News Reimagining Healthy Cities: Why Local Action Matters More Than Ever Over the past 30 years, Healthy Cities has grown from a bold experiment into a proven model for prevention and community well-being. What started as local projects in Wollongong, Noarlunga and Canberra has since evolved into a national movement with global connections. Today, Healthy Cities Australia continues this legacy, working to embed prevention, equity and healthier futures across communities. This blog shares my reflections as CEO of Healthy Cities Australia on the history of the movement, the challenges we face, and why I believe the Healthy Cities approach is more important now than ever. — Kelly Andrews, CEO, Healthy Cities Australia My Journey into Public Health Over the last 30 years, I have been blessed to follow my passion of improving public health. Part of this has been delivering health promotion programs in the community, part of it has been in research, and part of it in advocacy. For the last six years this has all come together in my role as CEO of Healthy Cities Australia. It has possibly been the most frustrating and exhausting journey of my career, constantly feeling up against a wall, constantly justifying our existence, constantly applying for grants. But even though I’m battle weary, I know in my soul that we have to hang in there because we are making a difference. What I’ve learned is two things: community action is imperative to getting things done, and public policy shapes our living conditions. The dance between the two is where the magic lies. I am reminded of the quote by Margaret Mead: “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.” I think of the people in this room as that small group, ready, passionate, persistent, determined to improve public health. We’re here again as we always are, collectively calling for a change in how health is defined in this country. That health is created not in hospitals, but in the places where people live, work and play. We all live in neighbourhoods shaped by public policy, and the health-in-all-policies approach delivers on this. Good health is good politics. Today, I want to share how the framework of Healthy Cities speaks to the dualities of grassroots action and policy intervention, how Healthy Cities manages the complex interplay of these two things, and why I believe we can and should scale the approach again. Why My Story Matters I’m a local girl, born here in Wollongong. My dad was an electrician in the mining industries, which took us to Port Pirie in South Australia when I was four, another industrial town, home to the world’s largest lead smelter. I grew up inside one of the clearest examples of how environments shape health: Pirie was synonymous with childhood lead poisoning, sparking decades of public health research and intervention. My own family’s story is marked by disadvantage and trauma. I mention this to demonstrate my lived experience of both environmental and social determinants of health, and why my professional path can also feel personal. Perhaps that is why I feel so passionate about changing the system. At university, in my first-year Social Science degree, I encountered the Ottawa Charter for Health Promotion. The fog lifted. Health was not just about doctors and hospitals — it was political, environmental, and community-based. We visited Healthy Cities Noarlunga, one of three pilot sites alongside Illawarra and Canberra, trialling this bold, federally funded approach to reimagining health through the setting of a whole city. Health challenges are increasingly urban challenges. More than half of humanity now lives in cities, projected to be 70% by 2050. These are the places where climate pressures, chronic disease, and inequality collide. Fast forward more than 30 years, and I have come full circle, back to Wollongong, and leading Healthy Cities Illawarra, now Healthy Cities Australia, and I want to show you why this movement is needed now more than ever. A Quick History Lesson Healthy Cities in Australia had some very brave, early pioneers, and I want to acknowledge their vision, which has shaped so much of the work we carry forward today. When Bob Hawke led Labor to victory in 1983, he promised fairness and universal healthcare — and Medicare was reborn. Less well known, however, is how the Hawke era also nurtured the Healthy Cities movement with Neal Blewett as Health Minister. In 1986–87, the federal government funded over $650,000 for pilot projects in Illawarra, Noarlunga, and Canberra. Their goal was to test the applicability of the European Healthy Cities model in Australia. Noarlunga led environmental clean-ups, city farms, and became a hub for advocacy on drugs, multicultural health, and youth unemployment. The Illawarra Healthy Cities Project delivered results that transformed the region and still exists today, thanks to ongoing funding from the NSW Ministry of Health. Two examples stand out: Emissions from Port Kembla — In the 1990s, Healthy Cities led a collaborative taskforce on airborne trace metals from heavy industry. This resulted in BHP upgrading its filters and emissions controls. Emissions dropped by up to 90%, significantly improving air quality and reducing respiratory illness in children. To this day, Healthy Cities continues to have a representative on the Bluescope Community Consultative Committee. Community workshops — In disadvantaged communities, Healthy Cities ran “visioning workshops.” These sessions brought together residents, local services, and councils to imagine what they wanted for their communities: food security, safe places, and opportunities for young people. The Healthy Cities approach was revolutionary for its time. It shifted the conversation from hospitals and sickness towards prevention, participation, and the social determinants of health. Under Blewett’s stewardship, Healthy Cities became a vehicle for partnerships between local and federal levels of government, linking national priorities with community action. By 1990, with support from Blewett and Minister for Local Government Margaret Reynolds, the first National Healthy Cities Conference was held in Wollongong. The aim was to establish a national network of Healthy Cities. Nearly 90 cities joined through newsletters, teleconferences, and regular meet-ups — but it was short-lived. So What Happened? Despite the early promise, Healthy Cities in Australia faced challenges that derailed its momentum: Political short-termism — Pressure for visible, quick wins undermined long-term solution building. In 1992, hospitals and other institutional care made up 50% of recurrent government spending, compared to just 2% for prevention and public health — about the same as today. Funding — In 1992, $300,000 in federal support was withdrawn. Without long-term institutional backing, most projects collapsed. Projectism — Too often, Healthy Cities was reduced to one-off activities — a breakfast program here, a clean-up there — rather than embedding its philosophy into enduring policy and organisational structures. Health sector dominance — While health leadership was crucial, it sometimes sidelined other critical sectors like housing, transport, planning, and environment. I also believe that a structural mismatch still exists today: health and social services sit mainly with the states, creating ambiguity around the role of cities. Why Cities Matter Put simply, cities can act faster and embed structural change in the places where people live, work, and play. During the time Australia stepped back from the Healthy Cities approach, others embraced it. In 2017, Mike Bloomberg established the Partnership for Healthy Cities, which now includes 74 member cities across 40 countries. But this model is top-down and solely policy-driven. In Australia, Local Government Acts require councils to embed public health, social inclusion, community safety, and environmental stewardship into action. The problem is that councils lack financial resources, capacity, and support. Healthy Cities Australia can re-engage, support, and empower local government as the fulcrum for population health. And Australia has done this before. During the Global Financial Crisis in 2008, the Rudd government sent over $1 billion directly to local governments. Under COAG’s National Partnership on Preventive Health, the Commonwealth committed over $70 million for the Healthy Communities Initiative, which funded healthy-eating and physical-activity programs. The lesson is clear: when Canberra backs councils, communities get healthier. City-level decisions can lock in structural change that outlasts election cycles. Healthy Cities Australia Today Healthy Cities Australia is an independent, not-for-profit health promotion charity. We have evolved from the Illawarra blueprint, grounded in place-based community programs but connected to councils and government through partnerships. Our independence is crucial, as it gives us flexibility and allows us to do and say things that others can’t. Just in the last 12 months, our advocacy has included: Opposing fossil gas in new builds by pushing Wollongong Council to use their powers to change Development Control Plans. Winning back the Mt Ousley pedestrian bridge by joining forces with other stakeholders to reinstate active transport infrastructure. Challenging junk food clustering in Shellharbour by working with UOW colleagues to oppose multiple fast-food outlets being approved on one corner. Scaling local wins to national reform, where our work with Shellharbour’s Mayor led to a motion at the ALGA General Assembly lobbying the Federal Government to increase preventive health spending by 5%. Our community programs also continue to deliver tangible results: Active In-Betweens is a weekly program for 8–12-year-olds in vulnerable communities. Over 200 kids across five areas come together to cook, play and connect, building lifelong healthy habits. Some, like Cooper and Alyse, joined as participants and are now youth volunteers, supporting younger kids and building leadership skills. Cook Chill Chat is a six-week healthy eating program where participants cook and share low-cost meals. It builds food literacy, confidence, and social connection. One group of young mothers navigating domestic violence and substance use found not only better nutrition but also new friendships, confidence, and stronger trust in their social workers. This is what grassroots prevention looks and feels like. These are not small wins — they change lives. Why Healthy Cities Australia? Healthy Cities Australia offers: A proven model, scalable nationally — More than 30 years of results in Illawarra show it works. Value for money — Every dollar invested in prevention saves multiple dollars in hospitals and crisis response. Leverage and partnerships — Collaborations with universities, health districts, NGOs, and local councils amplify impact. Place-based and locally owned — Communities co-design solutions that reflect their realities. National coordination, local action — Our strong brand and WHO-aligned frameworks can help councils boost capacity. Looking Ahead Coming back to the Healthy Cities movement over six years ago felt like coming home. In the last 12 months, I’ve travelled internationally, met others from this movement, and gained a sense of where Australia fits in the global picture. I believe Healthy Cities 2.0 is a credible vehicle for embedding preventive health strategies in local government planning. By funding a new generation of Healthy Cities projects — especially in regional and disadvantaged communities — we can deliver immediate impact and embed prevention, equity, and healthier futures. We must: Move to a long-term game plan and value health over sickness. Empower local community voices. Recognise the role of local government in changing the public health trajectory. Together, as a group of ready, passionate, and persistent public health advocates, it is time to reimagine and reinvest in a network of Healthy Cities — because that is how we can build a healthier nation.