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In the first phase of the Healthy Cities Project Development, World Health Organization (1990), the Working Group set out 53 indicators to help municipalities collect enough data to describe the state of health of their city. Before it set 53 indicators, the health plan working group was aware that cities made use of relatively simple, traditional quantitative indicators on health (such as "mortality"). These indicators do not provide a comprehensive view of the holistic health status of a city, however.  Therefore, when it set 53 indicators, qualitative indicators (such as "social support") were also  incorporated.

Between 1992-1994, 47 cities adopted the 53 indicators. After an interdisciplinary group of experts  analyzed the data collected from these cities, the World Health Organization Healthy Cities Project Office revised the 53 indicators as necessary.

Thus, among the 53 indicators, the indicators that lack reliability were excluded, and the narrative indicators amended in order to more clearly define the indicators, resulting in the following Healthy Cities WHO32 index.

A. Health indicators

  1.  Mortality﹔all causes
  2.  Main causes of death
  3.  Low birth weight

B. Health services indicators

  1.  City health education programs
  2.  Immunization rates
  3.  Inhabitants per primary health care practitioner
  4.  Inhabitants per nurse
  5.  Percentage of population covered by health insurance
  6.  Availability of services in foreign languages
  7.  Health debates in city council

C. Environmental indicators

  1.  Air pollution
  2.  Water quality
  3.  Sewage treatment rate
  4.  Household waste collection quality
  5.  Household waste treatment quality
  6.  Green cover rate
  7.  Green of availability
  8.  Derelict industrial sites
  9.  Sport and leisure facilities
  10.  pedestrian street (pedestrian zone)
  11.  Cycle routes
  12.  Public transport access
  13.  Public transport range
  14.  Living space

D. Socioeconomic indicators

  1.  Percentage of population in inadequate housing
  2.  Homelessness
  3.  Unemployment
  4.  Poverty
  5.  Availability of child care
  6.  Age of mothers at time of birth
  7.  Abortion rate
  8.  Employment of disabled people