Past Issues

The Picture of Health

• Byline:KELLY HER
• Publication Date:12/01/2009

Cyclists enjoy riding on the dedicated bike lane built along Hualien County’s Baibao River. Cycling is one of the major sports the county is promoting to boost physical health. (Photo by Central News Agency)

Hualien County has joined the international campaign to promote the concept of healthy cities.

Facing the immense Pacific Ocean on the east side and buttressed by the grand Central Mountain Range on the west, Hualien County is known for its natural landscape, with popular attractions including Taroko National Park, the East Coast National Scenic Area, the East Rift Valley National Scenic Area and the northeast portion of Yushan National Park. Since 2005, however, Hualien County has also worked to extend the quality of its natural environment to that of its human environment by participating in the World Health Organization’s (WHO) Healthy Cities project.

The WHO’s Regional Office for Europe launched the Healthy Cities initiative in 1986. Since that time, the goal of the project has been to turn the vision of a healthy living environment into reality through working to build political commitment and facilitating collaboration between the public and private sectors, among other things.

The WHO defines a healthy city as “… one that is continually creating and improving those physical and social environments and expanding those community resources that enable people to mutually support each other in performing all the functions of life and in developing to their maximum potential.” It is important to note that the healthy city designation is not an award recognizing the standard of health an urban area has attained, but rather indicates that a city places a strong emphasis on improving residents’ overall health. The movement also takes a broad view of health, focusing on the physical, mental, social and environmental factors that go together to make a healthy life. All told, the WHO lists 21 indicators for a city’s health, including its mortality rate, water quality and unemployment rate, among other criteria.

The Alliance for Healthy Cities (AFHC) was established in October 2003 at the inaugural meeting of the WHO Regional Office for the Western Pacific in Manila, the Philippines. The alliance accepts membership applications from local governments, non-governmental organizations (NGOs) and non-profit organizations (NPOs), universities, national agencies, the private sector and others.

In October 2008, the AFHC’s Third Global Conference took place in Ichikawa, Japan with the main theme of “Health Security in the City: Healthy Cities activities building a better future.” Participants at that conference included many city mayors and officials, academics, national coordinators, NGO representatives and public health and urban planning experts. Some 30 city and county government officials, scholars and district representatives from Taiwan attended the meeting in Ichikawa.

A number of local governments in Taiwan—Hualien County, Miaoli County, Tainan City and Danshui Township, as well as Beitou, Shilin and Da-an Districts in Taipei City—have joined the AFHC as associate members in the NGO/NPO category. Hsieh Wan-hua, an assistant professor in the Department of Public Health of Tzu Chi University, was one of the representatives of the Hualien County Government at the Japanese conference and regards AFHC membership as an important channel linking Taiwan to the world. “The AFHC is an international network aiming at promoting the interaction of people on the front line of health issues,” Hsieh says. “It holds regular conventions and activities to give members opportunities to learn from and cooperate with each other.”

Emerging Issues

At the conference in Japan, Hsieh says she and other Taiwanese delegates learned about how other cities coped with health issues that have emerged as urbanization has increased, as well as about how they have sought to improve their own overall environments. The Hualien delegation also presented research papers elaborating on the county’s promotion of Healthy City programs, as well as distributed tourism materials introducing the county’s major attractions to participants. Such experiences and information exchanges, Hsieh adds, are conducive to the global pursuit of “health for all” and increasing the area’s visibility.

Hualien County has a population of about 340,000 and has an area of 4,628 square kilometers, making it the largest county in Taiwan. The county’s residents are about evenly divided into four ethnic groups: Hakkas, more recent immigrants from mainland China, aborigines and Southern Mins (from south of the Min River in Fujian province, mainland China).

Workers at the Shoufeng Farmers’ Association place “toxin-free” certificates on vegetables produced by its member farmers. (Photo by Huang Chung-hsin)

The Hualien County Govern­ment began promoting the healthy city concept by inviting specialists from Taiwan and abroad to give lectures on the topic. In 2006, thanks to a grant from the Bureau of Health Promotion under the Cabinet-level Department of Health, as well as to the commitment of Hualien County Magistrate Hsieh Shen-san, the county hosted a series of planning sessions involving government agencies and professors from Tzu Chi University and National Dong Hwa University, both located in Hualien.

The next step was establishing the Hualien Healthy City Steering Committee, which is composed of representatives from the academic, governmental, industrial and NGO sectors. The representatives decided to divide the committee into environmental, healthcare and social sections in order to perform its duties more efficiently, which include assessing the needs of area residents, providing education and training, serving as a healthcare advocate, planning projects and forming partnerships. Furthermore, the county government set up the Hualien County Health Promotion Association to coordinate and integrate the various Healthy City proposals for Hualien County, as well as compile information to facilitate the committee’s operation.

Tzu Chi’s Hsieh, who took part in formulating the Hualien County Healthy City Project, says the initiative was developed in line with the WHO’s 21 healthy city indicators, as well as an additional 57 indicators developed by the county, which include the prevalence of major diseases, the development of organic agriculture areas and community outreach programs, among others. The professor’s planning group came up with a three-part vision for a safe and healthy, clean and ecological, and ethnically harmonious Hualien area. Accordingly, a number of objectives and comprehensive action plans were mapped out and put into practice to address various safety issues pertinent to diet, housing, recreation, schooling, transportation and medical care.

Apart from facilitating collaboration among local government branches and outside groups, the Hualien County Government also provides incentives through official resources including subsidies, venues and the know-how needed to assist with the implementation of health-related plans proposed by community residents. To encourage those in the area to lead healthier lives, the county government also designs community presentations and health-promotion activities.

Through the combined efforts of the public and private sectors, the Hualien County Health Promotion Association gained admission to the AFHC in November 2007. Moreover, National Hualien High School, Fengbin Elementary School and Kangle Elementary School in Hualien were accredited by the WHO as International Safe Schools, while the county’s Shoufeng and Fengbin townships were designated as International Safe Communities.

County Magistrate Hsieh Shen-san says that as Hualien is endowed with abundant natural resources and is free of industrial pollution, it features clean water, fresh air and rich ecological diversity. While the well-preserved natural environment has undoubtedly made it easier for the county government to promote health, it realizes there is more work to be done. Hsieh Shen-san’s administration has therefore earmarked more government funds for launching environmental education programs and installing facilities to generate electricity from solar energy in public structures.

In the area of food safety, the Hualien County Government has dedicated itself to developing toxin-free agriculture. The reason for the use of the term “toxin-free,” Hsieh Shen-san explains, is that existing government regulations require farmers to wait three to five years for their land to detoxify after it has been used for conventional agriculture before produce grown there can be certified as organic. The county government’s Department of Agriculture Development has worked with local farmers’ associations and academics to hold workshops and offer guidance and consultations on switching to organic farming. After years of promotion, the number of toxin-free farm operations in Hualien had surged to 368 in 2008, compared with 30 in 2004. Today, farmers from the area offer a broad range of toxin-free rice, fruit, vegetables, livestock and aquatic products.

The Hualien County Government organizes walking and running events on the first Saturday of every month to encourage local residents to make exercise a habit. (Courtesy of Liang Tai-jan)

Hermes Wu, an officer with the Shoufeng Farmers’ Association in Hualien County, says his organization is currently working with 20 farmers and assisting them in production, marketing, packaging and distribution. “When they are ready to harvest, farmers need to inform us, so we can go to their fields to conduct water and soil tests and check on their crops to make sure there are no harmful residues or pollution. If they pass the checks, we’ll award them toxin-free certificates,” he says. Wu notes that the association also benefits the farmers financially. “Since we commit to purchase their products in fixed quantities and prices,” he says, “they don’t have to worry about market changes.”

Wu says his organization has set up a logistics center to help member farmers classify their products based on weight and quality, package them and deliver them to individual customers or supermarkets under its management. Shoufeng Farmers’ Association has also established an e-commerce site for consumers to place orders online. So far, around 1,000 consumers have registered for and regularly purchase goods through the association’s website, which also receives international orders from Japan, Canada and the United States from time to time.

Grateful for Help

Li Jia-feng, a farmer participating in the contract production scheme commissioned by the Shoufeng Farmers’ Association, says he is grateful to have learned organic farming techniques for pest and disease control from government and industry experts. He is also thankful for assistance from the farmers’ association in marketing and distribution, saying that he can now concentrate on research and production activities. Li is notable because, according to the Hualien County Government, he currently cultivates the widest variety of organic vegetables of any farmer in the county.

Hualien County’s healthy setting, local government chief Hsieh says, serves to boost the overall quality of life for those in the area and is also favorable for outdoor activities. Given that sports are conducive to physical fitness, the county magistrate has worked to promote a variety of sports in hopes of motivating local residents to make exercise a habit. In addition to the International Marathon held in Taroko Gorge and the International Boating Matches held on the Xiuguluan River, both of which are annual events, the county government began organizing running and walking races on the first Saturday of every month starting early this year. The number of participants in the monthly event, the location of which rotates among the county’s 13 townships, has increased continually from an initial 2,000 to more than 5,000 by early October this year. The county government also funds the improvement of sports facilities at local schools and holds basketball, football and table tennis competitions on weekends.

The other major sport his administration is working to promote, Hsieh Shen-san continues, is cycling, which is an ideal way of taking in Hualien County’s beautiful coastline. Besides building more dedicated bicycle paths, setting up bike rental shops at scenic spots and improving roads and signage to promote the sport, the county government has also cooperated with local police stations to provide cyclists with rest areas where they can inflate bike tires, use the restrooms, take a shower or just relax and enjoy a cup of tea.

In the area of social health, the county magistrate admits his administration has encountered several challenges in its quest to make the county healthier. For example, it continues to face social and economic problems like unemployment, a declining population, a high number of traffic accidents and health problems including cirrhosis of the liver, likely caused by alcohol abuse. These problems are especially acute in aboriginal villages.

To improve employment prospects, the county government offers vocational training that includes courses in cooking, sculpture, weaving and knitting and the operation of guesthouses. To promote the tourism industry, which is a major source of income in the area, the county also helps organize large-scale festivals and related publicity campaigns.

Volunteer medical workers of the Hualien County Agape Care Association measure the blood pressure of elderly residents living in the community. (Courtesy of Hualien County Agape Care Association)

Still, Hsieh Shen-san emphasizes the importance and effectiveness of community involvement in devising solutions to complex health and social problems. Accordingly, the county government has raised the budget allocated to community organizations from NT$600,000 (US$18,460) in 2008 to NT$1 million (US$30,770) this year to encourage more organizations to offer ways to enhance social health.

The Hualien County Nouli Community Association based in Shoufeng Township is one of 200 such organizations in the area. Director Yang Jun-bi says his association works to turn unused spaces in neighborhoods into community centers where locals can gather for social, educational or recreational activities, children can do homework after school and wait for their parents to pick them up, and tourists can ask for information and find guided tours.

Yang adds that his association maintains close contact with local police and fire stations, schools and the county government’s Bureau of Health to keep up to date on the common types of accidents, injuries or other health problems that occur in the community. Such information helps the association develop countermeasures such as employing volunteers to make frequent home visits to support low-income and single-parent households, senior citizens living alone or foreign spouses.

Another major task of the Nouli Community Association is to create more local job opportunities. One way it does so is by teaching skills, such as by inviting professionals to instruct local women in how to make handicrafts and pickled fruit for sale. Another way it boosts employment is by providing paid services to the community such as catering, decorating and tourism assistance and hiring locals to staff them. Between the income from these services and receiving government funding for community-building projects, providing services for the elderly, conserving cultural assets and protecting the environment, the association is thriving, generating an average annual income of about NT$10 million (US$307,700). In line with its mission and status as a non-profit, Nouli Community Association plows back all of its income into providing services and covering operating expenses.

Boosting Social Health

Hualien County Agape Care Association, which is associated with the Taiwan Presbyterian Church of Meilun, is another of the many local organizations working to boost social health in Hualien County, particularly that of the elderly. Director Tseng Xing-chun says that because of the lack of job opportunities in Hualien, a growing number of young people have relocated to cities along Taiwan’s populous west coast. That, combined with Taiwan’s falling birth rate, has raised the county’s ratio of the elderly to the population as a whole to 12 percent, compared to the average of 10 percent for the rest of the island.

To help address the issues faced by senior citizens, since 2005 Agape Care has helped set up a community care center where elderly citizens can do exercise and other recreational activities, have meals and receive basic health checkups. Plus, the church’s volunteers regularly call or visit elderly residents in their homes to ask about their physical condition, check their medication intake and provide emotional support.

Hualien County appears to be on the right track in its efforts to bring about positive changes in the lifestyle and living environment of its residents. According to the county government, the overall number of traffic accidents in the county dropped from 110 in 2005 to 64 in 2008, while the number of accidents involving drunk drivers dropped from 37 in 2005 to 13 in 2008. Meanwhile, the percentage of elderly citizens receiving care increased from around 21 percent in 2005 to around 30 percent in 2008. “The government is taking the initiative and collaborating with the academic sector to develop health schemes and together with the active participation of community organizations and civic groups, we are making steady progress in our promotion of the Healthy City Project,” Hualien County Magistrate Hsieh says. “We are on our way to realizing our three-part vision for creating a safe and healthy, clean and harmonious Hualien.”

Write to Kelly Her at kelly@mail.gio.gov.tw