Healthy cities and self-reported health: evidence from Israel

The World Health Organization's Healthy Cities Network (HCN) enlists community stakeholders (residents, businesses, non-governmental organizations and municipal governments) to promote health, quality of life and sustainable development in urban settings. The project, now three decades old, involves thousands of municipalities globally, including 52 in Israel. However, there is very little evidence regarding the effects of joining the HCN. This study examines whether HCN membership affects residents' self-reported health (SRH). Social survey data for Israel's 13 largest cities in 2005-2017 were analyzed using difference-in-differences and event study research designs. We use the gradual entry of cities to the HCN to compare SRH before and after network entry. Examined variables include municipal spending on health and duration of the city's participation in the network. Data were analyzed through multivariate linear regression with fixed effects at the city and year levels. Joining the HCN does not have an immediate effect on SRH. SRH increases with the duration of the city's participation in the network, but this result is only marginally statistically significant. Municipal health spending mildly increases with membership duration. A weak negative association was found between municipal health spending and SRH. Duration of a city's membership in the HCN is positively associated with residents' SRH; this association is not explained by an increase in municipal health spending. Identifying a mechanism for this improvement is beyond the scope of this study and is left for future research.