Classical literature portrays rural life as the ideal serene and healthful environment - far from factory chimneys, crime-infested streets and dilapidated tenements. But many cities are becoming physically, intellectually and psychologically livable as their residents demand improvements in the urban quality of life. An initiative formulated 25 years ago in Canada and developed into an experimental project by the World Health Organization (WHO) was adopted here in 1990 as the Israel Network of Healthy Cities. The network's first four members were Jerusalem, Tel Aviv, Netanya and Ramat Hasharon, but it has since expanded to 32 cities, plus 10 local authorities and four regional councils; they include those with Jewish majorities as well as those in the Arab sector. The network promotes better health among each locality's residents with a wide variety of projects, including the boosting of physical activity, dental health and smoking cessation; the construction of biking and walking paths, recycling, reduction of teen vandalism; and battles against pollution and dog excrement on sidewalks. It also provides information on successful projects around the country and helps municipalities amass "health profiles" so they can assess what is working and what needs to be improved. It is a cooperative effort with the health funds and a variety of voluntary organizations. THE 18TH annual conference of the Israeli network, whose coordinating committee is chaired by Dr. Milka Donchin (head of the health-promotion track of the Hebrew University-Hadassah Braun School of Public Health), was held recently at Jerusalem's Ramada Hotel. Some 200 people attending the conference on "Political Commitment to Health" heard from municipal officials and MKs and were presented with success stories about promoting health at the urban level. Jerusalem's new mayor, Nir Barkat, surprised the audience when he divulged that five years ago, his predecessor Uri Lupolianski discontinued the municipality's involvement as a "project city," which requires even more commitment and obligations than being a "member city," including reporting back to the WHO's European division. This division, of which Israel is a member, has 30 national networks and about 1,300 cities, provinces and towns. All members must undertake a political commitment to convert the vision of the WHO's "Health for All" charter into reality. "Jerusalem was a project city from the beginning, but when Lupolianski took over, he didn't give approval for renewing participation in this phase of the project," Donchin told The Jerusalem Post. "I sent the mayor numerous letters and made calls, but he never even acknowledged them. It must have been some lack of understanding. We tried to get around it with participation by volunteer organizations and individuals, but municipality participation was minor. The capital was the only Israeli city that dropped out of the project cities phase." Barkat told the conference that Jerusalem is rejoining the phase, and that he had assigned Deputy Mayor Naomi Tsur (who has the planning portfolio and was formerly the head of Jerusalem's Society for the Protection of Nature branch) to participate in Israel's Healthy Cities Network. Barkat - who runs from his home in the Beit Hakerem quarter to City Hall a few times a week - concluded that the municipality and city are "more committed than ever" to the aims of the network. "With intelligence and dedication, voluntary organizations can do a lot to promote initiatives that later become accepted municipal activities. We want to adopt models and carry them out in true partnership with residents. "As an entrepreneur and philanthropist," said the former hi-tech businessman, "I know it can be done, as it has been elsewhere in Israel and abroad." Health Ministry associate director-general Dr. Boaz Lev, long an advocate for health promotion, said public enthusiasm for improvements in pro-health and -environment projects grows from year to year, but needs active community and political involvement. Not only the ministry and non-governmental organizations are enthusiastic, but also the health funds and industry, he added. RON MOSCOVICH, director-general of the Center for Local Authorities, noted that decades ago, when people said they were going to worry about their health, they meant they were going to "recuperation homes" in Safed or Jerusalem where people got good meals and relaxed. But today, he said, Israelis are much more aware of how lifestyles and environments need to be changed to make people healthier. "I have a vision that before too long, a young couple will even look at comparative tables to see which cities promote physical and emotional health for themselves and their children," said Moscovich. Dr. Agis Tsouros, a Greek national who heads the WHO's European Division office dealing with non-communicable diseases, lifestyles and the environment, was unable to attend the conference, but a recorded speech was screened there. "There can be no real urban development without considerable investment in health," he said. "Health is the business of all levels of government, not only the prime minister, his cabinet and at the policy and strategic level of the whole country, but also in the policies and actions of local government. It's not only making an explicit commitment and talking about it, but actually practicing it. What we do to promote urban development should not compromise the physical environment at the expense of future generations. Today, we think of development as actually contributing to health and not the opposite." Tsouros, who plans to visit Israel and meet officials and health experts in June, said that cities as an environment "can address the social needs of all citizens including the elderly. Today, many urban areas do not care enough for the needs of older people. The needs of children, migrants, the poor and marginalized are also unmet. But the days when we blamed people for indulging in unhealthy behaviors are long gone; our behaviors are the result of many factors - social, cultural and environmental. We can't just tell people not to smoke, to eat more vegetables or to drink less alcohol. We have to help them and provide them with a suitable environment for it." THE SEVERE economic difficulties now being felt around the world are a "wakeup call," Tsouros said. "This is probably a golden opportunity. Public health must be at the center of policy. In our efforts to focus on health and sustainable development, we must always remember that those who pay the most in a crisis are the poor and those unable to protect themselves. We must shield them from negative consequences of the economic crisis - those who are depressed, desperate, and pessimistic about the future." A happy note during the conference was provided during the session on Israeli projects that have proven themselves. Yotam Avizohar, head of the 10-year-old Israel for Bicycles, said the benefits of biking were clear, even though some dismiss this means of transportation as belonging to the Third World. But bikes are routine for getting to work in Holland, Scandinavia and other parts of the world, reducing air pollution and raising fitness levels. Surprisingly, the more bikers there are on the road, the fewer the road accidents involving bicycles, he maintained. The voluntary group campaigned during recent elections to support pro-biking candidates. "Bureaucracy and inertia work against biking. Israel Railways," he said, "still refuses to allow cyclists to take their bikes onto trains. And few employers invest in shower facilities so cyclists can start work fresh." Dr. Esti Kapolnik of Karmei Yosef in the Gezer Regional Council described her efforts to promote exercise, especially walking, among middle-aged women the area's kibbutzim and moshavim. That is a time in life when women undergo hormonal changes, gain weight and are at higher risk for a variety of chronic diseases from heart attacks and diabetes to osteoporosis and depression. The program was aimed at encouraging such women to become active on a daily basis, and not merely for a few weeks. They started their two-kilometer walks even before 7 a.m. so that the employed could go straight to work afterwards. They were coached and accompanied during their walks, and their awareness of other ways to improve health such as smoking cessation was raised. After nine months, the 20 women in the pilot program were in much better physical condition, with improved aerobic and cognitive ability, lower weight, better diets and healthier lifestyles. What they did improved the lifestyles of their husbands and children as well, said Kapolnik. Zvi Kessler of the Health Ministry's southern district was part of a team to promote health among Negev Beduin living in recognized towns. Even those in a permanent community raise sheep, goats and camels, and the children play among animal excrement. Many Beduin men collect junk that might be used in the future, but this stuff attracts rodents and other pests, he said. Working with the Rahat Municipality and Ben-Gurion University, Kessler and colleagues aimed at reducing zoonotic diseases (those caused by human/animal interaction) such as rabies and brucellosis. Pupils in 14 schools were selected to train their peers about avoiding disease. Men were spoken to at prayer houses, while women held meetings in their homes. Kessler said that at the end of the project, the prevalence of zoonotic disease had been reduced. Maccabi Health Services' Michal Hausman and Marit Zilberbush headed a two-year effort to reduce dental problems among 1,200 Negev Beduin children who normally eat a lot of junk food at school and are taken to dentists "only when their teeth hurt." Maccabi has 270,000 members in the Negev and four branches in Beduin towns. "We started with Beduin members as a pilot project to discover problems and find solutions, but we could use it on Ethiopian or haredi Jews as well," said Hausman and Zilberbush. The educational effort, they said, succeeded in improving dental health. The final plenary session included a panel of Kadima MK Dr. Rachel Adatto and Meretz MK Nitzan Horowitz; Ashdod Mayor Yehiel Lasri (who is also a physician); BGU health economics Prof. Gabi Bin-Nun; Naomi Tsur, Ma'aleh Adumim deputy mayor Gabi Ben-Zakkai; and Herzliya municipal health committee head Ruth Reznick. All agreed that promoting health in cities and pushing for needed legislation was an uphill battle, but that winning was possible - especially if the public is interested in it. They concluded that politics and the media could be harnessed for such good causes - even though such issues are almost never part of election campaigns.