HEALTHY COMMUNITIES Program

The Healthy Communities Program, implemented in collaboration with the City Council of Cardona, aims to promote the development of healthy lifestyles throughout all stages of life and to contribute to promoting quality of life, correcting health habits and self-management of the main risk factors for cardiovascular diseases, such as overweight, obesity, physical inactivity, blood pressure and smoking [4, 5].

Consequently, the aim is to turn Cardona (Barcelona, Spain) into a healthy city, that means, a city that prioritizes the health of its inhabitants in all its actions, including the creation of physical (healthy urbanism) and social environments (environment) that promote health. The idea is to be able to create a replicable model for the development of healthy municipalities. During the pilot phase of the project community activities were organized, involving the residents of Cardona according to their capacities, conferences about health were organized and motivational workshops were held by “health promoters”, trained specifically for the program, to promote healthy lifestyles [1, 4].

Moreover, Cardona’s program included an ambitious urban development plan designed to provide an atmosphere that promotes physical activity among the population. In this pilot study approximately 10% of the city population was longitudinally assessed in years 2014 (beginning of the pilot study), 2016 (impact of pilot health promotion activities) and 2018 (sustainability, end of the pilot study). Preliminary results were promising and showed in the first 18-month period (intervention period) a trend toward improvement of their health scores, mainly driven by improvements in the physical activity and dietary components. These findings justified the development of the next stage of the project in which the impact of the creation of a Healthy City is being appropriately tested through a quasi-experimental study design and relevant outcomes, so the model could be accepted and replicated elsewhere: Healthy Communities 2030.

The Healthy Communities study is the result of combining previously validated SHE Foundation programs with randomized studies (Fifty-Fifty Program [4] and SI! Program [5,6]), adapting the strategy to all age groups of the community. population. To this end, a community-level intervention study was initiated in 2021 with 1813 12-year-old participants (910 in the intervention municipality of Cardona and 903 in the control municipality of Sallent) over a period of five years.

The primary endpoint will be the between group (intervened town vs control town) difference for the change in the Fuster-BEWAT score [4] which consists of a 0-15 scale for behaviors/health factors related to blood pressure, exercise, weight, alimentation (diet), and tobacco use (smoking).

The Healthy Communities Program is a multidisciplinary health-promotion initiative. The project will result in a toolkit for a community-driven health promotion intervention that could be replicated in cities and towns both nationally and internationally. The core of the intervention will be based on the previous health promotion programs developed and evaluated by the Science, Health and Education (SHE) Foundation: the SI! Program for children [5, 6], and the Fifty-Fifty Program for adults [4, 7, 8].

The effect of these interventions was proven through randomized trials and the results were published in high-impact journals (Journal of the American College of Cardiology, American Heart Journal, American Journal of Medicine, etc.).