When Liverpool joined the World Health Organization’s Healthy Cities movement in 1986, the city was facing significant social and economic challenges. Forty years later, while health inequalities remain a reality, Liverpool’s experience demonstrates that meaningful improvements in health and wellbeing are possible when cities take a long-term, place-based approach.
The most important lesson from four decades of Healthy Cities work is that improving health equity takes time. Lasting change doesn’t happen over months or even years. It takes sustained commitment across generations. Liverpool’s progress has come not from a single programme, but from a shared belief that health is everyone’s business.
Healthy Cities encouraged us to look beyond healthcare services and focus on the wider determinants that influence health: housing, employment, transport, education, culture and the environment. This meant bringing together planners, housing officers, transport teams, cultural organisations, community groups and public health professionals around common goals. While partnerships are rarely straightforward, Liverpool has shown that consistent collaboration can survive political change, economic pressures and shifting national priorities.
A strong evidence base has also been central to our success. The city’s original Public Health Observatory and subsequent wider intelligence functions have helped ensure decisions are informed by data rather than assumptions. From regeneration programmes to health improvement initiatives, robust analysis has allowed us to target resources effectively and keep prevention at the forefront of decision-making. Our State of Health in the City 2040 report continues this tradition, providing a clear picture of where progress is being made and where further action is needed.
One distinctive feature of Liverpool’s approach has been the use of cultural activity as a public health asset. From European Capital of Culture in 2008 to hosting Eurovision on behalf of Ukraine in 2023, we have seen how cultural activity can strengthen civic pride, build social connections, and encourage participation. Organisations such as DaDa have demonstrated how arts and culture can promote inclusion and challenge stigma. These approaches engage people through identity and belonging, often reaching communities in ways traditional interventions cannot.
Community involvement has also evolved significantly over the last four decades. We have moved beyond consultation towards genuine partnership, with initiatives such as Community Champions, community researchers, and youth public health workers helping shape services and policies. Building trust takes time, but communities are far more likely to support and sustain change when they are actively involved in creating it.
Liverpool has also embraced innovation, from Healthy Homes and social prescribing to climate-focused programmes such as Urban GreenUP. Importantly, innovation has not been treated as a series of isolated pilots but as an ongoing process of testing, learning and embedding successful approaches into mainstream practice.
As we look ahead, the challenges are becoming more complex. Climate change, economic uncertainty, global instability and the continuing impact of poverty will all influence health outcomes. Addressing them will require even closer collaboration between local government, the NHS, community organisations and residents.
Liverpool’s Healthy Cities journey shows that while local leadership cannot solve every driver of inequality, it can create the foundations for healthier lives. The lesson from the last 40 years show that sustained partnerships, community involvement, strong evidence, and a long-term commitment to equity remain our best tools for building a healthier future.
This blog is based on the full policy briefing, 40 Years of WHO Healthy Cities in Liverpool: Lessons in Long-Term, Place-Based Leadership, published by the Heseltine Institute for Public Policy, Practice and Place.
Read the full policy brief on the Heseltine Institute’s website: https://www.liverpool.ac.uk/heseltine-institute/publications/policy-briefings/policy-in-an-age-of-uncertainty/policy-briefing-332/
The Heseltine Institute for Public Policy, Practice and Place is an interdisciplinary public policy research institute that brings together academic expertise from across the University of Liverpool with policymakers and practitioners to support the development of sustainable and inclusive cities and city regions. Its policy briefings promote innovative thinking and practical solutions to the challenges facing the UK’s cities and regions.
About the authors
Professor Matthew Ashton is Director of Public Health for Liverpool City Council and Honorary Professor at the University of Liverpool. Appointed in 2020, he leads a multidisciplinary public health team and is nationally recognised for his leadership in prevention, partnership working and reducing health inequalities. He played a central role in Liverpool’s response to the COVID-19 pandemic.
Professor John Ashton CBE is widely recognised as the founder of Liverpool’s Healthy Cities movement and a leading figure within the World Health Organization Healthy Cities Network. Throughout a distinguished career in public health, he has championed prevention, community participation and health equity, helping to shape policy and practice both nationally and internationally.
Craig Hamilton is a Senior Public Health Practitioner at Liverpool City Council, specialising in the wider determinants of health. He leads work on prevention, Marmot principles and reducing inequalities, supporting partnerships, community engagement and evidence-informed policy that strengthens Liverpool’s Healthy Cities approach through long-term, place-based action.
