Since April 2013, 266 municipalities or 86.3% of all municipalities (big & small) in Flanders (Belgium) enrolled in the project ‘Gezonde Gemeente’ (‘Healthy Municipality’). With this project the Flemish Institute for Health Promotion and Illness Prevention (VIGeZ) delivers a framework that enables local policy makers and all relevant partners to set up a sustainable health policy, at their own pace and according to their own needs. The starting point is subsidiarity, which entails that (political) decisions should be made by the smallest, lowest or least centralized competent authority.
By Werner Dewael
Healthy Municipality is a ‘framework methodology’ , similar to the ones VIGeZ developed for school (Healthy School) and work settings (Healthy Work). Their aim is to assist intermediary organizations to broaden and deepen their own health policy. To guarantee recognizability across settings similar formats, tools and processes are used.
The success of the framework is guaranteed by the following principles:
Local autonomy: The new administrative relationships between Flemish and the local governments (i.c. a local administration and a Public Centre of Social Welfare as independent governing bodies) are incorporated in the method. More policy freedom and less planning burden are the baselines of Flemish government. This implies voluntary participation, no planning and reporting burdens, and demand-driven work being as important as supply-oriented work. Moreover there’s a strong emphasis on communication and branding.
Two-pronged approach of action and policy: ‘Healthy Municipality’ supports local actions, which already had a long tradition, and tries to stimulates project work to guarantee a more sustainable health policy. That means making conscious choices, working with realistic targets and doing evaluations with recommendations for the administration and the local politicians.
Integrated policy: A successful sustainable health policy with equal health opportunities for all is a policy thatis supported by all political leaders and officials. VIGeZ and the Healthy Municipalities generates enthusiasm and support for this broad approach. The policy and management cycle (BBC) which is applicable to all Flemish local municipalities, offers many opportunities. The strength of the collaborative effort and mutual benefit gained by all partners fortifies Healthy Municipality. New partnerships arise by focusing on professional development and networking.
To enroll in the project, municipalities sign a charter. They are coached by their Local Health Platform and VIGeZ. The 15 LOGO’s use the ‘growthmeter’ and ‘health matrix‘ as supportive tools in the coaching process. The first comprises of a compass with 35 quality criteria grouped in 7 process components: long-term vision, intersectoral collaboration and networking, civic participation, administrative power, communication, the administration as an example, and a mix of interventions. The health matrix draws attention to the four strategies for health promotion (information and sensibilisation, structural measures, regulations and agreements, care and coaching) and different types of targetgroups, thereby ensuring a mix of actions. To promote these actions and activities they use personalized promotional materials.
To further support the local Healthy Municipalities there is an early (real and virtual) Flemish network ‘Healthy Municipality’ consisting of partners active in different sectors (sports, mobility, security …). They are invited to join because they can contribute to the ‘health in all policies’ philosophy. In turn they activate their local networks so that more local organizations, civil servants and politicians, volunteers, private partners are involved in local health policy. Thereby we move from one gatekeeper to many ambassadors.
Belgium is a federal country with different regions: Flanders, Brussels and Wallonia. A region has jurisdiction over health promotion and disease prevention, the organization of and the control over the local municipalities, etc. are three examples of.
Flanders has 308 municipalities which are very diverse (in terms of size, socio-economic characteristics, capacity …). The smallest municipality (Herstappe) has 85 and the largest (Antwerp) has 507.911 inhabitants. The median size is 14.000 inhabitants, the median capacity to work on health promotion and disease prevention is four hours a week; which is rather low. Setting realistic targets is key.Flemish municipalities are not obliged to work on health promotion and disease prevention and mostly fund their own local health promotion activities and campaigns . Flemish municipalities can appeal to the LOGO’s for substantive and logistical support.
LOGO’s on their turn can count on VIGeZ support. VIGeZ is recognized by the Flemish Government as a center of excellence for health promotion and disease prevention. VIGeZ develops methodologies, gives policy advice and expertise. For this specific and similar projects, VIGeZ works closely with VVSG (Association of Flemish Cities and Municipalities), VAD (Association for Alcohol and other Drug problems) and LOGO’s.