Practical lessons in using indicators of determinants of health across 47 European cities

A survey was conducted of 47 European cities applying to join the third phase of the World Health Organization Healthy Cities Project. The survey tested the feasibility of recording baseline information on health-promoting processes and activities in the cities. A broad multi-sectoral focus for health in the questionnaire presented formidable challenges to respondents. Despite goodwill and local networks, the quality of certain responses was variable. Socio-economic statistics are not universally available at city level; however, descriptive responses about services and health promotion yielded uniquely useful local information over the national level. Survey responses were not comparable across cities and such interpretation would be counter-productive. Recommendations for future surveys are made.