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1990年代以来健康社区研究与实践进展评述
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在健康中国战略理念指引下,社区不仅仅是组成健康城市的基本单元,更是落实全民健康目标、营造健康城市的重要行动主体。上个世纪末期以来国内外健康社区研究与实践呈现迅速发展。本文对国内外健康社区相关概念,以及1990年代至今相关理论研究和实践活动等方面的成果进行系统梳理与比较,从健康住宅、健康环境、健康邻里和健康服务等维度总结健康社区的影响要素及其作用路径,最后提出健康社区研究与实践中的主要问题及发展展望,指出未来我国应进一步加强健康社区领域的跨学科与跨层级协作、健康社区影响机制的系统性研究、健康社区全流程实施机制探索,以及智慧健康社区研究与建设等方面的工作.
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51
Theme Documents
A Review on the Progress in Healthy Community Research and Practice Since the 1990s
A Review on the Progress in Healthy Community
Research and Practice Since the 1990s
Abstract Under the strategic concept of “Healthy China,” communities are not only basic units to compose a healthy city, but also main bodies to
fulll the goal of “health for all” and healthy city development. Since the end of the last century, healthy community research and related practice
have seen rapid development in both China and abroad. This paper systematically reviews and compares the concepts, theories, and practices related
to healthy community since the 1990s, and analyzes the inuencing factors and their acting paths of healthy community in terms of healthy housing,
healthy environment, healthy neighborhood, and health services. In the end, the paper points out the main problems in healthy community research
and practice and proposes development prospects. It suggests that in the future, efforts should be made to further strengthen the interdisciplinary
and cross-level collaboration for healthy community, improve the systematic study on the inuencing mechanism of healthy community, enhance
the exploration of the whole-process implementation mechanism, and promote the research and construction of intelligent healthy community.
Keywords healthy community; healthy city; public health; community building
1. Background and signicance of healthy community
development
Since the launch of the Healthy Cities Project by the World Health
Organization (WHO) in 1986, healthy communities, as the basic units
of healthy city development, have gradually drawn wide attention
in Western countries and then in Japan, Singapore, China, and other
more countries (Wu, Yang, and Chen, 2020). In China, the strategy of
building a healthy China was proposed at the Fifth Plenary Session of
the 18
th
CPC Cent r al Com mit t e e i n 2015; t he
Outline of Healthy China
2030
in 2016 ma d e it cle a r that bu ild i ng healt h cit ie s should be ta ke n as
a strong foothold for the building of a healthy China; in 2017, the
An-
nual Report on Healthy City Construction in China (2017)
proposed
that communities, work units, and families should be the basic units to
implement the healthy city initiative; in 2018, the concept of “Greater
Health” was emphasized in the
National Healthy City Evaluation Indi-
cator Syst em (2018)
and indicators such as the coverage rate of healthy
communities were proposed. Thus, it can be seen that healthy com-
munities have become an important carrier for the implementation of
“Healthy China” strategy at the grassroots level.
T he role of com m u n it ie s as a fo r el a n d to de a l wit h he a lth r isk s was f u r-
t h e r h ig h l ig ht e d alo n g wit h the outbre a k of COV I D -19 pa nde m ic at t h e
end of 2019. The governance level of communities, as the grassroots
organizational units and places for human social life, directly affect
health and emergency response capacity of a city. Healthy communi-
ties cannot be built without the efforts of every community member
and their family, as well as the healthy and sustainable development of
the spatial environment, service facilities, neighborhood networks,
and organizational pattern of production and life in the community.
The sustained and all-round promotion of healthy community build-
Liu Jiayan, Zhao Yiyao
Translated by Li Caige / Proofread by Tang Yan
ing has become a cutting-edge field in interdisciplinary and multi-
sectoral research and practice.
2. Healthy community-related concepts
2.1 Health and community
The WHO defined the concept of health in 1948 as “a state of complete
physical, mental and social well-being and not merely the absence of
d i s e a s e or in f i r m it y.” Ge ne r a l ly, it i n volv e s th re e di m e n sio n s: physi c a l
healt h , me nt a l he alt h , a nd so c i a l he alt h .
There are diversified understandings on the concept of community
from different disciplines with varied research objectives. Hillery (1955)
regarded area, common ties, and social interactions as common ele-
ments essential to a community. This definition has been recognized
in the field of urban planning, and based on it the generally accepted
academic definition has been formed, regarding the community as
a socio-spatial unit in which a group of people gather in certain geo-
graphical areas and share common ideas and behavioral norms. In
healthy community research and practice, Western countries like the
UK and the US often define a community at the neighborhood scale,
and sometimes extend it to the town scale. In China, the community
usually refers to an area under the jurisdiction of the residents’ com-
mittee, which has been adjusted in scale after the community system
reform, according to the
Notice of the General Office of the CPC
Central Committee and the General Office of the State Council on
Forwarding the Opinions of the Ministry of Civil Affairs on Promot-
ing Urban Com munity Building Nationwide
issued in 2000. However,
researchers have shared common views that community, as a basic
unit as well as a socio-spatial unity of a city, has a comprehensive con-
notation that ranges from individual members to the community as a
52
Theme Documents
China City Planning Review Vol. 32, No. 2, 2023
whole and covers both physical and social environments.
2.2 Healthy community
The concept of “healthy community” was formally used by the US
Department of Health and Human Services in 1989 (Norris and Pitt-
man, 2000). Scholars and research institutions have proposed a variety
of definitions of it (see Table 1), the connotation of which has gener-
ally developed from multi-dimensional health, to holistic health, and
then to collaborative governance (Yuan, 2021). In general, the views
can be divided into two categories: one is regarding the healthy com-
munity as the result of multi-dimensional health. For example, Norris
and Pittman (2000) argued that a healthy community should include a
healthy natural environment, full participation in civic life, vigorous
economic development, and personal well-being; Wu, Yang, and Chen
(2020) proposed that a healthy community is characterized by healthy
development in the ecological environment, neighborhood relation-
ship, community economy, as well as physical and mental status of its
members. The other category regards the healthy community as an ac-
tion to advocate and realize the health concept. For instance, Boothroyd
and Eberle (1990) defined the healthy community as one in which all
organizations within the community were able to work together suc-
cessfully to enhance the quality of life of all its members; Dannenberg
et al. (2003) defined the healthy community as protecting and improv-
ing the quality of life for its citizens, promoting healthy behaviors
and minimizing hazards for its residents, and preserving the natural
environment; Sun et al. (2017) proposed that a healthy community was
a healthily developed entiret y based on the joint effor ts of all organiza-
tions and individuals in the community, in which the urban planning,
construction, and management practices are centered around people’s
health at the community level.
To sum up, a healthy community can be both a status and a process,
with the former being a multi-dimensional health status of not only
individual residents but also a community as a whole, and the latter
being an action to pursue and realize the health concept and healthy
lifestyles. Specifically, it means that individuals in the community
generally have healthy physical and mental status and lifestyles, as
well as the common will and concerted action to pursue and realize
health. Moreover, it also means that the community has a spatial and
social environment with healthy and coordinated development. The
subjectivity and local characteristics of the community can be effec-
tively brought into play w ith the ben ign interaction bet ween ind ividu-
als and the community environment, so as to improve the physical and
mental quality of its residents and create an ambience for the resilient
a n d su s t ai n abl e de vel opme nt of the co m mu n it y.
3. Healthy community-related theoretical research
Si nc e the 19 9 0 s , the t o pic of he a l t h y co m m u n i t y has gr a du a l ly be c o m e
a r e s e a r ch fo c u s in t h e f iel d of healt h . In th i s st u d y, aca d e m ic pa p e r s re -
lated to healthy community published from January 1990 to July 2022
in the Web of Science core collection and the CNKI (China National
Knowledge Infrastructure) database were examined and analyzed,
which showed that the number of papers in English or Chinese keeps
growing over the period.
3.1 Disciplinary composition of healthy community research
Regarding healthy community research abroad, a search under the
themes of “healthy community” and “healthy neighborhood” was
conducted, and 2,176 valid papers were obtained. The disciplines with
the highest number of publications were “Public, Environmental &
Table 1
Concepts of healthy community dened by domestic and foreign scholars
Concept of healthy community Source
A healthy community means that all organizations within the community, large and small, formal and informal, can work together successfully to
enhance the quality of life of all its members.
Boothroyd and Eberle (1990)
A healthy community should include a healthy natural environment, full participation in civic life, vigorous economic development, and personal
well-being.
Norris and Pittman (2000)
A healthy community protects and improves the quality of life for its citizens, promotes healthy behaviors and minimizes hazards for its residents,
and preserves the natural environment.
Dannenberg et al. (2003)
A healthy community is characterized by availability of healthy choices, safety, mixed designed land use, environmental sustainability, and the
opportunity for nature contact.
Largo-Wight (2011)
Emphasis is placed on the impact of the external (physical, economic, and social) environment on people’s life and behaviors, with the four most
basic and interrelated elements of land use, public facilities, transportation, and energy as the focus of healthy community building.
Wang (2015)
A healthy community refers to the overall healthy development based on the joint efforts of all organizations and individuals within the community,
in which urban planning, construction, and management are centered on people’s health at the community level.
Sun et al. (2017)
In a healthy community, healthy lifestyles are supported through planning, design, programmes, and engagement, which includes a built
environment designed and planned to support health, and an ongoing collaborative process to develop the healthy community.
Forsyth (2020)
In a healthy community, all organizations (formal and informal) can work together effectively to enhance the life quality of all its members and
improve the health level, and emphasis is placed on the signicance of health concept on community building which goes through the whole
process of community planning, construction, and governance.
Yuan, He, and Chen (2020)
A healthy community is an urban community characterized by a healthy development in the ecological environment, physical and mental status of
its members, neighborhood relationship, and community economy.
Wu, Yang, and Chen (2020)
53
Theme Documents
A Review on the Progress in Healthy Community Research and Practice Since the 1990s
Occupational Health,” “Medicine, General & Internal,” “Environ-
mental Sciences & Ecology,” etc. (see Figure 1).
The healthy community research in China was searched under the
themes of “
jiankang shequ
(healthy community),” “
jiankang zhuqu
(healthy settlement),” and “
jiankang juzhuqu
(healthy residential
area),” and 764 valid papers were obtained. The category with the most
publications was Medicine and Health Science and Technology, main-
ly covering the disciplines of Medicine and Health Policies and Laws,
Clinical Medicine, Preventive Medicine, and Hygienics (see Figure 2).
Since 2019, especially after the outbreak of the COVID-19 pandemic,
research in the discipline of Architectural Science and Engineering
has greatly increased, indicating that the quality of spatial environ-
ment improved through planning and design can indirectly improve
people’s health.
3.2 Research progress abroad
The healthy community research abroad has gone through three
stages. ① Focusing on physical environment. Related research
started in the 1990s, and the research focus was shifted from health
to healthy community, with emphasis placed on carrying out healthy
community movement and creating a comfortable spatial environ-
ment. ② Focusing on physical and mental health. After the 2000s,
the focus was expanded to health-influencing neighborhood factors,
health impact assessment, etc., with more emphasis on mental health
and social health. ③ Focusing on multi-dimensional health & multi-
disciplinary integration. Since the 2010s, with the interdisciplinary
development of sociology, economics, environmental engineering,
and other fields, the research has paid more attention to the relation-
ship between healt h a nd social e qu it y, social capit al, and envi ronmen-
tal justice.
Currently, the focus of healthy community research abroad is placed
on health-related human activities and feelings, neighborhood en-
vironment, and community involvement (see Figure 3). It mainly
includes: ① the effect of physical activity and diet on health promotion
and disease prevention. For instance, healthy food and regular physi-
cal exe r cise c a n ef fe ct i ve ly imp rove re sidents’ he a lt h st a t u s a n d re d uce
the risk of overweight and obesity (Balk et al., 2015). ② The influence
of neighborhood environment elements on residents’ health, including
spatial environment elements like green environment, activity space,
food supply, and medical facilities, as well as social environment ele-
ments like residents’ socio-economic status, neighborhood relation-
ship, and social capital, which can be studied empirically through
statistical analyses and qualitative methods to guide the planning
and design of healthy communities (Chandrabose et al., 2019; Rojas-
Rueda et al., 2019; Kepper et al., 2019). ③ Healthy community policies
and implementation paths that emphasize community involvement
and empowerment, such as adopting health intervention policies and
methods like participatory design, healthy community initiatives, and
community interventions to encourage residents to actively participate
Figure 3
Analysis on keyword co-occurrence network in health community
research abroad
300
250
200
150
100
50
0
Figure 2
Disciplinary distribution of health community research papers in China
Medicine and
Health Policies
and Laws
Clinical Medicine
Preventive Medi-
cine and Hygienics
Architectural
Science and
Engineering
Cardiovascular
Diseases
Chinese and
International
Politics
Endocrine Glands
and Systemic
Diseases
Sports
Environmental Scien-
ce and Resource
Utilization
Psychiatry
Psychology
Traditional
Chinese
Medicine
1,200
1,000
800
600
400
200
0
Figure 1
Disciplinary distribution of health community research papers abroad
Public, Environ-
mental, & Occupa-
tional
H
ealth
Medicine, General &
Internal
Environmental
Sciences & Ecology
Health Care
Sciences Services
Nutrition Dietetics
Urban Studies
Biomedical Social
Sciences
Geography
Geriatrics
Gerontology
Public Admini-
stration
Sociology
Science Techno-
logy & other topics
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