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National networks of Healthy Cities emerged in the late 1980s as a spontaneous reaction to a great demand by cities to participate in the Healthy Cities movement. Today, they engage at least 1300 cities in the European region and form the backbone of the Healthy Cities movement. This article provides an analysis of the results of the regular surveys of national networks that have been carried out principally since 1997. The main functions and achievements of national networks are presented alongside some of their most pressing challenges. Although networks have differing priorities and organizational characteristics, they do share common goals and strategic directions based on the Healthy Cities model (see other articles in this special edition of HPI). Therefore, it has been possible to identify a set of organizational and strategic factors that contribute to the success of networks. These factors form the basis of a set of accreditation criteria for national networks and provide guidance for the establishment of new national networks. Although national networks have made substantial achievements, they continue to face a number of dilemmas that are discussed in the article. Problems a national network must deal with include how to obtain sustainable funding, how to raise the standard of work in cities without creating exclusive participation criteria and how to balance the need to provide direct support to cities with its role as a national player. These dilemmas are similar to other public sector networks. During the last 15 years, the pooling of practical expertise in urban health has made Healthy Cities networks an important resource for national as well as local governments. Not only do they provide valuable support to their members but they often advise ministries and other national institutions on effective models to promote sustainable urban health development.

National networks of Healthy Cities in Europe