8-11 Dec 1993, Φ San Francisco: 1st International Healthy Cities and Communities conference, incl. EIA/HIA session

8.-11.12.1993, San Francisco: 1st International Healthy Cities and Communities conference, incl. EIA/HIA session


  • A project of the Western Consortium for Public Health, 2001 Addison St., Berkeley, CA. 94704
  • Chair: Leonhard Duhl, M.D. [1926-2019], Professor of Public Health, University of California at Berkeley (UCB)
  • Organizing institutions: California Department of Health Services, California Healthy Cities Project, League of California Cities, National Civic League, University of California / Office of the President, University of California at Berkeley, University of California at Los Angeles, US Public Health Service, Western Consortium for Public Health, World Health Organization
  • Participating organizations: AIDS Project Los Angeles, American Public Health Organization, American Society on Aging, Associa­tion of Schools of Public Health, Boston Department of Health and Hospitals, California Children’s Lobby, California Coalition for the Future of Public Health, Canadian Healthy Communities Network, Communications and Computer Applications in Public Health, Earth Island Institute, National Children’s Hospital (Japan), National League of Cities, Pan American Health Organization, Salk Institute, School of Health Sciences / University of Limburg, UC Berkeley / School of Public Health, UCLA School of Public Health, UNDP, UNEP, UNESCO, UNICEF, University of Liverpool / Dept. of Community Medicine, U.S. Conference of Local Health Officers, U.S. Conference of Mayors, U.S. Public Health Service / Region IX, Vietnamese Community Health Promotion Project, WHO, WHO Africa, WHO-EURO, Worldwatch, and >100 other institutions and organizations
  • Healthy Cities and Communities sponsors: Kaiser Permanente, California Department of Health Services, The California Wellness Foundation, Centers for Disease Control, ROLM A Siemens Company, IBM Corporation, Baxter International Inc., American Hospital Association, Genentech Inc., Lawrence Berkeley Laboratory, McKinsey & Co. Inc., Pacific Gas & Electric Co., 18 other institutions, companies, medical centers, hospitals, and foundations
  • Venue: San Francisco Hilton Hotel, Hilton Square, San Francisco, CA
  • Pre-Conference: 6-7 Dec 1993, Healthy Cities Communications Toolbox Summary.


  • Conference schedule, incl.: plenaries, break-out sessions, poster sessions, site visits, exhibits, table top displays
  • Special components”, incl. Signing in Portrait Gallery; World Map and Eco-Regions of the Continents; Healthy Cities Vision Board; Conversation on the Wall; Speaker’s Corner; Wish Cloth Workshop; Green Oasis Café; Commons Stage
  • Children’s Express Hearings” ask: How to build healthy cities for families and children?
  • Site visits: More than 50 site visits had been arranged, in San Francisco, Oakland, Richmond, and Berkeley (cf. document: Site Visit Summary)
  • Conference materials / handouts, incl. Eleven parameters of a Healthy City.

Handout: Eleven parameters of a Healthy City

(Source: Hancock, Trevor & Duhl, Leonard (1986): Healthy Cities. Promoting Health in the Urban Context. WHO/Europe/FADL Publishers)

  • A clean, safe, high-quality physical environment (including housing quality)
  • An ecosystem that is stable now and sustainable in the long term
  • A strong, mutually supportive and non-exploitive community
  • A high degree of public participation in and control over the decisions affecting one’s life, health and well-being
  • The meeting of basic needs (food, water, shelter, income, safety, work) for all the city’s people
  • Access to a wide variety of experiences and resources, with the possibility of multiple contacts, interactions and communication
  • A diverse, vital and innovative city economy
  • Encouragement of connectedness with the past, with the cultural and biological heritage, and with other groups and individuals
  • A city form that is compatible with and enhances the above parameters and behaviors
  • An optimum levell of appropriate public health and sick care services accessible to al
  • High health status (both high positive health status and low disease status)

Presenters included Len Duhl, Ilona Kickbusch (WHO Europe), C. Everett Koop (former Surgeon General), Joanna Macy (California Institute of Integral Studies), Oscar Arias (former President of Costa Rica, Winner of the Nobel Peace Prize and Martin Luther King Peace Prize), Hazel Henderson (Economist); Oren Lyons (Native American Studies Program, Buffalo, Faith Keeper of the Onondaga Nation)

Selected Plenary sessions

  • Vittachi, London: Cities, women and children
  • Kickbusch, WHO Copenhagen: Healthy Cities and the future
  • Guerrero, Cali, Colombia: Learning from the South
  • Macy, California Institute of Integral Studies: Visioning a healthy future
  • Arias, Costa Rica: A healthy and just Northern hemisphere is inextricably tied to justice and health in the Southern hemisphere
  • Tabibzadeh, WHO Geneva: Health and quality of life in Third World cities
  • Henderson, USA: Redefining wealth and progress
  • Work, UNDP: Local-local dialogue to improve the urban environment
  • Lee, US-PHS: Healthy communities of tomorrow
  • Duhl, UC Berkeley: Looking forward – New patterns of collaboration
  • Lyons, New York: The 7th generation – Our future.

Selected “Break-out” work sessions

Theme area 
Skills for urban improvement– Urban conflicts and effective mediation
– Community greening projects: Tools for empowering and healing
– Using communications technologies and information systems
– The Quality of Life Index: Assessing community improvement
– Effective leadership models for healthy cities
– Children and Youth participation in planning
– Strategies for empowerment in communities
– The art of building coalitions for community empowerment
– Current research and evaluation of healthy cities programs
– Tools and techniques for engaging community participation
System issues– Healthy cities around the world
– Integrating social and land-use planning
– Sustainable models of development
– Community architecture and neighborhood planning
– International development strategies for the 21st century
– Diversity and healthy cities
– Funding healthy cities
– Urban futures through community visioning
– Organizing around the U.N.
– Physical and social design of Muslim cities
Civil development– Housing and community-based actions
– Healthy businesses for healthy communities
– Healthy cities and the family support movement
– Spiritual values – Links with community health
– The role of art in improving communities
– Transportation: Reclaiming cities from the automobile
– Education: Creating healthy schools
– Recreation in healthy communities
– Economic conversion: Military base closures
– Population / Demographic changes for health
The new Public Health– Alcohol and drugs: Youth leadership and empowerment
– Community-oriented primary care
– Strategies for independent living
– New integrated health systems
– Environmental justice and community health
– Sociocultural barriers to health care
– Community-based action for a healthful environment
– Models for mental health programs
– Self-help groups in healthy cities
– Environmental Impact assessment: Promoting environmental health

Break-out session 416, Environmental Impact Assessment: Promoting Environmental Health. Rainer Fehr, William Pease (session coordinators) [93-31]

Rainer Fehr: Session introduction [93-20]

William Pease (Coordinator, Environmental Health Policy Program, School of Public Health, UCB): Risk Assessment and Risk Communication: The American approach

Denny Larson (Campaign Director, Citizens for a Better Environment, San Francisco, CA): Community participation: The right-to-know and the right-to-act

Wendell Brunner (Assistant Health Services Director for Public Health, Contra Costa County Martinez, CA): Incorporating Environmental Health in planning: The county perspective

Raymond Neutra (Acting Chief, Environmental Health Investigations, California Department of Health Services, Emeryville, CA): Health Assessment: Epidemiology and community health crises in California

Fehr R, Kobusch A-B, Protoschill-Krebs G, Serwe H-J: [EIA] New developments in Germany – Utilization of existing approaches. [93-24]

  • Audio recording: Conference Recording Service; Berkeley, CA
  • King J (SF Chronicle, 10 Dec 1993, p. A23): Small Wonders Touted for Cities. Modes programs may work best, conference participants agree. [More than 1,000 people are in San Francisco this week to discuss how to revitalize cities … ]
  • NN (1994): International Healthy Cities and Communities conference. Environmental Health No. 21 (Jan. 1994), p.13

Fehr R (1994): Conference report – First International Healthy Cities Conference, San Francisco, Dec.8-11, 1993. Zschr.f.Gesundheitswiss. 3.Vj.1994, pp. 271-275. [94-01] Extract:

  • If current trends continue, soon after the turn of the century more than half of the world population will live in cities […] Health hazards of city life are commonplace and seem so obvious that “Healthy Cities” strikes as an oxymoron. Ever since this movement started in Toronto in 1984, it had to fight the stereotype that “Healthy” and “Cities” is a contradiction in terms, and the first International Healthy Cities Conference in San Francisco in December 1993 took off with a lively dialogue on this very issue. Leonard Duhl, the conference chair and “grandfather” of the Healthy Cities concept, started out with a laudatio: “Cities can be healthy, vibrant, and even sacred places… The city is always changing; that is its magic… and yet, there is underlying that flux a personality that persists … there is community, there is neighborhood”. Anuradha Vittachi agreed that cities “could be wonderful places, enhancing life energy” but quickly added that to her, cities at present are closely associated with domination and exploitation […]
  • […] at the conference prevailed a notion of optimism, even enthusiasm. The conference was defined as a transient metropolis, featuring diversity, composite intelligence, mutual respect, and a quest for new solutions. It was indeed a multi-cultural, very special event, bringing together community activists, politicians, public health professionals, and others. […] The way the conference was organized tried to bear witness to the basic concepts of Healthy Cities. With 10 organizing institutions, more than 130 participating institutions, and 30 Healthy Cities sponsors […], diversity was guaranteed, and the conference was rightfully dubbed a historic event by Phil Lee, head of the US Public Health Service.


  • The conference was intended to bring together people with vision as well as charisma (“social entrepreneurs” in Duhl’s terms) […]. Former president of Costa Rica and winner of the Nobel Peace Prize Oscar Arias outlined global problems including poverty, inequity, racism, and xenophobia, and reminded that in many poor countries, the spending on arms and armies is still more than double what is spent on health and education […] the economist Hazel Henderson diagnosed national governments and global corporations as two “failing institutions”, creating the need for bottom-up coalition-building as a positive third force […] Trevor Hancock, Canada, reminded that the Ottawa Charter recognizes stable ecosystems as a prerequisite of health […] Joanna Macy from the California Institute of Integral Studies maintained that insight into the systemic self-organizing nature of life is a key feature of the Healthy Cities movement; “we can’t fix the cities like a broken machine because they are […] living systems.”
  • Among the key terms for discussion was, of course, sustainability […] the interpretation tends to be long-term and somewhat abstract. This conference focused also on the immediate future in terms of today’s children and youth […] Former Surgeon General C. Everett Koop suggested to turn our preventive attention to the pre-schooler which he regarded to be the most important age. Jock Gill from the White House called public education the bedrock of democracy but conceded that at present, public schools in the US are often like 19th century theme parks, not at all preparing for the challenges of contemporary life.
  • Another focus concerned the role of women for overall development and health in particular. Ilona Kickbusch from WHO Europe quoted the World Development Report of the World Bank to show that the best health investment for the developing world is the education of women and girls […]
  • From the multitude of conference issues, four subject matters are presented here in more detail […]


  • The significance of economic factors for societal life and for health seems obvious […] Henderson in one of the highlight presentations of the conference “redefined the issues” […] She identified the goals of material progress, technological development, and efficiency of production as a classic example of confusing means with ends […] she pledged that we learn to understand in systems terms the feedback loops that we need to incorporate into our decision-making, especially the time-honored feedback loops of votes and prices. “But prices can only be a good feedback to government and business decision-makers if they are full cost prices and include all the social and environmental costs.” […] the audience seemed to agree that a “win-win world” is necessary as well as feasible. As R.Work of UNDP put it: “There is enough of everything for everyone… We invented poverty, we can invent equity.”

Impact Assessment

  • If it is true that “we, in Public Health, have to confess that we do everything we do too late” and also that “prevention is really the name of the game” (Koop), it seems obvious that we need to strive for prospective impact assessment, i.e. for better prediction and assessment of the impact of societal actions […] on human health and the environment at large. R.F. Woolard from the University of British Columbia introduced the concept of the “ecological footprint”, defined as the per capita area (in hectars) required for food production, housing, transportation, consumer goods, and other resources and services and noted that for everybody on earth to enjoy the Western consumption levels, two “extra planets” would be required. Concerned with the earth’s carrying capacity is also the CIESIN project with its mission to advance the understanding of the impacts of human activities on the environment (B. Coullahan, Washington).
  • A pledge for impact assessment is already embedded in the Ottawa Charter […] which demands to build healthy public policy, and also shows up in the European Community’s Treaty of Maastricht in Title X, Public Health. WHO Europe’s representative Kickbusch devoted much of her presentation to this topic. While inventing the Public Health of the 21st century in this “time of crisis and desorientation”, she suggested, a “Department of Consequences” should be considered; and this phrase kept being referred to by subsequent speakers. To her, a key idea of Healthy Cities is to put health everywhere on the political agenda. “[…] This, of course, reminds instantly of the many calls for Health and Environmental Impact Statements. This kind of structure could be well envisioned at national, regional and local level, perhaps even at the level of the United Nations…”


  • In the past, the Healthy Cities movement did not seem to attach too much importance to the notion of measurement and evaluation. […] N. Gianotti from Milan reminded that we need to learn how to manage the complexity of cities as systems and convincingly concluded that “we need to learn how to measure the quality of city”. Evaluating our endeavors towards healthier cities as well as the related topics of health reporting and societal bookkeeping turned out another major theme of the conference.
  • I. Tabibzadeh of WHO Geneva found that information on the health status of people “is needed for each dis­trict, local community and city”. There seemed to be agreement on the need of adequate evaluation, both in terms of qualitative analysis and quantitative indicators. As for the former approach, examples of interview content analysis (Nina Wallerstein, Albuquerque) as well as story books documenting the development of healthy communities were presented. Evelyne de Leeuw, University of Limburg, reported that […] there is a network of researchers striving towards evaluation of Healthy Cities […] Special consideration was given to the one indicator which governs much of the global development, the Gross National Product. Henderson left no doubt: “We’ve got to change the GNP growth formula and correct it… Trying to guide a complex society using GNP … as your compass is a little like trying to fly a Boeing 747 with nothing on the instrument panel except an oil pressure gauge …”


  • Adjacent to the Healthy Cities conference, there was a two-day pre-conference session on computer applications, prepared by Michael McDonald, Communications and Computer Applications in Public Health, Berkeley. Telecommunications and networking, especially via the Internet, was a recurring theme throughout both pre-conference and main event. Recent technological development was seen to potentially change the movement of people, goods, services, and information in a fundamental way.
  • The basic idea about relying more on information exchange rather than flow of goods and persons seems fair enough; Keynes was reported to have said: “transfer the recipe, not the cake”. But there was lively debate on the details. T. Grundner advocated alternatives to the Internet which he regarded as “attractive, but not nutritious”. The importance of free public access to information networks was also stressed. […] K. Dowlin from the San Francisco Public Library stated that informa­tion navigation is now more important than technology. Participants called it a “baby step” to make vast databases accessible; the “real work” would lie in making the information understandable […].


The Healthy Cities movement was called “the best if not the only one answer provided today to the urban crisis both among affluent and low-income societies” by the representative of WHO’s Director General Dr. Nakajima. We tend to forget that in the 1800s and the early 1900s, Public Health was intimately connected with the problems of city planning; in fact, “the city-planners and public-healthers were indistinguishable until later in this century” (Duhl) […] incorporated into the conference was a meeting with mayors from around the world, and these mayors started a process of developing a constitution for cities, a Civic Charter of rights, obligations, and responsibilites.

In the closing session, Duhl found no reason to not believe in the (healthy) future of cities. “Increasingly, our technology will make it possible for us to share in the vast store of knowledge and information, to communi­cate with each other, to learn from each other without ever coming in contact with each other physically. …. If the city becomes less economically and technologically necessary, its spiritual and cultural importance will remain. People will come to cities because this is where trade and talk, excitement and diversity abound […]” Many participants […] may have felt what Lee summed up as “So little done – so much to do”. […] the conference managed to face reality, to maintain hope instead of nihilism, and to explore solutions. Given the scope and complexity of global existing problems, this seems a remarkable achievement indeed.


de Leeuw, E (2020): Remembering our friend Leonard J. Duhl. H Promot Int, 10.2.2020, https://academic.oup.com/heapro/advance-article/doi/10.1093/heapro/daaa003/5732808.