The majority of the world’s population lives in urban areas, and more and more people are migrating to urban areas. However, the health hazards of urban life affect the population as well. They often suffer from non-communicable diseases, cardiovascular diseases, cancer and psychosocial problems. To address the increasing concerns about urban health, the WHO developed health promotion initiatives, known as the Healthy Cities programmes in 1986, which aim to place health high on the agendas of decision-makers and to promote comprehensive local strategies for health promotion and sustainable development. It successfully engages local governments in health development from thousands of cities worldwide in both developed and developing countries, including China.
In 1994, China started to develop Healthy City pilot projects in the name of Healthy Cities with the suggestion of the WHO. However, the Chinese government started related activities about the environment and health long before WHO introduced the concept of Healthy Cities. The Patriotic Health Campaign was launched in 1952; despite it being a social movement that was not exclusively oriented to urban areas, it paved the way for Healthy Cities programmes in China. Since 1984, the National Government developed more than 40 policies and National Hygienic Cities to improve the urban environment and support Healthy Cities-related activities. However, the implementation of national policies depends on local level actions where collaboration across sectors is problematic, especially since different ministries tend to work separately according to their own prioritized programme.
Shanghai is the first mega-city in China to initiate the action for Healthy City development. It was successful in raising high standards for the health status of the population and improving the urban environment in a quantitative way. However, institutional change, especially intersectoral collaboration remains a big challenge for the implementation. Therefore, it would be interesting to know how the local actors develop the Healthy City programme in the specific context of China.
However, there is a lack of empirical studies on the Healthy City programme, and few studies focus on intersectoral relationships in Healthy City development; some researches only include limited actors, and some fail to identify the local institutional settings and connect with the international context. On this background, it looks into the policy making processes of making different programmes at different stages as well as the respective modes of policy implementation. This research aims to unfold how local actors develop the Healthy City programme in Shanghai.
Two propositions are guiding the analysis: first, whereas policies in China are mainly developed on a national level where everyday challenges of individual local level entities do not play a decisive role, Healthy City policies are implemented on the local level (of cities or city districts) where municipal specificities and local conditions heavily influence the action potentials and actions of authorities and other stakeholders. Second, whereas Healthy City-oriented policies are comprehensive in nature, their implementation is rather fragmented and sectoral.
The study applies an approach that is influenced by the discussion about actor-centered institutionalism. The interpretive lens of actor-centered institutionalism is taken to identify the main actors, analyse how they interact with each other, and the underlying institutional settings that are crucial to interpreting policy making and policy implementation. The study will also find out whether the actor-centered institutionalism approach is fully applicable under the conditions of China, or whether certain modifications are to be made.
The research follows a qualitative approach, collecting data from multiple sources such as documents, including historic documents in archives, and interviews, combining a variety of research methods including stakeholder analysis, discourse analysis and network analysis. Shanghai is used as a case study as it has the longest experience with the implementation of Healthy City programmes in China, and was also the first to issue a Healthy City Action Plan in 2003. It established the first municipal committee for health promotion in 2005. Whereas the older programmes are analysed based on documents, the latest Healthy City programme is scrutinised by employing document analysis and interviews of different stakeholders in order to get an in-depth understanding of the policy making and implementation processes.
This thesis aspires to contribute to the empirical knowledge of the development of public policies, the understanding of actors and actor constellations in Healthy City programmes with reference to specific institutional settings in China, and examining the compatibility and limitations of this interpretive lens in the Chinese context. Moreover, policy recommendations related to practice in Shanghai are provided as further motivation and commitment to Healthy City development in China
