development in, with and for Healthy Cities in the European Region of the World Health Organization. Materials for the assessment were sourced through case studies, a questionnaire and statistical databases. They were compiled in a realist synthesis methodology, applying theory-based evaluation principles. Non-response analyses were applied to ascertain the degree of representatives of the high response rates for the entire network of Healthy Cities in Europe. Further measures of reliability and validity were applied, and it was found that our material was indicative of the entire network. European Healthy Cities are successful in developing local health policy across many sectors within and outside government. They were also successful in addressing ‘wicked' problems around equity, governance and participation in themes such as Healthy Urban Planning. It appears that strong local leadership for policy change is driven by international collaboration and the stewardship of the World Health Organization. The processes enacted by WHO, structuring membership of the Healthy City Network (designation) and the guidance on particular themes, are identified as being important for the success of local policy development. [ABSTRACT FROM AUTHOR]

This paper presents the methodology, programme logic and conceptual framework that drove the evaluation of the Fifth Phase of the WHO European Healthy Cities Network. Towards the end of the phase, 99 cities were designated progressively through the life of the phase (2009-14). The paper establishes the values, systems and aspirations that these cities sign up for, as foundations for the selection of methodology. We assert that a realist synthesis methodology, driven by a wide range of qualitative and quantitative methods, is the most appropriate perspective to address the wide geopolitical, demographic, population and health diversities of these cities. The paper outlines the rationale for a structured multiple case study approach, the deployment of a comprehensive questionnaire, data mining through existing databases including Eurostat and analysis of management information generation tools used throughout the period. Response rates were considered extremely high for this type of research. Non-response analyses are described, which show that data are representative for cities across the spectrum of diversity. This paper provides a foundation for further analysis on specific areas of interest presented in this supplement. [ABSTRACT FROM AUTHOR]

The author discusses the evaluation of fifth phase of the World Health Organization (WHO) European Healthy Cities Network from 2009-2013 along with their opportunities and challenges. Topics include development of practical tools for local government, health promotion practitioners, communities and their political representatives, dedication to evaluation team and its supporters including Mariana Dyakova, Marian Biddle and Lucy Spanswick and policy & institutional development for health.