How to develop and sustain healthy cities in 20 steps

City governments and their partners are at the heart of policy-making and decision-making related to the wider determinants of health. City mayors and elected politicians provide leadership; professional coordinators provide support. Both are essential in orchestrating the contribution of many actors and agencies. The healthy city coordinator’s role is rewarding but can be very challenging. This guide by the European Healthy Cities Network outlines 20 steps or actions for a healthy city, focusing on how coordinators can organize or renew the process.

Photo credits: WHO / Malin Bring

Language: English
Not disease specific

Course information


Building a healthy, equitable and sustainable city for all is a journey of development – social, human, urban and economic. The 20 steps guide this development process. They provide a chain of interventions and events leading to a healthier city. This virtual training which is based on the 2022 guide accumulates the knowledge and experiences of pioneering cities and experienced coordinators within the Healthy Cities Network. The virtual training will cater to coordinators and secretariats of cities in the WHO European Healthy Cities Network and national healthy cities networks in the Network of European National Healthy Cities Networks. The virtual training is also for those who are considering adopting the Healthy Cities model. Furthermore, it can be used as a guide or a reference for those in the process of introducing Healthy Cities or reviewing and expanding an existing one.

The 20 steps are allocated into three modules. They are actions in a process of continual improvement and should not necessarily be taken in sequence. The participants of the course will be able to draw on the rich experience of the cities and it will also help in identifying the critical steps and actions for successfully building and sustaining a healthy city. The order in which cities adopt the steps depends on local circumstances and opportunities.

Course duration

Approximately 2 hours to complete.


A certificate of achievement will be available to participants who score at least 80% in the final assessment.

Participants who receive a certificate of achievement can also download an Open Badge for this course. Click here to learn how.

What you'll learn

  • navigate these steps with the support of the WHO European Healthy Cities Secretariat and the wider WHO European Healthy Cities Network
  • describe how coordinators can organize or sustain the healthy cities project in their city.
  • outline how to implement a 20 steps guide from real-life peer examples.

Course contents

  • Module 1: Getting Started:

    Module 1 “Getting Started” will focus on guiding participants through the first seven steps in implementing a healthy city approach. Throughout the module, participants will gain knowledge and skills to effectively navigate each step and contribute to the development of a healthier and more sustainable city. This module will establish a framework to guide efforts, gather support from stakeholders, and develop a city health profile to understand the specific health challenges the city faces. Then, participants will identify and mobilize the necessary resources, determine the location of the secretariat within the organizational hierarchy of the city for effective coordination, and draft a comprehensive proposal. Finally, participants will seek approval to move forward with the preparation of a formal healthy city proposal.
  • Module 2: Getting Organized:

    Module 2, “Getting Organized” will focus on steps eight to fourteen in establishing the necessary organization and administrative mechanisms to ensure the smooth implementation of the health city approach. Here individuals will learn how to appoint a steering committee, comprising of key stakeholders to lead, coordinate and select a location for the healthy city secretariat. Then, participants will learn how to assess the work setting to ensure that the healthy city secretariat will work within the right context, decision-making structure, and organization of city governance. Following, participants will learn how to set up the secretariat, which will serve as a central administrative hub, facilitating effective communication and collaboration. The module will also cover preparing a detailed plan, which will outline activities and responsibilities, providing a roadmap for implementation. Simultaneously, participants will understand the need to build capacity among team members and ensure that cities have skilled personnel, adequate funds, and access to information that will enable your healthy city to perform effectively. Lastly, participants will learn how to establish accountability mechanisms to monitor progress and hold individuals and teams responsible for their commitments.
  • Module 3: Taking action:

    Module 3, “Taking Action” will focus on steps 15 to 20, encompassing key strategies to drive effective change in our health initiative. Participants will learn tools to comprehensively, visibly, consistently, and continuously increase health awareness and well-being. This module will emphasize the importance of advocating for strategic planning, prioritizing evidence-based decision-making, and fostering long-term vision through a city health development plan. Participants will explore intersectoral collaboration, and community participation as the core principles of the healthy city approach. In such a setting, they will be encouraged to embrace innovative technologies and approaches to improve healthcare outcomes. Lastly, the module will underscore the integration of health considerations into all policies, and the evaluation of processes, structures, plans, and programme for improved community health.

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Certificate Requirements

  • Gain a Record of Achievement by earning at least 80% of the maximum number of points from all graded assignments.