Twenty-seven years of the WHO European Healthy Cities movement: a sustainable movement for change and innovation at the local level

Healthy Cities in Europe was launched with the ambitious aim to put health high onthe social and political agenda of cities. This ambition resonates well with the understanding today of the significance of the social, economic, environmental, cultural and commercial determinants of health and the fact that health is ultimately a political choice. What was remarkable from the start was that city leaders from across Europe enthusiastically embraced the concept of a healthy city as a whole-of-local-government responsibility. Paradoxically, 27 years on, such an understanding remains an elusive challenge for national governments, even though the evidence of the effects of these determinants of health is immensely stronger today than it was then. The evolution of healthy cities in Europe can be seen as the history of modern public health through a local lens, covering 27 years of major political developments in Europe and globally, major changes in how health and sustainable development are understood and dealt with as well as majorchanges in the social and public health landscape of the WHO European Region. The WHO European Healthy Cities Network was for